the “sensory-friendly” classroom: facilitating children’s

May 2-3, 2019

1

SAFE PLACE:

A Collaborative Sensory Integration-

Based Trauma Program

Teresa A. May-Benson, ScD, OTR/L, FAOTAExecutive Director, Spiral Foundation

[email protected]

Sarah Sawyer, MA, OTR/LPresident/Clinical Director, OTA The Koomar Center

[email protected]

May 2, 2019

Acknowledgements

◼ Jane Koomar, PhD, OTR/L, FAOTA,

❑ Co-founder of SAFE PLACE

❑ She was a visionary in the world of SI-OT

❑ In her honor, we carry SAFE PLACE forward, dedicated to continuing to

serve traumatized children and their families by supporting their

experience of true joy and hope.

◼ Daniel Hughes, PhD

❑ Co-founder of SAFE PLACE

❑ His pioneering work in attachment theory and clinical practice serves as

the enduring inspiration for and heart of SAFE PLACE.

◼ Contributors to the SAFE PLACE Model

❑ Margaret (Peg) Ingolia, OTD, OTR/L

❑ Marsha Raredon, MS, OTR/L

❑ Deborah Rozelle, PsyD.

©2019 OTA The Koomar Center 2

Copyright

◼ This material is the copyrighted property of

OTA the Koomar Center and may not be

reproduced, except for personal use, without

permission.

◼ All rights are reserved.


May 2-3, 2019

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Introduction to

SAFE PLACE


SAFE PLACE IS:

◼ A theoretical model explicating the relationship

between sensory processing, disrupted attachment and

complex developmental trauma concerns in children.

◼ A specific 12-week collaborative, interdisciplinary,

sensory integration-based trauma-informed

intervention program among occupational therapists,

mental health clinicians and parents for children with

sensory processing disorder (SPD) and complex trauma

and attachment concerns.


SAFE PLACE Model

◼ Provides a therapeutic framework for service providers and

parents

◼ Emphasizes development of body-based regulatory and

adaptive functions with co-regulation and intersubjective

experiences

◼ Supports a deepening of attachment bonds and security

◼ Facilitates the processing and healing of traumatic

experiences

◼ Occurs within the context of a sensory integration

intervention process


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SAFE PLACE Model

◼ Encompasses the concepts and philosophies

of three core knowledge areas

❑ sensory integration theory

❑ attachment theory

❑ complex developmental trauma models


Foundational Characteristics of the

SAFE PLACE Model


“SAFE”

◼ Reflects the sensory component

of the theory

◼ Means Sensory Attunement-

Focused Environment

◼ Represents use of safe,

supportive, developmentally

appropriate, sensorimotor

activities and environments

◼ Promote engagement through

play and fun in children’s physical

and emotional development


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“PLACE”

◼ Reflects the attachment

component of the theory

◼ Means Playfulness, Love,

Acceptance, Curiosity and

Empathy,

◼ Qualities of mindful

engagement utilized by

collaborating therapists to

facilitate secure attachment

and healing in the child and

family.


“SAFE” and

“PLACE” as

“safe place”

◼ Represents the trauma

component of the theory

◼ Highlights the process of

establishing and maintaining

an environment and

experience of safety and

stability for the child

◼ Allows processing of

traumatic experiences


SAFE PLACE Program: Criteria for

Participation

◼ Children 4 – 15 years of age

◼ Sensory integration problems

◼ Trauma background resulting in current attachment concerns

◼ Child is unable to make adequate progress in sensory

integration intervention because of trauma/attachment-

related problems

or

◼ Child is unable to make adequate progress with trauma

processing, etc. because of sensory integration and/or praxis

problems


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SAFE PLACE Program

◼ Program consists of 3 processes

❑ Pre-SAFE PLACE Screening – Identifies initial

potential need for the program

❑ Assessment - Multi-disciplinary comprehensive

assessment to fully identify SI & MH needs and

determine eligibility for intervention

❑ Intervention – Multi-faceted and multi-stage

progression to addressing client and family needs


SAFE PLACE Program: Participants

◼ Child

◼ Parents/Caregivers

◼ Mental Health Professional

◼ Occupational Therapists


SAFE PLACE Program: Intervention

Structure

◼ 12-week program consisting of:

❑ Twice weekly child therapy with parent, occupational

therapist, and mental health professional for 1-hour

each session, conducted in a sensory integration clinic

environment.

