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Sensory Rooms in Mental Health |
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Sensory
Room: An Umbrella Term
“Sensory Room” is an umbrella term used to categorize a broad variety of therapeutic spaces specifically designed and utilized to promote self-organization and positive change. There are multiple types of sensory rooms and purposes for use that have been created and implemented in different practice areas to date. When used appropriately, sensory rooms:
- Help to create a safe space
- Facilitate the therapeutic alliance
- Provide opportunities for engagement in prevention and crisis de-escalation strategies, as well as a host of other therapeutic exchanges (to teach skills, offer a variety of therapeutic activities, etc.)
- Promote self-care/self-nurturance, resilience & recovery
Generally, to help guide conceptualization, there are a variety of therapeutic spaces that may be categorized under the sensory room umbrella: sensory modulation rooms, sensory integration rooms and snoezelen rooms are examples.
The Sensory Room Umbrella
© Champagne, 2008
In mental health settings, there may be one or more sensory rooms created, which typically fall under the sensory modulation room category. For example, on an acute or long-term care unit, there may be converted quiet room spaces that are designed to be more sensory supportive and used primarily for the purposes of crisis de-escalation and/or prevention. However, other kinds of sensory rooms in mental health care also include any additional therapeutic spaces that have been enhanced or developed for sensory supportive, therapeutic purposes. In this way, all of these sensory room spaces are used primarily to promote sensory modulation. Whereas, sensory integration rooms are created and used specifically by occupational therapists who are trained in sensory integration techniques and these spaces contain very specific types of equipment and intervention processes. Snoezelen rooms are generally used with people with moderate to profound cognitive impairment (e.g., people with pervasive developmental disabilities or dementia), and are often used to promote relaxation, social interaction and/or to provide activities affording intense stimulation. In most cases, all but sensory integration rooms are used by inter-disciplinary staff with training or certification specific to the kinds of equipment and approaches offered within the space.
However, it is important to point out that a mixture of sensory modulation and snoezelen approaches may be combined if it is beneficial for the specific consumer population and practice setting. Additionally, sensory integration equipment and techniques may be utilized in either a sensory modulation or snoezelen room by a skilled occupational therapist. Further, therapeutic exchanges in sensory integration rooms may also focus on sensory modulation. Therefore, this sensory room categorization is meant to be flexible and is to be used only as a guide.
The enhancement of the physical environment, including the use of sensory rooms, affords a more nurturing and recovery-oriented therapeutic environment. Skilled nursing facilities, day treatment centers, schools, long-term care facilities, respite care homes, hospitals, emergency rooms and hospice care settings are just some of the organizations utilizing sensory rooms.
Creating & Naming the Sensory Room
The development of sensory rooms requires a collaborative process, evolving over time. Consumers and staff who are going to be using the space must be involved in the development process, as much as possible. Given the varied populations sensory rooms may be used with and purposes of use, naming a sensory room should also be a collaborative decision and reflective of the specific goals of use. For more information on the development and naming of sensory rooms refer to the section on setting up a sensory room on this web page.
Sensory Rooms in Mental Health?
The idea to expand the use of sensory rooms to acute inpatient mental health care settings with varied populations is a more recent application, incorporating a variety of sensory modulation approaches and modalities. Hence, the use of sensory rooms in mental health settings often falls under the sensory modulation category. An essential part of this mission is to maintain an emphasis on engaging in meaningful therapeutic activities and in recognizing the inter-relatedness and importance of the therapeutic use of self and physical environment. Offering humane and self-nurturing choices for prevention and crisis de-escalation is essential and afforded in an organized and safe manner through therapeutic exchanges in sensory modulation rooms.
Two recent articles demonstrate the purpose of the incorporation of the use of sensory rooms and additional sensory-related approaches into mental health inpatient practice (Champagne & Stromberg, 2004) and provide a guideline to assist in the evolutionary process (Champagne, 2006). Champagne’s book, available through this website’s product page, is another valuable resource available to assist in the process of developing and integrating sensory rooms and other sensory approaches into mental health care practice settings.
The
skilled and responsible use of sensory rooms has become readily
endorsed by the MA State Department of Mental Health (DMH) and the
Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), and has become a focal point in hospital surveys and
re-licensing visits. It is also being promoted by the National
Technical Assistance Center, a division of the National Association
for State Mental Health Program Directors (NASMHPD), as one of the
instrumental interventions influencing the reduction of restraint and
seclusion in mental health care settings. For more information on the
restraint and seclusion reduction initiative click
here to visit the restraint
reduction section of this website.
There
is limited literature and research available regarding the use of
sensory rooms in acute care inpatient mental health settings with
pediatric, adolescent, and adult populations. However, the following
is an article regarding a quality improvement study conducted on the
use of the sensory room at Cooley-Dickinson Hospital's acute care
psychiatric unit:
 The Effects of the Use of the Sensory Room in Psychiatry
A Quality Improvement Study
By:
Tina Champagne, M.Ed. OTR/L & Edward Sayer, Psy.D
This
quality improvement study was replicated on this unit in 2004 with
astonishingly similar results. Among the patients who utilized the
sensory room during group or individual sessions, most report having
had a positive response and a decrease in perceptions of distress.
