Sensory Integration Education

Kate Broughton is an Occupational Therapist and SI Practitioner (PGCert in SI), working as part of a commissioned health professional team at a specialist school in Norfolk. 

The school provides mainstream education for primary and secondary aged children with a diagnosis of Autism Spectrum Condition (ASC). All of the students have an Educational and Health Care Plan (EHCP). The school commissions a healthcare team including Educational Psychology, Clinical Psychology, Speech and Language Therapy, Occupational Therapy and a Specialist Autism Advisor, with the aim of providing a seamless and joined up approach between education and healthcare. The school recognises that holistic education, where children and young people are taught both academic studies and life skills, is essential. Therefore, healthcare interventions and therapies are part of the educational process and the healthcare team works closely with the teaching teams to create an environment where students are challenged as well as nurtured. Kate tells us how her practice has changed as a result of COVID-19. I have worked at the school, on a part time basis, since its opening in September 2017. My specific occupational therapy role is to provide direct Ayres Sensory Integration (ASI) Therapy with the focus on developing children’s function and participation for improved occupational performance during the school day. I feel very fortunate to have a therapy room that meets ASI fidelity criteria (Parham L.D. et al 2011), where I usually work with children on a one to one basis.

In collaboration with teaching staff, Goal Attainment Scaling (GAS goals) is used to formulate measurable goals that focus on progressing the child's functional skills; improving active engagement in learning opportunities and meaningful occupations; and developing skills for self-regulation and positive social behaviour during the school day.

The school itself offers a range of adapted environments and regular participation in activities to support and encourage engagement in learning. Training and supervision is offered to upskill teaching and support staff in embedding sensory and emotional regulation strategies into universal provision. For example; Sensory Circuits (Horwood, J. 2009) are delivered twice a day by teaching staff within each classroom; the Zones of Regulation programme (Kuypers, L.M. 2011) is embedded within school practises; and two sensory calming rooms are available for students to use during their school day to enhance regulation. Occupational Therapy provision at the school also includes another part-time occupational therapist whose role is to provide classroom based support for functional skills, including elements such as handwriting, activities of daily living and emotional regulation.

Following COVID-19 government guidance, the school is now temporarily closed, except for providing care for the most vulnerable children and children of key workers. Due to the high infection rate and contamination risk of COVID-19, I have not provided direct ASI therapy during this time. However, I have continued to work closely with the school leadership team, teaching and support staff, families and children and I have adapted my practice to enable me to provide remote intervention and support for the children on my caseload.

Some of the significant areas of focus for my OT/SI work over this period of time have been:

1. Contributions to the production of a range of information resources

Following school closure, the initial emphasis was on universal provision, to ensure that the school had mechanisms and resources in place to support all families. Within a few days, a small team of teaching and healthcare staff, devised a comprehensive guidance document to provide families with information and strategies to support children at home during the Covid-19 lockdown. 

This information resource was shared with all school families, and was also forwarded to other mainstream provision schools who had requested further support for children with ASD. The information covered topics such as links to Autism friendly online learning; a Keeping Well Plan; ASD strategies to support routines at home; managing demand avoidance behaviours related to anxiety; tips for staying well when social distancing; (https://www. rcot.co.uk/staying-well-when-social-distancing); Regulating Sensory Activities; and other services. It was recommended that materials were personalised whilst highlighting the importance of embedding positive learning strategies, leisure and social occupations into the child’s day at home.

I produced some guidance information focussed on supporting sensory processing difficulties within the home environment. Reminders were offered about sensory integration theory, and particularly the importance of targeting the proprioceptive sense, since learning how to use the sense of proprioception through heavy work activities can be especially powerful in helping children self-regulate, pay attention and remain calm in a variety of situations. A range of everyday, meaningful, childhood occupations were suggested as calming and regulating activities, such as walking, building dens and obstacle courses, deep pressure activities, and using yoga and deep breathing strategies. 

I have also offered a variety of ideas for oral motor games that can be easily carried out within the home environment with minimal resources required. This was considered to be another key area for supporting regulation, since we also use our breath to help regulate and organise ourselves. Parent friendly explanations were given about breathing techniques, highlighting that the way we breathe in response to stimuli from our environment can help us to process the stimuli better and that better breathing can also assist in the activities we do daily. Our oral motor skills, touch processing skills and ability to vary breathing patterns also contribute to attention and organisation of behaviour.

