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Abstract

Background/aim: Sensory approaches in mental health are designed to assist consumers to regulate physiological and emotional arousal. They have been highlighted as non-invasive, self-directed and empowering interventions that may support recovery-oriented and trauma-informed mental health practice and may assist in efforts to reduce the use of seclusion and restraint. Over recent years, there has been a substantial increase in research in this area. However, there has not yet been any attempt to map and summarise this literature. Method: A five-stage scoping review was conducted. Four databases were searched for literature evaluating sensory interventions implemented in mental health settings. Results: A total of 17 studies were included in the final review. A range of sensory approaches was evaluated and a range of outcomes measured. In general, consumers reported reductions in distress associated with engaging in sensory interventions. Results in terms of reduction of seclusion and restraint were mixed, with some studies reporting a decrease, others reporting no change and one reporting an increase. Methodological limitations in the studies reviewed mean that results should be interpreted with caution. Conclusions: Although there is emerging evidence for the usefulness of sensory approaches in supporting consumers' self-management of distress, there is less evidence for sensory approaches supporting reductions in seclusion and restraint when used in isolation. More research is necessary, but sensory approaches do appear safe and effective. Services wishing to reduce seclusion and restraint should implement sensory approaches in conjunction with other strategies to achieve this important outcome.
Sensory approaches in mental health 1
NB: This is not a definitive version of the paper. Several changes have been made
between this version and the final published version.
This is the pre-peer reviewed version of the following article:
Scanlan, J. N., & Novak, T. (2015). Sensory approaches in mental health: A
scoping review. Australian Occupational Therapy Journal, 62(5), 277-285.
which has been published in final form at
http://onlinelibrary.wiley.com/doi/10.1111/1440-1630.12224/full
TITLE
Sensory approaches in mental health: A scoping review
RUNNING TITLE
Sensory approaches in mental health
AUTHORS
Justin Newton Scanlan, PhD, MHM, BOccThy
Lecturer, Occupational Therapy, Faculty of Health Sciences, University of Sydney and
Professional Senior Occupational Therapy, Mental Health Services, Sydney Local Health
District.
Theresa Novak, BAppSc(OT), DipBus
Team Leader Occupational Therapy, Mental Health Services, Sydney Local Health District.
Sensory approaches in mental health 2
NB: This is not a definitive version of the paper. Several changes have been made
between this version and the final published version.
Abstract
Introduction: The use of sensory approaches in mental health has seen a massive surge in
popularity over recent years. Sensory approaches have been highlighted as non-invasive, self-
directed and empowering interventions that may support more recovery-oriented and trauma-
informed practice. There has also been suggestion that sensory approaches to care may
support efforts to reduce seclusion and restraint.
Method: Medline, CINAHL, ProQuest Central and Scopus databases were searched for
literature evaluating outcomes associated with sensory interventions implemented specifically
in mental health settings or for individuals experiencing mental illnesses.
Results: A total of 18 studies were included in the final review. A range of sensory
approaches were evaluated. In general, consumers reported reductions in distress associated
with engaging in sensory interventions. Other outcomes included improvements in staff-rated
behaviours or symptoms and improvements in communication between staff and consumers.
Results in terms of reduction of seclusion and restraint were mixed, with some studies
reporting a decrease, others reporting no change and one reporting an increase.
Methodological limitations in the studies reviewed mean that results should be interpreted
with caution.
Conclusions: Although there is emerging evidence for the usefulness of sensory approaches
in supporting consumers‟ self management of distress, there is less evidence for sensory
approaches supporting reductions in seclusion and restraint when used in isolation. More
research is necessary, but sensory approaches do appear safe and effective. Services wishing
to reduce seclusion and restraint should implement sensory approaches as well as a range of
other strategies to achieve this important outcome.
Sensory approaches in mental health 3
NB: This is not a definitive version of the paper. Several changes have been made
between this version and the final published version.
Sensory approaches in mental health: A scoping review
Introduction
The use of sensory approaches in mental health settings has expanded rapidly over the last 10
years. This surge in popularity has been spearheaded by US-based occupational therapist
Tina Champagne (Champagne, 2005; Champagne, Koomar, & Olson, 2010; Champagne &
Stromberg, 2004) and is often associated with international efforts to reduce and eliminate the
use of seclusion, restraint and other forms of restrictive practices in mental health services.
Occupational therapists in Australia, New Zealand, the United States and the United
Kingdom have embraced these roles and many have integrated sensory approaches into their
daily practice.
The term “sensory approaches” in this context covers a range of interventions including:
“sensory rooms”; sensory groups; sensory assessments and the development of “sensory
diets” or integration of sensory activities into “safety plans”; the use of “sensory kits”; and
the use of specific sensory integration programs. Sensory rooms (sometimes called “comfort
rooms”) are specialised spaces (typically in inpatient or residential settings) designed to
provide predominantly soothing sensory input to a variety of the senses. These can include:
coloured lights and scenic pictures (sight); aromatherapy (smell); self-massagers, “stress
balls,” fidget toys and textured items or fabrics (touch); sweet, sour or salty food or flavoured
tea (taste); relaxing music / sounds (hearing); rocking chairs (proprioception). Weighted
items such as weighted blankets, toys, vests and lap bags are multi-modal providing several
sensory inputs at once (e.g., deep pressure, touch and sight). Individuals can select to use the
sensory room for “time out” and to make active efforts to soothe and calm themselves. A
Sensory approaches in mental health 4
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between this version and the final published version.
specific form of sensory room, “Snoezelen rooms” originated in the Netherlands and are
designed to provide both soothing and stimulating sensory inputs. Snoezelen rooms have
been used for individuals with autism, developmental delay, dementia or brain injury as well
as, more recently, individuals with mental illnesses. Sensory groups (e.g., the Sensory
Connections program: Moore, 2005) can be implemented in inpatient or community settings
with the aim of providing stimulating or soothing sensory input to participants. Sensory
assessments, such as the widely used Adolescent/Adult Sensory Profile (Dunn, 2002), are
used to identify sensory processing difficulties and sensory preferences. Information from
these assessments can be used to develop individualised “sensory diets” or to establish a set
of sensory interventions that may be soothing for the individual (as each person‟s sensory
preferences are different). Although not specifically a sensory intervention, safety plans
(LeBel et al., 2004; Lee, Cox, Whitecross, Williams, & Hollander, 2010) are individually-
developed plans that outline situations that may cause distress and a range of interventions /
activities that may be helpful in managing this distress. Safety plans are often associated with
sensory approaches as management strategies frequently include sensory interventions.
“Sensory kits” can be personalised or general kits containing a range of sensory resources for
use in a variety of locations. Personalised sensory kits are often developed over time and
include items that have proven useful for the individual in managing their distress. General
“sensory kits” (also referred to as “sensory trolleys”) are a portable or mobile collection of
sensory resources for use by a variety of individuals. These general sensory kits are often
used in settings with limited space or where a sensory room is not available. Finally, Sensory
Integration is a very specific approach to sensory intervention, requiring additional training,
developed by A. Jean Ayers and adapted for use with individuals with schizophrenia by
Lorna Jayne King (King, 1974; Posthuma, 1983).
Sensory approaches in mental health 5
NB: This is not a definitive version of the paper. Several changes have been made
between this version and the final published version.