In 2006, Champagne published an article on creating sensory rooms for
the American Occupational Therapy Association's Mental Health Special
Interest Section. The reference information for this article is:
Champagne, T. (2006). Creating sensory rooms: Environmental enhancements for acute inpatient mental health settings. Mental Health Special Interest Section Quarterly, 29(4), 1-4.
AOTA members may download this article at: http://www.aota.org/Pubs/SISQs.aspx
The
sensory room's purpose also corresponds with the purpose of the
Safety
Tool
developed and promoted by the Department of Mental Health in the
state of Massachusetts. The Safety Tool was developed in an attempt
to facilitate trauma-informed care and to help to reduce the
occurrences of seclusion and restraint by learning about each
person's early warning signs, triggers and what helps each
individual early in the therapeutic process. The safety tool is
typically administered by nursing staff during the initial
assessment. The information obtained through the use of the safety
tool has been helpful to occupational therapists during the
information-gathering period prior to initial therapeutic exchanges
with each consumer.
Taking
A Leadership Role
Occupational
therapists are taking a leadership role in the planning and
implementation of the use of sensory approaches across mental
healthcare settings, including the focus on environmental
modifications and enhancements, such as sensory rooms. As in other
areas of practice, the education and knowledge base of occupational
therapists helps to justify the unique role of the OT as the
qualified professional to supervise the development and
implementation of the "sensory room" and other sensory
approaches. Currently, occupational therapists are also
collaborating with administrators and other disciplines to ensure
staff trainings and competencies are developed, implemented and
maintained. Program evaluation is another important component of any
new program initiative, and occupational therapists are also playing
a key role in this area as well.
The
first adult acute inpatient mental healthcare setting to develop a
sensory room was Berkshire Medical Center (BMC) in Pittsfield, MA.
With the help of consumers and staff, Tina Champagne, OTR/L initiated
and coordinated the development and implementation of this sensory
room for adult acute care psychiatry after receiving administrative
approval in 1999. She used interviews and questionnaires with staff
and consumers to collect the following types of information: what
people wanted the purpose of the room to be, ideas for ways to
utilize the space, ideas for what to have available in the room, how
people wanted the space to be decorated, etc. At this time, there
are many such rooms in existence within acute care mental health
settings with varied themes and purposes.
The
development and implementation of sensory rooms and sensory
enhancements across settings is a process that typically evolves over
time. This affords the ability to get staff and consumer involvement
and assistance throughout the entire process. Thus, it is possible
to start a room on a very low budget and to slowly develop the space.
One of the differences between the types of sensory rooms Champagne
promotes and the more traditional "Snoezelen" style rooms, is in
the shift from spaces filled with expensive technical equipment, to a
more normalizing and replicable environment. Safety considerations
within locked acute care settings as well as the need to offer
options that the consumers can replicate outside of the hospital
setting are some of the other reasons behind the differences in both
approach and décor. Snoezelen rooms and the kinds of sensory
rooms Champagne promotes are also different from the sensory
integration style treatment rooms used specifically by occupational
therapists that are trained, certified and competent to use such
specialized equipment and techniques. Hence, it is necessary to
understand these distinctions due to the very different purposes of
each of these sensory-related therapeutic environments.
An
International Initiative
Lesley
Pinkney is an occupational therapist that helped to pioneer the
bringing together of "Snoezelen" and occupational therapy
approaches with older adults with cognitive impairments, performing
some of the initial studies with this population in the United
Kingdom. Occupational therapists in China have used sensory rooms
and gardens for older adult long-term residential settings for many
years. Katherine Smith and Angie Turner are occupational therapists
in Cornwall, England (UK). They have been instrumental within the
Cornwall Partnership Trust's planning and re-modeling projects to
create and offer more "sensory-friendly" environments. In
2003, they contracted Tina Champagne to come to Cornwall and hosted a
sensory conference specifically for OT's in mental healthcare
services across the Cornwall Partnership Trust. This international
partnership continues today as they collaborate on different
initiatives and projects.
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| Tina
Champagne (left) & Katherine Smith (right) together on the shore
of the Helford River, at Trebah Garden in the UK (2003).
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Ultimately,
the use of sensory approaches and sensory rooms has increased the
focus on each individual's unique system's tendencies, patterns and
preferences. Thus, the skilled use of sensory approaches has brought
a host of more humane and recovery-focused therapeutic tools to
mental healthcare services, which appears to have significantly
influenced the quality of therapeutic exchanges occurring in mental
healthcare service delivery across the world. Providing such skilled
and supportive options empowers staff and consumers and embodies a
person-centered approach to care. This is a significant culture shift
and it is important to recognize that any significant change in the
culture of care takes time, an interdisciplinary team effort, a lot
of work and dedication.