2. Welfare contacts 

The school devised a comprehensive system for keeping in touch with families and conducting welfare calls - by telephone, online google meets, or face to face home visits adhering to social distancing measures. The healthcare team was included in this process, with the remit of contacting particular families that they are already working with. Welfare contacts have included discussions about the child’s progress with online google classroom work; general health and well being of the whole family; and more specific discussions about particular aspects of the child’s overall support package, as appropriate. In order to carry out this role successfully, I have communicated regularly with the appropriate teaching staff to agree a contact schedule and share information accordingly. After each welfare contact, a welfare log is completed, which is accessible to all staff. If there are any areas of concern, including safeguarding, these are forwarded to the school’s senior leadership team for further advice, guidance and monitoring. I have also supported families to access community facilities and resources in order to provide opportunities for engagement in outdoor play and other meaningful childhood occupations whilst adhering to COVID-19 government guidance.

3. Bespoke sensorimotor home programmes 

I have devised bespoke sensorimotor programmes for children to complete within their home environment. These programmes have been presented both visually (by using photographs of myself completing the activities) and with written instructions of how to complete the activity.

Most families have received their child’s programme as a laminated, hard copy document for ease of access. The programmes have followed the theory of Sensory Circuits (Horwood, J. 2009), as all the children are familiar with this approach from engaging in their Sensory Circuit activities at school. The activities have focussed on improving fine and gross motor skills, motor planning, sensory processing and emotional regulation. Some families have also been given a home resource kit, including a peanut ball, a wobble cushion, resistance bands and theraputty for use when completing the programme. 

Bespoke advice has been offered in order to support successful completion of the programme at home, and monitoring of progress is completed during welfare calls, with adjustments being made as required. One parent said “we have been following the programme of Sensory Regulating Activities that were sent to us by Kate, whilst we have been in lockdown. They have helped my son to regulate himself, providing him with better concentration and calmness ready for homeschooling."

4. Input to system and process changes

The remote “provision packages” that I have devised have also linked in to the review of the specific EHCP provision which has been done for all the children as part of expectations for pupils with SEND. Schools and providers have been expected to risk assess what provision can/cannot be offered from the EHCP and identify what “reasonable endeavours” can be made to continue to meet needs. The school Principal said “the sensorimotor programmes, email communications and discussions with families that Kate has offered are really strong adaptations of the in-clinic provision. The information that Kate has communicated in terms of the children she is working with, and the adapted provision she has offered are these reasonable endeavours.”

5. Staff support

I have also contributed to developing more staff resources that are now being used to aid teachers’ work whilst supporting families remotely. Information and strategies have been offered about Sensory Differences and Supporting Sensory Regulation for Learning at Home. Top tips included increasing proprioceptive input using heavy work and deep pressure activities, increasing movement opportunities and managing reactions to sensory stimuli, for example by creating a homemade workstation to reduce visual stimuli. CPD and staff supervision has also continued, albeit remotely, ensuring that the staff themselves have appropriate training and support during these unprecedented times. Following my recommendation, a large number of the teaching and support staff have recently completed the Sensory Integration Education online training, “Introduction to Sensory Integration Difficulties for Schools” and there are plans in place to now create a supervision group for SI champions in school.

6. Professional Development

Whilst working remotely, I have also taken the opportunity to support my own professional development. I have given more time to reading and reflecting on current research evidence; participating in international webinars; undertaking short online training modules of related interest; continuing to engage in my own supervision; and planning for my future professional development requirements.

Summary

Recent government guidance for special schools asks that we work towards a phased return of more children and young people, without a focus on specific year groups and informed by risk assessments. This is the next challenge! I anticipate that during the next few weeks, my work will continue to support those families who are remaining home based, whilst also contributing to transition processes for those children that will be returning to a very different school environment, very different school routines and very different school activities. There is still much work to do in relation to planning and preparing for providing direct ASI therapy in school within the “new normal”.