❑ Once weekly parent education/consultation session for

1 hour each week with the occupational therapist and

mental health professional.

❑ Once weekly professional collaboration for 1 hour

each week between the occupational therapist and

mental health professional.


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SAFE PLACE Program: Guiding

Tenets


Building Safety and

Co-Regulation of Arousal

Building Attachment

Bonds

Facilitating Engagement and Mastery

Providing Opportunities for Trauma Processing

Theoretical Foundations

of SAFE PLACE Model


Core Concepts and Practices.- originated from disciplines of OT &

Psychotherapy

• Ayres (1972, 1979)

• Koomar (2002, 2009) Sensory Integration

• Bolby (1958), Ainsworth (1969, 1991)

• Hughes (2007)Attachment Theory

• Van der Kolk (2003)

• Rozelle (2009)Trauma Theory

• Briere (2012, 2013)Mindfulness Orientated Practices


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Sensory Integration and Attachment

◼ Attunement

◼ Intersubjective experience

◼ Relational Treatment

Models

◼ Safety

◼ Co-regulation


Sensory Integration and Attachment

Continued

◼ Attachment bond helps the typically

developing child

❑ Cope with distress;

❑ Protects and mitigates ill effects of

stressful or traumatic experiences

◼ Physiologically sensitive children

with SPD are often more vulnerable

to adverse affects from traumatic

experiences that impact attachment.


https://blogs.extension.org/militaryfamilies/files/2

013/10/woman-comforting-upset-boy.jpg

Sensory Integration and Trauma

◼ Safety – physical and emotional

◼ Regulation

◼ Processing and integrating (Trauma & SI)

◼ Competency

“Children who have experienced trauma must build a sense of

competency and mastery in order to gain physiological control over

their arousal state” Van der Kolk (2003)


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Trauma and Attachment

◼ Research indicates up to

80% of children who have

experienced complex trauma

experience attachment

challenges (Ogle 2015)

◼ Early caregiving attachment

relationships, especially

those of mother and infant

are often compromised in

complex trauma


This Photo by Unknown Author is

licensed under CC BY-ND

SAFE PLACE

Program:

Assessment

&

Intervention

Components


Pre-SAFE PLACE Screening

◼ Purpose: to identify initial potential need

for the SAFE PLACE Program

◼ May be completed by OTs, mental health

professionals

◼ Initially screens for SI and trauma/attachment

challenges

◼ Outcome: referral for a comprehensive multi-

disciplinary SAFE PLACE evaluation


http://theconversation.com/psychiatric-labels-and-kids-benefits-side-effects-and-confusion-9702

https://creativecommons.org/licenses/by-nd/3.0/

May 2-3, 2019

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SAFE PLACE Assessment

◼ 3 phase

◼ Phase 1: Referral for SAFE PLACE Program and Initial

Program Screening

❑ Determines initial eligibility for program and initial assessment needs

◼ Phase 2: Multi-Disciplinary SAFE PLACE Assessment

❑ Comprehensive assessment of sensory integration and mental health

concerns identifies need areas and final eligibility for intervention

◼ Phase 3: Evaluator Meeting, Goal Setting and Identifying

Outcomes

❑ Evaluator meeting with parents to convey assessment results and

recommendations, set goals if intervention is recommended and

identify anticipated treatment outcomes


SAFE PLACE Intervention

Components

◼ Structural Components

❑ Sensory-Rich

Treatment Space

❑ Collaborative Team

❑ Parent Involvement

◼ Process Components

❑ Contextual Factors

❑ Interpersonal Factors

◼ Expected Outcomes

❑ Establishment of

Safety and Regulation

❑ Building Attachment

❑ Engagement and

Mastery

❑ Trauma Processing


Intervention: Structural Components

Sensory-Rich Treatment Space

◼ Intervention happens within a sensory-rich treatment space

designed and set-up for comfort, safety, and to facilitate

participation of all

◼ The SAFE PLACE environment should be at a minimum a

room 12’ X 12’in size which is equipped with a variety of

suspended and non-suspended equipment that can provide

tactile, proprioceptive and vestibular sensory inputs;

postural challenges; and praxis activities.