Setting
Up A Sensory Room
Involving
both staff & consumers!
It
is essential to involve both staff and consumers in each step of this
process. Meaningful items and themes for rooms can only be determined
through actively involving staff & consumers who will be using
the treatment space. Therefore, no sensory rooms are ever the same
because this is not a cookbook process. The information and lists
provided on this web site are provided to assist with starting up a
room, are not all-inclusive and the ideas presented may not be
suitable for all settings or populations. Clinical reasoning and
brainstorming sessions with staff and consumers are essential in
order to individualize your sensory space, from the ground up. In
this way, it will surely become a unique and meaningful therapeutic
space!
Ideas
for involving staff & consumers in the process:
- Post
a flyer on your unit stating the plan to create a sensory room,
sensory area, sensory cart, sensory bins, bags or baskets.
- Ask
for any suggestions and/or donations of time to help with the
organizing of the whole project.
- Post
sign up sheets to determine who is interested in helping to plan and
create the room.
- Circulate
a unit survey to staff and consumers for ideas regarding how to
decorate the room, what to offer in the space, on the cart, theme
ideas, what to call the room, etc.
- Include
everyone in the process of creating and decorating.
- Ask
for volunteers to help you provide educational in-services to assure
staff are qualified to utilize the space and the items in a manner
that is appropriate each person's cognitive/emotional/physical
status and that things get washed as per policy.
- Ask
for ideas when creating the policies and procedures for use of the
space and the items in the space.
- Provide
opportunities for staff to explore their own sensory tendencies,
preferences and to think about how these tendencies influence their
daily routines and work habits.
Naming
your sensory room
Sensory
rooms go by many different names and are often related to the purpose
of the space within each specific setting. Some examples of names of
sensory rooms include:
- The
Sensory Modulation Room
- The
Sensory Room
- The
Zen Room
- Chillville
- The
Serenity Room
- The
Comfort Room
Developing the policy & procedure
Sensory rooms all must have a policy and procedure for use. It is important to create a policy and procedure specific to the purpose and kinds of equipment in your sensory room. The following is a sample of a general
sensory room policy:
Sample sensory room policy and procedure
Sensory
Equipment Suggestions
General
"Sensory Room" Ideas
For
adolescent and adult sensory rooms
(29 KB)
General
"Sensory Cart" Ideas
For
adolescents & adults with moderate levels of cognitive impairment
(27
KB)
For
adolescents & adults with low levels of cognitive impairment
(19 KB)
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Sensory Diet: ADL Basket |
A
Few Ideas for Sensory Baskets, Buckets, or Bins
•
Keep a bucket, bin, or basket of fresh nature items for use during
each season (things to sort through, smell, touch, etc.)
◦
For the fall season (pumpkins, gourds, larger-sized cinnamon sticks,
fall flowers, Indian corn, etc.)
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A basket with assorted items for each of the sensory areas
•
Create a men's grooming basket
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Create a women's skin & nail care basket
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Create a bin of beading supplies for jewelry making
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Create a craft basket
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Create a reminiscence basket
General
Considerations Prior to Purchasing Equipment:
•
One good rule of thumb before purchasing equipment is not to buy it
if it can't be washed in the washing machine or in hot soapy water.
•
Anything electrical always needs to go through your facility's
inspections prior to being brought onto or used on the unit.
•
Most units require rugs, curtains, beanbag chairs, and similar items
to be made with fire resistant materials. Request this information
prior to ordering, Certificates are often available upon request from
companies who assure products are fire resistant.
How
to keep track of what you have & where things are:
•
Use of a dry erase board, checklist or clipboard for signing items
in & out helps things from walking away or vanishing altogether!
General
treatment precautions:
•
Be aware of those consumers who have allergies and seizure
disorders. Do not use items with people if there is any possibility
they may be hypersensitive to it.
•
Always ask the person if they have any hypersensitivies to what you
are planning to use PRIOR to use.
•
Be aware of any respiratory or cardiac precautions
Sensory
Room Slide Shows
Community
Integration
It
is essential for consumers to leave hospital settings with discharge
"packets" (an occupational portfolio) to share with out
patient providers, family members and caregivers. This should be
organized and contain worksheets and information regarding the
variety of techniques learned and practiced, and plans for
incorporating these skills and ideas into daily schedules and home,
school and/or work environments. This is an essential part of the
discharge planning process. This provides one of the necessary
links between hospital and discharge environments to support success
with the transition from inpatient to community level of care.
With
this increased support, many consumers have created sensory spaces
within their group homes with the assistance of staff. Others have
created various types of "sensory spaces" within their own
homes. Residential educational settings often request occupational
therapy consultation services to create more "sensory-friendly"
spaces and sensory rooms within classrooms and living quarters.
Recommendations and planning for the transition from hospital to the
community typically requires assistance to adapt what was helpful in
the hospital for use at home and in community levels of care.
