Expectations and Assumptions: Examining the Influence of Staff Culture on a Novel School-Based Intervention to Enable Risky Play for Children with Disabilities.

Risky play is challenging, exciting play with the possibility of physical, social, or emotional harm. Through risky play, children learn, develop, and experience wellbeing. Children with disabilities have fewer opportunities than their typically developing peers to engage in this beneficial type of play. Our team designed a novel, school-based intervention to address this disparity; however, our intervention yielded unexpected quantitative results. In the present study, we qualitatively examined divergent results at two of the five schools that participated in the intervention. Specifically, we aimed to explore how staff culture (i.e., shared beliefs, values, and practices) influenced the intervention. To explore this relationship, we employed a retrospective, qualitative, multiple case study. We used thematic analysis of evaluative interviews with staff members to elucidate the cultures at each school. Then, we used cross-case analysis to understand the relationships between aspects of staff culture and the intervention's implementation and results. We found that staff cultures around play, risk, disability influenced the way, and the extent to which, staff were willing to let go and allowed children to engage in risky play. Adults' beliefs about the purpose of play and recess, as well as their expectations for children with disabilities, particularly influenced the intervention. Furthermore, when the assumptions of the intervention and the staff culture did not align, the intervention could not succeed. The results of this study highlight the importance of (1) evaluating each schools' unique staff culture before implementing play-focused interventions and (2) tailoring interventions to meet the needs of individual schools.

Creating play opportunities on the school playground: Educator experiences of the Sydney playground project.

INTRODUCTION: Children with disabilities often experience unsupportive environments that restrict their play opportunities and inclusion on the school playground. This exclusion can perpetuate inequities for children with disabilities, with lifelong implications. The Sydney Playground Project uses a simple, innovative intervention consisting of placing recycled materials on the playground and engaging parents and educators in risk reframing sessions to create increased playground choice, control, independence and inclusion for all children. METHODS: The purpose of this study was to learn from participants about the utility of the intervention for promoting choice and control among children with disability on the school playground. Data included evaluative interviews with 27 school staff (teaching assistants, teachers, therapists, school leadership) across five participating schools after completing of the intervention. Analysis was thematic and explored prominent ideas first within schools, and then between schools. RESULTS: Prior to the intervention, participating school staff focused on active supervision to support play and student needs. During the intervention, school staff experienced role shift and confusion as they allowed the children increased independence while using the recycled materials and learned to navigate how much independence to give the children. Children engaged in increased imaginative and social play, and school staff adopted higher expectations of children's capabilities. CONCLUSION: Interventions such as the Sydney Playground Project that collaboratively shift adult perceptions to focus on the capabilities of children with disabilities and increase the supportiveness of the physical environment have great promise in increasing play choice and inclusion on the school playground.

Construct Validity and Test-Retest Reliability of the Coping Inventory (CI) for Children With Developmental Disabilities.

OBJECTIVE: A reliable, valid, and readily usable method of measuring coping is essential for occupational therapy practitioners and researchers working with children with developmental disabilities. The aim of this study was to examine evidence for the construct validity and internal and test-retest reliability of the Coping Inventory (CI), a 48-item survey designed for use with children. METHOD: School staff (N = 39) completed CIs for 79 students with developmental disabilities age 5-13 yr (mean = 8.0, standard deviation = 2.0) who were primarily boys (n = 52; 68%) with autism spectrum disorder (n = 40 of 47 diagnoses provided). We used Rasch analysis to examine construct validity, internal reliability, and possible redundancy of items and intraclass correlations, Pearson correlations, Bland-Altman plots, and t tests were used to examine test-retest reliability. RESULTS: Rasch analysis provided evidence of construct validity: All items correlated positively with the overall measure; data from 94% of items conformed with Rasch expectations, and the items form a logical hierarchy. Intraclass correlations revealed an average coefficient of .96, providing evidence of test-retest reliability. CONCLUSION: The CI demonstrated good evidence for construct validity and internal and test-retest reliability. Redundancy of items suggests that some items could be eliminated after further research.

Sydney Playground Project: A Cluster-Randomized Trial to Increase Physical Activity, Play, and Social Skills.