Sensory approaches have been highlighted as non-invasive, self-directed and empowering
interventions that may support more recovery-oriented and trauma-informed practice. Several
“best practice” guidelines focused on the reduction of seclusion and restrain have
recommended the use of sensory approaches as part of a comprehensive seclusion and
restraint reduction strategy (e.g., MacDaniel, Van Bramer, & Hogan, 2009; O‟Hagan, Divis,
& Long, 2008).
Given their intuitive appeal, very promising initial findings (Champagne & Stromberg, 2004)
and support from regulatory agencies, it is not surprising that sensory approaches have
captured the imagination of occupational therapists and other clinicians in mental health
services across the world. However, until recently, very few published studies evaluated the
effectiveness of sensory approaches in mental health. Research in this area is expanding, but
the evidence has not yet been synthesised. As occupational therapists are likely to be the
profession most vocally advocating for the adoption of sensory approaches to care, the
synthesis of this evidence is especially important for this audience.
This project was established to explore the current evidence base for the effectiveness of
sensory approaches in psychiatric or mental health services. The research question that
guided this study was: From published, peer-reviewed literature, what are the outcomes
associated with sensory approaches designed specifically for use with individuals
experiencing a mental illness or mental health problems?
Method
The search strategy is outlined in Figure 1. Four databases (Medline, CINAHL, ProQuest
Central and Scopus) were searched using the following keywords: ("sensory modulation" OR
Sensory approaches in mental health 6
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between this version and the final published version.
"sensory room" OR "comfort room" OR "sensory approac*" OR "sensory interven*" OR
"sensory integrat*" OR Snoezelen) AND (psychiat* OR "mental health"). These searches
returned 1,174 documents. The title (and abstract where necessary) were reviewed to evaluate
potential for relevance to the research question. Papers were retained if they reported on
specific evaluations of sensory interventions / approaches implemented in psychiatric or
mental health settings, or with individuals experiencing a mental illness. As the research
question was specifically related to psychiatric and mental health services, studies exploring
the use of sensory approaches with other populations (e.g., individuals with intellectual
disability, brain injury, dementia or autism) were excluded. Published conference abstracts
and articles in languages other than English were also excluded. After removing duplicates,
there were a total of 35 potentially relevant references. Full texts of these papers were
retrieved and reviewed. A total of 13 were retained for inclusion in this review. Reference
lists and citations of included papers were also reviewed to identify any further relevant
papers. This process identified an additional five papers (Barton, Johnson, & Price, 2009; Lee
et al., 2010; Levine, O'Connor, & Stacey, 1977; Maguire, Young, & Martin, 2012; Moore &
Henry, 2002).
< insert Figure 1 about here>
The final 18 papers were read in detail and summarised. Using an inductive approach,
commonalities between studies were identified from the studies themselves rather than
summarising studies according to a pre-determined set of criteria.
Results
Summary information about each of the studies is presented in Table 1.
Sensory approaches in mental health 7
NB: This is not a definitive version of the paper. Several changes have been made
between this version and the final published version.
< insert Table 1 about here>
Types of studies
The majority of papers included reports of naturalistic studies designed to evaluate the
effectiveness of sensory approaches implemented in an established treatment setting
(typically inpatient psychiatric units) with existing consumers. While most studies measured
consumer outcomes associated with use of sensory interventions, several also took the form
of pre- post- implementation evaluations (Barton et al., 2009; Chalmers, Harrison, Mollison,
Molloy, & Gray, 2012; Champagne & Stromberg, 2004; Cummings, Grandfield, & Coldwell,
2010; Lee et al., 2010; Lloyd, King, & Machingura, 2014; Maguire et al., 2012; Novak,
Scanlan, McCaul, MacDonald, & Clarke, 2012; Sivak, 2012; Smith & Jones, 2014; Sutton,
Wilson, Van Kessel, & Vanderpyl, 2013). These measured one or several indicators before
and after the implementation of sensory approaches to address the question: is the availability
of sensory interventions associated with improvements in the service or treatment
environment? The main other study design was pre- and post- evaluations of outcomes
associated with specific interventions delivered to a defined cohort of participants (Costa,
Morra, Solomon, Sabino, & Call, 2006; Knight, Adkison, & Kovach, 2010; Levine et al.,
1977; Reddon, Hoang, Sehgal, & Marjanovic, 2004; Reisman & Blakeney, 1991).
Sensory approaches used
The most common type of sensory approach reported was sensory rooms (Barton et al., 2009;
Chalmers et al., 2012; Champagne & Stromberg, 2004; Costa et al., 2006; Cummings et al.,
2010; Lloyd et al., 2014; Maguire et al., 2012; Novak et al., 2012; Sivak, 2012; Smith &
Jones, 2014; Sutton et al., 2013). These were either implemented as the main intervention
Sensory approaches in mental health 8
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(although use of sensory modulation interventions was not restricted to the confines of the
sensory room: Champagne & Stromberg, 2004; Cummings et al., 2010; Lloyd et al., 2014;
Novak et al., 2012; Reddon et al., 2004; Sivak, 2012; Smith & Jones, 2014), alongside a suite
of other sensory tools (Chalmers et al., 2012; Costa et al., 2006) or as one part of larger multi-
strategy seclusion reduction initiatives (Barton et al., 2009; Maguire et al., 2012; Sutton et al.,
2013). Most were implemented in inpatient settings, although two (Costa et al., 2006; Moore
& Henry, 2002) were implemented in community settings. Another was essentially “setting
free,” as it investigated the immediate physiological effects of Snoezelen treatment sessions
on volunteer participants (Reddon et al., 2004).
Other sensory approaches used included: sensory modulation interventions without a sensory
room (i.e., general sensory kits: Chalmers et al., 2012; Knight et al., 2010; Lee et al., 2010);
safety plans incorporating sensory strategies (Lee et al., 2010; Maguire et al., 2012); group
sensory modulation programs (Chalmers et al., 2012); the Wilbarger Protocol (a specific
intervention program involving "brushing" techniques and deep pressure via joint
compressions to various body parts: Costa et al., 2006; Moore & Henry, 2002); sensory diets
(Costa et al., 2006; Moore & Henry, 2002); weighted blankets (Mullen, Champagne,
Krishnamurty, Dickson, & Gao, 2008); and formal Sensory Integration programs (Levine et
al., 1977; Reisman & Blakeney, 1991). Again, these interventions were predominantly
delivered in inpatient settings, although two were delivered to community-based consumers
(Costa et al., 2006; Moore & Henry, 2002).
Outcomes
Various outcomes have been used to measure the usefulness of sensory approaches. The two
most common outcomes measured were consumers‟ self-rated distress and seclusion and/or
Sensory approaches in mental health 9
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restraint rates. Outcomes in these areas for each study (where measured) are shown in Table
1.
Many studies used consumers‟ self-reported distress as a primary measure of effectiveness
for sensory room use (Chalmers et al., 2012; Champagne & Stromberg, 2004; Costa et al.,
2006; Cummings et al., 2010; Lloyd et al., 2014; Novak et al., 2012; Sivak, 2012). The
process used most frequently was to ask consumers to retrospectively rate their level of
distress before and after using the room (Chalmers et al., 2012; Champagne & Stromberg,
2004; Cummings et al., 2010; Lloyd et al., 2014; Novak et al., 2012; Sivak, 2012). In all
studies, most consumers reported significant reductions in distress after use of the room. In
most studies, a very high proportion of consumers (generally over 85%) reported a decrease
in distress after room use. Results from one study were less positive (Sivak, 2012): although
eight out of 13 consumers (62%) reported a decrease in distress following room use, five
(38%) reported an increase. Despite this increase in distress, all five consumers reported that
room use was helpful (Sivak, 2012). Costa et al. (2006) did not report specific results, but
suggested that consumers using the room experienced an increase in relaxation.
