The profile
Te Pou has been supporting District Health Boards (DHBs) to roll out the use of sensory modulation through the use of training workshops, supporting the evidence base for its use, information, and disseminating stories of the use of sensory modulation, such as this one.
Until recently, sensory modulation has mostly occurred in acute mental health inpatient units, within dedicated rooms called sensory rooms. These rooms have a range of tools that service users (with the guidance of clinicians) can choose to use to help get the right amount sensory input. These tools can be specialised (such as weighted blankets for the lap or shoulders, or massage chairs) or more commonplace (such as rocking chairs, blankets, or music).
More recently, clincians in some DHBs have been working with service users to provide sensory modulation in service users homes or in other community settings. This story focuses on the development of a workshop series that was designed to deliver sensory modulation to service users with a diagnosis of Borderline Personality Disorder within the Waitemata District Health Board (WDHB). These workshops are unique in New Zealand, and demonstrate the potential of sensory modulation to be successfully used in the community.
The WDHB serves more than 525,000 people, the largest DHB population in New Zealand, and has the second fastest growing population. It covers the areas of North Shore City, Waitakere City and the Rodney district. There are two adult acute mental health inpatient units within the DHB, along with a number of community based teams. These teams provide community (usually home-based) support for service users within the WDHB catchment area.
All of WDHB’s mental health services are currently using sensory modulation as a clinical intervention to support service users to moderate their sensory input and maintain or regain a sense of calm. ‘North Shore One’ is one of these teams.
The beginnings
Since implementing sensory modulation in 2010, North Shore One has had feedback from service users about the benefits of the intervention. Service users, as well as the people close to them, credit sensory modulation for helping them to feel calmer, relieve anxiety, better cope and decrease the need for
re-admission to hospital.
The senior occupational therapist at North Shore One, Andrea Dempsey, believes sensory modulation is a useful way of demonstrating to service users that they can choose more useful ways to respond to distress when given the right tools and environment. The success of the individual work encouraged North Shore One to deliver sensory modulation to service users in small groups through a three-week workshop series. The team also encouraged service users’ key workers, support workers, friends and family members to attend.
The process
The prototype of the first workshop series was based on an American workshop model, but it soon became apparent that the workshops were not quite ‘hitting the mark’ for two reasons. First, the theoretical content outweighed the hands-on activities that were preferred by attendees. Second, the group interaction was not working as intended. Attendees were being asked to verbalise their experiences in the workshops, but feedback suggested that this was difficult to do, especially in a group situation. Within weeks of starting, interest in the workshop had faltered, forcing the sessions to be cancelled.
Rather than abandoning the concept, North Shore One set about adapting the workshop to better meet the needs of attendees. Firstly, the amount of content delivered was dramatically reduced in favour of more opportunities to use the sensory tools. Secondly, alternative ways of generating interaction and sharing among the group were tried. Dempsey presented three bowls, each with a different type of lollies and encouraged group members to choose one of these depending on what they were experiencing at that moment. This exercise proved to be a useful way to break the ice and provide a basis for discussing why each person had chosen a particular sweet.
Currently the groups are delivered in the occupational therapy room where many of the tools are kept, and involve discussion about the theoretical basis of sensory modulation, but the focus is on examining ways of applying practical strategies to everyday life. The group brainstorms coping strategies and works through handouts to help each person identify things that have calming or alerting effects on them. The group members get to try a range of sensory tools and practice using different strategies to moderate their level of arousal. Andrea stresses the importance of maintaining a sense of playfulness and curiosity when introducing sensory tools to the group.
Giving real-life examples of sensory modulation is a crucial way of personalising and normalising the skills being taught. Andrea partly attributes the success of the groups to the facilitators’ willingness to share their own personal experiences. She considers this essential as it reinforces how sensory modulation is based on skills that anyone uses to cope with overwhelming emotions or experiences.
The two-hour group sessions are structured as follows.
Week one: What is sensory modulation and how can it make me feel better?
Objectives:
- To understanding the influence of the nervous system.
- To identify stimuli that is calming versus alerting.
- To understand the role of sensory modulation in acute situations.
- To understand the role of a sensory diet in maintaining a calm state of arousal.
Week two: What are the tools and how do they make me feel?
Objectives:
- Introduce the concept of arousal level.
- To trial and understand use of weighted modalities.
- To trial and understand use of the sensory room.
- To trial a range of sensory tools.
- To begin to identify which tools/strategies may enable us to maintain an optimum arousal level.
Week three: What are the tools and how do they make me feel?
Objectives:
- To identify which tools/strategies may enable us to maintain an optimum arousal level.
- To observe arousal levels through a ‘normal’ day.
- To begin to create a sensory diet.
- To identify a range of strategies to use when distressed/anxious.
- To make scented balm.
The results
After further revisions of the workshop, Andrea is satisfied that the overall format is working well. The current workshop series, dubbed ‘Coping through the Senses’, consists of three two-hour sessions. A mix of service users, their key workers or support workers, and their friends and family members attend the sessions. Interest in the workshops has grown so much that the most recent group was at full capacity, and Andrea has had to start a waiting list for the next series of workshops.
Given the success of sensory modulation with both individuals and in the workshops, North Shore One is now looking at other ways of embedding the intervention into their work. The team has already started to incorporate sensory modulation into service users’ crisis plans and relapse-prevention plans. A new acute inpatient ward is currently under construction, and is likely to feature allocated ‘sensory spaces’. Another exciting initiative is the trialling of a publicly accessible sensory modulation group in a community centre.
The lessons learnt
- Keep the group sessions short and provide more practical activities rather than allocating a large proportion of time to theoretical concepts.
- Recognise group dynamics and adapt the sessions to suit the needs of each group.
- Fully involve key workers or support workers, as well as friends and family of the service users.
- Ensure two trained facilitators are present at each group.
For more information
- Anne McDonald, clinical team lead, Te Pou.
- Andrea Dempsey, senior occupational therapist, Waitemata District Health Board.
Andrea Dempsey wishes to acknowledge Jaime Courtney and Kate McGeady’s significant contribution to the work described in this story.
Website
http://waitemata.webhealth.co.nz/provider/service/view/857187/
Documents / Links
- Further information on sensory modulation
- Sensory modulation
- Creating alternatives
- Developing a tiered sensory modulation training package
Download this story in PDF format
Successful use of sensory modulation in community group work (PDF, 96KB)
