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AOTA Article: Trauma and OT

Many Occupational Therapists using a sensory integration approach in their clinical practice have worked productively and mindfully with children, adults and older adults with trauma. Our unique education and training facilitates our practice in a range of settings- schools, mental health settings and hospitals, where as a profession we are tasked to address barriers to participation in everyday life.

Occupational Therapists are uniquely placed to be able to offer not only cognitive behavioural and occupation based activities.

Neuroscience now provides us with the evidence to support our practice of Ayres’ Sensory Integration with our clients with trauma – confirming our understanding about how trauma impacts early and ongoing sensory and motor development, underlying physiology and levels of arousal and attention.

Now and into the future, we will need to further consider the evidence for how inter-generational trauma manifests in underlying neurobiological processes that underpin function – the sensory, motor and cognitive building blocks of participation in everyday life.

To read the full article please follow this link. https://www.aota.org/~/media/Corporate/Files/Publications/CE-Articles/CE-article-May-2019-Trauma.pdf

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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

 

 

 

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Clinical Dilemma: The theory of Sensory Integration and how it is currently informing practice in young people with trauma. But what about Fidelity?

An interesting video about how this therapist is applying learning about sensory integration to inform her practice in young people with trauma. It is really important to the growing application of Ayres’ Sensory Integration in the field of trauma that we clearly define what we are doing and how we practice, how we work in away that meets Fidelity or not. We need to describe what we do – and if it is according to Fidelity so that what we describe is clear – when is it the use of the theory of sensory integration to inform clinical reasoning and develop and implement sensory informed cognitive behavioural approaches and when is it Ayres’ Sensory Integration. This is an important and critical distinction. This does not mean either approach is not valid or useful – but just that we are clear about what we are delivering so our intervention and outcomes can be measured and reported clearly.

Can we use the assessments from ASI and then deliver sensory approaches, sensory strategies and not one to one therapy according to Fidelity to Ayres’ Sensory Integration? Yes, sometimes this is all we might be funded or able to do a bit is is the best we are able to offer given local commissioning and geographical challenges.

I work with young people with trauma and I use Ayres’ Sensory Integration that meets Fidelity, but I can also sometimes only deliver consultation – but my strategies and clinical reasoning are deeply embedded in the theory of Ayres. When I do this the results can make a significant impact on the person’s ability to be safe, takes less medication or self-harm less, as my theoretical knowledge is sound and robust, grounded in current neuroscience and Ayres’ theory.

How do you practice if you work with trauma using Ayres’ theory, and how do you record what you do?

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Clinical Dilemma: The theory of Sensory Integration and how it is currently informing practice in young people with trauma. But what about Fidelity?

An interesting video about how this therapist is applying learning about sensory integration to inform her practice in young people with trauma. It is really important to the growing application of Ayres’ Sensory Integration in the field of trauma that we clearly define what we are doing and how we practice, how we work in a way that meets Fidelity or not. We need to describe what we do – and if it is according to Fidelity so that what we describe is clear – when is it the use of the theory of sensory integration to inform clinical reasoning and develop and implement sensory informed cognitive behavioural approaches and when is it Ayres’ Sensory Integration. This is an important and critical distinction. This does not mean either approach is not valid or useful – but just that we are clear about what we are delivering so our intervention and outcomes can be measured and reported clearly.

Can we use the assessments from ASI and then deliver sensory approaches, sensory strategies and not one to one therapy according to Fidelity to Ayres’ Sensory Integration? Yes, sometimes this is all we might be funded or able to do. It is the best we are able to offer given local resources, commissioning and geographical challenges.

I work with young people with trauma and I use Ayres’ Sensory Integration that meets Fidelity, but I can also sometimes only deliver consultation post assessment – but my strategies and clinical reasoning are deeply embedded in the theory of Ayres. When I do this the results can make a significant impact on the person’s ability to be safe, takes less medication or self-harm less, as my theoretical knowledge is sound and robust, grounded in current neuroscience and Ayres’ theory. Now we need the research to eveidence this way of working when funds and time is limited.

How do you practice if you work with trauma using Ayres’ theory, and how do you record what you do?

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When trauma occurs, the brain changes

Bessel A. van der Kolk M.D. is a clinical researcher who integrates developmental, neurobiological, psychodynamic and interpersonal aspects of the impact of trauma and it’s treatment. Learn a bit more from him about how perceptual changes happen because of trauma, and how this impacts on engaging with ordinary situations, focus as well as attention. Hear how this can impact on someone’s sense of self.