Interview with an OT

I was lucky enough to interview an occupational therapist who works in mental health. She provided some really interesting insight into her experience of learning about sensory modulation and how she implemented it into her practice.

1. How did you first find out about SM?

I first heard about SM from colleagues (specifically another two OT’s that I worked with) who had completed the Tina Champagne SM Training. Around about this time it became an interested topic by the DHB as they were trying to get the rates of seclusion down and there was a huge emphasis on restraint minimisation across the Mental Health Sector.  Te Pou then carried out a multidisciplinary training workshop after researching SM to try and educate workers. This training was the first I had experienced and that’s when I became interested in how I could use it in practice. I was then lucky enough to be funded to go for the Tina Champagne Training and from there I got ideas of how I could implement it in practice.  

2. Were other staff in the unit receptive to the creation of the sensory room? Did they understand what it was used for?

The staff on the unit were mostly passive about the prospect of a comfort room (it’s not a full sensory room) on the unit. Some saw the relevance in having a quiet space for people to go and rest, others did not really say anything. Once they started seeing the development of it, particularly the carpet going in and the development of the mural, they was more interest but again it was just left to me as an ‘OT thing’. In retrospect I could have explained a bit more about what I was doing and brainstorm ideas for the comfort room, but after giving an initial in-service on sensory modulation there was little interest and some resistance to the topic so I just went ahead with what I thought was best for our clients and our manager was also supportive of this.

3. What were the challenges of creating the sensory room?

The challenges to creating the sensory room were mostly financial. However due to the drive from the DHB around the use of SM we were lucky as an OT department to be given some funds to purchase resources.The service bought us some modalities such as weighted blankets, mink blankets, cd players, massage pads which took a lot of organising time in terms of ordering and collecting which in turn took more time out of my role working with clients. It was good to get the clients involved with choosing the mural and what they wanted on the wall, but I had to make sure it was appropriate and suitable for what we were trying to do i.e. relaxation, calming room. Another challenge was that the room we were using was previously open to the unit at all times so we could not make it a proper Sensory Modulation Room as the guidelines state that it should be locked and used when required with staff aware of usage and patients state on entry and exit from the room. This was not possible to do as the room had to be open all the time for use and due to its previous use. I suppose the other part to the question of did they know what it was used for, if you mean the patients, I think they understood it was a comfort room to calm and relax but I don’t think they understood the whole concept of sensory modulation de-escalation and to be honest that was not primarily what the room was set up for on the unit. I hoped that with time this would be the case as staff became more familiar and saw it being used. 

4. What were the patients experiences of the sensory room? Did they find it beneficial?

A number of the patients would be observed using the room to relax and sleep. We also had a Tai Chi Group in the room every week. The room was also used for 1:1s with the patients. It’s hard to quantify if they found it useful as we had no measure of usage or rating but from talking to patients there was a lot of people who really liked using the room for time out as they found it relaxing and quiet. We did have one patient in particular who was problematic during the night; he would often wake up and disrupt the others. The night shift started using the room and weighted blanket with the patient after myself and his key worker developed a management plan with good results. I think this was actually a bit of a turning point with the staff as some of them could see it working.

5. Has there been any instances where the sensory room has been used instead of restraint/seclusion? If so has it helped the situation?

No documented instances although if someone is beginning to escalate the room is often used for a discussion. This cannot be said because of the room as there are a limited amount of rooms available that are quiet for de escalation purposes anyway. 

6. Do you think that sensory modulation could be used in a variety of different settings?

Yes definitely, for me I think that it works with every individual. I myself find it useful to be aware that I am becoming anxious or agitated or when I feel de motivated and then implementing a strategy to become more calm or alert. I think that people with anxiety/ depressive/ psychotic disorders or children/ adults with attention or hyperactivity disorders benefit most. If you think about SM from a physiological perspective; that heightened arousal comes from your nervous system being in a constant state of fight/ flight or flux (which is evident in a lot of the above disorders) and that this does not always happen because of thought processes that it can also be a body response to its sensory input or previous trauma, it makes sense that talking therapy will not always be affective and that to get someone to a calm state to be able to hear, process and absorb information will then be able to better facilitate talk therapy and reasoning. With people who do not experience the above disorders there is also benefit as everyone experiences life stressors or feels a bit de motivated at times. Knowing how to make yourself more calm or alert can only enhance your experiences associated with daily life.

Benefits of Sensory Modulation

Below is a list of potential benefits of sensory modulation strategies taken from OT-Innovations.com:

• Increased self-awareness
• Increased ability to self-nurture
• Increased resilience
• Increased ability to engage in therapeutic activities
• Increased ability to engage in meaningful life roles
• Increased ability to engage in social activities
• Increased ability to cope with triggers

Sensory Rooms

Sensory rooms promote self-organisation and positive change and allow the service users to engage in therapeutic and meaningful occupaitons (Champagne, 2010). 

