Time to take play seriously: The Royal College of Occupational Therapists’ Occupational Therapy and Play practice guideline

A child playing is a child who is well, happy and included in their community and society. A child who can play has hope – to grow, to develop, to heal and connect with others (Kolehmainen, 2023). Play is an essential domain of childhood but is often overlooked, especially when it comes to children and young people with developmental difficulties or disabilities. Typically, disabled children are viewed as non-playing, and even when disabled children’s play is considered, it is often framed through their impairment. Too often the focus is on how ‘well’ or often a child or young person plays, rather than their enjoyment, motivation or autonomy to choose what, how and when to play (American Occupational Therapy Association, 2020). As such the notions of play are usually understood and applied by adults and framed by their standards. The Royal College of Occupational Therapists’ practice guideline Occupational therapy and play (RCOT, 2023) brings together evidence from within occupational therapy about what we mean and understand by play as it relates to all children and young people. It directs us to pay attention to play as an internal state of being and not just as an observable state of doing.

This comprehensive new practice guideline takes an occupation-focused perspective, describing how play is defined, used and evaluated in occupational therapy practice and education. It places fresh emphasis on the potential impact of occupational therapy and play for children and young people. We expect the guideline to be a catalyst for change within the profession, helping to consolidate and articulate occupational therapy’s unique role in relation to play within multidisciplinary contexts. It both supports and challenges occupational therapists to understand play that is personally meaningful to the children and young people who access occupational therapy, and to translate that understanding into practice.

The guideline, developed using processes defined within the Practice Guideline Development Manual (4th ed.) (RCOT, 2020), makes recommendations based on high-quality research evidence to support occupational therapists’ use of play throughout the occupational therapy process. This includes recognising play participation as a meaningful occupational therapy goal or outcome for the child or young person and using play in assessment and as an intervention tool.

While the body of evidence informing occupational therapists’ use of play is developing, there is often a time lag between the publication of the evidence and translation of that evidence to inform real-world practice. This guideline helps narrow that gap with recommendations to support decision-making and clinical reasoning related to play and occupational therapy. Occupational therapists can use the guideline to establish an evidence-based rationale for selecting assessment tools and play-based interventions and to identify factors to consider when evaluating the impact of occupational therapy on play participation.

To truly embed the recommendations into clinical practice, individuals and occupational therapy teams should take time to review the guidelines in the context of their local environment and identify areas for development. We suggest starting with an audit of current practice and knowledge against the guideline recommendations. How often is play participation identified as a therapy goal? If self-care and productivity goals are being prioritised over play, why is that and does this need to change? Do occupational therapists understand the influence of culture, environments and personal factors on play, and how does this inform practice? Are occupational therapists considering what meaningful play might look like for a child or young person? And what support and learning opportunities might help occupational therapists develop their knowledge and skills further? The guidelines can be used to identify continuing professional development needs and advocate for additional resources through building a service business case to meet the guideline recommendations.

However, there are still many gaps in the evidence base, the guidelines include unanswered questions about occupational therapy and play which could be used to support future research funding bids. The guidelines also challenge researchers to ensure the voices of children and young people are included throughout the research process, including identifying outcomes that are meaningful and capture children’s experiences of play participation.

These guidelines will help occupational therapists provide care that is based on the best available evidence relating to play and occupational therapy and offers an opportunity to all of us to begin to take play more seriously. They should be used to prompt discussions with teams, commissioners and others to ensure occupational therapy skills and expertise are recognised and used to enable all children and young people to play.

The full Occupational Therapy and Play practice guideline (RCOT, 2023) together with evidence tables, implementation resources and the audit tool can be found at https://www.rcot.co.uk/practice-resources/rcot-practice-guidelines.