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.
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!”