The other most common measure of the usefulness of sensory approaches was the
comparison of rates of seclusion or restraint before and after the adoption of sensory
approaches. Although the landmark study (Champagne & Stromberg, 2004) demonstrated a
very large reduction in rates of seclusion and restraint, this has not been replicated
consistently in other studies. Of the nine studies reporting on changes in seclusion or restraint
rates, five studies (56%) showed a decrease (Barton et al., 2009; Champagne & Stromberg,
2004; Lloyd et al., 2014; Maguire et al., 2012; Sivak, 2012), there was no change in three
(33%) (Chalmers et al., 2012; Cummings et al., 2010; Novak et al., 2012) and one (11%)
Sensory approaches in mental health 10
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between this version and the final published version.
reported an increase (Smith & Jones, 2014). In addition, some studies (Lee et al., 2010;
Sutton et al., 2013) implemented sensory approaches to care in the context of seclusion and
restraint reduction, but did not report the actual change in these rates.
A variety of other outcomes were reported. These are summarised in the final column of
Table 1. In general, consumers‟ use of or engagement with sensory interventions was
associated with positive changes in most of the outcomes measured. These outcomes
included: (i) improved or more settled behaviour as rated by staff (Chalmers et al., 2012;
Levine et al., 1977; Novak et al., 2012; Reisman & Blakeney, 1991; Sutton et al., 2013); (ii)
better engagement between consumers and staff (Smith & Jones, 2014; Sutton et al., 2013);
and (iii) improved consumer experience in the inpatient setting (Smith & Jones, 2014).
Individual studies also noted: (i) reduction in overt psychiatric symptoms (Reddon et al.,
2004; Reisman & Blakeney, 1991); (ii) a trend towards lower rates of consumer to consumer
aggression (Sivak, 2012); and (iii) reduced physiological signs of arousal (Reddon et al.,
2004).
Comparisons
Very few studies compared sensory approaches with other interventions. Knight et al. (2010)
compared the change in consumers‟ scores on the Brief Psychiatric Rating Scale (BPRS)
before and after a sensory intervention or a “traditional” nursing intervention (e.g., one on
one time with the nurse; facilitating “time out” in a quiet location). Both types of intervention
led to an improvement in BPRS scores and sensory interventions were shown to be as
effective as the “traditional” interventions. Other studies (Cummings et al., 2010; Lloyd et al.,
2014) have compared seclusion or restraint rates in units with and without sensory
approaches. Results from one study suggested a lower rate of seclusion on the unit where
Sensory approaches in mental health 11
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sensory approaches had been implemented (Lloyd et al., 2014) whereas the other found no
difference between the units (Cummings et al., 2010).
Another study (Novak et al., 2012) compared the relative usefulness of different items in the
sensory room environment. Results suggested that consumers who used the weighted blanket
were more likely to report greater reductions in distress than consumers who did not use the
weighted blanket (Novak et al., 2012). A similar trend was reported for use of the rocking
chair, although this did not reach statistical significance (Novak et al., 2012).
Finally, Mullen et al. (2008) compared the safety, physiological and anxiety-related effects of
lying down for 5 minutes with and without a weighted blanket. Results demonstrated that the
weighted blanket appeared safe (i.e., did not cause any harmful changes in pulse, blood
pressure or oxygen saturation) and participants reported feeling less anxious when using the
blanket, although there were no differences in participants‟ physiological signs of anxiety
between the “blanket” and “no blanket” conditions.
Discussion
This project was established to synthesise the current evidence regarding the use of sensory
approaches in mental health practice. A sound understanding of this evidence base is essential
for all occupational therapists in mental health to inform intervention planning and advice
given to other multidisciplinary team members.
Interestingly, only three (Costa et al., 2006; Moore & Henry, 2002; Mullen et al., 2008) of the
16 studies published in the last 20 years have been published in occupational therapy
journals. Whilst presenting occupational therapy research to a wider audience is essential, the
Sensory approaches in mental health 12
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downside may be that unless specifically searching for it, occupational therapists in mental
health may not be aware of these studies. Thus, the evidence synthesis generated through this
project aims to arm the occupational therapy workforce with evidence-based information to
support the implementation, further development and review of sensory interventions.
Prior to considering the results from this project in more detail, it is important to highlight
some of the methodological shortcomings of these studies. The most substantial limitation in
almost all studies is that raters (either consumers rating their own distress or staff rating
behaviours or symptoms) were not blinded (i.e., they were aware of the intervention received
by the consumer). Although this non-blinding of raters is difficult (in the case of staff) or
impossible (in the case of consumers) to overcome, it does introduce a substantial source of
potential bias. As raters know that the intervention has been received and they may expect
that the intervention will support a reduction in distress or improvement in behaviour, then
they may be more likely to rate in such a way that shows this change. Additionally, the
relatively small sample sizes and lack of comparison conditions or control groups typically
reported also mean that these results should be interpreted with caution. Finally, some
publications were quite limited in terms of the detail presented about the research
methodology and the specific results obtained were not reported, or reported very briefly.
This lack of detail makes it more difficult to examine the rigour of the studies described in
the literature. Considered together, all of these factors suggest that the current state of
knowledge surrounding sensory interventions remains in its infancy. More rigorous research
to confirm these initial findings is necessary.
Notwithstanding the limitations outlined above, all studies that explored effects on
individuals receiving sensory interventions demonstrated positive results. Over time, the aim
Sensory approaches in mental health 13
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of sensory approaches in mental health has shifted from Sensory Integration treatment to
improve sensory integration in individuals with long-term mental illness towards a focus on
the use of sensory approaches as an intervention to support consumers‟ self-management of
distress and other strong emotions. This change in focus has also meant a change in what is
measured in terms of outcomes. Earlier studies (Levine et al., 1977; Reisman & Blakeney,
1991) measured perceptual-motor performance, whereas newer studies (Chalmers et al.,
2012; Champagne & Stromberg, 2004; Cummings et al., 2010; Lloyd et al., 2014; Novak et
al., 2012; Sivak, 2012) have tended towards a greater focus on distress and disturbed
behaviour. Although modest perceptual-motor improvements were noted in the Sensory
Integration studies, outcomes in terms of reduction in distress and improvement in behaviour
have been much more consistent. Although there is a risk that some of these positive results
are influenced by “expectancy” or “placebo” effects, the consistency of the results, coupled
with Reddon et al.‟s (2004) finding that heart rate and some other physical signs of arousal
reduced following sensory intervention, allows the tentative conclusion to be drawn that
sensory interventions are likely to support reductions in distress and behavioural disturbance.
