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CPD: Understanding and Applying Trauma-Informed Approaches Across Occupational Therapy Settings

AOTA has really helpful and supportive articles right now – promoting the best clinical practice, with an emphasis on participation in occupation.

This article is particularly pertinent to OT’s using ASI theory and practice to create therapeutic environments supporting and scaffolding participation in daily life for those with trauma.

Read the full article here.

 

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Autumn Special: Book now for a chance to win an online module free

#book classroom module now to win online module freeAutumn Special – Book and pay in full for one of our ASI WISE onsite classroom modules in November or December 2018, and you will be entered into a free draw to win a place on an online module worth £200.

You can use this place for yourself or gift it to a colleague or friend. The person attending must be eligible to attend and commence learning by June 2019.

You can make your booking here today or request an invoice

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Trauma and development of the brain.

Watch this amazing TED about trauma…here’s a taster of what Nadine Burke Harris will share with you in her presentation, which explores the underlying neuroscience.

close up photography of grizzly bear

Well, imagine you’re walking in the forest and you see a bear. Immediately, your hypothalamus sends a signal to your pituitary, which sends a signal to your adrenal gland that says, “Release stress hormones! Adrenaline! Cortisol!”

And so your heart starts to pound, Your pupils dilate, your airways open up, and you are ready to either fight that bear or run from the bear. And that is wonderful if you’re in a forest and there’s a bear. (Laughter) But the problem is what happens when the bear comes home every night,and this system is activated over and over and over again, and it goes from being adaptive, or life-saving, to maladaptive, or health-damaging.

Children are especially sensitive to this repeated stress activation, because their brains and bodies are just developing. High doses of adversity not only affect brain structure and function, they affect the developing immune system, developing hormonal systems, and even the way our DNA is read and transcribed.”

<div style=”max-width:854px”><div style=”position:relative;height:0;padding-bottom:56.25%”><iframe src=”https://embed.ted.com/talks/lang/en/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime” width=”854″ height=”480″ style=”position:absolute;left:0;top:0;width:100%;height:100%” frameborder=”0″ scrolling=”no” allowfullscreen></iframe></div></div>

 

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Early trauma is stored in the body via the senses, this is why therapy through the senses is effective

“Early trauma is stored in the body via the senses, this is why therapy through the senses is effective.”
Smith, K BPD and SI 2004
boy wearing gray hoodieOccupational Therapists are ideally placed to work through play and via the senses to promote the development of healthy neurological pathways and structures; impacting the development of sensory motor skills and abilities that underpin our ability to move, learn, play, develop, communicate, think and process emotions.

 Sensory integration is integral to the process of healthy development ‘when the functions of the brain are whole and balanced, body movements are highly adaptive, learning is easy and good behaviour is a natural outcome’

Ayres, 1979

girl jeans kid lonelinessThey can do this with clients who are very young, or those who are adults with childhood trauma, who often find talking therapies very hard to engage with as the trauma memories are stored before language has developed, so are instead stored in the body and via the senses.
These young people do need trauma-informed schools, but this is not enough! The problem with whole school approaches to trauma is that for these children whole school strategies are not individualised and personalised and as such, are not specifically targeted. Specialist assessment and intervention is needed for these young people to reduce the impact of trauma on their young plastic brains, still in development.

Postgraduate education in Ayres’ Sensory Integration theory and practice alongside undergraduate education in infant and child development means that occupational therapists are ideally placed to address the sensory-motor needs of looked after children who have often been subjected to trauma in utero and early childhood.

Ayres’ Sensory Integration is a theory that suggests that brain “maturation is the process of the unfolding of genetic coding in conjunction with the interaction of the individual with the physical and social environment. As a result of experience, there are changes in the nervous system.”
Spitzer and Roley 1996
Sensory qualities of the environment can positively or negatively interact with function and development.
Schneider et al, 200
IMG_2043
created, a sensory ladder key ring with football players, to support a young man with trauma to develop improved self-awareness and how to communicate what he needs and when to others

Occupational Therapists working in this area are able to use a discreet but comprehensive range of skills and resources within their scope of practice to offer direct one to one sensory integration – based intervention. These may be with the individual child, while also supporting foster and adoptive families, and typically includes parent participation in therapy.  Occupational therapists will also offer parent and family education and work alongside schools and other organisations via a consultation model, offering education, in-service training, supervision for staff.