Sensory Room and Snoezelen References
The
following is a growing listing of many of the articles and studies
published about the use of sensory rooms available in the literature
to date. If you are aware of any others please email those references
to:
This email address is being protected from spam bots, you need Javascript enabled to view it
.
This will assist in keeping this resource list as up to date as
possible for worldwide networking!
Sensory Room and Snoezelen References
Links to vendors of sensory room equipment
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Last Updated ( Sunday, 27 April 2008 )
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Sensory Modulation Symposium for Occupational Therapy in Mental Health |
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On
April 25, 2006 at Westborough State Hospital a symposium was held for
all occupational therapy practitioners working in MA State Department
of Mental Health facilities to help prepare them to be resource
professionals for the further development and implementation of
sensory modulation approaches within their own facilities. The
Symposium was funded by a grant obtained by the MA State Department
of Mental Health as part of the MA State Restraint Reduction
Initiative. It was coordinated by Laurie Adelstein, MS, OTR/L, a
member of a work group of inter-disciplinary professionals who
recognized the need for such a training for MA State DMH facilities.
Eighty-seven
participants attended the symposium. Approximately ninety-five
percent of the OT practitioners who work in the MA state DMH
facilities were in attendance.
Occupational therapists who
attended will participate in the training and education of staff
members including nurses, psychiatrists, psychologists, social
workers and mental health workers regarding safe and effective
treatment approaches when using sensory modalities. Upon completion
of these trainings, the goal is for all disciplines to be more
actively involved in carrying out sensory modulation treatment
approaches.
The
new MA State DMH regulations now include the integration of the use
of sensory approaches by all DMH licensed facilities. The skilled
and responsible use of sensory modalities is now widely recognized as
having the potential to help patients regulate emotions, maintain
safety, and to avoid crisis situations, thus leading to the decreased
need for the use of physical and chemical restraints.
Presenters
I
had the pleasure of creating and presenting this conference with a
talented and experienced clinician, Karen Moore.
Tina
Champagne, OTR/L (left) & Karen Moore, OTR/L (right) at the
Sensory Symposium, April 2006
Karen
has extensive experience with the use of sensory modalities. She
recently published her first set of books entitled the Sensory
Connection Program (2005). These are valuable resources full of
treatment ideas. For more information on her work refer to her
website: www.sensoryconnectionprogram.com
The
following were some of the key points made at the Sensory Symposium:
- The
most important and readily available sensory modulation
approach is the therapeutic use of self.
- Sensory-related
therapeutic approaches are person-centered. This begins with
helping to increase self-awareness and moves to self-care and
self-regulation.
- In
order to be successful, patients need to be intimately involved in
every step of therapeutic processes.
- Therapeutic
approaches using sensory modalities will be carried out by the
coordinated effort of all disciplines.
- Continuous
training of patients, as well as staff, is essential in order to
develop an appreciation of how and why sensory strategies work.
- Occupational
therapists have a key role in training others in the use of
sensory-related therapeutic approaches due to their educational
background and familiarity with these modalities and frames of
reference.
- The
body of knowledge and evidence-based practice guidelines regarding
sensory modulation evaluation and therapeutic exchanges comes
primarily from occupational therapy research and clinical
experience.
- Occupational
therapists are qualified to perform the assessments necessary to
recognize aspects of behavior that may be driven by sensory-related
problems and to match appropriate sensory activities for those with
varied cognitive levels, symptoms, diagnostic concerns, sensory
thresholds, receptivity to sensory stimulation, and personal
preferences.
- The
centrality of the consumer throughout the assessment, planning and
entire therapeutic process is crucial when utilizing sensory
approaches or any other type of therapeutic approach.
- Self-regulation
(the ability to self-organize/self-modulate arousal to meet the
demands of a situation) is a complex phenomenon influenced by many
factors including cognition, emotions, physical state, environment,
and spiritual considerations.
- People
seek the sensory stimulation they need adaptively or maladaptively!
Our job is to offer healthy sensory choices to meet these needs and
to recognize and address the sensory-related patterns (in addition
to the many other patterns) of these behaviors.
- Safety
is paramount and everyone involved must receive training regarding
symptoms of distress and potential problems related to patient
diagnosis, symptoms and sensitivities.
- When
consumer's cognitive levels are low and they are unable to problem
solve, generalize information, and plan for the future, care
providers must be involved in plans for discharge and follow through
with helpful sensory-related strategies.
- The
skilled use of sensory modalities must be integrated across the
entire program so that consumers are afforded a variety of sensory
experiences in order to determine their preferences, practice the
use and identification of calming, alerting and grounding
characteristics of sensory-related activities. Further, it is also
important to help each individual to reflect upon and recognize when
these different strategies may be the most useful.
- Sensory
rooms offer a therapeutic physical environment, which helps to
promote the effective use of sensory activities. Sensory rooms are
designed according to many factors.
- What
will be the main purpose of the room? Who will use it?
