Adapting Practice During a Global Pandemic: The SenSI Clinic
By Moira Veira, 1 August 2020
Moira Veira, Specialist Occupational Therapist at SenSI Treatment in Norwich tells us about the practical implications, which the new COVID-19 restrictions have brought to their clinical practice. This demonstrates the creativity, adaptability and resourcefulness of how this practice has responded in a time of crisis.
At SenSI we work with children, young people and adults with a variety of needs. We work with families with young people who have difficulties with sensory processing, many of whom have had early trauma and are placed with foster carers, special guardianship orders or with their adoptive parents. We also work with compensation cases and children with physical disabilities. We are a team of mostly Occupational Therapists but also provide Speech and Language Therapy, Psychotherapy, Clinical Psychology and Nursing.
Our practice changed substantially on 23rd March once lockdown started. We needed to quickly adapt how we did things to support our families and do our best to adhere to ASI principles but recognising the constraints with this.
The journey to continue to support families has evolved over the weeks and continues to evolve, responding to the ongoing needs of the individuals we support. The following is a summary of all that we are providing to families to help coach and educate them to help their children as well as to individuals themselves.
- Weekly resource packs – these explore a different sensory system each week, with narrative, therapy suggestions and a session plan to be carried out at home. Topics also include Interoception, Bilateral Integration, Visual Perception, Social Communication, Mental Health etc. These are specifically designed for three different age groups (children, teenagers and adults).
- Weekly booklets written and illustrated on each of the topics for the resource packs so children and young people can learn about things in an age appropriate way and increase their knowledge.
- Weekly bespoke social media posts based on the weekly theme.
- Pre-recorded sensory motor sessions on a PowerPoint – based on the weekly theme so parents can carry out activities, using bespoke YouTube clips to help facilitate a session with a child, if a virtual session is not possible.
- Virtual sensory motor sessions using equipment which an individual has at home or which has been delivered.
- Virtual speech and language and social communication sessions.
- Virtual psychotherapy sessions.
- Virtual sensory attachment sessions followed by parent debriefing sessions to facilitate attunement.
- Equipment delivery – providing peanut balls, scooter boards, lycra tunnels, yoga wheels and learning packs to help families know different ways to use this equipment. We have provided tables and chairs, pencils, paper and educational resources for vulnerable children.
- Virtual teenage groups with a focus on social communication, social anxiety and sensory processing, supported through activities such as baking, gardening, making hand scrubs etc.
- Community visits when needed, maintaining social distancing but supporting children to manage the easing of lockdown restrictions by applying anxiety management principles.
- Parent support through phone calls, coaching, and training depending on what is required.
- Sleep support – through phone calls, sleepy recipes, homemade sleep sprays, bedtime yoga routines and sleep hygiene programmes.
- Mindful yoga sessions through virtual support or bespoke YouTube access.
- Interoception sessions through virtual support, provision of packs and bespoke YouTube clips.
- Virtual sessions and support from other members of the multidisciplinary team.
- Stories read by our psychotherapist, including The Soul Bird, My Huge Bag of Worries and The Boy Who Built a Wall Around Himself, all available on YouTube.
Face to face contact
Assessments recommenced at the beginning of June, but there have been a number of changes to our practice to ensure the safety of clients and staff:
- New entrance and exit within the building, to enable one-way traffic around the therapy centre.
- Families greeted on arrival, and waiting room chairs spread 2m apart.
- Handwashing stations created in every room, and child and family shown to station on arrival.
- Temperatures taken on arrival.
- PPE is worn, and families are advised when the assessment is arranged.
- Families are invited to face to face assessments based on a risk assessment i.e. if the child cannot maintain social distancing and spits and bites, we may suggest a virtual assessment instead.
- Video and photos of the new layout and approach sent to families prior to the assessment session.
- Parental and teacher questionnaires sent in advance.
- The assessment room is a large, low stimulus environment, with no toys or soft furnishings, due to infection control.
- Assessment tools are minimised i.e. Movement ABC is avoided due to small items of component parts, however, the Clinical Observations, Beery VMI and TVPS are able to be administered.
- The assessment is ‘hands off’ but we ask parents to be involved for any aspect were physical touch is required i.e. testing hand reflexes.
Face to face intervention will not commence until September 2020, if this is in line with Government policy. We will allow an hour in between each treatment session to ensure the room and toys are thoroughly cleaned. Footfall will always be reduced, with most staff working from home and remotely, unless offering face to face sessions. We have had to modify the equipment we are using, only choosing equipment that is easily cleaned and wiped. This will potentially have an impact on sessions, which could therefore impact on engagement. For example, all soft toys have been removed due to guidelines around infection control.
We have always placed an emphasis on home programmes and sensory diets, and helping parents to become more attuned, educated, playful and responsive with their children. Our current provision has facilitated this and has been positively received. COVID-19 has placed more focus on parents delivering home based sensory sessions, using the equipment and garden spaces available to them, and as a result, we are seeing much more regulated children (and parents).
