Play Included C.I.C.

Mission statement

We envision a world where every young person, regardless of their background or neurodivergence, has the opportunity to thrive through the transformative power of play. By 2030 we aspire to reach over 10,000 health and education professionals with Play Included programmes and resources, meaning over 100,000 children will benefit around the world. We are experts in LEGO brick based therapy and wish to share high quality training and resources for educators to deliver effective programmes for children to support skill development, fun and friendship.

Core values

We believe that play has the power to help all young people grow. We aim to be a hub of effective, playful and trusted approaches that support social development, communication and emotional wellbeing. We particularly champion the use of LEGO play to create joyful and effective experiences for neurodivergent young minds. Our training and resources are evidence-based, high quality, and dedicated to equipping parents and professionals with the necessary skills and resources to deliver impactful outcomes for young people. Children and young people are at the heart of our programmes. We specialise in supporting autistic children and other neurodivergent children but all children are welcomed. Our products are aimed at professionals working with children in the health, education and social care sectors, as well as parents and carers.

Dr. Gina Gomez de la Cuesta is the Founder and Chief Product Officer. As one of the company Directors, Gina leads on the strategy for Play Included. As a clinical psychologist and expert in LEGO brick based therapy, Gina is the public-facing figurehead of the organisation, and author of the training and resources provided. She is active in the research and evaluation of programmes, as well as leading on new innovations and product development.

Dr. Gina Gomez de la Cuesta has clinical psychology and academic doctorates specialising in autism research, child mental health and LEGO brick-based therapy. Her clinical skills make her best placed to ensure best practice in implementing the Brick-by-Brick programme. Dr. Gomez de la Cuesta speaks English and Spanish. Gina will be able to commit the time necessary to participate in this project with regards to the Brick-by-Brick programme and engaging fully with the support on offer.

Dr. Elinor Brett is Managing Director of Play Included and responsible for operational delivery and project management within the team. Along with our Head of Operations, Elinor will focus on keeping Play Included's business as usual running throughout this project and will engage with the LEAP programme in her capacity as Director as required.

Dr. Margaret Laurie is the Research and Evaluation Lead and has an academic background in autism research, specialising in implementation of play-based approaches to support neurodivergent children and young people. Dr. Laurie has overseen the development of evaluation tools to support Brick Club delivery, and manages the generation and use of evidence behind Play Included’s programmes. Margaret will be able to work alongside Gina in the implementation and day to day management of this project and has the capacity to be fully involved.

Benjamin Huaman is Head of Partnerships and has successfully set up our partnership with Autismo Puebla in Mexico, as well as other international partnerships to deliver and scale the Brick-by-Brick programme. Native to Peru and fluent in English, Spanish and Portuguese. Benjamin will support with language, partnerships and implementation as needed.

The Brick-by-Brick® programme supports social, communication and emotional development through LEGO play. It may be particularly helpful for neurodivergent children. 

Neurodiversity refers to naturally occurring variation in human society and development, and neurodivergence refers to specific individuals who think and learn differently. Sometimes this means that they have a diagnosis such as autism, ADHD, or a mental health condition. It is thought that up to 20% of the world’s population is neurodivergent – around 2% are autistic, around 5% have ADHD, and many more require support with their learning, development, or mental health.

Being neurodivergent brings both strengths and challenges. Some neurodivergent people have remarkable academic or creative talents, are incredibly passionate about particular topics or incredibly skilled at certain things, and often have social values related to trust, integrity, and justice. However, many neurodivergent people also meet challenges in their lives - differences in social communication can lead to being marginalised, misunderstood, or excluded from society, and having poorer mental health and wellbeing (it is estimated that as many as 94% of autistic children have at least one mental health disorder). In school, neurodivergent pupils might be socially excluded, bullied, and poor staff awareness or practice may mean that students struggle to reach their academic potential. A negative experience at school or in the community can have a lasting impact on someone’s identity, development, and potential. Into adulthood, many neurodivergent people are under- or unemployed in the workforce, have higher rates of suicidality and are over-represented in mental health care and the criminal justice system. It is therefore essential to support neurodivergent children to mitigate against these negative outcomes. 

A growing academic literature has consulted neurodivergent adults about the changes that they would like to see in society. In particular, having more positive, inclusive and specific support at an early stage (e.g. in school) would have been a positive thing, according to autistic adults. Having a space where neurodivergent people could be together, in a safe and inclusive space, meet others with similar life experiences or interests to them, has been found to have a positive impact on neurodivergent people’s identity and wellbeing. Appropriate training in neurodiversity for health and education professionals has the potential to improve life experiences and outcomes for millions of neurodivergent children and young people.  

