Sensory Integration Education

Julia-Marie White received her MSc through Ulster University and Sensory Integration Education. Here, she shares her research project.

Julia-Marie White qualified from London South Bank University as an occupational therapist in 2007, and has since worked in various roles within Forensic Mental Health services. Attending an ‘Introduction to Sensory Integration’ course through SI Education in 2011 provided a ‘lightbulb moment’, and she consequently embarked upon the modular pathway to become a qualified ASI practitioner, completing her MSc in Sensory Integration with Distinction through Ulster University and SI Education in Dec 2018. Julia-Marie shares her findings from her research project entitled “A mixed-methods approach to investigate the implementation of Ayres’ Sensory Integration® (ASI) by qualified ASI practitioners working with adolescents / adults / older adults in the UK”. 

Take a moment and consider how you have found the process of implementing Ayres’ Sensory Integration® (ASI) in your workplace following qualification. Have you managed to implement ASI in the way that you envisaged, or at all? Along your journey, have you been able to communicate your factors for success and discuss the associated challenges? It turns out that stopping to think about these questions may provide a useful conduit to improve both our own ASI practice and others’.

The ability to implement evidence-base into routine practice is key to demonstrating effective intervention (Eccles and Mittman, 2006). We are fast approaching 2020; for the ASI community, this marks 100 years on from the birth of the theory’s originator, Dr A. Jean Ayres and proposes a vision for future ASI development. For the NHS, it is the target year marked to close the projected £30 billion funding gap (NHS England, 2014). Whilst associated service redesign may offer ASI practitioners’ opportunities for newly commissioned health care roles, the focus on cost-effective and outcomes-focused service delivery requires us to demonstrate effective intervention. Within this climate, leading ASI researchers are appealing for increased practitioner engagement in advocacy, education and practice-based research activity, to better capture service user outcomes and move the field forward (Schaaf et al., 2015). Implementing evidence-based practice can be complex though, demonstrated by the growing research field of implementation science. 

There is acknowledgement that interventions (such as ASI) that aim to improve quality and outcomes for clients may not always be fully realized due to implementation challenges (Aarons et al., 2011). In order to address these challenges, research suggests that consideration of the environmental, contextual and cultural factors that affect implementation (Marshall 2011; Shaw 2012) can support our practice development, and help transfer knowledge to others where achieving best practice may remain difficult.

The MSc research project completed by Julia-Marie investigated ASI implementation in the population of qualified ASI practitioners working with adolescents/adults/older adults in the UK. A convergent identical mixed methods design was used. Qualitative data sought to understand practitioners’ experience and explore the factors that could support or act as barriers to ASI implementation, in addition to factors that might support future implementation. 

Quantitative data sought to provide descriptive statistics to define ASI practitioner/ workplace characteristics and provide a broader understanding of variables that might be linked to successful/unsuccessful ASI implementation. The data was triangulated to provide a more holistic understanding of the research issue. Ethical approval was gained from the Ulster University filter committee. Recruitment and funding support was received from the Sensory Integration Education (UK & Ireland), which advertised the study online and via a membership database of ASI-qualified practitioners who consented to be contacted for research purposes.

Key Findings

24 eligible respondents participated in the survey.  

The quantitative data identified two key, statistically significant variables that had a positive impact upon ASI implementation: ‘Support from service leaders’ and ‘Sufficient supervision to discuss clinical aspects of ASI’. Data triangulation identified an additional key variable; ‘MDT support/understanding’. Analysis of the survey responses revealed several important findings with regards to these variables: Firstly, whereas MDT support seemed to impact more upon how ASI was processed, service leader support appeared to link more to how ASI was structured and resourced. ‘MDT support/understanding’ linked most directly with how ASI was perceived and implemented within the workplace. Where MDT colleagues valued intervention, survey respondents identified to specialize and offer ASI formulations / interventions. In contrast, lack of MDT understanding deprioritized ASI intervention, and had the potential to reduce it to an assessment-only basis. Another important finding related to ASI practitioner independence: It was interesting to see how increased autonomy enhanced practitioner flexibility, however too much could lead to feelings of isolation. Expert supervision was identified as a desired future means to mitigate isolation but securing this on a consistent basis was acknowledged to be problematic, with many respondents identifying peer mentoring as a current support strategy. Table 1 displays the factors that survey respondents identified as influential to current and future ASI implementation.

Table 1. First Cycle Coding Results: Factors affecting ASI Implementation

The survey respondents identified many variables that impacted upon their ASI implementation. It is important to be aware that there are implementation frameworks and socio-economic theories available that we can draw upon to better understand the factors that influence ASI implementation, why they may be difficult to access, and how we can work with others to secure them. Sharing our factors for success and the challenges we face, and making visible to others the value, meaning and outcomes of ASI intervention may be the first steps to improving the effectiveness of our services.

Recommendations for Action

The following recommendations are based upon the study findings, and resource and implementation-based research used to provide context.

- Seek out implementation frameworks to help guide you to plan, implement and sustain ASI practice in your workplace e.g. i-PARIHS (Harvey and Kitson, 2016)

- Obtain consistent, expert supervision – where unavailable, seek out peer mentoring as an alternative

- Get involved in local ASI support networks, if they don’t exist, try regional/ online support networks – or set up a local group yourself!

- If using online support networks for education / support – research suggests that relatively closed / organized groups may work better than open forums

- Create a communication strategy to improve others’ understanding of ASI – make sure you communicate (Rogers, 2003)

- The ‘relative advantage’ of ASI (the extent to which ASI is perceived as improving existing practice) – this is one of the strongest predictors of how quickly an innovation is adopted

-  ‘Complexity’ (make sure ASI is made easy to understand by others)

- ‘Compatibility’ (how ASI can fit with existing values, past experiences and client needs)

- ‘Trialability’ (consider proposals for how ASI could be trialled on an initial basis – this makes it more likely for teams to consider)

- ‘Observability’ (ensure that ASI outcomes are made visible to others)

- Secure senior managerial support – research has linked this to increased provision of resources and logistical support

- Actively enrol and work with stakeholders to decide how ASI will operate within the workplace – joint decision making is a powerful way to activate practice

- Engage service users as key stakeholders - research indicates that raising consciousness and working collaboratively with service users can effect positive organisational culture change and help to redress inequality / accessibility issues

- Get involved in building up the ASI evidence base and share your knowledge openly

If you would like to find out more about the above research project, a copy can be accessed through the Royal College of Occupational Therapy library: A mixed-methods approach to investigate the implementation of Ayres’ Sensory Integration® (ASI) by qualified ASI practitioners working with adolescents / adults / older adults in the UK. You can also contact Julia-Marie at [email protected]. Many thanks to Dr Greg Kelly, Ulster University, who provided academic supervision for the research study and to SI Education for providing funding and recruitment support. Huge thanks also to members of the pilot sample and to all those who responded to / participated in the study, who took time to provide valuable, considered feedback.