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Sensory modulation is an emerging approach that aims to reduce distress and agitation in mental health service users and potentially avoid the necessity for coercive practices such as seclusion and restraint. Despite the growing use of this intervention, there has been limited research exploring the implementation of sensory modulation at an organisational level, both internationally and within the New Zealand context. The purpose of this study is to investigate the implementation of a sensory modulation programme in two New Zealand inpatient mental health services using an exploratory organisational case study design.

Organisational case study design methodology was used to explore the implementation of a sensory modulation programme in two New Zealand acute adult inpatient mental health services. This study explored how key organisational and staff factors (including policies and practices related to de-escalation and seclusion reduction) influence sensory modulation implementation. Cases were described and examined the pattern of findings.

Strategies found to support implementation were identified at environmental, organisational, group and individual staff levels. Aspects highlighted as being particularly important included taking an inter-professional approach in leadership and training, rostering flexibility and leeway in staffing levels to support training attendance and responsiveness to crises.

The facilitators and strategies highlighted in this study may be used to support the design and implementation of future sensory modulation programmes in New Zealand and internationally.

The complexity of factors that influenced the implementation of the sensory modulation approach within an inpatient setting made determining the effectiveness of the approach challenging. However, the general principles and strategies identified in this study offer useful insights for the design and implementation of future sensory modulation programmes.

Sensory modulation intervention involves using calming and grounding sensory stimuli to support coping with distress and intense emotions. Evaluating the impact of sensory modulation is challenging in inpatient settings due to the numerous variables influencing outcomes in ward environments. This study aims to determine the impact of sensory modulation across all organisational levels including service users, staff confidence and attitudes, ward climate and seclusion events.

Organisational case studies were conducted in two Aotearoa New Zealand inpatient mental health services, using qualitative and quantitative data to explore the effects of a sensory modulation programme.

Results showed that sensory modulation enhanced staff knowledge and confidence in fostering therapeutic relationships and reducing restrictive practices, positively impacted ward climate and provided service users with sensory strategies to use in everyday life.

The findings captured the complexity of implementation and impact of sensory modulation programmes at individual, group and organisational levels. It is important to recognise the influencing factors and impact of sensory modulation across all levels of service delivery.

Organisational case study methodology offered a unique approach to evaluating the impact of sensory modulation within inpatient mental health services. Data analysis suggests that in addition to managing acute service user distress, sensory modulation impacts broader staff, team and service level outcomes.

This paper aims to explore service-user perspectives of sensory approaches introduced and promoted by the trauma and self-injury service within the National High Secure Healthcare Service for Women (NHSHSW) at Rampton Hospital.

This cross-sectional descriptive study used a semi-structured questionnaire, which was devised for this evaluation and included both open and closed questions. The data collected were then analysed using descriptive statistics and thematic analysis.

The paper evaluates the current use of sensory approaches within the NHSHSW. Sensory approaches were widely used across the service, with essential oils being the most commonly used sensory approach. The use of sensory approaches can be understood according to the following three themes: independence, accessibility and self-regulation. The self-regulation theme contained three sub-themes as follows: safety-seeking, relaxation and reducing distress. The evaluation also highlighted barriers to using sensory approaches and sought service-user feedback as to how these may be overcome.

Participants’ feedback informed changes to practice, such as introducing sensory approaches to service-users earlier in their care pathway and increasing the accessibility of sensory items. These approaches may be of relevance to service provision in other forensic or inpatient settings.

This paper offers a unique contribution to the current literature with its focus on using sensory approaches to ameliorate trauma symptoms, in the context of a forensic setting.

This chapter opens with the current thinking about sensory processing difficulties acknowledging the works, opposing stand points of the Sensory Integration Community, Ayres and APA and discussing implications for current assessment, treatment options and provision.