- How
will safety be maintained?
- What
space is actually available and how can it be adapted to fit the
individual's therapeutic goals?
- Does
it need to be a simple and non-stimulating environment or a more
complex one to stimulate the senses?
- Who
will supervise the environment?
- How
will equipment be cleaned and stored?
Protocols
for the use of the room must be developed taking these and many other
factors into consideration. Involving the entire inter-disciplinary
staff and consumers in the development of the sensory room can make
the space more valued, unit specific and more highly utilized.
- Sensory
carts help make sensory supplies mobile by making varied activities
available whenever and wherever needed. In order to understand how
to collaboratively assess what items/activities might be most
beneficial, staff need proper training.
- Certain
sensory modalities require additional training and certification
including the use of the Wilbarger Protocol, aromatherapy, and
therapeutic listening.
- Quality
improvement and research studies are encouraged once sensory-related
programming is established and skillfully running, which will help
to examine the efficacy of sensory approaches.
- Collaboration
with nursing staff and all other mental health professionals will be
quintessential in making this treatment approach viable and to reach
the goal of reducing restraints. "It takes a village!"
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Last Updated ( Sunday, 11 June 2006 )
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The Seclusion and Restraint Reduction Initiative |
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The current initiative to reduce and/or eliminate the use of seclusion
and restraint is being taken very seriously by healthcare facilities in
general and by mental health organizations in particular. A
person-centered model of care and the skilled integration of sensory
approaches have become recognized internationally as being fundamental
in facilitating a more humane and collaborative approach to the
dynamics of crisis prevention and intervention. The knowledge base of
occupational therapists justifies the role of occupational therapists
as one of the primary and qualified professions to help supervise the
development and implementation of sensory approaches within mental
healthcare settings, as it has within other settings to date with other
populations.
Currently, occupational therapists are collaborating with
administrators and other disciplines, helping to bring person-centered
care and sensory approaches into mental healthcare programming safely
and responsibly. This increases the repertoire of what occupational
therapists have to offer across levels of are within mental health
services. When taking a central role in any initiative it is essential
to become knowledgeable about it. The following information, and
information from other pages on this website, offers an introduction to
both the seclusion and restraint reduction initiative and to other
innovations for those practicing in mental healthcare services.
The National Association for State Mental Health Program Directors (NASMHPD)
NASMHPD is a private, not-for-profit 501(c)(3) membership organization,
helping to set the agenda and determine the direction of state mental
health agency interests across the country, including state mental
health planning, service delivery, and evaluation. NASMHPD was founded
in 1959 and it is currently located in Alexandria, VA. It is the only
national association to represent state mental health
commissioners/directors and their agencies.
NASMHPD has a central role in the national S/R reduction initiative. For more information on NASMHPD visit: http://www.nasmhpd.org
The National Technical Assistance Center (NTAC)
NTAC is part of NASMHPD. NTAC's mission includes assisting state
mental health agencies to implement the goals and recommendations of
the President's New Freedom Commission on Mental Health final report Achieving the Promise: Transforming Mental Health Care in America.
All technical assistance requests are required to meet/address at least
one of the six goals in this New Freedom Commission report.
National Coordinating Center to Reduce and Eliminate the Use of Seclusion and Restraint
The Alternatives to Restraint and Seclusion State Infrastructure Grant
Project (S/R-SIG) is an initiative of the Substance Abuse and Mental
Health Services Administration's ( SAMHSA) Center for Mental Health Services ( CMHS),
designed to promote the implementation and evaluation of best practice
approaches to preventing and reducing the use of seclusion and
restraint (S/R) in mental health settings. NTAC spearheaded an
initiative, with the support of SAMSHA, to develop and provide a
national executive training institute for the chief executive officers
of mental health organizations.
The National Executive Institute: Creating Coercion Free and Violence Free Mental Health Treatment Environments
NTAC coordinated the development of this training, which began in 2003,
to explore and identify the multiple dimensions and variables involved
in attempting to facilitate the significant culture changes necessary
to more safely and effectively shift to the use of a more safe,
trauma-informed and person-centered model of care. This training was
entitled: The National Executive Institute: Creating Coercion Free and Violence Free Mental Health Treatment Environments (NETI).
Within this training, the use of sensory approaches (which includes
sensory rooms) is promoted (in addition to many other tools) as being
instrumental for facilitating both crisis prevention and crisis
reduction. In this way, the skilled use of sensory approaches is viewed
as essential to help facilitate the decreased need for the use of S/R.
In 2003, Tina Champagne, M.Ed., OTR/L was asked by Kevin Huckshorn to
join the training faculty of the National Executive Training Institute.
Tina was the first OT to become involved as a faculty for this training
and continues to work with this group to present on prevention
approaches to S/R and to provide resources for inclusion in the
training and resource manuals.