More and more children are being identified as being neurodivergent, yet few receive the understanding and support they need to thrive. Neurodivergent children need opportunities for positive social interaction and playful learning experiences. This is what we hope the Brick-by-Brick programme offers. As well as being used for children who are neurodivergent, the Brick-by-Brick programme is an inclusive concept enabling neurotypical children to learn and engage alongside their neurodivergent peers, allowing more inclusive, playful, learning opportunities for everyone. Whilst some programmes focus on treatment or ‘fixing’, it is important that the Brick-by-Brick programme follows a respectful, child-centred, strengths-based approach.

The Brick-by-Brick® programme represents the most up to date and innovative version of LEGO brick-based therapy. At Play Included, we train health and education professionals on how to deliver the Brick-by-Brick programme in their school or health setting. Children know the sessions as 'Brick Clubs'.

The Brick-by-Brick programme brings children together through a shared interest in LEGO play. Children work together to build LEGO models in pairs or small teams in weekly Brick Clubs for up to a year or more. Through collaborative LEGO play, children have the opportunity to practice many different skills including cognitive, creative, emotional, social and physical skills, all while having fun and making friends.

Children working together on the LEGO model are encouraged to chat, solve problems, help each other and work together. When children build a LEGO model, one child can be the engineer describing the instructions, one child can be the supplier and find the right pieces, and one child is the builder and puts the pieces together. Children take turns to play the different roles. Children have agency and choose which models they make and who with. As children get more confident in Brick Club, they may do freestyle LEGO building activities without instructions, create their own rules and roles in Brick Club teams, or create stop-animation videos with LEGO models. 

Brick Clubs are playfully facilitated by adults who are trained in the Brick-by-Brick® methodology. In the sessions, situations occur that create natural opportunities for developing social and emotional competence and communication skills. Trained adults use playful facilitation and guided questions to support children to solve any challenges they face (e.g. a piece is missing, someone doesn’t want to swap roles, deciding who gets to be which role first etc.). Social problem solving can be used, emotions can be labelled, validated and explored, and children can practice different strategies to support them to collaborate successfully with their team mates. All of these strategies are used in the present moment, are relevant to the activity and are therefore more meaningful and memorable.

Professionals supporting neurodivergent children can take Play Included training courses to be able to deliver Brick Clubs in their setting. The certified (first) level of training is an asynchronous, self-paced e-learning course, available in English, Spanish, Danish and Chinese. This course provides an understanding of neurodiversity, playful facilitation techniques, and details how to set up and run Brick Clubs with children. The advanced (second) level of training is completed in-person as a full day course, and allows professionals to role-play different Brick Club scenarios and enhance their playful facilitation techniques. Our partner in Mexico, Autismo Puebla, has been trained to deliver this in person advanced course. Through the training, health and education professionals achieve a good understanding of neurodiversity, learning through play, and can apply playful facilitation techniques so that Brick Clubs are fun for children and promote social and emotional learning.

Foundational

Our ongoing desk research supports that LEGO brick-based therapy has a  positive impact on autistic children’s social and emotional development.

Formative

Funded by the LEGO Foundation, we worked with local partners to go through our online training in the Brick-by-Brick programme, and implement Brick Clubs with approximately 10 children aged between 5 and 12 years in Mexico and Kenya. We found that Brick Clubs were feasible and acceptable in each location, and there were small and positive effects on children’s development after 6 weeks of attending Brick Clubs. Families shared that programmes have often excluded or not been suitable for their autistic child, and they were grateful to have been able to access the Brick-by-Brick programme.

We have worked with an external marketing agency who have developed a portfolio of Brick Club case studies from around the world. All of our case studies can be accessed from our website: https://playincluded.com/en-GB/case-studies, and video case studies from Mexico are available on our YouTube Channel: https://www.youtube.com/@playincluded

Funded by the LEGO Foundation, we commissioned an evaluation of both the Brick-by-Brick programme training and Brick Clubs. We worked with AT-Autism, an expert consultancy team specialised in neurodiversity and implementation evaluation. AT-Autism conducted participatory action research with neurodivergent people and experts to develop bespoke surveys to evaluate both the training and Brick Club outcomes. In 2020-2022, we gathered feedback on our new online training, which was undertaken in across several different countries, including Australia, Denmark, Hong Kong, Malta, Singapore, the UK and the USA. Feedback indicated that professionals had improved their knowledge of learning through play, playful facilitation and neurodiversity, and they felt confident and motivated to set up Brick Clubs. 100% of professionals said that they would recommend the Brick-by-Brick programme training.

Funded by the LEGO Foundation, we then looked at implementation of the Brick-by-Brick programme and child outcomes. Participatory action research was used to develop bespoke surveys and interviews to collect impact data from children, their families, and professionals. The findings showed that after attending Brick Clubs for 6 weeks, there were improvements in children’s social and emotional wellbeing. 85% said that there were improvements in children’s willingness to be part of a group activity, 77% said that there were improvements in children’s self-confidence, and 71% said that there were improvements in children’s friendships, communication and social connection.