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Space and Environment and

Equipment



Equipment



Equipment


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Equipment



Equipment



Equipment


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Collaborative Team

◼ Members

❑ Occupational Therapist

❑ Mental Health Professional

❑ Child

❑ Parent/caregiver

◼ Occupational Therapist - sensory environment that is: Safe

and supportive & facilitates regulation and skill, promotes

interaction with caregiver and child to support trauma

processing

◼ Mental Health Practitioner - Guides and facilitates trauma

processing within sensory environment and promotes

attachment healing with child and parent/caregiver



Collaborative Team

◼ Child – Supported to develop competency in:

❑ Sensory processing

❑ Co-regulation leading to Self-regulation

❑ Skill development and mastery

❑ Reclaim the innate capacity for fun and play

❑ Engage in trauma healing

◼ Parent - Supported to co-regulate with their child

❑ Engage in attachment healing with the child through play

❑ Supports child in progression of mastery and competency

❑ Collaborates with therapists during sessions and meetings

❑ Recognizes and addresses their own sensory and trauma

patterns



Parent Involvement

❑ provide emotionally and physically

safe spaces for interactions with

their child

❑ Understanding their own sensory

profiles

❑ Understanding any trauma and

attachment history and associated

response patterns of their own

❑ Understanding how their own

background impacts how they deal

with relational and behavioral

challenges when working with their

child

Parents are integrated

part of therapy sessions

in sensory space and

collaborative meetings.


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Intervention: Process Factors


Intervention: Contextual Factors

◼ Include implementation of key principles of

Ayres Sensory Integration based on ASIFM

❑ Insures physical and emotional safety,

❑ Presents rich sensory opportunities for the body

senses

❑ Available activities allow child to calm as well as

move into a joyous state, provision of activities

that allow the child to use postural muscles and

balance over time


Intervention: Contextual Factors

Continued

❑ Provision of materials child can create with,

creation and tailoring of play activities to just the

right challenge

❑ Insures that play activities are successful

❑ Monitors the child’s arousal level and adjusts

accordingly


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Intervention: Interpersonal Factors

◼ Intersects with contextual factors in provision of

physical and emotional safety of the child.

◼ Includes establishment of a partnership with the

child through therapist-parent-child

collaboration on activity choice and

development of a therapeutic alliance

◼ Key are PLACE concepts of playfulness, love,

acceptance, curiosity, and empathy.


Intervention Process: Phases

◼ Intervention sessions promote a phase-oriented

process which emphasizes aspects of sensory

processing, attachment and trauma processing

at varying times.

◼ Phases are flexible and child may move among

phases within a session and over time.

◼ Specific steps and goals occur during each

phase as well as varying roles of individuals

involved, intervention activities and support

activities.


Intervention: Expected Outcomes

◼ Traditional outcomes of OT-SI such as

integration of sensory information to

build body scheme, praxis and self-

regulation

◼ Facilitation of co-regulation between

child and caregiver

◼ Security of attachments between child

and caregiver

◼ Healthy adaptive child development

across all domains

◼ Healing of child’s reactions to traumatic

experiences


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SAFE PLACE

Intervention


SAFE PLACE Intervention

◼ What is needed to implement the program

❑ Manualization of the program

❑ Staff considerations

❑ Stages of Intervention


SAFE PLACE Intervention Manual

◼ SAFE PLACE Program

has been manualized.

.


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SAFE PLACE Intervention Manual

◼ Describes core components of the theory and

model;

◼ Describes assessment process in detail

◼ Description of the program structure

◼ Describes staffing requirements and space

◼ Core components of the intervention along with

descriptions of the clinical reasoning process

and activities needed to implement the

intervention

◼ Allows for replicable implementation


Staff Considerations

◼ Required staff characteristics for those who

implement SAFE PLACE

❑ Qualifications

❑ Self Awareness


Qualifications of Staff: OT

Sensory

Integration

• Must have expertise in SI theory and intervention

• Be SIPT certified

• Have 5 years experience in sensory integration

• 50 hours of mentoring in sensory integration

Attachment • Understanding of and ability to use PACE

• Good understanding of attachment theory

• Have taken Dan Hughes’ one day course on attachment

and trauma

Trauma • Good understanding of trauma theory

• Ability to recognize signs and symptoms of trauma

reactions

• Have available ongoing consultation/mentoring from a

mental health professional

• Have taken at least one course (6 hours) on trauma

informed care©2019 OTA The Koomar Center 48

May 2-3, 2019

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Qualifications of Staff: Mental