An experiential perspective is then presented from Graves’ work as an occupational therapist in CAMHS, from identification of commonly recognised presentations which can indicate sensory processing difficulties which include: ASD, ADHD, ‘fussy eater’, ‘emotional dysregulation’ and ‘meltdowns’ to detailing how these difficulties can be assessed and formulated with use of the sensory profile. Then the authors provide the practical examples of how to screen for these difficulties, explain them to young people, parents and schools and manage them through esnsory activities and environmental adaptations. The contributions from Howl’s experiences by working in the African Caribbean Community Initiative and as a specialist psychological wellbeing ractitioner improve access to psychological therapies for the ‘hard to reach’ population, consideration has been given to adapting these resources with the intention of them being more acceptable and accessible for use in work within BAME communities.

The chapter concludes with questions about the future implications for service provisions for people with sensory processing difficulties and how raised awareness of these difficulties might impact on other evidence-based diagnoses and treatments such as cognitive behaviour therapy (drawing on the authors recent learning on the CYP IAPT CBT course) for anxiety presentations.

An emerging evidence base, and increased awareness of the effects of trauma on the body, advocates a sensory-based approach to treatment with posttraumatic stress and complex trauma survivors. This paper aims to identify, analyse and summarise the empirical evidence for the sensory-based interventions, which occupational therapists are using in the treatment of adult and adolescent trauma survivors.

An integrative review of the literature was undertaken. Both empirical and conceptual papers were included. An inductive approach and constant comparative method were used to understand and synthesise the research.

The literature search yielded 18 papers describing the types of sensory-based interventions used, sensory processing (SP) patterns and the context and evidence for sensory-based occupational therapy practice with trauma survivors. Nine of the studies were empirical and nine were conceptual and review papers. Themes identified included: atypical SP patterns; type of sensory-based intervention used with trauma survivors; and transdisciplinary treatment programmes can reduce the symptoms of trauma.

Sensory-based interventions with adult and adolescent trauma survivors are emerging as promising areas of practice and research in the literature. Although empirical data is limited, the sensory needs of the body in processing trauma experiences is becoming more recognised and are supported by the atypical SP patterns identified in survivors. A sensory-based, transdisciplinary approach to treatment has the potential to be effective in treating the trauma survivor.

With a skill base in sensory integration and occupational analysis, occupational therapists have much to offer the field of trauma studies. This review begins to address the gap in the literature, recommending more rigorous controlled outcome research with larger sample sizes, person-centred studies focussing on the trauma survivor’s perspective and continuing professional development and mentorship for occupational therapists working with this population.

Lack of research means guidance regarding the most effective sensory interventions for adults with intellectual disabilities is limited. Preliminary consensus evidence was created by gathering experienced occupational therapists’ views on practice. The purpose of this study was to establish important elements of practice when using sensory integration-informed approaches on assessment and treatment units.

A modified Delphi process was used to gather, explore and synthesise the views of 13 occupational therapists. Data was collected via online surveys and included quantitative importance ratings and qualitative comments.

An experienced panel was in strong agreement regarding many elements of practice they felt were important for use in this setting, and a list of important practice items was created. Two themes were identified: “Complexity” and “Pragmatism vs. Ideal World.” The themes highlight challenges to practice in this area and the complex clinical reasoning used to overcome these.

Participants disagreed about the level of importance of a substantial number of items, therefore items that did not reach consensus may still be important.

This study indicates potentially helpful clinical tools, facilities and training and identifies support needed for occupational therapists working in these settings.

This study contributes to the body of knowledge regarding how occupational therapists do and could work with people with intellectual disabilities and sensory integration difficulties. Although this study takes a UK and Ireland perspective, similar agendas regarding care and support for those with intellectual disabilities internationally mean findings are relevant more widely.

Workshops are commonly used to up-skill staff and their usefulness can be determined by measuring whether or not learning needs have been met and, in particular, whether attitudes have changed. In the field of mental health, sensory modulation workshops have been introduced to educate staff about preventative measures that reduce the use of seclusion and restraint for service users with challenging behaviours. The purpose of this paper is to evaluate the impact of such a workshop.