Summative

Dr. Gina Gomez de la Cuesta was a co-applicant and advisor on the I-SOCIALISE trial - a cluster randomized controlled trial where UK schools were randomly allocated to either 12-weeks of LEGO brick-based therapy (n = 127) or usual support (n = 123) and funded by NIHR. Intention to treat analysis of the main outcome measure (Social Skills Improvement System) showed a modest and positive effect of 3.75 points for the intervention arm, which was statistically significant but not clinically significant. Health economics analysis showed cost-effectiveness of the intervention through reduced service use costs and a small but significant increase in quality adjusted life years (QALYs). Intervention fidelity and acceptability were both positive.

Our research suggests that the Brick-by-Brick programme has a positive impact on children’s social and emotional development. 

Within the I-SOCIALISE trial, allocating three hours of training was a pragmatic decision based on time barriers encountered by the study team. Training content was reduced and condensed - in particular psychoeducation modules about autism, and a deeper look at the role of the facilitator or experiential role-playing to develop as a facilitator. This may have impacted the extent to which facilitators were able to fully understand their role and the importance of not being explicitly directive with the groups. It may also have failed to combat the pre-existing misconceptions about LEGO brick-based therapy held by some schools with previous experience of this methodology. Additionally, time barriers meant that additional training or supervision of delivery was not available to facilitators. The Brick-by-Brick programme responds to each of these concerns by adapting a hybrid, self-paced and flexible model of training, an emphasis on learning through play and playful facilitation throughout, as well as a Facilitator resource area where professionals can access evaluation tools and support for delivering Brick Clubs (e.g. a Facebook Community of Practice, fidelity checklist, drop-in sessions and specialist webinars delivered by Brick-by-Brick experts).

Within the Brick Club outcome pilots conducted with AT-Autism, we found that it was challenging for Facilitators to collect data from children in Brick Clubs. During the research study, attempts were made to increase data collection from children by reminding Brick Club facilitators, condensing the forms and questions asked of children, but this was not very successful. We have been working on a larger monitoring and feedback project whereby the process for monitoring and evaluating Brick Clubs will be embedded into a web app, where Facilitators can be more involved in data collection, management and reflection of the data gathered in Brick Clubs. We have condensed the questions that we ask of children significantly further and are planning to conduct pilot studies looking at innovative ways to collect data from children, such as using LEGO building activities within Brick Clubs or using photo-elicited interview methods.

Some of the children recruited into pilot studies were not autistic; some had dual diagnoses of autism and ADHD, some have learning difficulties or speak few to no words, some have health conditions or have other social, emotional and behavioural needs. We want to continue to explore the potential of the Brick-by-Brick programme for these children, since much of the academic research into LEGO brick-based therapy has focused on autism. We have been planning further pilot studies in different groups of children, such as those who have ADHD, children from different socioeconomic backgrounds, or children who have missed out on social and communication opportunities as a result of Covid-19 isolation. We are planning to conduct more thorough desk research into the evidence of programmes like the Brick-by-Brick programme for non-autistic children. We would also like to explore whether different cultural adaptations are needed within the Brick-by-Brick programme to support international scaling.

Having more focused evidence gathering in this region would best support current and future partnerships and business opportunities in Latin America and beyond. Play Included have continued a successful partnership with The LEGO Foundation and other partners for the last four years to develop an organisational strategy. Most recently, working with the LEGO Foundation and external business consultants, Play Included have redeveloped their organisational strategy and ambition. We now have the target to reach over 10,000 health and educational professionals, and 100,000 children, with our programmes and resources across the world by 2030.

Our internal market research has identified Mexico be of key interest to us for promoting awareness and impact of the Brick-by-Brick programme. Factors which led to this conclusion include Mexico being a key geography within our current LEGO Foundation grant, Mexico having a LEGO Factory in Monterrey and therefore having awareness and access to LEGO bricks and resources, and an opportunity to bring LEGO brick-based therapy to an area where there is some level awareness, appetite and acceptance, but (so far) very little implementation of the Brick-by-Brick programme or similar programmes. We also completed a successful pilot in Kenya, supported by the LEGO Foundation, and are keen to explore, replicate and scale the programme across other countries, in line with our mission to improve outcomes for neurodivergent children.

With support from the LEGO Foundation we have launched a partnership with Autismo Puebla in Mexico so that they can deliver in-person training courses, and will very soon be making our e-learning and Brick-by-Brick® programme resources available in Spanish. Now is the right time for us with a relaunch of our business strategy and ambition since April 2024, as well as a new focus on Mexico and surrounding countries to target advocacy, learning, and reaching more children.