BACKGROUND: We assessed the effectiveness of a simple intervention for increasing children's physical activity, play, perceived competence/social acceptance, and social skills. METHODS: A cluster-randomized controlled trial was conducted, in which schools were the clusters. Twelve Sydney (Australia) primary schools were randomly allocated to intervention or control conditions, with 226 children (5-7 years old) selected randomly to participate. Data were collected at baseline and after 13 weeks. The intervention consisted of introducing recycled materials without an obvious play purpose into school playgrounds and a risk-reframing workshop for parents and teachers. RESULTS: Children from the intervention schools increased physical activity and reduced sedentary time while control schools decreased physical activity and increased sedentary time. The intervention yielded increases in total accelerometer counts (ß = 9350 counts, 95% CI 3490-1522, p = .002), minutes of moderate/vigorous physical activity (MVPA) (ß = 1.8 min, 95% CI 0.52-3.12, p = .006), and reductions in sedentary time (ß = -2.1 min, 95% CI -3.77-(-0.51), p = .01). Although the changes in time spent in play and nonplay were not statistically different (p = .08) the effect size (d = .27) indicates clinical significance. CONCLUSIONS: This intervention was effective for increasing MVPA during recess and demonstrated capacity to improve play opportunities in school playgrounds.

The Sydney playground project--levelling the playing field: a cluster trial of a primary school-based intervention aiming to promote manageable risk-taking in children with disability.

BACKGROUND: Providing children and adults with opportunities to engage in manageable risk taking may be a stepping stone toward closing the gap in life conditions currently experienced by young people with disabilities. We aim to demonstrate the effectiveness of a simple, innovative program for 1) changing the way parents and teachers view manageable risk-taking for children with disabilities and 2) increasing the level of responsibility that children take for their own actions, as seen on the school playground. METHODS/DESIGN: We will employ a cluster repeated measures trial with six Sydney-area primary-school-based programs for children with disabilities. The intervention comprises two arms. 1) Risk-reframing--teachers and parents will participate together in small group intervention sessions focusing on the benefits of manageable risk-taking; 2) Introduction of play materials--materials without a defined purpose and facilitative of social cooperation will be introduced to the school playground for children to use at all break times. A control period will be undertaken first for two school terms, followed by two terms of the intervention period. Outcome measures will include playground observations, The Coping Inventory, qualitative field notes, and The Tolerance of Risk in Play Scale. DISCUSSION: New national programs, such as Australia's National Disability Insurance Scheme, will place increasing demands on young people with disabilities to assume responsibility for difficult decisions regarding procuring services. Innovative approaches, commencing early in life, are required to prepare young people and their carers for this level of responsibility. This research offers innovative intervention strategies for promoting autonomy in children with disabilities and their carers. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registration Number ACTRN12614000549628 (registered 22/5/2014).

Increasing physical activity in young primary school children--it's child's play: a cluster randomised controlled trial.

OBJECTIVE: To explore the effects of an innovative school-based intervention for increasing physical activity. METHODS: 226 children (5-7 years old) randomly selected from 12 Australian primary schools were recruited to a cluster randomised trial with schools randomly allocated to intervention or control conditions. The 13-week intervention comprised: (1) altering the school playground by introducing loose materials and (2) a teacher-parent intervention exploring perceptions of risk associated with children's free play. The primary outcomes were total accelerometer counts and moderate-vigorous physical activity during break times. Testing took place in Sydney, 2009-2010. RESULTS: 221 participants were tested at baseline. Mixed-effect multilevel regression revealed a small but significant increase from the intervention on total counts (9400 counts, 95% CI 3.5-15.2, p=0.002) and minutes of MVPA (1.8 min, 95% CI 0.5-3.1, p=0.006); and a decrease in sedentary activity (2.1 min, 95% CI 0.5-3.8, p=0.01) during break times. We retested children in one intervention school after 2 years; they maintained the gains. CONCLUSIONS: Capturing children's intrinsic motivations to play while simultaneously helping adults reconsider views of free play as risky provided increases in physical activity during break times. Using accelerometry as the sole measure of physical activity may underestimate the effect. TRIAL REGISTRATION: ACTRN12611000089932.

The Sydney playground project: popping the bubblewrap--unleashing the power of play: a cluster randomized controlled trial of a primary school playground-based intervention aiming to increase children's physical activity and social skills.

