Sensory Ladders Global

This article was compiled and edited by Kath Smith & Katie Crowfoot.

The first Sensory Ladders for Self-Regulation were created in 1999 as Sensory Levels, with the first publication in teaching materials and Cornwall’s DBT Skills Training resource booklets adapted for use in inpatient units in 2001 as part of the Be Smart Programme (Smith, 2002).

In 2006, NIMHE (National Institute for Mental Health Excellence – Department of Health) recognised and promoted them as part of the Be SMART Programme as best practice. Kath Smith has always generously shared Sensory Ladders, Sensory Spiders and Sensory Grids as therapy resources, including teaching about the programme across the UK, Ireland and the globe over the past 25 years.

They have been integrated into training for DBT therapists working with adults and adolescents. They have also been presented and shared in the UK and abroad as part of mental health and wellbeing training programmes delivered by lead Mental Health and Learning disabilities specialist lecturers Kath Smith and Ros Urwin, expert therapists and researchers, with publications referencing innovation and implementation of Ayres Sensory Integration beyond childhood.

Influenced by the Paediatric Alert Program, they offer therapists a top-down and bottom-up approach that can be combined with other therapies, including dialectical behaviour therapy. Grounded in Ayres’ seminal theory of sensory integration (Ayres, 1972) and processing, they support the development of the person’s self-awareness and self-regulation skills; aligned to client-centered practice; they are one of a few early approaches to champion and pioneer co-productions and co-design. Sensory Ladders support communication and can be easily used by all members of the multidisciplinary team, supporting collaboration across professional groups, including ward staff of all levels within acute psychiatric inpatient units.

Importantly, because of their origin within learning disability and mental health services working with people with trauma, Sensory Ladders support the health care professional to meet unmet needs – reframing the behaviours that “challenge teams”. Critically, Sensory Ladders address sleep dysregulation and deprivation and provide reframing and reformulation of self-states typically viewed more negatively. This powerful reframing of attempts to have adaptive responses, including protective states of flight, fight, and dissociation, provides a powerful and trauma-informed was and remains necessary to reframe and understand better the link between, the senses, self-states and actions – an alternative model of understanding with related person-centred care approaches that are often missed and or unaddressed by other approaches.

When therapists introduce the use of Sensory Ladders, they start with understanding the person and where they are ‘at’ before introducing curious exploring and curiosity about new ways of being. This approach includes gathering and hearing the story, understanding development and considering the person’s unique strengths and challenges impacting participation. Discovering and learning about the sensory systems brings new opportunities for new ways of doing things, and exploring how the environment and activity can impact participation. Used in conjunction with Sensory Ladders, Sensory Spiders, and Sensory Grids support therapists and the person to capture and remember old while also discovering new sensory strategies for use in the hospital, for use at home and school, and when out and about. This can include creating person-specific person-centred Sensor Spaces anywhere.

A core and necessary part of developing Sensory Ladders with people is that they will remain specifically and deliberately very individualised and personalised, developed as a co-production within the context of a safe (and therapeutic) relationship. This is an essential component of Sensory Ladders that differentiates it from other similar tools.

Developmental theories of sensory-motor integration, including sensory integration in support of self-regulation, sit neatly alongside and resonate with cognitive behavioural approaches like Dialectical Behaviour Therapy (DBT), Attachment Theory, Polyvagal Theory and Perry’s Neurosequential Model. These approaches consider and share a common understanding, grounded in neuroscience, that developing new skills and therapeutic change can only occur within a safe environment.

The DBT idea of balancing safety and challenge reverberates strongly with developmental, motor control and sensory-motor theories and the concept of the ‘just right challenge’. Creating a Sensory Ladder is about creating opportunities for an adult or child to learn to become aware of themselves in a new way – to explore and discover new things about their mind, body and brain. It allows the therapist and person to do “curious wondering” together and for the person to try new things. It creates and promotes active but informed risk-taking, testing how we might feel and experience something when we do it differently and new ways of being and responding.

Making and using a Sensory Ladder is about the journey together within a safe therapeutic relationship. It’s about getting to see and know someone in a very different way, getting underneath the skin of what they do and why they do it – reframing “behaviour” in a positive way – challenging the ideas of others about why people may do the things that are commonly but not rightly described by others as “challenging behaviours”. This powerful reframing of misunderstood and unmet needs via Sensory Ladders has been changing practices of service delivery and care within the health and social care area and in education.

Sensory Ladders facilitate top-down and bottom-up learning and development. They scaffold everyone’s understanding of the person and provide a means to consider the person, the environment, and the activity they want and need to do – what might help and what might hinder.

In the context of occupational therapy, Sensory Ladders support the development of a person-centered unique narrative – with a strong visual reminder and communication tool. Sensory Ladders help to make simple the links between the person and their unique sensory experiences through prior learning and the ability to participate in everyday life and learn and develop increasingly more complex ways of interacting with the world and others.

Sensory Ladders reframe adaptive behaviours as responses to sensory events within the world and the person’s own body create a place to start to explore the goodness of fit between the person, the task (activity/occupation) and the environment.

They are a powerful first step to understanding any person’s unique and personal responses to the challenges of living in everyday life. It is a privilege to share this tool that speaks to our humanity. In the spirit of social justice, we are pleased that Sensory Ladders Global is sponsored by The Sensory Project, fueled by infectious generosity of therapists, parents, and other volunteers across the globe who have joined us in translating this very special open-access learning opportunity for everyone everywhere, anytime.

References:

Bhreathnach E. Sensory modulation: A training course presented by Plymouth Community NHS Trust Learning DisabilityService. Plymouth, 2001.

Brown S, Shankar R, Smith K, et al. Sensory processing disorder in mental health. Occupational Therapy News 2006; May:28-29.

Shankar, Rohit & Smith, Kathryn & Jalihal, Virupakshi. (2013). Sensory processing in people with Asperger syndrome. Learning Disability Practice. 16. 10.7748/ldp2013.03.16.2.22.e658.

Smith, K (2002) Abstract and Training pack: Sensory and Adult Mental Health, BAOT Annual Conference and presented to Cornwall Partnerships NHS Trust CPD Training Day.

Williams MS, Shellenberger S. ‘How does your engine run?’ A leader’s guide to the alert program for self-regulation. Albuquerque, NM: Therapy Works, 1994.21.