MULTI-SENSORY ROOMS……….HOW CAN WE MAKE THEM WORK?

Ian Murphy Occupational Therapist, Kilmallock Day Hospital, Co. Limerick.

Edel Feury 1st Year Occupational Therapy Student, University of Limerick.

Colin Jones 1st Year Occupational Therapy Student , University of Limerick.

26th June 2014

Presentation Overview

Sensory Rooms (Where, What & How?) Sensory Regulation Literature Review

Equipment How to use the room Practicalities

Case Study Recommendations Summary & Questions

Mental Illness is ‘a medical condition that disrupts a persons thinking, feeling, mood, ability to relate to others and daily functioning’ (NAMI 2014).

Sensory-based interventions expand the range of therapeutic interventions available and are useful in avoiding or resolving crisis situations that could lead to seclusion and restraint (Champagne & Stromberg, 2004).

Recovery: Empowering the client. Productive coping methods.

• Anzalone et al (2013)

Sensory Rooms…their history

1975: Holland. Snoezelen rooms for

people with intellectual disabilities.

Since 1999: Inpatient adult

psychiatric programmes developing

sensory rooms.

Multi-sensory environments now used in a

variety of settings

• Baillon et al (2002).

• Champagne & Stromberg (2004).

Sensory Rooms…their aims

RelaxationStimulationFailure-

freeNon-directiveResponsive to individualEnablin

gRapport-building

• Baillon et al (2002).

Our Senses

http://www.youtube.com/watch?v=1K1XKClRb38

Sensory Regulation

http://www.youtube.com/watch?v=78b67l_yxUc

Ability to maintain homeostasis while

taking interest in the world and regulating arousal and response

to sensory input.

Building block to other functional

capacities.

• DeGangi, 2000; Greenspan, 1992; Lachmann & Beebe, 1997.

• Greenspan & Wieder, 2007, Siegel, 1999.

Literature Review

Positive Findings:

Baillon et al (2002) – How multi-sensory therapy works.

Chalmers et al (2012) – Mental health inpatients. Decreased distress levels. Nursing conducted most sessions.

Reddon et al (2004) – Adult psychiatric setting. Positive effects for patients and staff.

Sutton & Nicholson (2011) – Positive findings.

Gardner et al (2012) – Successful use of WRAP and sensory-based approach in mental health.

Limitations:

Limited research in area of mental health.

Focus on intellectual disabilities, dementia.

Positive change ascribed to interaction between participant and enabler (Martin et al, 1998).

Relevance to Acute Psychiatric Settings

Reduced distress levels in patients reported following use of sensory room (Chalmers et al, 2014).

Use of a sensory room and sensory-based treatment approaches by skilled and/or educated staff has significant positive effects among clients of varied ages and diagnoses. 89% reported positive change. Used Allen Cognitive Levels. (Champagne & Sayer, 2003).

Therapeutic relationship with staff strengthened. Individual’s health and recovery promoted (Champagne & Stromberg, 2004).

Build a record of client’s responses to various stimulation

Collaboratively complete mood questionnaire (post-session)

Observe client’s response and grade stimulus appropriately to regulate mood

In room, select one piece of equipment for calming/alerting patient as appropriate

OT/client collaboratively complete mood assessment questionnaire (pre-session)

Select patient(s) for sensory session

Receive list of appropriate referrals for room from 5B staff

Practicalities

Up to date risk assessment completed for all clients

Sensory room must remain locked when not in use

Electrical equipment must be regularly checked

Equipment must be kept clean using antiseptic wipes in keeping with infection control guidelines.

Clients must be supervised at all times in room

Education and training should be provided for all staff• Sensory Room Policy Document

(2010).

Case Study: MichaelMichael is a 37 year old male diagnosed

with bi polar disorder since the age of 22, having previous hospital

admissions when ill

Michael is employed as a mechanic, has not worked in three months

due to his illness

Michael lives with his girlfriend, his social supports

include his family, friends and work

colleagues

Michael experienced periods of a natural

high in his 20’s needing little sleep for

several weeks. Had persistent enthusiasm

and took on new projects for which he

was ill suited

Michael recently experienced an

elevation in his mood where he was seen

shouting at friends. He had also taken on too

much at work

This affected his ability to

concentrate, problem solve, make decisions

and his judgement in his employment

Michaels interpersonal and

social relationships,

vocational functioning,

leisure participation, self

care and independence were affected

• Anzalone et al (2013)

Step 1

• Initiate sensory room session with Michael to help regulate mood

Step 2

• Complete mood questionnaire (pre-session) collaboratively

Step 3

• If client needs alerting, use projector to raise mood (visual)• If client needs calming, seat client in beanbag, using deep pressure

to regulate arousal

Step 4

• Observe client’s response to the stimulus and grade appropriately to regulate mood

Step 5

• Complete questionnaire again (post-session) and use to build record of client’s responses to various stimulation

Recommendations

• MIDI invisible keyboard.

• Encourages and rewards movement.

• Anyone can operate.

• Weighted Blanket/Shawl.

• Deep pressure to regulate arousal.

• Champagne & Stromberg (2004).

Summary

Aim to regulate client’s senses in the ‘optimal zone of engagement’.

Sensory rooms can be used for both calming and alerting patients in mental health.

This can improve function in areas of self-care, productivity and leisure.

