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Ayres’ Sensory Integration – Sharing the Evidence

What a fantastic Coffee and Chat we had this week! We started to consider the Hume et al 2021 article as a way to guide discussion on the topic.

Join us to join the conversation and share the evidence.

And, it was a treat to have the very eloquent Teresa May-Benson share her passion about this subject with us. Her enthusiasm was infectious. As therapists providing ASI we all need to deliver a clear message about the evidence – to challenge others who say ASI has no evidence or inconclusive with current and emerging evidence.

Teresa’s clarity and eloquence on this subject was something we can all model and aspire to. The discussion afterwards was certainly thought-provoking, with exciting planning to consider how we use social media to share the evidence with others.

Join us to listen to the recording of Coffee and Chat and to work together to develop skills and resources to professionally, mindfully and with intention address the unhelpful messages being shared without reference to what evidence-based practice is and without consideration of recently published research and reviews.

Exciting times #timesarechanging #asi #sensory #rcot #cypf #asi #sensory

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EHCP: Are Private Reports Recognised?

here to help lettering text on black background

and what to do when they are not!

Reports by therapists outside of the NHS must be recognised by Local Authorities when the additional support needed by a child is required for an Education, Health and Care Plan (EHCP). The SEN and Disability Code of Practice (2015) is quite clear on this point – there is no basis in law for any Local Authority to reject a professional assessment or diagnostic report simply because it was part of a private assessment.

The SEN and Disability Code of Practice (SEND) is statutory guidance issued by the government – it contains detail on what Local Authorities should consider.

Paragraph 9.14 of the Code states that “the local authority should consider whether there is evidence that despite the early year’s provider, school or post-16 institution having taken relevant and purposeful action to identify, assess and meet the special educational needs of the child or young person, the child or young person has not made expected progress”. 

The advice given within the Code covers the relevant education, health, and care needs of the child or young person, as well as the views, wishes, and feelings of the parent. 

The Local Authority (LA) is expected to pay particular attention to:

  • Evidence of the child or young person’s academic attainment (or developmental milestones in younger children) and rate of progress;
  • Information about the nature, extent, and context of the child or young person’s SEN;
  • Evidence of the action already taken by the school or other settings;
  • Evidence that where progress has been made, it has only been as the result of much additional intervention and support over and above that which is usually provided;
  • Evidence of the child or young person’s physical, emotional and social development and health needs, drawing on relevant evidence from clinicians and other health professionals and what has been done to meet these needs by other agencies.

Refusal by a Local Authority to accept private assessments that follow NICE guidelines would suggest an omission in following clear and explicit requirements re SEND. An assessment towards or as part of diagnosis made under these terms should be regarded as credible evidence for a Tribunal – refusal to issue an EHC Plan, would be an appealable decision. This means if you appeal a Local Authority’s decision, a Tribunal would be under a lawful duty to consider all the documents placed before them, private or otherwise.

In relation to the NHS, a privately obtained report is as crucial as an NHS one. If you are advised that a private diagnosis report will be ignored, this is incorrect advice. NHS England state, “You’re still entitled to free NHS care if you choose to pay for additional private care.”

In summary, an assessment report written by a registered, specially trained, and experienced professional is as reliable, lawfully credible, and clinically crucial as an NHS report.

Read here about actions you can take should a local authority try to reject a report.

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Intervention without assessment is like darts without a target.

When Occupational Therapists are asked by a family, person or teacher to address participation challenges – we need to be able to evidence our recommendations and interventions. Robust assessment with a range of tools including ‘testing’ is the onky way therapists can provide effective and targeted and individualised support and measure outcomes.

So very often nowadays we hear ‘Its definitely modulation difficulties linked to Joe’s ASD” or “she can’t regulate touch because of trauma” – have you gut other ideas for me because therapy isn’t working. When we ask what dies the assessment show we are offered results from a lone Sensory Profile or a list of things the teacher said are hard.

Despite strong neuroscience that tells us how trauma alters not just modulation – but importantly and essentially registration and perception, assessment often does not include investigation across all the senses, aspects of registration, perception and praxis. Poor perception clearly links to difficulties of executive function and how this translate to actions.

In adult trauma clients the co-occurrence of difficulties in development of self regulation is very closely linked to differences with registration, perception and praxis challenges, we see and can evidence this via assessment time and time again in practice… ensuring registration and perception of vestibular, proprioceptive and tactile input is essential for the body to feel safe, to support function and importantly enable development of self-regulation skills. The science is clear – humans need regulation within the ANS and the senses are a gateway to function. Underlying sensory difficulties need exploring with thorough assessment – carefully and mindfully explored via a range of tools that includes standardised testing.

And comprehensive assessment doesn’t have to be onerous – we can turn testing into ‘games’ to really understand a person!

A GP will not just hand out iron pills because a parent repeatedly says their child is tired – yes a checklist helps the GP see the child’s diet is adequate or parent report assures adequate sleep – but then they test through clinical observations – looking at colour under the eye and they take blood and test formally.

Why would we as OT’s not use the tools we have to provide comprehensive assessment and therefore targeted and specific intervention and advice.

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Coffee and Chat | May 2022 | Sensory Integration, Mental Health, Trauma and Adverse Childhood Experiences

This week, we extended this month’s discussions about mental health, trauma, and safe spaces to explore adverse childhood experiences (ACES). Last week we watched Alexis Quinn speak about the trauma of being an autistic adult on a mental health unit.

This week we watched Dr. Nadine Burke Harris explore the impact of trauma on both physical and mental health across the lifespan.

Join us on the 25th of May 2022 for Coffee and Chat where members will be sharing photos and examples of safe spaces and equipment that supports the therapist create therapeutic safe states to promote regulation.

You can hear Dr Burke speak here

Dr Nadine Burke on how childhood trauma affects life across the lifespan.

This table below from Cook et al 2005, Complex Trauma in Children and Adolescents explains the pervasive nature of trauma and it’s impact on the developing brain that we explored after Dr Burke’s talk.

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11 May 2022 | Coffee and Chat | Mental Health Awareness Week
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Community of Practice | Resources for Families

Sharing great resources for practice – This from Dr Zoe Mailloux.