Although sensory approaches are often implemented in an attempt to reduce seclusion and
restraint, results in this area have been mixed. Despite the small number of studies, it appears
that reductions in seclusion and restraint were more likely achieved when sensory approaches
were coupled with other seclusion and restraint reduction strategies (e.g., Barton et al., 2009;
Maguire et al., 2012) as opposed to being the main change in practice (e.g., Chalmers et al.,
2012; Novak et al., 2012). While some authors attempted to “explain away” the lack of
change in seclusion or restraint rates, these results are maybe not as surprising as they first
appear. Seclusion and restrain reduction is acknowledged as a complex issue requiring
multiple strategies (Huckshorn, 2004, 2006). Although it is tempting to think that by reducing
Sensory approaches in mental health 14
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consumers‟ level of distress, the need for seclusion or restrain would be reduced, in the
absence of a shift in workplace culture or external pressure to change practice, this may not
always occur. A previous review of interventions to reduce seclusion and restraint in inpatient
psychiatric settings suggested that “bottom up” program changes implemented without other
“top down” pressure for change were unlikely to achieve reductions in seclusion or restraint
(Scanlan, 2010).
The small number of published studies that have included qualitative components (Smith &
Jones, 2014; Sutton et al., 2013) is disappointing. One of the most commonly reported
benefits of sensory approaches is to improve the experience of consumers who are
hospitalised and to minimise re-traumatisation. Therefore, the deep exploration of consumer
(and staff) experiences is essential to fully understanding how these improvements in
consumer experience are supported in practice. Themes emerging from these qualitative
studies highlight that the use of sensory approaches can support a more positive relationship
between consumers and staff; facilitate a calm state and support consumers to develop self-
management strategies (Smith & Jones, 2014; Sutton et al., 2013). Improvements in
communication may be a result of the changed nature of support. Instead of nurses and other
staff being the “owners” of treatments to reduce distress (e.g., medication), the nature of
sensory approaches allows this ownership to be shared. The staff member and consumer can
work collaboratively to develop effective strategies aiming to reduce distress. Several studies
also noted the potential of using sensory strategies to support the consumers‟ longer term
management of distress even following discharge, although longitudinal outcomes have not
been explored.
Sensory approaches in mental health 15
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In addition to the topics discussed above, three other important issues were raised in some of
the papers reviewed. These were (i) the importance of multi-disciplinary team involvement;
(ii) staff education and training; and (iii) the sometimes low use of sensory approaches by
males. Involvement of the whole team in the implementation of sensory approaches is
highlighted as an extremely important factor (e.g., Chalmers et al., 2012). Although
occupational therapists may lead the implementation process for sensory approaches, there
must be effective engagement of other multi-disciplinary team members in this process. This
is critical for several reasons: firstly, occupational therapists are generally only available
during working hours and tools for the management of distress should be available to
consumers 24 hours per day; secondly, other clinicians should be familiar and comfortable
with recommending sensory approaches to consumers and providing assistance if necessary;
and finally, other staff members should be familiar with the evidence behind sensory
approaches to support rather than undermine their usefulness in discussions with consumers.
Staff education is an important aspect of the engagement process and can support increased
confidence and use of sensory approaches (Martin & Suane, 2012). Education should focus
on: the theory and evidence behind sensory approaches; how to identify early signs of distress
and disturbed behaviour; orientation to and practical exploration of sensory items; and how to
support consumers to use sensory equipment safely and effectively (Chalmers et al., 2012;
MacDaniel et al., 2009). Ongoing training is optimal as staff often report low confidence in
the use of sensory approaches even subsequent to training (Lee et al., 2010; Te Pou o te
Whakaaro Nui, 2010). A final observation worth considering is that, in some studies, males
have had very low rates of utilisation of sensory rooms (Novak et al., 2012; Sivak, 2012).
This suggests that further work is required to ensure that sensory rooms and other sensory
approaches are considered acceptable to male consumers and that staff understand how
sensory approaches can be useful for managing males‟ expressions of distress (which are
Sensory approaches in mental health 16
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often externally-directed) as well as females‟ expressions of distress (which are more likely
to be internally-directed).
Conclusion and future directions
This project has synthesised the evidence for sensory approaches in mental health settings.
The ability to draw clear conclusions from the currently-published literature is limited by
issues with the quality and rigour of the reported studies and the risk of bias. Despite these
limitations, the available evidence appears to suggest that adopting sensory approaches to
care is effective in supporting reduced distress and reduced behavioural disturbance in
consumers. The evidence for an association between the introduction of sensory approaches
in isolation of other strategies and reductions in seclusion and restraint is inconclusive.
The implications of these results for occupational therapists (and other clinicians interested in
applying sensory approaches to care) are significant. Although it is important to highlight the
potential of sensory approaches to support the implementation of seclusion and restraint
reduction programs, it is critical to identify that the introduction of sensory approaches alone
cannot change culture and practices that are associated with the use of seclusion and restraint.
The risk of “overpromising” in terms of what sensory approaches can deliver, is that
numerous other potential benefits associated with sensory approaches may be ignored or
overlooked if seclusion and restraint is not reduced.
The evidence summarised in this project suggest that sensory approaches to care can be
implemented effectively and can have numerous positive outcomes. Sensory approaches are
tools that can empower both staff and consumers to build more effective and collaborative
relationships that focus on self-management of distress through the implementation of simple,
Sensory approaches in mental health 17
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positive and inexpensive strategies which can also be integrated into consumers‟ routines
following discharge.
From a “pure” evidence based practice approach, future research in this area should include
studies designed to include rater blinding and randomised assignment to either sensory
interventions or other comparison interventions. Although such studies would be useful to
further build the evidence base for sensory approaches to care, these may be difficult to
implement in practice. For example, would it be ethical to stop a distressed consumer from
accessing sensory interventions, even if they had previously consented to be involved in such
a study? Given the importance of consumer choice and collaborative decision making in the
context of recovery-oriented and trauma-informed approaches to practice, this may be a
challenging conflict to reconcile.
Future research should also focus on studies with larger sample sizes, longitudinal studies and
multi-site studies comparing various settings such as acute, rehabilitation, aging older
person‟s mental health, drug health, adolescents, forensic and eating disorders units. Other
research could include the exploration of whether specific types of sensory approaches are
more effective than others and may support the development of a “hierarchy of sensory
interventions in mental health.” This would further guide the implementation of sensory
approaches by supporting staff and consumers to more efficiently identify the most effective
and appropriate types of sensory approaches for differing settings.
Overall, there has been a significant expansion of knowledge related to sensory approaches to
care in the last 10 years. Much of this evidence points to the value and usefulness of sensory
interventions, but it is important to remain aware of the limitations of this knowledge base.
Sensory approaches in mental health 18
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Occupational therapists currently using or considering integrating sensory approaches into
their practice are encouraged to do so, but with a caution not to “over promise” seclusion and
restraint reduction outcomes from sensory approaches alone. Additionally, services
implementing sensory approaches should ensure that robust evaluation processes are in place.
There is an emerging evidence base for the usefulness of sensory approaches to care,
especially in terms of assisting consumers to find positive and safe ways of managing distress
and disturbed behaviours. The evidence for sensory approaches to care leading to reductions
in seclusion and restraint is much less consistent. Services wishing to assertively reduce
seclusion and restraint are encouraged to implement sensory approaches as part of a larger
strategy incorporating Huckshorn‟s (2004, 2006) “six core strategies.” More research is
required, but sensory approaches to care do hold substantial promise for being one aspect of a
larger strategy to support the positive, recovery-oriented and trauma-informed mental health
services that consumers, clinicians and communities want and deserve.
References
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Inpatient Behavioral Health Unit. Journal of Psychosocial Nursing & Mental Health
Services, 47(1), 34-40.
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. doi: 10.1177/1039856211430146
Champagne, T. (2005). Expanding the role of sensory approaches in acute psychiatric
settings. Mental Health Special Interest Section Quarterly, 28(1), 1-4.