Champagne (2010) states that when sensory rooms are used appropriately they:

• Help to create a safe place
• Facilitate the therapeutic alliance
• Provide opportunities for prevention in engagement in prevention and crisis de-escalation strategies
• Promote self-care

Tips for setting up a sensory room:

• Involve staff and service users: It is really important to involve everyone who will be using the treatment space. Sensory rooms aren't all the same and it needs to be unique and meaninful to the people involved.
• Come up with a name for the sensory room: Come up with a name that describes the purpose of the space within the setting.
• Develop policy and procedure: It is important to set clear policies and procedures outlining the equipment and its purposes. As well as ensuring a safe environment for all.

Check out OT-Innovations.com for more ideas and help when setting up a sensory room. 


References

Champagne, T. (2010). Sensory rooms in mental health. Retrieved from http://www.ot-innovations.com/content/view/49/28/

Seclusion & Restraint Reduction

In New Zealand and around the world there is a growing need to reduce restraint and seclusion in mental health facilities and organisations. A study conducted by Mayers et al. (2010) found that when restraint or seclusion was used service users felt that their "human rights had been infringed during acute episodes of illness" (p. 60). Sensory modulation is a safe, more client-centred and effective way to help regain a sense of calm during high states of arousal and/or distress instead of using restraint and seclusion.

While I was on placement there were service users who were put into seclusion. I didn't see how this was effective nor did it help in their recovery process. I observed that when people where in seclusion, more staff where needed to monitor them which resulted in the rest of the service users not being able to engage in activities that they normally would have done, for example, playing sport, going for walks and art group due to the reduced staff numbers. So it not only affected the individual in seclusion but also the rest of the service users.

It is im my opinion that using sensory modulation as an alternative to restraint and seclusion interventions allows service users to be treated more humanely and helps to stop situations from escalating. I believe that restraint and seclusion should only be used in cases of emergency. Stewart et al. (2010) notes that when service users realise restraint is going to take place they can become more anxious, scared and angry which can sometimes escalate the situation.

References:

Mayers, P., Keet, N., Winkler, G., & Flisher, A. (2010). Mental health service users' perceptions and experiences of sedation, seclusion and restraint. International Journal of Social Psychiatry, 56(1), 60-73. 

Stewart, D., M, Bowers, L., Simpson, A., & Jones, J. (2010). A review of interventions to reduce mechanical restraint and seclusion among adult psychiatric inpatients. Issues in Mental Health Nursing , 31(6), 413-424.

What is Sensory Modulation?

"The experience of being human is embedded in the sensory events of our everyday lives" (Dunn, 2001, p. 608).

Miller, Reisman, McIntosh & Simon (2001) refer to sensory modulation as, "the capacity to regulate and organise the degree, intensity and nature of responses to sensory input in a graded and adaptive manner. This allows the individual to achieve and maintain and optimal range of performance and to adapt to challenges in daily life" (p. 57).

Sensory modulation is an intervention tool used to support distressed or agitated service users in mental health settings. It can involve therapeutic brushing, weighted blankets, massage, exercise, or a hot shower to name a few.

In everyday life an individual self-organises and regulates responses to sensory stimuli (whether they are aware of it or not) to adapt to the environmental demand which helps to produce optimal performance. However people with "trauma histories, mental illnesses, or addictions, or who have developed behaviour patters, are sometimes unaware of their particular sensory needs or stress responses" (Champagne & Stromberg, 2004, p. 38). This may decrease a person's ability to regulate the sensory input and result in becoming over reactive or under reactive to stimuli. Sensory modulation can help people to make appropriate adaptive responses.

While on placement I saw first-hand the effect of sensory modulation. For the service users who were over-aroused, anxious and agitated, it helped to calm them down and relax. And for the service users who were under-aroused it helped them to become more engaged in activities.

References:

Champagne, T., Stromberg, N. (2004). Sensory approaches in inpatient psychiatric settings: innovative alternatives. Journal of Psychosocial Nursing & Mental Health Services, 42(9), 34-44.

Dunn, W. (2001). The 2001 Eleanor Clarke Slagle Lecture. The sensations of everyday life: empirical, theoretical, and pragmatic considerations. American Journal of Occupational Therapy, 55(6), 608-620. Retrieved from EBSCOhost.

Miller, L., Reisman, J., McIntosh, D., & Simon, J. (2001). An ecological model of sensory
modulation. In S. Smith Roley, E. Blanche, & R. Schaaf (Eds.), Understanding
the nature of sensory integration with diverse populations (pp. 57–82).
San Antonio, TX: Therapy Skill Builders. 

Welcome

Hi everyone and welcome to my blog. My name is Jenna McMurray-Cole and I am in my final year of studying Bachelor of Occupational Therapy. Throughout my three years of study I have had the opportunity to have fieldwork placements in many different areas, one of which was a forensic mental health unit. On this placement I was introduced to sensory modulation and became very interested in this concept. This blog will explore the use of  sensory modulation in mental health settings and the benefits to the client.