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
‡ Create partnerships with caretakers and providers ‡ Provide person-centered care

Here s Why
‡ Increase implementation frequency ‡ Increase knowledge of caregiver for developmental outcomes ‡ Provide more practice and encourage generalization ‡ Provide structure for decision making

‡ Embed your expertise within children s daily routines and natural contexts ‡ Provide theoretically sound interventions

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
± ± ± ± ± ± ± ± ± Seek Avoid Sensitivity Registration Auditory Visual Touch Movement Behavior

‡ School Factors Scores
± ± ± ± School Factor #1 School Factor #2 School Factor #3 School Factor #4

‡ System Scores

School Practice Factor #1 Assistance Child Requires
Registration ‡ Misses oral directions in class more than other students ‡ Has trouble keeping material and supplies organized for use during the day Seeking ‡ Hums, whistles, sings, or makes other noises throughout the day ‡ Gets up and moves around more that other students

School Practice Observation #2 Level of Attention & Awareness of Self Environment
Seeking ‡ Adds more details to drawing and coloring than other students ‡ Seems more curious than other students Sensitivity ‡ Comments on small details in objects or pictures that others haven t noticed ‡ Is bossy with classmates and peers

School Practice Observation #3 Present with Defiant Behavior
Sensitivity ‡ Is easily upset by minor injuries such as bumps, scraps, and cuts ‡ Becomes distressed during assemblies, lunch, or other gatherings Avoiding ‡ Withdraws when changes in the environment or routine occur ‡ Flinches when people get in close proximity to or touch 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

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