Sensory Integration Education

Rachael Daniels, an Advanced Specialist Occupational Therapist with Somerset Partnership NHS Foundation Trust, talked to us about applying a sensory integration approach with older adults. This article was originally published in SensorNet Issue 48, November 2016:

What was your introduction to SI?

“Twenty-one years ago, one of my children (aged 4) was diagnosed with dyspraxia, then with sensory processing challenges when he was 10. I was a young mum trying to understand the challenges he was facing and our OT gave me a book called ‘The out-of-sync child’, which helped the family understand him at a new level. It was revolutionary.”

How did SI become part of your work with older adults with learning disabilities?

“Prior to becoming an occupational therapist (OT), I had 15 years’ experience working in mental health, with older adults, young people, adults with learning disabilities and physical disabilities. As my understanding of sensory processing developed, I began viewing my professional work differently. My newly developing ‘sensory goggles’ gave me another perspective on the challenges diverse populations experience. This motivated me to take it forward within my new adult learning disability OT role. I presented a service plan to my manager and began my SI training in 2006, becoming an Advanced Practitioner in 2012.

“I see Ayres SI and SI approaches as valuable parts of my toolkit. The success of SI in the service I work in, has been humbling but sometimes I remind people we’re an OT service not a SI service. I’m passionate about remaining true to OT; identifying occupational participation strengths and challenges and treatment goals based on this. In our small service, we work to a tight priority matrix, resulting in the majority of our work using Ayres SI and SI approaches with those who have highly complex needs, which includes self injurious and challenging behaviour. We also find SI approaches valuable in the work undertaken with older adults attending our memory services. Increasingly we work with young adults coming to our service with a dual diagnosis of learning disability, dyspraxia and mental health needs.”

What were initial reactions when you started practising SI therapy and have responses changed during your career?

“Initially, there was scepticism and questions from peers about whether there was an evidence base. Levels of understanding tend to fluctuate so I need to be ready to explain SI practice and research to consultants, Allied Health Professionals, parents or carers and service users, in the most appropriate ways. Care providers initially thought SI was about fluffy stuff and sensory rooms. Once they started observing outcomes related to changes in engagement, participation and reduction in maladaptive behaviours, with service users and staff having fun they came on board quickly. I feel the key to having successful outcomes is to educate and train staff to use effective and appropriate sensory interventions, enabling them to recognise those small adaptive responses. This in turn assists with analysing an individual’s sensory processing needs.

“The service has developed from carrying a few SI resources in car boots to working in a bespoke SI clinic, designed for adults and wheelchair users. The trust has been very interested and supportive in our developing work. We’ve had board members visit the clinic and I was invited to present at the Trust Recognition Awards.

“SIT is now a recognised model of practice within ALD, Asperger’s, the Psychiatric Intensive Care Unit and some areas of community mental health, to include some high-profile cases where SI approaches have been successful in reducing restraint. Older adult community and the in-patient unit is in development with two OTs attending the training last year. We hold SI peer supervision meetings, where there is the opportunity for non-SI trained OTs to bring cases we can support them with.

“We’ve also received Trust Recognition Awards for our work, but we face similar challenges to other services, such as SI training costs and movement of staff, meaning loss of expertise. As a service we have to manage our business plan, together with the expectations of our many stakeholders. A creative approach towards development is essential in today’s financial climate of public services.

What is the most positive aspect of SI in your work?

“The people I work with and the changes to their lives, particularly when SI enables me to reach people with complex needs. One person had been self-injuring for years; she was blind in one eye due to a detached retina. After seven weeks of SI therapy at the clinic, staff training, changes made to her environment and implementation of sensory integration activities along with a personalised SI diet in place, she has now stopped self-injuring. Carers report this has been life changing for her and she is likely to keep the sight of her good eye. She is so much happier and the staff approach has significantly changed for the better.

“Presenting the care pathway we have developed in Somerset at ESIC 2015 was a very proud moment. It encompassed all the service developments, to which we had a wonderful response including from Diane Parham.”

How does SI support older adults within your service?

“Within Adult Learning Disability services, there’s a high incidence of dementia for adults with Down’s Syndrome. I also offer consultancy to our older inpatient units and to the community services. We find SI approaches valuable for challenges with personal care, to include changes to vestibular processing affecting hoisting and mobilising. It can help with calming and self-soothe strategies, especially for individuals experiencing distress and agitation, including pacing.”

You work with a physiotherapy technician, can you explain how this improves outcomes for service users?

“Joint work with physiotherapy developed when I started receiving referrals for adults with profound intellectual and multiple disabilities. Carol Minty, the Learning Disability physiotherapy technician, has been working with me from the onset and her work has been invaluable ensuring safe practice in regard to positioning. Carol is highly skilled and taught me how to work hands-on with individuals. SI therapy with this population begins with passive movement and touch, building towards that all exciting moment of stepping into Ayres SI as that adaptive response is elicited and starts the SI communication and scaffolding.”

How does the physiotherapy role in SI differ from an OT role in SI?

“It’s a complementary role rather than a different one. We know when to step in and when to step out, like a dance. The choices we make in terms of the work we do come naturally. Carol is very intuitive to people’s needs.”

You’ve completed your MSc in Sensory Integration, what were the main findings in your dissertation?

“To complete my MSc studies, I carried out a systematic review of the literature considering Ayres SI as an Occupational Therapy Intervention for Maladaptive Behaviours. Findings suggested that using Ayres SI, in the treatment of maladaptive behaviours may increase independence, reduce carer need and improve occupational participation. The findings demonstrate positive outcomes in regard to increased occupational participation, which was positive to demonstrate how OTs can use their core skills to plan outcomes of Ayres SI therapy.”

For therapists working with older adults, wanting to use an SI frame of reference, how could they start?

“The Pool Activity Level for sensory aspects is a good starting point. For people with profound difficulties, the STEP model looks systematically and holistically at sensory processing needs. The combination of PAL and AMPs, with an SI hat on, can be useful in terms of unpicking the challenges and engagement at the right level.”

How did you go about developing the new clinic?

“The development process was terrifying at times. We needed to consider the structural elements of the Fidelity Measure and adapt parts of it to meet the varying needs of our service users to include those who had significant ASD needs and those who are not ambulant.

“We gained valuable input from other services with clinics about what had worked well for them. We needed to have space and sufficient height for adults to move about, and to accommodate suspended equipment, which was suitable for adult weight. We’ve created a space that can be adapted to individual needs. Safety for service users, staff and ourselves have also played a role in choice and access to equipment, having storage directly off the room is invaluable when you need to calm the environment down quickly to accommodate increasing arousal levels.”

If you would like to learn more about introducing a sensory integration approach with older adults, we host regular live, online training sessions on Applying SI Therapy Principles with Older Adults.