Health Professional


Sensory

Integration

• Must have good understanding of SI theory and

intervention

• Recognize impact of sensory inputs on arousal

• Understand what inputs are provided by specific pieces

of equipment

Attachment • Expertise in area of attachment theory and intervention

• Have taken Dan Hughes’ Level 1 course on attachment

and trauma

Trauma • Expertise in trauma theory and intervention

• Have 5 years experience in counseling/psychotherapy in

the area of trauma and attachment

• Have at least 12 hours coursework or continuing

education in trauma and 12 hours in attachment

• Have 50 hours of mentoring in trauma and attachment

counseling/psychotherapy

Intervention: Considerations for

Service Providers

◼ SAFE PLACE assumes providers understand

their own sensory preferences and profiles

and are sufficiently adaptive in their overall

social, emotional, and behavioral functioning

to assist the child as co-regulators in the

SAFE PLACE treatment process.


Activity: Sensory Preferences

Questionnaire

◼ Complete questionnaire on

yourself

◼ Complete questionnaire on

your child or partner

◼ How are your sensory

preferences similar or different

than your child or partner?

◼ What kind of mismatches might

occur when there are

differences?


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Intervention: Implementation

◼ The SAFE PLACE intervention process is

based on the13 core contextual and

interpersonal intervention principles

presented earlier.

◼ Implemented over four phases of intervention

that reflect the desired outcomes of SAFE

PLACE.

◼ Each phase consists of multiple steps.


Intervention: Phases


•Integration

•Child directed play

•Resiliency and engagement with others

•Stabilization, grounding, centering

•Processing emotions

•Reconnection

•Orientation to the present

•Attunement

•Intersubjectivity in here and now

•Co-regulation & co-creation of meaning

•Intersubjectivity in sharing past experiences

•Development in sense of self

•Establish safe physical environment

•Establish safe emotional environment

•Provide sensory activities for regulation of arousal

•Develop competency in motor skills

Establishing Safety and

Regulation of Arousal

Promoting Opportunity for Building Attachment

Facilitating Engagement and Mastery

Providing Opportunities for Trauma Processing

Intervention Phase One: Establish

Safety and Regulation of Arousal


◼ Step 1: Establish Safe Physical Environment

❑ Child can freely engage in child-directed activities

◼ Step 2: Establish Safe Emotional Environment

❑ Child can trust others and take risks

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Intervention Phase One: Establishing

Safety and Regulation of Arousal

◼ Step 3: Provide Sensory Activities for

Regulation of Arousal

❑ Child can self-regulate to maintain functional arousal

❑ Child can stay with an activity to completion

◼ Step 4: Develop Competency In Motor Skills

❑ Child can initiate and complete motor skills


Intervention Phase Two: Promote

Opportunities for Building Attachment


◼ Step 1: Attunement

❑ Child and Parent are able to engage together in

parallel activity

◼ Step 2: Inter-Subjectivity in Here and Now

❑ Child and Parent are able to engage in positive

reciprocal interactions in the here and now



◼ Step 3: Co-Regulation & Co-Creation of

Meaning

❑ Child and parent are able to engage in clinician-

initiated positive interactions

◼ Step 4: Inter-Subjectivity in Processing

Past Experiences

❑ Child and parent are able to engage in child

initiated positive interactions around past

experiences that build trust and predictability


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◼ Step 5: Development of Sense of Self