“Adopted children who have suffered traumatic early experiences are “barely surviving” in the current high-pressure school environment and need greater support if they are to have an equal chance of success, a charity has said.

They are falling behind in their studies because they are struggling to cope emotionally with the demands of the current education system which “prizes exam results at the expense of wellbeing”, according to a report from Adoption UK.”

from The Guardian 27 June 2018

https://www.theguardian.com/society/2018/jun/27/adopted-children-barely-surviving-in-high-pressure-schools

The development of Occupational Therapy care pathways for children, adolescents and adults with trauma is increasing, as the role of Occupational Therapists in this area is increasingly being recognised.
‘Sensory Integration sorts, orders and eventually puts all the sensory inputs together into whole brain function.’
Ayres 1979
What emerges from this process is increasingly complex behaviour, the adaptive response and occupational engagement.
Allen, Delport and Smith 2011
You can read more about work in this area by following these links:
1. MayBenson, T. A. (2016). A Sensory Integrative Intervention Perspective to
TraumaInformed Care. OTA The Koomar Center White Paper. Newton,
MA: OTA The Koomar Center(PDF) A Sensory Integration-Based Perspective to Trauma-Informed Care for Children. Available from: https://www.researchgate.net/publication/303383214_A_Sensory_Integration-Based_Perspective_to_Trauma-Informed_Care_for_Children [accessed Jul 01 2018]
3. Werner, K. (2016) “Occupational Therapy’s Role in Addressing the Sensory Processing Needs of Young Children with Trauma History” Entry-Level OTD Capstones. 8. http://commons.pacificu.edu/otde/8[accessed Jul 01 2018]
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Resources for Practice in Mental Health and Trauma-Informed Care: improving self-regulation to eliminate control and restraint aka TMAV

On our courses, we teach staff from CAMHS and adult/older adult mental health services how to use Ayres’ Sensory Integration to inform care including for those who have had early trauma.

On our in-house courses, we regularly teach mixed staff teams including Mental Health Nurses and Healthcare Assistants, CPN’s, OT’s, PT’s, SLT’s and Therapy Support Staff, Complementary Therapists, Psychologists and Psychiatrists. Working with staff teams from forensic, secure, acute and longer stay units, our lecturers help teams to develop and implement sensory informed care pathways. This includes working with sensory providers to develop secure safe sensory rooms for safe self-regulation and sensory-rich movement activities suitable for secure and forensic environments, where ligature risks mean traditional swings and other equipment cannot be used.

The use of Ayres’ Sensory Integration to support health and well-being has grown across the UK and Ireland.

The research and evidence base is expanding across the globe, with more clinical audits and studies being published that report that Ayres’ Sensory Integration is

  • improving self-awareness
  • improving self-regulation
  • promoting participation in everyday life
  • increasing clients ability to engage with others, with therapy

this means that there are significant reductions in

  • days in secure or acute care
  • deliberate self-harm
  • the use of PRN medication
  • the need for the use of physical support aka TMAV

We’d like to thank Tina Champagne for pointing us in the direction of this resource which fits so neatly alongside the resources and tools we teach on our courses.

Tina ChampagneTina is a colleague and critical friend of ASI WISE – having started her journey into sensory integration in parallel to our journey here in the UK where we were focussing on improving participation in care and daily life, addressing development of skills and occupations including self care to reduce self harm and use of PRN medication. We finally met in 2004 at a first conference about ASI in MH in Cornwall, UK.

Her work in addressing the use of chemical (mace) and mechanical (cuffs) restraints in the US helped transform their mental health care and she wrote several chapters in this free online resource about developmental trauma and practical ways to institute trauma-informed care.

Resources for Eliminating Control and Restraint aka Therapeutic Manage of Aggression and Violence 

https://www.mass.gov/files/documents/2016/07/vq/restraint-resources.pdf