• How do we scale the Brick-by-Brick programme in Mexico and LATAM  sustainably and with quality?  
• Can we gather further localised evidence of the Brick-by-Brick programme including children’s perspectives of the programme?
• What adaptations need to be made to the Brick-by-Brick programme to make it more relevant and impactful? 

We have launched a partnership in Mexico and piloted Brick Clubs there. We identified Mexico as one of the biggest markets for our solution in LATAM, and are keen to replicate learnings in other countries. We have also implemented a successful pilot of Brick Clubs in Kenya, and are keen to nurture this relationship and explore potential replications in sub-Saharan Africa.

Studies to gather local evidence on feasibility and acceptability

Our pilot research indicated that the Brick-by-Brick programme was feasible and acceptable in Mexico and Kenya. We now have an evaluation toolkit ready to use in Brick Clubs, and we could use this opportunity to further pilot Brick Clubs in Mexico and other countries where our e-learning is available. We would particularly welcome a focus on gathering perspectives from children and young people directly. We recommend that evaluation happen over a 6- 8 week period with about 10 children (2-3 Brick Clubs total), and we may have already have some Brick Clubs ready to take part in an evaluation through our partnership with Autismo Puebla. We would like to focus on strengths and barriers to programme implementation in this context, and explore any adaptations that we could make to our programme or resources to strengthen their impact. We would also like to collect some localised outcome data from children to use for evidence sharing and awareness raising.

Creating a sustainable pathway to scale

We would like to identify and conduct stakeholder interviews and desktop research to look at pathways to scale for the Brick-by-Brick programme in different geographical regions. We recognise the potentially prohibitive cost of LEGO materials, the variation in accessible and effective support for neurodivergent children, and potentially varying levels of neurodiversity awareness, understanding and acceptance in different parts of the world. We would value exploration of the awareness and feasibility of LEGO brick-based therapy or similar programmes and a better understanding of the neurodiversity landscape. We would like to know how we can best support and deliver the Brick-by-Brick programme in Mexico and the wider region in a way that is financially and operationally sustainable and delivers impactful outcomes for children. It would be great to identify some key actors or stakeholders that we should contact, where neurodivergent children currently receive support and look for other examples of successful organisations and business models we can learn from. 

Studies on feasibility and acceptability

With pilot Brick Club findings, we would share the results with internal and external stakeholders to leverage advocacy and support for the Brick-by-Brick programme. Internal stakeholders include the Play Included team and our advisory committee, and external stakeholders include future Facilitators, Trainers and people who make decisions about Brick Clubs such as families and professionals, and partners such as Autismo Puebla and the LEGO Foundation who have vested interests in our implementation in LATAM. We would publish the pilot as an additional case study on our main website, and package quotes and outcome summaries as content for social media, engaging with future stakeholders and partners, as well as potential funders and investors for Play Included.

Internally, we would grow and learn from the pilot outcome data, and consider whether adaptations could be considered for the programme. We would use learnings from the report to leverage discussions with funders and other partners to help test and refine our programme and resources. This would allow us to increase the reach and impact of Brick Clubs within the region and across the world, by making them more accessible to children, and ensuring that the programme is culturally relevant.  

Pathways to scale

We would create a business plan and marketing strategy of how we could work towards a sustainable business model from the outcomes of this work, understanding how best we can use funding and/or revenue generation to reach more children with high quality training, resources and programmes. Our revised business plan would allow us to identify and priorities countries in LATAM or sub-Saharan Africa where there is most potential for the Brick-by-Brick programme, and use localised evidence to increase reach and impact. Recommendations on who, where and how to target our advocacy and campaigns work would be incorporated into our regional marketing strategy. We would leverage these recommendations to reach more children, families and professionals with our programmes, training and resources. This would allow us to increase the reach of the Brick-by-Brick programme and allow us to engage with stakeholders more directly, using examples and insights from current stakeholders (e.g. “here’s what other teachers in your region or context said about our programme”).   

Organisational outcomes

For Play Included, our intended outcomes for the LEAP project are to increase our reach and impact in this region and develop quality evidence to support and improve the Brick-by-Brick programme. We have recently translated our resources into Spanish and launched a new partnership with Autismo Puebla, and the insights from the LEAP project would allow us to continue to grow our presence in this region and reach more children, families and professionals. We need to better understand a pathway for our work in this region to be sustainable, as we look towards our whole organisational strategy for the future.

Solution outcomes

For the Brick-by-Brick programme, our intended outcomes are to maintain the high quality of our solution and ensure that it is culturally feasible and relevant in this region. Testimonials and insights would allow us to increase awareness, advocacy, and implementation of the Brick-by-Brick programme. This data would allow us to potentially adapt the solution, and improve outcomes for children and young people.