❑ Child will develop trust and a working alliance with

parent

❑ Child and parent are able to engage in parent-

initiated positive interactions which allow the child

to take direction


Intervention Phase Three: Provide

Opportunities for Trauma Processing

◼ Step 1: Stabilization/ Grounding/ Centering

❑ Child will develop an awareness of his/her

body and internal sensations in response to

emotional events

◼ Step 2: Processing Emotions

❑ Child will develop ability to recognize and

modulate emotions and memories

❑ Child will develop a coherent, mindful

orientation to living


Intervention Phase Three: Provide

Opportunities for Trauma Processing

◼ Step 3: Reconnection

❑ Child will create and enhance meaningful

involvement in interpersonal pursuits

❑ Child will be able to handle healthy aggression

and return to equilibrium

◼ Step 4: Orientation to Present

❑ Child will attend to their current state and

demonstrate agency and empowerment in

managing emotional situations


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Intervention Phase Four: Facilitate

Engagement and Mastery

◼ Step 1: Integration

❑ Child will be able to engage in and assist in planning

of activities

❑ Child will be able to self-regulate during and following

disrupting events with support of parent or therapists

◼ Step 2: Child-Directed Play

❑ Child will be able to plan and engage in child-directed

activities with parent and therapists

❑ Child will be able to process disrupting events and

continue or return to the original activity


Intervention Phase Four: Facilitate

Engagement and Mastery

◼ Step 3: Resiliency and Engagement with

Others

❑ Child will be able to plan and engage in child-directed

activities with peers

❑ Child will be able to recover from disrupting events

and continue activity with minimal support from parent

or therapists


Parent Education and Support

◼ Step 1: Identification of Future Interventions

❑ Identify need for continued individual SI-OT and/or

mental health services

❑ Parent support services

◼ Step 2: Identification and Provision of On-

going Family Supports

❑ Sensory diet programs

❑ Consultation to family or school


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Resources

◼ Family Sensory Preferences Profile

❑ (Koomar & Hughes, 2007)

◼ Tool is designed to increase understanding and

respect for individual differences. Also used to

help identify activities that are mutually

enjoyable and where participation between

parent and child can help to lay a foundation for

establishing or enhancing attachment.



Resources

◼ Parenting Profile for Developing Attachment

❑ (Hughes, 2012)

◼ Examines the parenting style of the caregiver

to identify areas of personal growth that may

need to be addressed to allow the caregiver

to most effectively promote attachment

bonding in their child.



Resources

◼ Questions for Parental Self-Reflection

❑ (Hughes, 2012)

◼ A series of 10 question for parents and

caregivers to assist them in relating their

personal attachment histories to their child’s

experiences.


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Resources

◼ Sensory Regulation Activities for Parents and

Therapists (Video)

❑ Available through the Spiral Foundation at

www.thespiralfoundation.org.

❑ This video demonstrates a variety of treatment

activities for parents and therapists for over ten pieces

of primarily non-suspended and easy to use or make

equipment. It provides ideas for promoting self-

regulation and praxis in children, adolescents, and

adults with sensory processing disorders.


Research Supporting

SAFE PLACE


SAFE PLACE Research To Date

◼ Studies have been completed which

examine:

❑ Validation of the theoretical construct

◼ Qualitative video review

◼ Examination of intervention fidelity

❑ Feasibility of implementation and preliminary

outcomes of clinical implementation

◼ Case study of clinical outcomes

◼ Feasibility program review with one child


http://www.thespiralfoundation.org/

May 2-3, 2019

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Construct Validity Through Video

Review

◼ Mixed methods study

◼ Used a grounded theory model

◼ Examined qualitative themes in transcriptions of video segments of sessions purporting to use SAFE PLACE tenets.

◼ 6 videos of sessions

◼ Included an occupational therapist, a mental health practitioner (usually a psychotherapist or psychologist) with knowledge of SAFE PLACE principles, a parent, and the child

◼ Coded by 4 OTs.

70©2019 OTA The Koomar Center


Review: Results of Themes

◼ Four themes supported

SAFE PLACE theoretical

model

◼ Communication

❑ Across persons communications

involved verbal and non-verbal

communications that were

directed at each other and in

general.

❑ All persons communicated with

each other and the child.


https://wearyourvoicemag.com/wp-

content/uploads/2016/02/3895377417_cbe655ddbb_z.jpg



◼ Management and

Engagement of

Activities❑ All individuals participated in

activities in some way.

❑ OT and mental health

professional tended to manage

aspects of the activity such as

presenting activities, assisting

the child, changing activities,

and hanging up equipment.

