We are delighted to see Sensory Ladders highlighted in the recent research article by colleagues at Cygnet; Reducing Challenging Behaviours with Sensory Modulation Strategies: A Quality Improvement Project in an Acute Mental Health Service by Fredericks et al, 2025.
“Nine patients completed the evaluation forms. All of those surveyed (n = 9) enjoyed the sensory sessions and found them helpful (Figure 6). The key themes identified were:
“Frequent references to the Sensory Ladder” … “and the concept of alertness levels, indicating a growing understanding of how sensory input influences emotional regulation”
Fredericks et al 2025.
Sensory Ladders have a long and consistent history of changing practice. First developed in 2001 as a co-produced tool to help people recognise, understand, and communicate their self-states, they have supported individuals and services for over two decades. What began as an idea, accelerated in practice within the NHS, now reaches across settings, services, and even countries.
Over the years, this work has been shared and published in:
- Smith, K. (1999) Sensory Levels in LD. Training Pack, Cornwall Partnership NHS Trust.
- Smith, K. (2001). Sensory Ladders. Retrieved from www.sensoryladders.org
- Brown, S., Shankar, R., Smith, K., et al. (2006). Sensory processing disorder in mental health. Occupational Therapy News, May, 28–29.
- Smith, K. and A, H. (2002) Be SMART Profile, Cornwall Partnership NHS Trust. Published as a handout and Learning Tool (National and International Lectures and Workshops 2004 – present)
- Urwin, R. and Smith, K. (2009) Developing the Evidence Base for Personalising Sensory Integration Approaches with Adults (poster/presentation).
- Smith, K., Brown, E., Fisher, J., Fisher, R. et al (2020) Sensory Ladders Webinars, ASI Wise and The Sensory Project; https://www.sensoryproject.org/shop [last accessed 5 April 2024].
- Brown, S., Shankar, R., & Smith, K. (2009). Borderline personality disorder and sensory processing impairment. Progress in Neurology and Psychiatry, 13(4), 10–16.
- Emmerson, F. (2024) Autism is my friend, Anorexia is not. Cambridge: Pegasus Elliot Mackenzie.
- Vaughan, H. (2025). Supporting people in mental health crisis. OT News, Royal College of Occupational Therapy, London, March, 41–43 .
Including these references ensures that Sensory Ladders are recognised within the practice history, acknowledging the pioneering work that continues to influence how we understand and support participation and wellbeing today.
This latest Cygnet article feels especially meaningful because of our close connections. Over the years, we have had the privilege of teaching some of the authors, and today, we are delighted to be working with Cygnet staff who are currently training with us. It is a real privilege to walk alongside them as they deepen their knowledge of Ayres Sensory Integration®️ and explore how tools like Sensory Ladders can enrich therapeutic practice in adult mental health.
We are also proud that Courtney, one of the authors, is actively involved in the Mandarin translations of Sensory Ladders. This highlights how tools first created within the NHS are now being shared internationally, extending their reach and impact far beyond the UK.
Sensory Ladders are growing across the globe day by day.
From their humble beginnings in the year 2001 to their established and vital role within today’s National Health Service (NHS), and now extending their impact through translation and adoption across the globe, these initiatives continue to evolve as a collaborative, co-produced approach. This transformative process changes healthcare practices and empowers individuals, providing them with the tools and knowledge necessary to navigate and enhance their everyday lives in meaningful ways. They actively engage communities and foster a deeper understanding of co-production within personal health management, ensuring that individuals feel supported and informed at every step of their journey.