Sensory approaches in mental health 19
NB: This is not a definitive version of the paper. Several changes have been made
between this version and the final published version.
Champagne, T., Koomar, J., & Olson, L. (2010). Sensory processing evaluation and
intervention in mental health. OT Practice, 15(5), CE1-CE7.
Champagne, T., & Sayer, E. (2003). The effects of the use of the sensory room in psychiatry
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Champagne, T., & Stromberg, N. (2004). Sensory Approaches in Inpatient Psychiatric
Settings: Innovative Alternatives to Seclusion & Restraint. Journal of Psychosocial
Nursing & Mental Health Services, 42(9), 34-44.
Costa, D. M., Morra, J., Solomon, D., Sabino, M., & Call, K. (2006). Snoezelen and sensory-
based treatment for adults with psychiatric disorders. OT Practice, 11(4), 19-23.
Cummings, K. S., Grandfield, S. A., & Coldwell, C. M. (2010). Caring with comfort rooms:
reducing seclusion and restraint use in psychiatric facilities. Journal of Psychosocial
Nursing & Mental Health Services, 48(6), 26-30. doi: 10.3928/02793695-20100303-
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Dunn, W. (2002). The Adolescent/Adult Sensory Profile. San Antonio, Texas: Therapy Skill
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Huckshorn, K. (2004). Reducing seclusion restraint in mental health use settings: Core
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Knight, M., Adkison, L., & Kovach, J. S. (2010). A comparison of multisensory and
traditional interventions on inpatient psychiatry and geriatric neuropsychiatry units.
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LeBel, J., Stromberg, N., Duckworth, K., Kerzner, J., Goldstein, R., Weeks, M., . . . Sudders,
M. (2004). Child and adolescent inpatient restraint reduction: A state initiative to
promote strength-based care. Journal of the American Academy of Child &
Adolescent Psychiatry, 43, 37-45.
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10.1017/S1742646410000014
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17-21. doi: 10.1177/000841747704400105
Lloyd, C., King, R., & Machingura, T. (2014). An investigation into the effectiveness of
sensory modulation in reducing seclusion within an acute mental health unit.
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MacDaniel, M., Van Bramer, J., & Hogan, M. F. (2009). Comfort rooms: A preventative tool
to reduce the use of restraint and seclusion in facilities that serve individuals with
mental illness. New York, NY: New York State Office of Mental Health.
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setting. Journal of Psychiatric and Mental Health Nursing, 19(2), 97-106.
Martin, B. A., & Suane, S. N. (2012). Effect of Training on Sensory Room and Cart Usage.
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between this version and the final published version.
Moore, K. M. (2005). The sensory connection program: Activities for mental health
treatment. Manual and handbook. Framingham, Massachusetts: Therapro.
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Wilbarger Protocol. Occupational Therapy in Mental Health, 18, 43-63. doi:
10.1300/J004v18n01_03
Mullen, B., Champagne, T., Krishnamurty, S., Dickson, D., & Gao, R. X. (2008). Exploring
the safety and therapeutic effects of deep pressure stimulation using a weighted
blanket. Occupational Therapy in Mental Health, 24(1), 65-89.
Novak, T., Scanlan, J., McCaul, D., MacDonald, N., & Clarke, T. (2012). Pilot study of a
sensory room in an acute inpatient psychiatric unit. Australasian Psychiatry, 20(5),
401-406. doi: 10.1177/1039856212459585
O‟Hagan, M., Divis, M., & Long, J. (2008). Best practice in the reduction and elimination of
seclusion and restraint; Seclusion: time for change. Auckland: Te Pou Te Whakaaro
Nui: the National Centre of Mental Health Research, Information and Workforce
Development. Available from www.tepou.co.nz.
Posthuma, B. W. (1983). Sensory integration in mental health: dialogue with Lorna Jean
King. Occupational Therapy in Mental Health, 3(4), 1-10.
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.
Reisman, J. E., & Blakeney, A. B. (1991). Exploring sensory integrative treatment in chronic
schizophrenia. Occupational Therapy in Mental Health, 11(1), 25-43.
Scanlan, J. N. (2010). 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, 56, 412-423.
Sensory approaches in mental health 22
NB: This is not a definitive version of the paper. Several changes have been made
between this version and the final published version.
Sivak, K. (2012). Implementation of Comfort Rooms to Reduce Seclusion, Restraint Use, and
Acting-Out Behaviors. Journal of Psychosocial Nursing & Mental Health Services,
50(2), 24-34. doi: http://dx.doi.org/10.3928/02793695-20110112-01
Smith, S., & Jones, J. (2014). Use of a sensory room on an intensive care unit. Journal of
Psychosocial Nursing & Mental Health Services, 52(5), 22-30. doi:
10.3928/02793695-20131126-06
Sutton, D., Wilson, M., Van Kessel, K., & Vanderpyl, J. (2013). Optimizing arousal to
manage aggression: A pilot study of sensory modulation. International Journal of
Mental Health Nursing, 22(6), 500-511. doi: 10.1111/inm.12010
Te Pou o te Whakaaro Nui. (2010). Impact of sensory modulation in mental health acute
wards on reducing the use of seclusion. Aukland: Te Pou o te Whakaaro Nui.
Available from http://www.tepou.co.nz.
Sensory approaches in mental health 23
NB: This is not a definitive version of the paper. Several changes have been made
between this version and the final published version.
Figure 1. Outline of overall search strategy and selection of papers for final review
Sensory approaches in mental health 24
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Table 1. Summary of studies included in final review
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Barton et al. (2009)
Setting: 26-bed unit (including psychiatric intensive care and
general sections) in a 248-bed private community hospital
Location: United States
Intervention/s: Conversion of the seclusion room (which had never
been used) into a sensory room in the context of numerous other
restrain reduction strategies
Comparison setting / intervention: Nil
Consumer participants: No specific consumer measures
Use of restraints reduced
with zero restraints in the
final year reported
Not reported
Reduction in restraint use was
achieved without increase in
use of anti-psychotic or
sedative medications
Sensory approaches in mental health 25
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Chalmers et al. (2012)
Setting: 29-bed acute psychiatric unit
Location: Victoria, Australia
Intervention/s: Sensory trolley; Sensory room; Sensory-based
group program
Comparison setting / intervention: Nil
Consumer participants: Consumers reported on ~127 uses of the
sensory room; ~1029 consumers were rated by staff before and
after their participation in the group program
No change; actual rate not
reported
Significant reduction
in self-rated distress.