NTAC continues to offer this training but has broadened it's scope to
include professionals at all levels of care, still emphasizing the
importance of CEOs to attend and be a central part of both the
trainings and the entire culture change process. For more information
regarding the NETI trainings email:
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NTAC also helps to address systems issues by offering Technical Assistance (TA), which includes the following:
- Assessing the role and function of the State Mental Health Agency within a managed care environment
- Creating
strategies for involving consumers and families in mental health
service planning, delivery, and evaluation; building coalitions among
key stakeholders within state systems
- Implementing
models of excellence and innovative practices (e.g., cultural
competence, employment services, and co-occurring disorders).
- Facilitates state, regional, and national consultation
- Supports special topic technical assistance and training
- Organizes consensus development conferences and teleconferences
- Maintains a consultant database
- Produces publications and reports
- Promotes model service system standards review and analysis
NTAC accepts requests for TA aligned with the recommendation of the
President's New Freedom Commission on Mental health from State Mental
Health Agency directors on a continuous basis throughout the year. The following document provides guidelines information for applying for technical assistance: Application Guidelines For more information regarding the guidelines for applying for technical assistance email:
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Culture Change
Essentially, in order to become successful in this mission, it is
necessary to recognize the complexity of the factors involved. The
following is a list of some of the core elements that together help to facilitate the kind of organizational change necessary to fully embrace this initiative.
- Leadership (administrative and clinical leadership committed and centrally involved in the entire S/R initiative, etc.)
- Timely & Responsive Treatment (collaborative, responsive and timely treatment planning and engagement, etc.)
- Staffing (qualified staffing, adequate numbers, adding staffing during critical times, etc.)
- Orientation & Training of Staff (quality, types, timeliness, etc.)
- Programming (structure, content, quality, person-centered, etc.)
- Physical Environment (sensory spaces, noise levels, body language, etc.)
- Communication (ongoing communication and involvement of consumers and families/caregivers in all aspects of care)
- Debriefing (processing after events with staff and consumers/families, etc.)
- Quality Improvement/Research Studies (systems & program evaluation, etc.)
- Evidence-based Practices
The following documents are provided courtesy of NTAC to serve as
resources to all professions working toward decreasing or eliminating
the use of S/R.
- Violence and Coercion in Mental Health Settings: Eliminating the Use of Seclusion and Restraint (Summer/Fall 2002) ( PDF) - References ( PDF)
- Six Core Strategies© to Reduce the Use of Seclusion and Restraint Planning Tool ( PDF)
- A Snapshot of Six Core Strategies© for the Reduction of S/R ( PDF)
- Policy and Procedure on Debriefing for Seclusion and Restraint Prevention/Reduction Projects ( PDF)
- Review of Recovery Literature: A Synthesis of a Sample of Recovery Literature ( PDF)
- Developing
Trauma-Informed Behavioral Health Systems: Report from NTAC's National
Experts Meeting on Trauma and Violence, August 5-6, 2002, Alexandria,
VA ( PDF)
- White Paper, "Responding to Childhood Trauma: The Premise and Practice of Trauma Informed Care" ( PDF)
- Technical Paper, Phase II Technical Report, "Mental Health: What Helps and What Hinders?" ( PDF)
Curriculum on Restraint Reduction
SAMHSA has created a training curriculum to give mental health providers
information on prevention strategies and alternative approaches to avoid and
reduce the use of seclusion and restraint.
This curriculum is organized into seven modules and emphasizes the
importance of creating culture change within organizations in order to
influence a reduction in seclusion and restraint practices.
Click here for your free copy of the Roadmap to Seclusion and Restraint Free
Mental Health Services from SAMSHA .
SAMHSA
Grant Funding
In the
news: SAMHSA Grant funding
has been approved for the Vermont state restraint reduction
initiative with lead consultant, Tina Champagne. This initiative
will provide the opportunity to focus on the use of the sensory
modulation program with child
and adolescent populations at the Brattleboro Retreat and adult
populations at Vermont State Hospital. The influence of the use of
sensory approaches in the efforts to decrease the need for the use of
restraint and seclusion, and to facilitate culture change, will be
evaluated as part of this process. For more information go to this
link and scroll down to the last third of the article:
http://www.masspsy.com/leading/0712_ne_cover_SAMHSA.html
SAMHSA
provides grant opportunities for state organizations to enhance their
seclusion and restraint reduction efforts in addition to other grant
affordances. For more information on potential resources and
application information go to: http://www.samhsa.gov/grants/
The following power point presentation slides are excerpts from the National
Executive Training Institute, created by Kevin Ann Huckshorn, RN, MSN, CAP,
ICADC and colleagues. Ms. Huckshorn is the director of the Office of
Technical Assistance of NASMHPD and has a central role in the NTAC. She is a
leader in the national initiative to reduce and/or eliminate the use of
seclusion and restraint.
