I’m so excited that 3 years after starting my postgraduate training in Ayres Sensory Integration, I have finally been able to take the next step in my journey and this week I have started to study the materials for ASI WISE CLASI CASI Module 2 online, with face to face M3 later in August.
Next year will mark 20 years since I completed my Master’s degree in medicinal chemistry and I have thoroughly enjoyed having the opportunity to return to academia by studying occupational therapy. I love the parallels and overlaps between the theory in chemistry and neuroscience, and how both subjects challenge me to understand how microscopic unseen worlds impact on everyday life in tangible ways.
I am enjoying all the fresh challenges and the immense opportunities which the new ASI WISE CLASI CASI offers; blended learning combining digital and online learning (including the chance to be part of an international global community) alongside face to face hands on learning – putting the theory into practice, while thinking about local, regional and national challenges with lectures from the U.K. and Ireland. At university, the research and evidence-based practice modules give me the opportunity to reflect on how far I have come and I am inspired to use both my upcoming final year projects and my learning and work with ASI WISE to both explore and contribute to the latest most up to date research in ASI – including development of the EASI.
We should use and value our specialist skills – promoting our profession – information from one assessment tool is not a comprehensive assessment. We should act with integrity and only practice what we are skilled in and trained to do. This can and must include postgraduate training and we should value this investment in our own skills to deliver a great service to our clients. I felt ashamed of my own profession today, and here is why.
Today I chatted with a parent I was introduced to on social media. They had paid almost more money than I earn in 2 days in private practice for a 10-page report written after the parent returned a completed Sensory Profile to a therapist via the mail. Then after a 45-minute meeting where the child played on the floor while the therapist interviewed the Mum, the report and recommendations were written.
On the back of this report, the child who lives far away from the assessing therapist is now about to undertake:
Balance exercises every morning which the Mum was training to do over the internet. These include standing on one leg eyes open and eyes closed, and, hopping eyes open and eyes closed along a line.
A brushing programme; which Mum will be soon be trained to do over the internet – this needs to be done every morning and every night.
Using a sensory diet sheet and the child will follow 5 activities off this sheet each day with her TA at break-time while her friends are out on the playground.
Using a wobble cushion at lunch to facilitate eating new foods.
An after-school calming plan – spinning on a wheelie board and jumping on a trampoline for 10 mins.
The final recommendation was getting sensory therapy from a ‘Sensory OT’ if these things didn’t work. I am apparently one of the closest ‘sensory therapists’, so I got a call. The therapy has not worked. Where do I start? What is a ‘Sensory OT’? Am I one of these?
I have to be professional. So I started with educating the parent about our profession and how we practice.
Then I told her about Jean A Ayres and about Ayres’ Sensory Integration and Practitioner Education including the ICEASI. I had to dispel some myths she’d been sold that sensory diets are not related to Ayres’ Sensory Integration – exploring the history of the theory’s development, explaining how the theory should be used to inform assessment and clinical reasoning even when we can only provide advice and strategies – but that these should still be individualised following a comprehensive assessment.
The approach used and charged for is not what I recognise and not what encompasses best practice – best practice in occupational therapy, wherever we work, involves using assessment tools; some standardised and with norms or some just structured questionnaires that collect and collate our clinical observations. Then we listen and hear the client’s voice/story via their narrative and then using this to confirm our clinical observations. Then using the best possible evidence we should work alongside clients to develop goals and set a way to measure if what we then do makes a difference – improving participation in daily life.
This is not a process restricted to Ayres’ Sensory Integration, but one that should guide best practice in any area of clinical practice; judicious collection of data through assessment to inform clinical reasoning that will allow the setting on individualised, personal goals to inform intervention planning and implementation – with careful measurement of outcomes alongside reflective practice.
This is our profession – working with people in partnership, alongside them in conversation and while using assessment tools in the assessment is expected, we choose tools specific to the person, the referral reason using our clinical reasoning. This is our expertise and what makes our jobs a profession.
The Sensory Profile, like all assessments, is meant to only guide and inform clinical reasoning. Otherwise, we could just hire number crunching computer programs that use algorithms to assess plan intervention and write reports instead of OT’s.
[This blog was written a while ago, with some details changed to protect the family, but at their request and with their permission. It was written just after my father in law fell and then sadly did not recover. I was very sad anyway, but after this conversation, I was really very very sad and I waited to make sure I still felt as concerned and as sad after some time had passed.]
ICEASI has recommended education standards for competency to practice Ayres Sensory Integration. AOTA have published an article, including the table below, in their publication OT Practice in 2017 discussing this in more detail. Sadly the full article is not accessible to those who are not AOTA members.
These standards were finalised at a meeting in 2017. They were developed from original proposals and ideas first developed by an international group of leaders in the field of Ayres’ Sensory Integration in 2009/2010 at R2K in LA, USA with further development and refining at meetings held at ESIC’s including Austria (2009), Portugal (2011), Finland (2014), Birmingham, United Kingdom (2015) and Austria (2017).
As OT’s using Ayres’ Sensory Integration, we are mindful of her early work which reminded us of the importance of sensory input in developing the mother-infant bond, a building block which she saw as essential for emotional stability alongside sensory-motor and sensory-perceptual skills that underpin our ability to engage in purposeful activity.
Ayres’ recognised the importance of being able to take in, process and integrate sensory input not just for activity and praxis but also for future health and well-being, including the development of self-esteem, self-control, and self-confidence.
I am constantly amazed by her vision and insight, and how she built on the seminal and emerging neuroscience of her peers, how she valued this work of others and built on it, leaving a legacy that has continued to be developed and researched by others since her.
A lovely article “The Neurobiology of Attachment to Nurturing and Abusive Caregivers” by Regina Sullivan summarises more recent literature and helps remind us about and understand more why positive experiences or nurture from the primary caregiver are essential. This nurture is experienced through the senses, and when what is experienced is not as it should be, in early phases of critical development, it irrevocably changes the brain.
” a mother’s sensory stimulation of the infant is the hidden regulator of the infant’s physiology and behavior”
Click here to read this article, and on the last day of OT Week! OT has so much to offer mental health care – we have a unique role using Ayres’ work to inform current practice in inpatient care – proud to be an OT owning the sensory integration frame of reference!