BACKGROUND: In the Westernised world, numerous children are overweight and have problems with bullying and mental health. One of the underlying causes for all three is postulated to be a decrease in outdoor free play. The aim of the Sydney Playground Project is to demonstrate the effectiveness of two simple interventions aimed to increase children's physical activity and social skills. METHODS/DESIGN: This study protocol describes the design of a 3-year cluster randomised controlled trial (CRCT), in which schools are the clusters. The study consists of a 13-week intervention and 1 week each of pre-and post-testing. We are recruiting 12 schools (6 control; 6 intervention), with 18 randomly chosen participants aged 5 to 7 years in each school. The two intervention strategies are: (1) Child-based intervention: Unstructured materials with no obvious play value introduced to the playground; and (2) Adult-based intervention: Risk reframing sessions held with parents and teachers with the aim of exploring the benefits of allowing children to engage in activities with uncertain outcomes. The primary outcome of the study, physical activity as measured by accelerometer counts, is assessed at baseline and post-intervention. Additional assessments include social skills and interactions, self-concept, after school time use and anthropometric data. Qualitative data (i.e., transcriptions of audio recordings from the risk reframing sessions and of interviews with selected teacher and parent volunteers) are analysed to understand their perceptions of risk in play. The control schools have recess as usual. In addition to outcome evaluation, regular process evaluation sessions are held to monitor fidelity to the treatment. DISCUSSION: These simple interventions, which could be adopted in every primary school, have the potential of initiating a self-sustaining cycle of prevention for childhood obesity, bullying and mental ill health. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registration Number ACTRN12611000089932.

Speed kills: the complex links between transport, lack of time and urban health.

Road safety experts understand the contribution of speed to the severity and frequency of road crashes. Yet, the impact of speed on health is far more subtle and pervasive than simply its effect on road safety. The emphasis in urban areas on increasing the speed and volume of car traffic contributes to ill-health through its impacts on local air pollution, greenhouse gas production, inactivity, obesity and social isolation. In addition to these impacts, a heavy reliance on cars as a supposedly 'fast' mode of transport consumes more time and money than a reliance on supposedly slower modes of transport (walking, cycling and public transport). Lack of time is a major reason why people do not engage in healthy behaviours. Using the concept of 'effective speed', this paper demonstrates that any attempt to 'save time' through increasing the speed of motorists is ultimately futile. Paradoxically, if planners wish to provide urban residents with more time for healthy behaviours (such as exercise and preparing healthy food), then, support for the 'slower' active modes of transport should be encouraged.

Playful interaction: occupational therapy for all children on the school playground.

We examined the impact of an intervention on the playfulness of 5- to 7-year-old children who are developing typically. Materials that had no defined purpose were placed on a school playground for 11 weeks. The Test of Playfulness (ToP) was used to compare videotaped play segments pre- and postintervention. Teachers who did playground duty were interviewed regarding changes in play. ToP data were analyzed using a Wilcoxon signed-ranks test. Interview data were analyzed for themes. ToP scores were significantly higher after intervention (Z= -1.94; p = .025, one-tailed; Cohen's d = 0.55). Teachers reported that children were more social, creative, and resilient when the materials were on the playground. Children who were creative, rather than very physically capable, became leaders in activity. Our results revealed a potential role for occupational therapists with typically developing children in schools. This finding has clear implications for children with disability.

Relationships between interest in motor racing and driver attitudes and behaviour amongst mature drivers: an Australian case study.

Interest in motor racing is investigated as a possible source of influence on driver attitudes toward speeding and driver behaviour. Previous studies have identified links between motor racing and road accidents on public roads. One study found that the level of interest in motor racing was positively correlated with risky driving behaviours of young male drivers. This paper outlines a conceptual framework for investigating the association between interest in motor racing and speeding violations on public roads. A sample survey of households in Queanbeyan, NSW, was used to examine the relationship between the level of interest in motor racing and attitudes to speeding and driving violations in a group of mature drivers. Results indicate that the level of interest in motor racing is significantly related to attitudes towards speeding, controlling for age, education level and sensation seeking propensity. Higher levels of interest in motor racing are associated with higher pro-speeding attitudes. Unlike the previous research on young male drivers, there was no significant relationship between interest in motor racing and speeding violations for this study of mature drivers. The implications of the study for road safety interventions are discussed.

The place of motorsport in public health: an Australian perspective.

The sport of motor racing provides various public health messages and impacts. Positive messages include road safety campaigns aimed at discouraging drink driving. Negative messages include the sponsorship of racing teams by cigarette companies. Locating motorsport events in significant public places can magnify any health messages or impacts of motorsport in two ways. First, the total local impact of the motor racing events (e.g. through pollution or disruption to healthy modes of transport) is greater in city street circuits than in dedicated racing circuits away from urban areas. Second, the symbolic characteristics of locations with special significance and meaning can enhance the impacts on health by adding legitimacy to the events, thus helping to promote products or activities that either undermine or support public health. This paper explores the health messages and impacts of major motorsport events in Australia, and argues that the distinctive geographies of Australian motorsport work to exacerbate the negative impacts of motorsport on public health.