The following power point presentations are copyrighted and provided for
viewing on this website with the author's permission:
Reducing the Use of Seclusion and Restraint: A National Initiative for Culture Change and Transformation (Kevin Ann Huckshorn, RN, MSN, CAP, ICADC)
A National & International Review: What's New in Seclusion & Restraint Reduction Efforts? (Austin, TX, 2007)
Presenters: Kevin Ann Huckshorn RN, MSN, CAP, ICADC & Janice LeBel, PhD
Creating
Violence-Free and Coercion-Free Mental Health Treatment Environments
for the Reduction of Seclusion and Restraint: The Emerging Science of
Trauma Informed Care (Kevin Ann Huckshorn, RN, MSN, CAP, ICADC)
The Centers for Medicare & Medicaid Services (CMS) offers a web
cast on the Reduction of the Use of Seclusion and Restraint in mental
health settings, also featuring Kevin Ann Huckshorn. To view this web
cast go to: http://cms.internetstreaming.com
In 2004, Ms. Huckshorn asked Tina Champagne to author one of a group of
three continuing education articles. These articles were published in
the September 2004 special restraint reduction edition of the Psychosocial Journal of Nursing and have been used as informational, continuing education and/or staff training materials. These articles include:
1. Huckshorn, K. (2004). Reducing seclusion and restraint use in mental health settings: Core strategies for prevention . Journal of Psychosocial Nursing and Mental Health Services, 42(9), 22-33.
2. Champagne, T. & Stromberg, N. (2004). Sensory approaches in
inpatient settings: Innovative alternatives to seclusion and restraint.
Journal of Psychosocial Nursing, 42(9), 33-44.
3. Bluebird, G. (2004). Redefining consumer roles: Changing culture & practice in mental health care settings. Journal of Psychosocial Nursing, 42(9), 46-53.
Tina Champagne requested the co-authorship of Nan Stromberg, RN, MSN,
CAP, ICADC for this article. Together they were able to demonstrate the
value of a collaborative inter-disciplinary approach, integrating
occupational therapy and nursing perspectives. Ms. Stromberg is the
director of nursing for the licensing department of the MA State
Department of Mental Health and she has been one of the core faculty
for the NETI trainings. She specializes in the treatment of people with
trauma histories and is a strong supporter of the skilled use of
sensory approaches in the S/R reduction initiative.
MA State Department of Mental Health (DMH): Taking a Leadership Role
The MA State Department of Mental Health is one state that has been in
a leadership role in this national restraint reduction initiative. This
group has been actively engaged in conducting and authoring research
articles and in creating tools on the subject.
In 2007, as part of the state’s restraint reduction initiative, the MA State Department of Mental Health and a host of experts in the area of restraint reduction in mental health published the resource manual Developing Positive Cultures of Care. This manual was created to assist programs in their efforts. Tina Champagne contributed four chapters to this manual on the topics of: nurturing environments, sensory approaches, touch and physical environment.
Developing Positive Cultures of Care is a compendium of information specifically created for those involved in providing mental healthcare services to child and adolescent populations. However, it may also serve as a helpful resource for those working with adults as well. This is a free resource guide that will be posted online in the future. Until then, to request a copy send an email to:
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Additional publications
Several of the Massachusetts State Department of Mental Health staff
authored the following article regarding their efforts and successes in
this initiative across child and adolescent units across this state.
Child and adolescent inpatient restraint reduction: A state initiative to promote strength-based care
LeBel, J., Stromberg, N., Duckworth, K., Kerzner, J., Goldstein, R., Weeks, M., Harper, G., LaFlair, L., & Sudders, M.
Janice LeBel, Ed.D is the director of program management for the MA Dept of
Mental Health's child & adolescent division. She co-authored the following
articles:
LeBel, J. & Goldstein, R. (2005, September). The economic cost of using
restraint and seclusion and the value added by restraint reduction or
elimination. Psychiatric Services, 56(9), 1109-1114.
LeBel, J. (2008). Regulatory Change: A Pathway to Eliminating Seclusion and
Restraint or Regulatory Scotoma? Psychiatric Services, 59(2), 194-196. View Article 
The safety tool is one such tool, which may be modified to be both age
and program specific. It was developed to serve as a brief trauma
screening and as an advance directive.
MA State DMH Safety Tool - Adult Version
The following is an example of a safety tool modified for use on an
inpatient acute care unit for use with adolescent and adult
populations. This is a draft version modified by: Tina Champagne,
M.Ed., OTR/L; Victor Petrella, MSN, CNS; Debra Dickson, MSN, CNS;
Theresa Lamb, RN, BSN and Wendy Noonan, RN for Cooley-Dickinson
Hospital in Northampton, MA (USA).
Safety Tool Sample - Adolescent/Adult Version (last updated 9/28/2006)
For a host of additional documents and tools regarding the Seclusion
and Restraint Reduction initiative, visit the MA State DMH web site
page:
Restraint/Seclusion Reduction Initiative (RSRI)
The Sensory Modulation Program
The Sensory Modulation Program (Adolescent/Adult version) was created by
Tina Champagne, M.Ed., OTR/L at the request of many inter-disciplinary staff
in order to help organize the components of the program into a practical and
easy to use resource for staff trainings and for use as a therapist
guideline. A general outline of the Sensory Modulation Program for
adolescents and adults is provided on this web site and more information on
this and many other related topics are available in the book Sensory
Modulation and Environment: Essential Elements of Occupation (3rd Ed.).
