Evidence Based Intervention

Sensory Integration
Planning
 Intervention Planning
• Reviewing evidence on traditional
interventions
• Decision making with interdisciplinary
evidence
• Using evidence to create a focus
• Implementing an evidence-based sensory
processing approach
 Process of Planning
&
Implementing Intervention
• Setting goals and objectives
– Collaboration with client
– Mutually agreeable to client, caregivers, and therapist
– What would they like to do after intervention
• Determining the type (or types) of service delivery
– Direct service vs. consultation
• Developing preliminary ideas about intervention
– Types of activities that would best address the clients needs
– Physical layout of environment where services will be provided
(home, daycare, school, community, or clinic)
– Type of interactions and outcomes anticipated
 Play Theory and Sensory Integration

• Play is a transaction between the individual

and the environment that is:
– Relatively intrinsically motivated
– Relatively internally controlled
– Free of some of the constraints of objective reality
 Intrinsically Motivated
– Relatively intrinsically motivated
• Engagement in an activity because the activity itself is
appealing rather then someone told you to do it
• Just right challenge
• Provides clear feedback
• No rules about how many activates should be done
 Internal Control
• Relative Internal Control
– Feeling physically and emotionally safe is the most
basic aspect of internal control
– Safety is matched with the challenge of the client’s
skills
– Unless clients are actively involved, an activity is
neither therapeutic nor play
Freedom from Some Constraints of Reality

• There are two important aspects of relative

freedom from some constraints of reality:
1. The ability to pretend or to engage in fantasy
play
2. The reduction of consequences that might
normally be associated with performing the
same activity in “real life”
 Environment to Support Play
• Familiar peers, toys or other materials likely to engage
children’s interest
• Agreement between adults and children, expressed in
words or gestures
• Adult behavior minimally intrusive or directive
• Friendly atmosphere designed to make children feel
comfortable and safe
• Scheduling that reduces the likelihood of the children’s
being tired, hungry, ill or experiencing other type of
bodily stress
 Intervention
• What to target first
– If change is not observed re-evaluate
• Therapist-client relationships
– Therapeutic alliance with shared goals with precaution to becoming
“friendly playmates”
– Personal-social happy cheerful, honest, sense of humor, sincere,
confident
• Establishment of a safe environment
– Physically and emotionally
• Incorporating competition
– Minimize deliberate failures
• Assuming pretend roles
– Caution of playing roles without an invitation of a child
 Intervention Con’t
• Voicing praise, feedback, and instructions
– Verbal and non verbal feedback
• Creating the “just right” challenge
– Create a flow where the client is involved in what they are doing and scaffold,
adjust the task just beyond the current skill and still allow for success in completing
the task
• Balancing freedom with structure
– Freedom to explore, initiate and choose activities
• Striving to find the inner drive and look at a child’s “lack of motivation”
– To difficult, believes the activity is too difficult, level of arousal not optimal, theme
is too juvenile, lacks meaning for the client
• Modifying or discontinuing activities
– Remain with a given activity as long as clients demonstrate active involvement and
increasingly adaptive interactions
 Discontinuing Intervention
• When clients have reached their objectives and many
of the day to day interferences of sensory dysfunction
• Short term intensive intervention may be useful for
meeting specific goals
• Clients and caretakers are involved with making
decisions about duration and intervention
• Therapist maintains distant contact for consultation
• Assist the adults with the transition to
psychotherapist, support groups or other activities
Using Children’s Routines for Intervention

• Routines provides more varied opportunities for

practice
• Using everyday activities has a positive impact on
children’s development
• Parent-facilitated child learning is equally or more
effective that therapist implemented interventions
– Active, intentional, purposeful, and contextual
– Interest-based, responsive to children as they
interactive
 Capacity Building
• Family, person-, and home/school centered has >
capacity-building effect
• Build capacity by teaching care providers how to
interact with the child within the natural
environment (activity analysis)
• Capacity building
– Therapist support strengths and abilities
– Care providers recognize, learn and use their abilities
– Therapist and care providers assume responsibility for
working toward desired goals and or outcomes
 Natural Environment Intervention
• Interventions during daily life routines
improves participation
• Skill development develops isolated skills
• Sensory processing interventions need to be
part of the natural context to support
generalization
 Tips for Practice
Here’s What to Do Here’s Why
• Create partnerships with caretakers • Increase implementation
and providers frequency

• Provide person-centered care • Increase knowledge of caregiver

for developmental outcomes

• Embed your expertise within • Provide more practice and

children’s daily routines and natural
encourage generalization
contexts

• Provide theoretically sound • Provide structure for decision

interventions making
Understanding The Special Context of School

• Gaining insights about the teacher’s point of

view
• Understanding the special context of school
and learning environment
• Learning about the data available from the
school context
• Practicing how to meet the demands of
learning and interacting at school
Sensory Profile School Companion
• Quadrant Scores • School Factors Scores
– Seek – School Factor #1
– Avoid – School Factor #2
– Sensitivity – School Factor #3
– Registration – School Factor #4
• System Scores
– Auditory
– Visual
– Touch
– Movement
– Behavior
 School Practice Factor #1
Assistance Child Requires
Registration Seeking
• Misses oral directions in • Hums, whistles, sings, or
class more than other makes other noises
students throughout the day
• Has trouble keeping • Gets up and moves around
material and supplies more that other students
organized for use during the
day
 School Practice Observation #2
Level of Attention & Awareness of Self
Environment
Seeking Sensitivity
• Adds more details to • Comments on small details
drawing and coloring than in objects or pictures that
other students others haven’t noticed
• Seems more curious than • Is bossy with classmates
other students and peers
 School Practice
Observation #3
Present with Defiant Behavior
Sensitivity Avoiding
• Is easily upset by minor • Withdraws when changes in
injuries such as bumps, the environment or routine
scraps, and cuts occur
• Becomes distressed during • Flinches when people get in
assemblies, lunch, or other close proximity to or touch
gatherings body
 School Practice
Observation #4
Ability to Learn

Registration
• Shows little emotion
regardless of the situation
• Seems oblivious within an
active environment to other
activities
Avoiding
• Stands or sits at the side of
the playground during
recess
• Withdraws from active
environment or situations
 Summary Review
• Design programs that accommodate unique
sensory processing patterns
• Task and environmental modifications
• Systematic data collection to chart progress
• Traditional sensory integrative (SI) therapy is
beneficial however anecdotally, evidence does
not substantiate effects
• Functional activities in daily routines in natural
contexts
 Resources
• Sensory Processing in Everyday Life (
http://classes.kumc.edu/sah/resources/sensoryprocessing/ )
A learning Web site that explains concepts, summarizes research, and presents
case studies
• Living Sensationally (http://livingsensationally.blogspot.com/ )
The Web site for Living Sensationally: Understanding Your Senses; discusses
sensory concepts as applied to the public and summarizes media events
• Puckett Institute Research and Training Center on Early Childhood Development
(www.researchtopractice.info/productBridges.php )
Web site with summary reviews of literature for people serving children and
families
• CanChild Centre for Disability Research (
http://www.canchild.ca/Default.aspx?tabid=109 )
Web site with summary reviews of literature for people serving children and
families