Long-term, the aim should be self-regulation as part of a recovery focus.

ReferencesAnzalone, M. E., & Ritchey, M. (2013). Developmental and Dyadic Implications of Challenges With Sensory Processing, Physical Functioning, and Sensory-Based Self-Regulation. Infant and Early Childhood Mental Health: Core Concepts and Clinical Practice, 209.

Baillon, S., van Diepen, E., & Prettyman, R. (2002). Multi-sensory therapy in psychiatric care. Advances in psychiatric treatment, 8(6), 444-450.

Chalmers, A., Harrison, S., Mollison, K., Molloy, N., & Gray, K. (2012). Establishing sensory-based approaches in mental health inpatient care: a multidisciplinary approach. Australasian Psychiatry, 20(1), 35-39.

Champagne, T., & Sayer, E. (2003). The effects of the use of the sensory room in psychiatry. Copyright by Tina Champagne.

Champagne, T., & Stromberg, N. (2004). Sensory approaches in inpatient psychiatric settings: innovative alternatives to seclusion & restraint. Journal of psychosocial nursing and mental health services, 42(9), 34-44.

DeGangi, G. A., Breinbauer, C., Roosevelt, J. D., Porges, S., & Greenspan, S. (2000). Prediction of childhood problems at three years in children experiencing disorders of regulation during infancy. Infant Mental Health Journal, 21(3), 156-175.

Gardner, J., Dong-Olson, V., Castronovo, A., Hess, M., & Lawless, K. (2012). Using Wellness Recovery Action Plan and Sensory-Based Intervention: A Case Example. Occupational therapy in health care, 26(2-3), 163-173.

ReferencesGreenspan, S. I. (1992). Infancy and early childhood: The practice of clinical assessment and intervention with emotional and developmental challenges. International Universities Press, Inc.

Greenspan, S. I., & Wieder, S. (2007). Infant and early childhood mental health: A comprehensive developmental approach to assessment and intervention. American Psychiatric Pub.

Lachmann, F. M., & Beebe, B. (1997). Trauma, interpretation, and self-state transformations. Psychoanalysis and Contemporary Thought, 20(2), 269-291.

Martin, N. T., Gaffan, E. A., & Williams, T. (1998). Behavioural effects of long‐term multi‐sensory stimulation. British Journal of Clinical Psychology, 37(1), 69-82.

National Alliance of mental health (NAMI) (2014) What is Mental health [online] available: http://www.nami.org/ accessed 06th June 2014

Reddon, J. R., Hoang, T., Sehgal, S., & Marjanovic, Z. (2004). Immediate effects of Snoezelen® treatment on adult psychiatric patients and community controls. Current Psychology, 23(3), 225-237

References

Sensory Room Policy (2010) [online] available: http://www.nepft.nhs.uk/_uploads/documents/trust-policies-and-procedures/sensory-room-policy-2010.pdf accessed 6th June 2014

Siegel, D.J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. New York: Guilford.

Sutton, D., and Nicholson, E. (2011). Sensory modulation in acute mental health wards: A qualitative study of staff and service user perspectives. Auckland, New Zealand: Te Pou o Te Whakaaro Nui.

Additional Bibliography:

AOTI (2011) Mental health advisory group. [Online] available: http://www.aoti.ie/ [accessed 02 June 2014.

Brown, C. (2002). What is the best environment for me? A sensory processing perspective. Occupational Therapy in Mental Health, 17(3-4), 115-125.

Champagne, T. (2011). The influence of posttraumatic stress disorder, depression, and sensory processing patterns on occupational engagement: A case study. Work: A Journal of Prevention, Assessment and Rehabilitation, 38(1), 67-75.

Champagne, T., & Koomar, J. (2011, March). Expanding the focus: Addressing sensory discrimination concerns in mental health. Mental Health Special Interest Section Quarterly, 34(1), 1–4.

Hill, L., Trusler, K., Furniss, F., & Lancioni, G. (2012). Effects of Multisensory Environments on Stereotyped Behaviours Assessed as Maintained by Automatic Reinforcement. Journal of Applied Research in Intellectual Disabilities, 25(6), 509-521.

Hope, K. W., Easby, R., & Waterman, H. (2004). ‘Finding the person the disease has’–the case for multisensory environments. Journal of psychiatric and mental health nursing, 11(5), 554-561.

Additional Bibliography:

Mental Health Ireland [Online] available http://www.mentalhealthireland.ie/information/what-is-mental-health.html accessed 06th June 2014

Moore, K.M. (2008) the sensory connection program, [Online] available: http://www.sensoryconnectionprogram.com/sensory_room.php accessed 02 June 2014.

Pollock, N. (2009). Sensory integration: A review of the current state of the evidence. Occupational Therapy Now, 11(5), 6-10.

Pfeiffer, B., & Kinnealey, M. (2003). Treatment of sensory defensiveness in adults. Occupational Therapy International, 10(3), 175-184.

Scanlan, J. N. (2009). Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far. A review of the literature. International Journal of Social Psychiatry.

Segal, S. P., Watson, M. A., Goldfinger, S. M., & Averbuck, D. S. (1988). Civil commitment in the psychiatric emergency room: II. Mental disorder indicators and three dangerousness criteria. Archives of General Psychiatry, 45(8), 753-758.