❑ Child engaged in activities

and invited other to

participate.

❑ Adults participated in child

activities primarily at the

child’s invitation.


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◼ Expression of Emotion

and Affect

❑ All individuals expressed

emotions and varied affect during

the sessions.

❑ OT and mental health

professional

◼ Encouraged and praised the child

◼ Celebrated the child’s achievements

◼ Generally expressed positive

emotions through words and affect

such as smiles and laughter.


http://www.parcofontario.com/



❑ Parents

◼ Expressed emotions and affect, generally positive

◼ At times expressed refusals, upset, and distress.

❑ Child

◼ Expressed a wide range of emotions and affect

❑ From increased or avoidant eye contact

❑ To screams

❑ To smiles and laughter.




◼ Interpersonal

Interactions

❑ Individuals moved their

physical placement in

relation to others

❑ Reasons included:

◼ To allow one person to

have increased proximity

to the child or equipment

◼ To distance proximity

◼ Included interactions in

close proximity such as

touching the child.


http://www.catalysttherapy.com/

May 2-3, 2019

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❑ For child and parent additional interactions

involved:

◼ Non-engagement

◼ Rejection

◼ Ignoring

◼ Approaching

◼ Accepting suggestions

◼ Following


http://www.specialneeds.com/


Review: Role Differences

◼ Observations within each theme were examined

by participant roles.

◼ Differences among participants roles emerged

by themes.

◼ There was a distinct difference in adult roles and

the child roles as well as differences among

each adult role which varied by individual

themes as well as overall.

◼ Supported need for all participants in

intervention


Fidelity to Intervention

◼ A SAFE PLACE Fidelity Measure reflecting

structural and process elements was

developed as part of manualization of

intervention process

◼ Two studies were completed

❑ Fidelity during qualitative video review

❑ Fidelity during program review


May 2-3, 2019

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◼ Fidelity during Qualitative Video Review

Study

❑ 6 videos (4 treatments, 1 consult, 1 assessment)

were rated by 4 therapists

❑ ICC for inter-rater reliability of ratings was .989 for

total score, .985 and .972 for Contextual and

Interpersonal factors

❑ Assessment case did not meet fidelity criteria of

85%



◼ Fidelity during Program Review

❑ Six fidelity checks were completed approximately

equally spaced across the study

❑ All sessions met fidelity to the intervention with

responses of 85% or greater on the fidelity

measure.

❑ Thus adherence to the intervention was

supported.


Research on Implementation

of

SAFE PLACE in Practice


May 2-3, 2019

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Case Study: Preliminary Outcomes

◼ M, 4.10 year old male, adopted from Russia,

◼ Received no previous occupational therapy

services

◼ Attended a preschool setting

◼ Both parents were professionals

◼ M was often watched by a nanny, who was a

family relation

◼ Mother primarily participated in the intervention


Case Study: Outcome Measures

◼ Sensory & Motor

❑ Movement Assessment Battery

for Children – 2 (MABC): Motor

development.

❑ Sensory Integration Clinical

Observations (COs): Sensory

integration and sensory

processing difficulties.

❑ The Beery-Buktenica

Developmental Test of Visual

Motor Integration – 6th Ed.:

Visual motor problems.

❑ Sensory Processing Measure

Home Form (SPM): Sensory

processing.

◼ Behavior/Executive

Function/Social

❑ The Behavior Rating Inventory

of Executive Functioning

(BRIEF): Executive functioning

skills.

❑ Behavior Assessment System

for Children – Third Edition

(BASC-3): Adaptive behaviors

and emotions.

❑ The Social Skills Improvement

System Rating Scales (SSIS):

Social skills.


Case Study: Outcome Measures

◼ Functional Performance

❑ Pediatric Evaluation of

Disability Inventory – Computer

Adaptive Test (PEDI-CAT):

Functional performance.

❑ The Roll Evaluation of

Activities of Life (REAL):

Activities of daily living.

❑ Goal Attainment Scaling (GAS)

Goals: Functional Performance

Measure.

◼ Parent Measure

❑ Parenting Profile for

Developing Attachment

(PPDA): Parent preferences for

sensory experiences.


