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Sensory Modulation in Mental Health & Addictions
Document Type
Guideline
Function
Clinical Service Delivery
Healthcare Service Group (HSG)
Mental Health and Addictions
Department(s) affected
Inpatient and Community Mental Health
Patients affected (if applicable)
All service users of Mental Health and Addictions
Staff members affected
All clinicians and identified non-registered staff members
Key words (not part of title)
Sensory Strategies, Sensory Modalities, Sensory Room
Author – role only
Sensory Modulation Project Lead
Owner (see
ownership structure)
Nurse Director of Mental Health and Addictions
Edited by
Clinical Policy Advisor
Document Controller:
Copy edit
Formatting
Proofreading
Date first published
September 2012
Date this version published
February 2016
Review frequency
3 yearly
Unique Identifier
PP40/RBP/032
Contents
1.
Purpose of guideline
2.
Guideline management principles and goals
3.
Definitions
4.
Responsibilities
5.
General precautions
6.
Documentation
7.
Sensory room purpose
8.
Equipment maintenance of supplies
9.
Infection control
10.
Sensory preference form
11.
Supporting Evidence
12.
Associated ADHB documents
13.
Disclaimer
14.
Corrections and amendments
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1. Purpose of guideline
This guideline outlines requirements for the safe utilization of a sensory modulation
approach across inpatient and community mental health services within Auckland District
Health Board (ADHB). Sensory modulation is a Ministry of Health endorsed approach
underpinned by a trauma informed care philosophy and a valuable tool used for supporting
recovery, reducing the use of seclusion and restraint in acute settings, and as an adjunct to
risk, safety and treatment planning.
2. Guideline management principles and goals
Sensory modulation is a multi-disciplinary intervention which is expected to be utilized by all
mental health (MH) clinicians in inpatient and community settings. It is an expectation that
all service users should have access to sensory assessments, equipment and sensory
strategies as part of the model of care in inpatient and community mental health services. It
is recommended that all MH clinicians complete the one-day training package in sensory
modulation.
Service user preferences must be documented in a timely manner using the Sensory
Preference form, completed collaboratively with service users and their whānau. Sensory
modulation is a multi-disciplinary intervention which is expected to be utilised by all MH
clinicians in inpatient and community settings.
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3. Definitions
3.1 Sensory modulation
Sensory modulation is defined as the “capacity to regulate and organise the degree, intensity
and nature of responses to sensory input in a graded and adaptive manner. This allows the
individual to achieve and maintain an optimal range of performance and adapt to challenges
in daily life (Miller and Lane, 2000)”.
As an intervention, sensory modulation is used to help service users evaluate their sensory
preferences, in order to identify what sensory tools would assist them in modulating their
responses to their environment. This may be used for de-escalation in times of emotional
distress, calming prior to commencing a distressing activity, or as an alerting mechanism to
increase motivation to participate in purposeful occupation.
Sensory modulation is an approach which utilises sensory input to promote emotional
regulation, grounding and encourage adaptive ways of performing simple and complex
purposeful activities. Sensory modulation is also believed to be a powerful complement to
cognitive-based therapies.
The implementation of a sensory modulation approach in MH services has been identified as
an organisational and practice priority for MH services across New Zealand. This initiative
has been led by Te Pou and the “Seclusion: Time for a Change” project, and the use of
‘sensory strategies’ to support de-escalation practices and recovery.
3.2 Mental health clinician
All registered mental health clinical staff members, including nurses, social workers,
occupational therapists, psychologists and medical staff members (e.g. registrars and
consultant psychiatrists). Mental health assistants, support workers, rehab workers and OT
assistants who work in a clinical setting will also be required to complete sensory modulation
training in order to administer sensory interventions; however they will not be expected to
administer assessments such as the forms listed in th
e forms section.
3.3 Sensory preferences
Sensory preferences (e.g. what the person finds calming, alerting) are identified using the
Sensory Preference form. These preferences are unique to the person and dynamic in
nature. It is essential that identified sensory preferences are incorporated into
risk/safety/treatment planning.
3.4 Sensory strategies/modalities
Sensory strategies/modalities involve the use of sensory tools to calm or alert the person.
Sensory strategies may involve the use of a ‘sensory diet’, aromatherapy or as a
compensatory technique to assist the person in coping with situations in which the person is
over stimulated or struggling with motivation.
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3.5 Sensory room/space
Sensory rooms are therapeutic spaces that are designed to promote self organisation and
sensory awareness. They are equipped with a variety of sensory modalities and may be used
for individual and group sessions. In acute settings sensory modulation rooms may be used
for de-escalation or identifying new skills and preferences that can be transferred to other
environments. In the community, sensory rooms may be used for individual sessions or in a
group context. For some services, sensory rooms are multipurpose rooms that incorporate
aspects of sensory modulation.
3.6 Comfort room/multi-purpose room
Comfort rooms are therapeutic spaces which have soft furnishings. They are designed to
contain minimal sensory equipment so that they may be used by the person for individual
use, family visits or meetings. Service users may choose to bring sensory items into the
comfort space.
3.7 Sensory equipment
Sensory equipment ranges from everyday items such as hand creams and ‘stress balls’ to
specialised items such as weighted dogs, weighted blankets and massage chairs. The
equipment may be stored in a variety of places depending on the needs of the unit, e.g.
locked in drawers/cupboard of the sensory room, in a sensory cart, or kept in the service
users’ personal belongings.
4. Responsibilities
4.1 Training
All MH clinicians responsible for the inclusion of a sensory modulation philosophy and
approach in their practice are advised to complete the Sensory Modulation Training
package. This package has been developed in partnership with Te Pou and Waitemata DHB.
