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Foster Carers' TSD Standards covered:

Author Details

Name: Linda Plowden

Job Title: Occupational Therapist

Specialist Therapy: Sensory Integration

Current place of work: Therapy Space, Bristol

Can you explain, in brief, what Sensory Integration is and what sessions entail?

Occupational therapy is a health profession whose goal is to help people achieve independence, meaning and satisfaction in all aspects of their lives. Occupational therapists (OT’s) apply their specific knowledge to enable people to engage in activities of daily living that have personal meaning and value.

As a specialist trained sensory integration occupational therapist I use play to enable the child to find what makes them feel just right. If there is any reason why a child cannot achieve something the reason could be physical, emotional or sensory therefore it is my job to peel back the layers of the onion to see what is inhibiting progress. Children who attend sensory integration clinics will have opportunities to play on swings, climb and explore their physical environment. Sessions usually last for an hour working closely with the parents to help them and the young person understand why they cannot do something and to analyse activities to make them easier so that they are provided with a “just right” challenge. Once they find what helps them to feel physically, sensorially and emotionally regulated, exploration of more difficult subjects can be begin. This is where sensory attachment therapy comes into its own. This is a relatively new specialist approach (pioneered by Eadaoin Bhreathnach, OT and attachment counsellor) that looks at attachment behaviours and relationships between children and parents. It analyses survival behaviours and looks at what activities regulate the young person through play. Movement can often help a child to feel better about themselves especially swinging in a hammock or climbing on top of a giant cushion and crashing off into the floor (soft of course!).

What kind of changes to you aim to achieve with Sensory Integration for adopted and fostered children?

The changes I would hope to see in fostered and adopted children can be significant for both the children and the parents. (as it is a joint process) . The therapist is a facilitator for the play between the child and parent and the parents are taught (separately from the child) what type of attachment pattern is being exhibited through initial questionnaires and interviews and are then they are encouraged to work closely with the child where the therapist will lead the child and parent to:

  • Explore their environments and learn to develop a secure base from which to develop confidence in their bodies and emotional security.
  • Understand what makes them feel just right through the use of physical activity
  • Understand what foods help to support a just right feeling.
  • Understand and recognise survival behaviours such as fight, flight, freeze and shut down.
  • Learn to trust and engage reciprocally with each other
  • An increased ability to open up and share painful experiences in a safe trusted environment.
  • To have fun together and be happy.

How does Sensory Integration work for adopted and fostered children?

The very nature of the therapy is fun and about experiencing things which make you feel good, so usually children love to come to sessions. We always have a snack, chat and stories near the end once they have had a big bounce, swing and crash about. Children learn exercises on therapy balls which are easy pieces of equipment to keep at home and generally, because they are having fun, they feel emotionally secure and able to off load about more negative aspects of their lives. Some children are very controlling, as we all know, and to help them learn to share their ideas and create things, for example an obstacle course, together is an excellent way of letting go of control and sharing ideas. Learning to become more secure physically by improving core stability, strength and ability will increase the child’s confidence so they will attempt more challenging tasks.

Children can choose to do large body movement activities by swinging in the hammock, tyre swing, climbing and diving off a giant cushion or they can choose to do drawing or clay and putty work (which may be more acceptable to some children). There is no pressure for children to perform, only for them to enjoy and find activities that make them feel happy and regulated. As soon as a therapist sees that a child is deregulated they will step in and try to suggest a different activity to support the parent in understanding when a child loses it physically. Movement activates some children as it mimics the flight response so care is required to analyse and assess continuously, for the benefit of both children and parents. As a therapist I will look at and assess how the child copes with all the different sensory inputs e.g. touch, noise, movement and balance, oral taste and, smell, body awareness.

During the sessions we look at anxiety states through a set of little books (The Scared Gang2). Children often end up making their own just right books during the sessions. Parents are given their own course separately to help understand the underlying attachment and sensory processing difficulties that children who are adopted or fostered often present with.

In my experience the fears of fostered and adopted children generally fall into two categories. I will explain briefly what I believe they are and how this affects their behaviour.

Avoidant/Cognitive Bias- these children tend to fear rejection and/or intimacy. They often pretend everything is ok, never want support and take on a caring role to the parents. These children find it hard to open up and share feelings so building on trust in playful, safe way is important.

Coercive/Emotional Bias– these children tend to fear separation from key care giver. They will often be difficult to manage and are the ones who get into trouble most. They will pull you in and push you away, fight, get jealous and be in your face. They can also present as very sweet and charming which disarms parents but this is another way of getting attention drawn to themselves. These children need containment and boundaries as feel unsafe and insecure without it.

The SI approach is, in my experience, really effective with these children as it is client led and it allows children to explore and develop confidence with their emotions in a safe, contained environment with people they trust.

Who does Sensory Integration?/What kind of training do Sensory Integration Therapists have?

Generally SI is delivered by qualified OT’s. All OTs have to be trained to a degree (since 1988) or Diploma level from College of OT (1987 and before). They are registered by the Health and Care Professions Council (HCPC) and should also be member of the British Association of Occupational Therapists BAOT. The course is three years with approximately one year in practise while training.

Once qualified OTs can do a post graduate training in Sensory Integration and additional training on the Just Right state.

Why are you passionate about Sensory Integration for fostered and adopted children?

Sensory attachment training brings together my knowledge of how a child copes physically with how they engage with others using sensory and attachment principles. This work has been so rewarding for me and my clients I can think of no other way to work now.

I feel passionately about delivering training to and implementing sensory strategies in schools and other organisations in the form of a sensory diet. This approach can make life, for children who have sensory difficulties, much easier.

I have the best time working with the families referred to me and I know that the input is so often one of the most important things families have done.

Linda is a private practitioner in the Bristol area. Her website http://www.therapyspacebristol.co.uk contains lots of incredibly valuable hints, tips and resources including descriptions of the various sensory systems in the blog section.

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