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Preliminary Intervention Outcomes:

Sensory & Motor

Assessment Pre-Post Changes

Movement ABC Total Score Improved 4 Points

Beery VMI Total Score Improved10 Points

Clinical Observations Total Score Improved 50 Points

SPM 5/7 Sub scores Improved 4 – 10

Points

2/7 Sub scores Got Worse 3 – 7

Points

Total Score Improved 6 Points



Behavior/Executive Function/Social

Assessment Pre-Post Change

BRIEF 9 Sub scores Improved

2 Sub scores Decreased 2 Points

BASC 11/18 Sub scores Improved

3/18 Sub scores Got Worse

4/18 Sub scores No Change

SSIS* *All scores in Average or Above Average

range



Functional Outcomes & Parenting

Assessment Pre-Post Change

REAL Total Score Got Worse 2.6 Points

PEDI-CAT 1/4 Sub scores Improved

1/4 Sub scores Got Worse

2/4 Sub scores No Change

GAS t-score = 53

Parenting Profile for

Developing

Attachment:

Perception of Self

5 Point Improvement


May 2-3, 2019

30


Qualitative Feedback from Parent

◼ “This has been a fantastic experience and had

a significant impact on my son and our

relationship.”

◼ “The program not only helped my son, but

helped me to be more aware of my reactions

and learning new methods and techniques for

dealing with his behaviors in a positive, loving

and effective manner.”

◼ “The ability to participate in this intervention

program was a blessing!”



Conclusions

◼ Objective sensory and motor outcomes

demonstrated the most positive change

◼ Parent report outcomes of behavioral, social

and functional skills were variable

◼ Functional goals (GAS) demonstrated above

average change

◼ Qualitative changes experienced by family

were valued and identified as extremely

positive to changing parent-child relationship


Program Review Feasibility Study

◼ Recruitment Capability

◼ Safety and Acceptability

◼ Resources and Management of Study

Implementation

❑ Staffing

❑ Space

❑ Scheduling

❑ Finances


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Recruitment Capability

Safety and Acceptability

◼ Recruitment of clients for participation in the

project was no problem.

◼ There were no adverse events or safety

concerns during the program.

◼ The program was acceptable to family with

an average rating of 4.3 on a five-point scale.

◼ The family was very satisfied with the

intervention and its outcomes with a rating of

4.75


Resources and Management of

Study Implementation

◼ Staffing

❑ Qualified OT were easy

❑ Challenge to recruit a MHP

❑ Need a regularly scheduled MHP on staff

◼ Space

❑ Coordinating space around regular clinic use was

a challenge to scheduling

❑ SI clinic space was vital for program


Resources and Management of

Study Implementation

◼ Scheduling

❑ Scheduling for family a challenge

❑ Afterschool and weekend hours would be helpful

❑ Coordinating multiple schedules for makeups,

vacations, holidays, etc. extended program

duration

◼ Finances

❑ Only able to do partial insurance coverage

❑ Out of pocket costs may be prohibitive


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Important Take Home Points -

Clinicians

◼ Assess how you are collaborating with child,

parent and other professionals

◼ Bring parents into sessions as participants

not observers and facilitate their interaction

with the child during in the moment activity

◼ Model how to have fun WITH the child

◼ Model for parents how to process and

facilitate child in times of frustration



Clinicians

◼ Develop relationships with local mental health

professionals/ or and OT

◼ Create opportunities for regular case

consultation with other professionals

◼ Explore ways to implement sensory activities

in other settings and facilities across

professions



Parents

◼ Respect child’s desires for activities and

conversational topics

◼ Be aware of impact of sensory differences

among parent/child/family members

◼ Be aware of your own needs, history and

support systems

◼ Support collaboration among OT and mental

health professionals involved with your child


May 2-3, 2019

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Resources

◼ OTA The Koomar Center:

❑ Distance Mentorship Program

❑ Therapeutic Consultations

❑ Sensory Integration Facility Design Consults

◼ Spiral Foundation

❑ Educational Webinars, podcasts and courses

www.otathekoomarcenter.com

www.thespiralfoundation.org


Thank you!

Questions???


the “sensory-friendly” classroom: facilitating children’s

Documents