Research is currently being implemented on the effectiveness of the Sensory
Modulation Program, which utilizes terminology that corresponds with the
most current research available on this and related topics. The Sensory
Modulation Program, when used by skilled therapists, is a useful guide for
the implementation of the use of sensory approaches in general (across
levels of care), and it may also be used in the efforts to decrease the need
for the use of restraint and seclusion in mental health settings.
Making Sensory Approaches a MA State DMH Regulation
The MA State Department of Mental Health further demonstrated the
sincere commitment to the skilled integration of the use of sensory
approaches across mental healthcare services on April 3 rd,
2006 when the use of sensory approaches became a state mandate for all
licensed DMH facilities. In addition to this mandate they have been
actively promoting the use of OT services to support the safe, skilled
and responsible integration of sensory-related assessment, treatment
and environmental approaches across levels of care and with varied age
groups.
The support of OT involvement in all aspects of this
initiated was once again demonstrated by hosting a one day training for
all MA State occupational therapists employed by the Department of
Mental Health. The Sensory Symposium was co-created and co-presented by
Tina Champagne & Karen Moore. For more information on this event click here.
It Takes a Village
Working together in both principle and practice professionals across
all levels (governmental/regulatory bodies through inter-disciplinary
professionals) are able to better provide person-centered care. This is
evidenced by the following case in point.
Case In Point: A Sensory Room in Acute Mental Healthcare Settings?
The idea of expanding the use of multi-sensory rooms to adolescent and
adult acute care inpatient mental healthcare settings incorporates a
variety of sensory approaches, while maintaining an emphasis on
engaging in meaningful activities and the "therapeutic use of self"
(the most valuable sensory modulation tool). Sensory rooms have been
primarily used with clients with moderate to severe developmental
delays and among geriatric populations with dementia or Alzheimer's
disease. Skilled nursing facilities, day treatment centers, schools,
long-term care facilities, respite care homes, hospitals, and hospices
are some of the many organizations most commonly utilizing sensory
rooms in the past.
The use of the "sensory room" in acute care inpatient mental healthcare
settings has been a great success and readily endorsed by the MA State
Department of Mental Health (DMH) and the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO), during several
recent hospital surveys. Further, it is promoted by NTAC, a division of
NASMHPD, as one of the instrumental interventions influencing the
reduction of restraint and seclusion in mental health care settings.
Although there is limited literature and research available specific to
the use of sensory rooms in acute mental healthcare settings with
adolescent and adult populations, the following is an article regarding
a sensory room (quality improvement) study conducted in 2003 at
Cooley-Dickinson Hospital's acute care behavioral health unit in
Northampton, MA (USA):
The Effects of the Use of the Sensory Room in Psychiatry:
A Quality Improvement Study
By: Tina Champagne, M.Ed. OTR/L & Edward Sayer, Psy.D
This quality improvement study was replicated on this unit in 2004 with
astonishingly similar results. Among the patients who utilized the
sensory room during group or individual sessions, most report a
positive response and a decrease in perceptions of distress.
In 2006, Champagne published an article on creating sensory rooms for the American Occupational Therapy Association's Mental Health Special Interest Section. The reference information for this article is:
Champagne, T. (2006). Creating sensory rooms: Environmental enhancements for acute inpatient mental health settings. Mental Health Special Interest Section Quarterly, 29(4), 1-4.
AOTA members may download this article at:
http://www.aota.org/members/area3/links/link02.asp?QStatus=Y&ID=M
In 2007, Tina Champagne authored/co-authored 4 sections in the "Developing
Positive Cultures of Care Resource Guide" published and funded by the
Massachusetts State Department of Mental Health. It will soon be available
on the MA State DMH website in it's entirety. For a free copy while supplies
last contact:
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Networking
As a networking web site, please consider submitting related works for
consideration for inclusion on this web site. Email submissions to:
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Consultation Services
Tina Champagne, M.Ed., OTR/L is an award winning occupational therapist
offering consultation services on the topics of sensory modulation,
trauma-informed care, restraint reduction and organizational change. She
also consults on a range of other topics!
For information on potential consultation services with Tina Champagne click here
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Last Updated ( Tuesday, 26 February 2008 )
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Attendee Comment 2 |
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Comment from the January 2006 conference: A Nonlinear Dynamics Approach to Sensory Modulation - "Tina Champagne was wonderful! Her ability to answer questions so that all the professionals in the room would benefit (OTR, COTA, RN, support staff) was unmatched. To be able to present as much information as well as she did in such a short time is unmatched!" - Meghan Franklin, MS, OTR/L
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Last Updated ( Wednesday, 13 February 2008 )
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