Mean 5.98 [pre] to
3.09 [post] on a 10-
point scale
Significant reduction in
clinician-rated level of arousal
following use of sensory room
and engagement in sensory-
based group program
Sensory approaches in mental health 26
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Champagne and Stromberg (2004)1
Setting: 24-bed locked psychiatric unit in a 125 bed community
hospital
Location: Massachusetts, United States
Intervention/s: Sensory room
Comparison setting / intervention: Nil
Consumer participants: 47 consumers reported on 96 uses of the
sensory room
Seclusion and restraint rate
reduced by 54% (actual rate
or time period not reported)
89% reported an
improvement; 10%
reported same; 1%
reported worse
--
Sensory approaches in mental health 27
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Costa et al. (2006)
Setting: Community based agency that serves persons with mental
health and substance abuse issues
Location: New York, United States
Interventions/s: Centre sessions: Weekly 1-hour group sessions in
the Snoezelen room for one month; Home program: Wilbarger
Protocol and sensory diet developed from results of Adult Sensory
Profile
Comparison setting / intervention: Nil
Consumer participants: Total of 27 consumers over two years
Not applicable (community
setting)
No specific outcome
data reported; “Clients
reported an increased
state of relaxation in
the multi-sensory
environment... Those
clients who followed
through with the
Wilbarger Protocol
reported positive
results, stating they felt
„better‟ and „more
grounded‟” (p. 22)
Home program was
challenging for consumers to
maintain;
A second study focused on 2-
hour sessions, twice per week
for six weeks; data were not
presented, but authors stated
“...there was [statistically
significant] reduction in
tension, decrease in sensory
defensiveness, decrease in
urges to use drugs and/or
alcohol and an increase in
activity participation” (p. 22)
Sensory approaches in mental health 28
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Cummings et al. (2010)
Setting: Admissions unit in a 238-bed acute public psychiatric
facility
Location: New Hampshire, United States
Intervention/s: Sensory room
Comparison setting / intervention: Comparison unit in same
hospital without a sensory room
Consumer participants: 105 consumers reported on their use of the
sensory room
No significant change in
seclusion rates over a 9-
month period
89% reported a
reduction in distress;
None reported an
increase in distress;
Specific scores not
reported
Only 12% of uses of the
sensory room were followed
by the use of a “restrictive
practice”
Sensory approaches in mental health 29
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Knight et al. (2010)
Setting: Participants were recruited from a general psychiatry unit
and a geriatric neuropsychiatry unit
Location: Massachusetts, United States
Intervention/s: Sensory modulation equipment / resources selected
by clients
Comparison setting / intervention: “Traditional” nursing
interventions (e.g., 1 to 1 staff contact; quiet time)
Consumer participants: 24 participants in “sensory interventions”
group (36 participants in traditional interventions group)
Not measured
Not measured
Significant improvements
noted in BPRS scores as rated
by nurses before and after both
sensory and traditional
interventions
Sensory approaches in mental health 30
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Lee et al. (2010)
Setting: 30-bed acute psychiatric unit (including “Low
Dependency” and Psychiatric Intensive Care area)
Location: Melbourne, Australia
Intervention/s: Sensory modulation items available for use. Safety
plans completed with “high risk” consumers
Comparison setting / intervention: Nil
Consumer participants: Not reported (46 consumers completed
safety plans)
Actual change in seclusion
not reported
Not measured
Completion of a safety plan
associated with a reduced
likelihood of being secluded.
Staff reported safety plans and
sensory resources “somewhat”
to “moderately” useful in
working with potentially
aggressive consumers and
managing behavioural
escalation
Sensory approaches in mental health 31
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Levine et al. (1977)
Setting: Long-term psychiatric hospital
Location: Montreal, Canada
Intervention/s: Six weeks of daily, 1-hour sessions of Sensory
Integration treatment (based on the work of King, 1974)
Comparison setting / intervention: Nil
Consumer participants: Six consumers “diagnosed as non-paranoid
process schizophrenics” (p. 17) (average length of admission of
participants was 24 years)
Not measured
Not measured
Average scores on perceptual-
motor measures (“design
copying,” “kinaesthesia,”
“finger identification” and
“position in space”) generally
increased (but may not be
statistically significant);
Authors noted that behaviours
in the group sessions also
appeared to improve
Sensory approaches in mental health 32
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Lloyd et al. (2014)
Setting: Inpatient unit at a large hospital
Location: South East Queensland, Australia
Intervention/s: Sensory room and “sensory screen” to identify
potentially helpful sensory interventions
Comparison setting / intervention: Similar unit in same hospital not
using sensory approaches
Consumer participants: Consumers reported on 71 uses of the room
Number of seclusion
episodes measured (6
months before and after
sensory room
implementation):
substantial reduction (157
to 46) in intervention unit
but increase (53 to 81) in
comparison unit
Significant reduction
in self-rated distress.
Mean 6.58 [pre] to
3.72 [post] on a 10-
point scale
--
Sensory approaches in mental health 33
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Maguire et al. (2012)
Setting: 116-bed forensic hospital
Location: Victoria, Australia
Intervention/s: Introduction of sensory rooms, sensory assessments
and safety plans in the context of larger seclusion reduction
program using the “six core strategies” (Huckshorn, 2004, 2006)
Comparison setting / intervention: Nil
Consumer participants: No specific consumers measures
Seclusion rates (and total
seclusion hours) appeared
to decrease during the 2-
year project
implementation phase,
although increased again
following (although not to
pre-project levels); No
change in numbers of
people secluded
Not measured
--
Sensory approaches in mental health 34
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Moore and Henry (2002)
Setting: Community setting
Location: Massachusetts, United States
Intervention/s: Wilbarger Protocol and “sensory rich” sensory diet
Comparison setting / intervention: Nil
Consumer participants: 3 women with depressive disorder and
histories of self-injurious behaviours; Identified by referring agent
as having multiple symptoms of sensory defensiveness
Not applicable (community
setting)
Not measured
All three participants reported
no episodes of self harm since
commencing the treatment; All
were able to do previously-
avoided activities more
frequently
Sensory approaches in mental health 35
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Mullen et al. (2008)2
Setting: N/A (pilot study prior to implementation of study in acute
psychiatric units)
Intervention/s: 5 minutes lying down with 30 pound (13.6 kg)
weighted blanket
Comparison setting / intervention: 5 minutes lying down with no
weighted blanke (Cross over design: participants randomised to
receive either weighted blanked or no weighted blanket condition
first)
Consumer participants: Nil (Participants were volunteers without
any known mental or physical health condition)
Not measured
Not measured
In the group of “healthy adult”
volunteers, use of weighted
blanket did not cause pulse,
blood pressure or blood
oxygen saturation to decrease
to unsafe levels
Volunteers generally reported
greater reductions in self-rated
anxiety when using the
weighted blanket; No
difference between weighted
blanket and no weighted
blanket in terms of
physiological measures of
anxiety
Sensory approaches in mental health 36
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Novak et al. (2012)
Setting: 40-bed acute psychiatric unit
Location: Inner-city Sydney, Australia
Intervention/s: Sensory room
Comparison setting / intervention: Nil
Consumer participants: Consumers reported on 75 uses of the room
No change in seclusion
rates 12 months before
(mean17.2 episodes per
month) and after (mean
18.2 episodes per month)
implementation
Significant reduction
in self rating of
distress: Mean 4.87
[pre] to 2.54 [post] on
a 10-point scale
Significant reductions in staff-
rated anxiousness, irritability,
elevation and pacing
Compared with clients who did
not use the weighted blanked,
those that did had larger
reductions in distress and staff-
rated anxiousness
Sensory approaches in mental health 37
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Reddon et al. (2004)
Setting: N/A (not conducted in a specific treatment setting)
Intervention/s: 20-minute session of Snoezelen treatment
Comparison setting / intervention: Nil
Consumer participants: 100 volunteer participants (50 consumers
and 50 hospital staff as comparisons)
Research purpose: Explore the effects of Snoezelen on signs of
arousal (heart rate, oxygen saturation and Galvanic Skin Response
[GSR - a proxy measure for autonomic arousal])
Not applicable
Not measured
Following Snoezelen
intervention, heart rate was
significantly reduced (all
groups); male consumers and
controls had reduced blood
oxygen saturation (indicative
of more relaxed state) and
male consumers had reduced
GSR
Sensory approaches in mental health 38
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Reisman and Blakeney (1991)
Setting: Large state psychiatric hospital
Location: United States
Interventions/s: Sensory Integration following King‟s (1974)
model: five 1-hour sessions per week for four 3-week blocks spread
over 17 weeks
Comparison setting / intervention: Nil
Consumer participants: Five inpatients with DSM-III chronic,
undifferentiated schizophrenia with repeated, lengthy admissions,
“an S-curve posture, an inability to differentiate head and trunk
movement and a shuffling gait” (p. 28)
Not measured
Not measured
Nurses (who were unaware of
which consumers received
intervention) rated consumer‟s
behaviour on the ward before
and after each treatment block;
There was a significant
improvement in ratings over
time, particularly at the later
stages of intervention;
Perceptual-motor function also
improved
Sensory approaches in mental health 39
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Sivak (2012)
Setting: Male and female admission units of a small, rural, tertiary
mental health hospital
Location: United States
Intervention/s: Sensory room
Comparison setting / intervention: Nil
Consumer participants: 31 consumers recorded a total of 78 uses of
the rooms over 4 months; 14 consumers provided voluntary
feedback about the room.