A one-day workshop was developed based on a review of the literature and feedback from previous workshops, and with input from an industry-based reference group. An evaluation tool was designed to measure the learning outcomes, i.e., the knowledge, skills, and attitudes of the 23 participants. The Statistical Package for the Social Sciences (SPSS v20) was used to analyse the data. Multi-variate analysis of variance was used to determine the relationship between variables.

A significant increase in the knowledge, skills, and attitudes of mental health staff was identified after the one-day workshop (F=106.346, df=1, p<0.000). When considering which participants showed most benefits, it was shown that the demographics had no effect, i.e., education level, practice discipline, years of work experience in mental health, and previous sensory modulation training.

Measuring learning outcomes provides essential information about whether or not the learning objectives have been met. This allows future workshops to be tailored to ensure that the learning opportunity is at the correct level for the learners. More traditional evaluations that elicit the views of the content covered and teaching methods should additionally be used to supplement this information.

Workshops are often evaluated on the basis of the participants’ subjective response to a quick questionnaire. Developing a tool to measure outcomes is a more effective way to determine what has been learned and to ensure that positive outcomes for individuals and their organisations can be reached.

The purpose of this paper is to examine the results of New Zealand initiatives to reduce seclusion rates and report the attitudes of mental health nurses to seclusion, factors involved in seclusion use, and alternatives to seclusion.

A questionnaire was circulated to mental health inpatient staff. Data from the Ministry of Health for seclusion numbers and rates for Ma¯ori and non-Ma¯ori were also collected.

The major barriers to reducing the use of seclusion related to staffing issues, a lack of management and medical support, and physical characteristics of the facility. Data from the Office of the Director of Mental Health annual reports from 2007-2014 clearly show a reduction in the total seclusion events, the number of patients secluded, and the percentage of total patients secluded. However, the percentage of Ma¯ori secluded compared to the total number of patients secluded showed little change from 2007 to 2013.

Further analysis of the nurse’s responses showed that four of the six least-used strategies incorporated Ma¯ori cultural approaches. The authors surmise that an inability to provide culturally sensitive care, either through staffing or education factors, may be implicated in the lack of change in the seclusion rates for Ma¯ori. This may also be pertinent to seclusion rates for indigenous peoples in other countries.

This paper aims to investigate infant sensory patterns and their associations with previous perinatal loss, maternal-foetal attachment and postnatal maternal sensory patterns.

In a prospective cohort study, women with and without perinatal loss (N = 57) were recruited from an Australian public hospital. Participants were surveyed during pregnancy (maternal-foetal attachment, loss) and again postnatally (maternal/infant sensory patterns). Chi-square tests and logistic regression analyses controlling for previous perinatal loss were conducted with infant sensory patterns as outcome variables.

“More than typical” infant low registration was associated with poorer quality of maternal-foetal attachment. “More than typical” infant sensory seeking was associated with previous perinatal loss and higher levels of maternal sensory seeking. “More than typical” infant sensory sensitivity was linked with previous perinatal loss, poorer quality of maternal-foetal attachment and higher maternal low registration. “More than typical” infant sensory avoidance was associated with poorer quality of maternal-foetal attachment and higher levels of maternal sensory sensitivity.

To support more typical infant sensory patterns, results point to the potential benefit of occupational therapists supporting pregnant women with previous perinatal loss; facilitating favourable maternal-foetal attachment; and educating new mothers on how their sensory patterns impact on interactions with their infant. Sensory modulation strategies that consider the sensory patterns of both mother and infant may be beneficial to promote engagement in co-occupations.

These findings are the first to suggest that previous perinatal loss, poorer quality of maternal-foetal attachment and higher levels of maternal postnatal sensory patterns represent risk factors for infant sensory patterns that are “more than typical.”