4.2 Documentation
All MH clinicians (see
definitions) are responsible for documenting service user sensory
preferences using the Sensory Preference form. If non-clinical staff members document
sensory information, this must be supervised by a registered clinician.
4.3 Reflection
Mental health clinicians are expected to use professional supervision as a way of developing
professional practice, skills and knowledge around the inclusion of a sensory philosophy and
approach in practice.
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5. General precautions
Staff members are expected to consider the following precautions; as well as mental state
and risk assessments:
Allergies
Trauma history
Environmental effects (lighting, background noise etc)
Respiratory/cardiac precautions: these conditions may contraindicate the use of sensory
modulation. Do not proceed without appropriate advice and support from medical staff
members
Weighted blankets have contraindications for use. Please see weighted blanket
guidelines
6. Documentation
Documentation regarding sensory modulation is to be completed using the Sensory
Preference form. This should be accessible in the forms section on HCC. It is recommended
that the form be completed in the first 72 hours following admission to inpatient settings. In
community settings, the form should aim to be completed within the first 2 weeks of
introduction to the service. The documentation is required to be stored in HCC, and service
users are to be provided with a copy. Following the assessment it is recommended that
service users be provided with a summary of their preferences.
A ‘guest book’ may be a useful record kept in the sensory modulation room (if applicable) to
record service user experiences of sensory modulation. The guest book provides information
to help measure the effectiveness of the room, and to identify which modalities are most
effective.
7. Sensory room purpose
Where appropriate, sensory rooms are only to be available for individual and small group
sessions. The preference is that the sensory room is used for sensory modulation purposes
only. Use of the room should always be on a voluntary basis.
7.1 Maintenance
The room must be left in a clean and orderly condition.
7.2 Monitoring room use
Mental health clinicians are required to actively supervise any service user utilising a
sensory modulation room
Appropriate signage should be posted to indicate the room is in use. When using the
room with service users, staff members should not be interrupted unless in an
emergency
When the sensory modulation room is not in use it is recommended the door remains
locked to ensure the safety of the service users and equipment. It is advised that comfort
rooms/multipurpose rooms remain unlocked
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If locked, it is recommended that keys for the sensory modulation room are kept in a
designated area known by all clinical staff members
Please refer to the services specific guidelines around the locking/unlocking of sensory
modulation rooms and comfort spaces
7.3 Room booking
Inpatient: It is recommended that the room is not booked. Expected time frames for
using the room is approximately 20 - 30 minutes
Community: The room may be booked through reception booking systems
8. Equipment maintenance of supplies
An inventory of sensory equipment is kept in an agreed on space by the responsible clinician
and is regularly reviewed to ensure supplies are well stocked.
8.1 Infection control
Mental health clinicians and service users are advised to use alcohol hand sanitiser prior
and after using sensory modulation equipment. It is recommended alcohol hand sanitiser
is available at the entry to or within rooms where sensory equipment is being used
It is advised sensory modulation equipment come into contact with intact skin only
Where clothing is soiled or might be soiled, a sheet or paper sheet or similar should be
placed between the person and the sensory modulation equipment. Any sheets used
should be sent to the contracted laundry services depending on local arrangements
It is recommended that any hard surfaces of sensory modulation equipment are
routinely wiped with disinfectant spray
Mental health clinicians are recommended to adhere to the Infection Control policy
regarding the cleaning of all items. All staff members are responsible for informing the
nominated person when items are soiled and needing to be cleaned urgently, or in need
of replacement or repair
Please see the
Associated Auckland DHB documents section for more detailed infection
control information regarding weighted modalities
9. Sensory preference form
The Sensory Preference form (see
Associated Auckland DHB documents section) is designed
to be filled out collaboratively with the service user and their whānau. This can be filled out
in one setting, or administered over several days. It consists of a series of tick box questions
that cover a variety of areas, e.g. early warning signs, triggers, and sensory strategies and is
designed to assist service users to identify sensory strategies that are useful. It is
recommended that the service user be provided with a copy of the assessment at its
conclusion.
9.1 The sensory profile
The sensory profile is a standardised assessment that measures sensory abilities and
preferences and the effect these have on the functional performance of adults, older adults,
adolescents and children. There are two separate profiles, The Sensory Profile (ages 3 to 10)
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and the Adolescent/Adult Sensory Profile (self questionnaire). The assessment can be
administered by a health professional with training in the use of this assessment tool.
10. Supporting evidence
Champagne, T., Stromberg,N. (200
4). Sensory approaches in inpatient psychiatric
settings: innovative alternatives. Journal of Psychosocial Nursing and Mental Health
Services, 42(9), 34-44.
Champagne, T. (201
1). Sensory Modulation & Environment: Essential Elements of
Occupation (3rd Ed. Revised) Pearson PsychCorp: Australia.
O’Hagan M., Divis., 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.
11. Associated Auckland DHB Documents
Code of Rights
Privacy of Patient Information
Restraint - Mechanical (Physical Restraint) in MH&A
Restraint Minimisation (MH&A)
Weighted Blankets in Mental Health & Addictions
11.1 Other resources
Seclusion: Time for a Change Te Pou website
Sensory Preference Form, District Mental Health Services, Waitemata DHB
Sensory Preference
form.htm
12. Disclaimer
No guideline can cover all variations required for specific circumstances. It is the
responsibility of the health care practitioners using this ADHB guideline to adapt it for safe
use within their own institution, recognise the need for specialist help, and call for it without
delay, when an individual patient falls outside of the boundaries of this guideline.
13. Corrections and amendments
The next scheduled review of this document is as per the document classification table (page
1). However, if the reader notices any errors or believes that the document should be
reviewed
before the scheduled date, they should contact the owner or th
e Clinical Policy
Advisor without delay.
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