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Monday October 15, 2012

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The occupational therapists at Eastern State Hospital, a 220-bed psychiatric hospital in Lexington, Ky., created their own sensory integration program, called SenseAble Connections, within the framework of the facility’s treatment mall structure. Started in 2009, staff and patient feedback about the program has been positive.

"Individuals who have sensory processing problems along with major mental disorders, can sometimes develop severe behavioral problems that jeopardize their ability to live safely in home or community settings. Until and unless their sensory integration needs are addressed, problem behaviors often persist," said Jeannette Hall, OTR, Eastern State.

Studies recently published in the American Journal of Occupational Therapy and in OT Practice have posited that sensory modulation disorder may be both a cause and a result of mental health conditions. For example, those with schizophrenia frequently present with low registration and sensation avoiding scores on the Adolescent/Adult Sensory Profile. This can result in slow movement patterns, withdrawal and lack of motivation to participate in group activities.

In the treatment mall (or recovery mall) approach, participants work closely with staff to determine outcome goals and find learning activities that will help meet these, such as problem solving, decision making and time management, according to Hall.

"Measurable outcomes are being developed as a result of subjective observations about change in clients' behaviors," said Shirley O’Brien, OTR/L, PhD, FAOTA, Eastern State.


Front row, left to right, are Jeannette Hall, OT; Amee Osborn, OT; and Beverly Combs, OT; and back row, Peggy Wittman, OT; Leslie Reed, OT; Frances Howard, OT; and Shirley O'Brien, OT.
(Photo courtesy of Eastern Kentucky University)
Typical patient

Hypothetical, typical patient Frederick Smith is a 57-year-old diagnosed with mood disorder NOS and moderate intellectual disability. He is admitted to Eastern State from his residential care community because of self-injurious behaviors, such as banging his head, scratching his skin, pulling out his hair and eating impulsively.

Prior to hospitalization, Smith may have engaged in outdoor walks, gardening activities, watching television and playing with the cat at his residential facility. At Eastern State, Smith may remain in bed all day, exhibit increased anxiety when out of his room, and not perform or allow nursing staff to assist him with self-care tasks. He might run around the unit yelling and physically attack staff when outside of his room or when he is encouraged to get out of bed for daily activities.

Patients like Smith receive individual and group skilled services to facilitate socialization, enhance sensory processing deficits, increase engagement in self-care tasks, and decrease impulsive behaviors when eating and functionally mobile. Nursing staff education would include recognizing early warning signs and triggers for self-harm, then implementing sensory-based interventions that have been found to calm him.

During individual therapy done initially in his room on the unit, he might be provided with scented hand lotion to apply to himself and encouraged to walk slowly up and down the hallway with his therapist. As he becomes less agitated during these times, he would be encouraged to attend the sensory groups at the treatment mall, where he might participate in a chair aerobic group to gradually introduce new sensory input. He also might enjoy doing simple craft and gardening projects, which would provide him with graded tactile input.

Development of the program

The staff developed the SenseAble Connections Program based upon A. Jean Ayres’ sensory integrative approach. The sensory integration program at Hazard (Ky.) ARH Regional Medical Center was used as an initial model for further development. The staff explored ways to use sensory techniques to help decrease misinterpretation of information, such as irrational thoughts, mood swings and anxiety. The staff also pulled from the Sensory Connection program website (sensoryconnectionprogram.com) and began to use carefully planned sensory activities done individually and in groups to target calming, orienting and self-regulation as outcome measures. "It was found that the implementation of sensory techniques can provide an alternative to the use of seclusion and restraints for clients," said O’Brien.

OTs provide some individual therapy based on a global, observation-based assessment, but primarily their work is done with groups of 10-15 patients who attend sensory exploration groups that provide graded activities that require registration and processing of information from visual, olfactory and proprioceptive senses.

The other two components of the program center on the use of environmental adaptations organized in sensory cabinets and comfort rooms. Materials found in the sensory cabinets and comfort rooms provide options for clients to experience self-selected sensory input and exploration. Aides are being trained in data collection of the outcomes associated with these.

Outcomes measures

Preliminary observation data reflects a decrease in restraint use for those involved in the SenseAble Connections Program. Feedback from the OT staff indicates that patients who do not participate in any other groups in the treatment mall become functional and participate in SI groups for 45 minutes.

Chart data is being collected for analysis of specific outcomes and individual intervention goals (e.g., arousal levels at beginning and end of group; social participation/engagement in groups on the treatment mall). "Administrators are beginning to recognize the value that OTs bring to the professional team and to understand the role of occupational therapy in developing innovative ways to solve ... problems," according to Leslie Reed, OTR/L, MS, Eastern Kentucky.

"As these outcomes are used to further shape programming, the SenseAble Connections Program will hopefully provide a model for others to follow," said Reed. "Establishing partnerships with other state and private facilities and with a local academic program is seen as a way to facilitate and reinforce ongoing development of innovative and effective occupation-based programs." •

Peggy Wittman, OT/L, EdD, FAOTA, is a professor at Eastern Kentucky University. Shirley O’Brien, OTR/L, PhD, FAOTA; Jeanette Hall, OTR/L, MS; Amee Osborn, OTR/L, MS; and Leslie Reid, OTR/L, MS, contributed to this article.


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Monday October 15, 2012
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