Seclusion and restraint rates
very low prior to
implementation (0 episodes
seclusion, 5 episodes of
restraint); After
implementation, there were
0 episodes of both
Of the 14 respondents,
8 reported lower
distress after using the
room, 5 reported an
increased in distress
and one response was
missing
13 out of 14 consumers
reported that the room was
helpful;
Trend towards reductions in
rates of client to client and
client to staff aggression; No
change in rates of self-
injurious behaviour
Smith and Jones (2014)
Setting: Male only, 15-bed psychiatric intensive care unit
Location: inner city area in United Kingdom
Intervention/s: Sensory room
Comparison setting / intervention: Nil
Consumer participants: Seven consumers completed semi-
structured interviews
Apparent increase in
seclusion rates: from 27
episodes in 3 months prior
to introduction to 37
episodes in 3 months
following introduction
Not reported
The sensory room was seen as
a positive intervention by both
consumers and staff: improved
the experience of being on the
PICU and assisted
communication between
consumers and staff
Sensory approaches in mental health 40
NB: This is not a definitive version of the paper. Several changes have been made between this version and the final published version.
Study information
Outcome: Rates of
seclusion and restraint
Outcome: client rated
distress
Other outcomes / findings
Sutton et al. (2013)
Setting: Pilot study in one youth and three adult units
Location: New Zealand
Interventions/s: Sensory rooms implemented as part of a larger
seclusion reduction project introducing the “six core strategies”
(Huckshorn, 2006)
Comparison interventions: Nil
Consumer participants: 20 consumers participated in semi-
structured interviews or focus groups
Not specifically reported
Not specifically
reported
Consumers and staff reported
that: sensory approaches (i)
facilitated a calm state; (ii)
improved communication
between staff and consumers;
and (iii) supported consumers
to manage their own distress
1 Additional information was collected from Champagne and Sayer (2003), as this unpublished report contained more detailed information about
the study presented in this publication.
2 Although this study did not involve people with mental illness as study participants, the study was included as it was directly related to the
safety of weighted blankets for use in psychiatric inpatient units.
... Agitation and distress are common issues experienced by consumers in mental health inpatient settings. Sensory approaches are a safe and empowering means for consumers to self-manage distress and agitation (Hedlund Lindberg et al. 2019), and include a range of techniques that target sight, touch, taste, hearing, smell, and/or proprioception to assist regulation of emotional and physiological arousal (Scanlan & Novak, 2015). Weighted modalities (WMs) are a sensory approach providing deep pressure stimulation to reduce arousal and promote a sense of calm (Eron et al. 2020;Mullen et al. 2008). ...
... In recovery-oriented rehabilitation services, the focus of care should include supporting consumers to develop self-management strategies as alternatives to PRN use. Within this context, there is emerging evidence for, and increased uptake of sensory approaches to assist consumers to employ safe ways to manage distress and agitation (Fletcher et al. 2019;Scanlan & Novak, 2015). Sensory approaches are recoveryoriented, and trauma-informed, aligning to current mental health values, policies, and models (Fletcher et al. 2019;Scanlan & Novak, 2015). ...
... Within this context, there is emerging evidence for, and increased uptake of sensory approaches to assist consumers to employ safe ways to manage distress and agitation (Fletcher et al. 2019;Scanlan & Novak, 2015). Sensory approaches are recoveryoriented, and trauma-informed, aligning to current mental health values, policies, and models (Fletcher et al. 2019;Scanlan & Novak, 2015). Findings from a study exploring the implementation of sensory approaches in an acute inpatient setting in New Zealand found sensory interventions were considered effective and feasible by clinicians and patients (Sutton & Nicholson, 2011). ...
Article
Implementing psychosocial approaches into mental health inpatient settings continues to be challenging. This is despite mental health policies prioritizing trauma-informed and recovery-orientated care approaches. This study reports on an interdisciplinary project that implemented and examined the uptake of weighted modalities in a psychiatric inpatient rehabilitation setting. While over-reliance on pro re nata (PRN) medication in these settings has been reported, weighted modalities are a sensory approach that can be self-initiated by consumers as an alternative to use of PRN to manage distress and agitation. A mixed-methods realist approach was used to determine what works, for whom, and in what circumstances weighted modalities were offered by clinicians and used by consumers. Additionally, we were interested in determining whether there was an associated change in PRN use during the trial. Data included in-depth interviews with consumers (n = 12) and clinicians (n = 11), and extraction of PRN medication use preceding, throughout, and following implementation. Statistical analysis revealed a significant increase in PRN rates in the first 3 months of implementation (mean difference from baseline = 29.5, P = 0.047) but a significant decrease in the second three-month period following implementation (mean difference from baseline = −30.7, P = 0.036). Qualitative findings highlighted the key components of successful implementation as being environmental restructuring (availability/accessibility and visibility of weighted modalities) and social influences. Strategies to enhance these components are discussed.
... Collaboration between burns and mental health services Therapist training 21 Specific therapist training in trauma-informed care 22 Specific training for therapists in sensory modulation treatments appropriate level of arousal within the environment, to establish emotional stability, and to de-escalate in times of emotional distress [22,23]. Sensory modulation approaches have been shown to be effective in improving performance in adults with mental health diagnoses [45], adult trauma survivors [46], the management of aggression in people with Huntington' Diseases [47] and neurological impairments [48], and in adults and children with disabilities [38,49,50]. The present study offers valuable insights into the potential use of sensory modulation therapy for adults after burn who are sensory over-responsive and have difficulty adhering to compression garment wear, which have hitherto not been considered. ...
... Trauma-informed care is particularly relevant in a burn-injured cohort as trauma is frequently central to the presentation, and a high prevalence of preceding and proceeding mental health disorders exist [52]. Sensory modulation therapy, posited as a trauma-informed practice, aims to improve the experience of people in the healthcare system and avoid re-traumatization [45]. ...
Article
Full-text available
Background Sensory over-responsiveness, identified through self-report and quantitative sensory testing, has been associated with compression garment non-adherence in a burn-injured cohort. This study sought expert consensus on the usefulness of, and recommendations for, sensory modulation strategies to improve compression garment adherence in sensory over-responsive adults post-burn. Method Experts in the field of sensory modulation were invited to participate in a mixed-methods, three-round electronic Delphi study. Results Experts (N=18) agreed that sensory modulation therapy may be a useful clinical tool to improve compression garment adherence. Twenty-two items reached consensus as essential to assessment, treatment, or therapist training. Conclusion With adequate therapist training and individualised assessment and treatment, sensory modulation strategies may be a useful clinical approach to improving compression garment adherence in those who are sensory over-responsive post-burn. Further research is needed to gather perceptions from burns therapists, and to implement and evaluate the effectiveness in clinical practice.
... These provide visual, auditory, tactile, olfactory, and proprioceptive stimulation (the sense of self-movement and body position). Importantly, users can control their sensory input, creating an environment that may stimulate or calm their senses, according to their preference (Scanlan and Novak 2015). Typically, such spaces have been established in institutions e.g. ...
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... e theory of sensory processing recognizes that sensory stimuli affect our emotional states [17]. Approaches using sensory stimuli to improve self-regulation, known as sensory modulation approaches [18], have received growing attention in mental health and trauma fields [25]; however, there is little research specific to pain. A recent cold pressor study revealed that people who were more sensitive to stimuli (i.e., lower thresholds) were more likely to use maladaptive coping strategies, while those who were less sensitive (i.e., higher thresholds) reported more adaptive coping strategies [14]. ...
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Introduction: Current research evidence suggests that people with schizophrenia have sensory processing difficulties. Sensory modulation has growing evidence for use in this population. This study aimed to evaluate the extent to which health, social, cognitive, and occupational functioning outcomes were impacted by sensory modulation interventions for people with schizophrenia. Methods: A prospective observational cohort study using a waitlist control design was used in two large hospital and health services in Queensland, Australia. The study recruited patients who used sensory modulation (n = 30) across the two hospitals and those who did not use sensory modulation interventions as a control (n = 11). Results were analysed using a series of planned comparisons including independent and paired t-tests, and mixed ANOVA was used whenever statistically indicated. The analysed measures were pre- and post-intervention scores. Results: This study found no statically significant differences between the control and intervention groups at both pre- and post-intervention. However, analysis of results from within the intervention group showed statistically significant improvements between pre- and post-test scores on distress, occupational functioning, and health and social functioning but not on sensory processing and global cognitive processing. Further analysis of results from this study, compared with those from an earlier study on the general population showed significant differences in Low Registration and Sensation Avoiding, as measured by the Adult/Adolescent Sensory Profile, between participants with schizophrenia and those without schizophrenia. Conclusion: This study provides evidence to suggest that sensory modulation interventions can be complementary to standard care when utilised appropriately in clinical settings. Findings also suggest that the sensory profile of people with schizophrenia is different to that of the general population and this may have clinical implications. Further longitudinal research is needed with larger and randomised samples, using more targeted measures to better explore effectiveness of sensory modulation interventions.
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In this paper we report the findings from an evaluation of the introduction of sensory modulation (SM) in an acute mental health inpatient unit. It was expected that SM could be used to help settle patients experiencing high levels of disturbance and that as a result, there would be less need for use of more restrictive seclusion practices. The evaluation took place in a hospital in south-east Queensland, Australia. SM was introduced in one acute unit while the other served as a control. The evaluation comprised two studies. In the first study we aimed to determine whether SM reduced the level of disturbance among patients given the opportunity to use it. In the second study we aimed to find out whether the introduction of SM reduced the frequency and duration of seclusion. In study 1, we found that most patients reported marked reduction in disturbance after using SM and there was a very large effect size for the group as a whole. In study 2, we found that frequency of seclusion dropped dramatically in the unit that introduced SM but rose slightly in the unit that did not have access to SM. The change in seclusion rate was highly significant (χ2 = 49.1, df = 1, p < 0.001). Results are discussed, having reference to the limitations inherent in a naturalistic study.
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Background The scoping review has become an increasingly popular approach for synthesizing research evidence. It is a relatively new approach for which a universal study definition or definitive procedure has not been established. The purpose of this scoping review was to provide an overview of scoping reviews in the literature.MethodsA scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in four bibliographic databases and the gray literature to identify scoping review studies. Review selection and characterization were performed by two independent reviewers using pretested forms.ResultsThe search identified 344 scoping reviews published from 1999 to October 2012. The reviews varied in terms of purpose, methodology, and detail of reporting. Nearly three-quarter of reviews (74.1%) addressed a health topic. Study completion times varied from 2 weeks to 20 months, and 51% utilized a published methodological framework. Quality assessment of included studies was infrequently performed (22.38%).Conclusions Scoping reviews are a relatively new but increasingly common approach for mapping broad topics. Because of variability in their conduct, there is a need for their methodological standardization to ensure the utility and strength of evidence. Copyright © 2014 John Wiley & Sons, Ltd.
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This study explores the use of a sensory room on a psychiatric intensive care unit (PICU), with a particular focus on the effect on seclusion rates and staff and patients' experiences of using the sensory room. A mixed method research design was used, with the collection of seclusion data before and after a sensory room was introduced followed by qualitative interviews with staff and patients. No significant reduction in seclusion rates was noted with the introduction of the seclusion room. However, the interviews revealed a perception among staff that there had been a reduction in seclusion rates. Other findings from the interviews were that staff and patients viewed the sensory room as a positive therapeutic intervention, and use of the sensory room had improved staff-patient communication and patients' overall experience of the PICU. The use of a sensory room should be an intervention considered by other PICUs and inpatient psychiatric settings. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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During the past decade, mental health practitioners within and outside of occupational therapy have begun to understand the relevance of using sensory integration intervention principles with clients receiving mental health services. In addition, some occupational therapy practitioners are evaluating clients for sensory processing disorder and examining its contributions to mental health status, trauma correlations, and attachment problems. Interventions are expanding from addressing only sensory modulation problems to including difficulties in sensory discrimination and praxis as it affect occupation.
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In this study, the authors assess the effectiveness of education on the consistency of use of sensory rooms within a large mental health facility. Eleven staff and thirty-six clients received additional multimodal education in sensory strategies, the use of the sensory rooms on their assigned units, and the link between the rooms and clients' personal crisis intervention plans. Staff knowledge and room usage rates were analyzed pre- and post-training. The authors found statistically significant increases in staff knowledge post-training and increases in the use of the sensory rooms by study participants. The results support the effectiveness of training which uses hands-on, population-specific strategies.
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An investigation of the efficacy of sensory integrative treatment of the psychiatric status and physical functioning of patients with chronic schizophrenia is reported. Patients were involved in sequenced sensory integrative treatment over a seventeen week period. Significant improvement was found in scores of the NOSIE-30 as well as on some of the usual idicators of sensory integrative status: thumb-finger opposition, diadochokinesis, eye pursuits and balance. Length of treatment time was linearly related to amount of improvement.
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This paper focuses on scoping studies, an approach to reviewing the literature which to date has received little attention in the research methods literature. We distinguish between different types of scoping studies and indicate where these stand in relation to full systematic reviews. We outline a framework for conducting a scoping study based on our recent experiences of reviewing the literature on services for carers for people with mental health problems. Where appropriate, our approach to scoping the field is contrasted with the procedures followed in systematic reviews. We emphasize how including a consultation exercise in this sort of study may enhance the results, making them more useful to policy makers, practitioners and service users. Finally, we consider the advantages and limitations of the approach and suggest that a wider debate is called for about the role of the scoping study in relation to other types of literature reviews.