Workshop I II and III combined - Reach...3/10/2017 5 Oral Motor Sense is a combination of flavor, texture, temperature and movements of lips jaw and facial muscles Oral Motor Sense,

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Understanding the Senses and Their potential for Treatment

Sensory Connection to Trauma and Treatment in Youth

Aspire Clubhouse

Presentation by Karen Moore, OTR/L

Angie Balzarini-Leonhart, OTR/L

Albany GAApril 30 or May 1, 2014

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OUR SENSES

Auditory

Visual

Olfactory

G t t r /Or l M t r Gustatory/Oral Motor

Tactile

Vestibular

Proprioception

Introception

As the SCP workshop progresses, use this form to k k f d h ll

Make Your Own Toolbox

keep track of ideas that will make sense to use in your clinical setting so that you can develop your own personalized tool box.

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See Handout p. 3

Sensory Integration

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Who May Have Difficulty with Sensory Processing?

Individuals who experience:

Physical or sexual abuse

Emotional neglect

Traumatic Birth

Traumatic injury/Surgery

Chronic Pain

Multiple hospitalizations

Sensory deprivation

Torture / War

Institutionalization

Who May Have Difficulty with Sensory Processing?

Diagnoses to consider:

Autism Asperger's ADHD/ADD PTSD PTSD Reactive Attachment Disorder Intermittent Explosive Disorder Anxiety Disorders OCD Schizophrenia Major Depression

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Sensory Strategies for:

Stress coping through the senses identify leisure and self-care

techniques -deep abdominal breathing

Emotional Regulation- sensoryEmotional Regulation sensory snacks identify sensory input that helps

with calming or alerting

Poor Reality Orientation- provide strong deep pressure and

proprioceptive input Display environmental cues and

decrease clutter

Coping Through the Senses

Stress‐ “thoughts or feelings that tax or exceed our ability to respond effectively.” ‐Karen Moore, 2005

Severe Stress or TraumaResearch done by Robert Macy‐ 2007

More Primitive Responses Prevail

C i i i dCommunication is suppressed

Brain Scans show increased activity in the hypothalamus and decreased in the Brocaarea (speech) is diminished

The Power of the SensesThe Power of the Senses

Focus is on the present

Brings self-awareness and i lenvironmental awareness

Vacation from thoughts (and problems)

Using the Body to Calm the MindUsing the Body to Calm the MindIn crisis and critical illness there is “no wise mind.”In crisis and critical illness there is “no wise mind.”

Sensory input can be used to help calm the Sensory input can be used to help calm the system system ––

even when cognitive techniques fail!even when cognitive techniques fail!

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Sensory Qualities that Are Calming and Alerting

Alerting: Fast paced

Irregular

Complex

Calming: Soft

Rhythmic

FamiliarComplex

Unexpected

Unpredictable

Intense

Strong

Irritating

Negative Associations

Familiar

Soothing

Simple

Mild

Predictable

Slow

Positive Associations

Handouts page 3

JustJust‐‐Right BalanceRight Balance

Arousal Arousal -- Finding the Right AlertFinding the Right Alert--Calm Balance to Match the SituationCalm Balance to Match the Situation

sleep low arousal just‐right balance high arousal shutdown

Factors:Factors:CognitiveCognitiveEmotionalEmotionalPhysicalPhysicalEnvironmentEnvironmentSpiritualSpiritual

What Input Do We Need? Calming Alerting

UpsetUpset

Losing controlLosing control

AgitatedAgitated

Needs groundingNeeds grounding

Needs reality orientationNeeds reality orientation

Lacks attentionLacks attention

Needing to relaxNeeding to relax

AnxiousAnxious

OverwhelmedOverwhelmed

In state of In state of shutdownshutdown

Unable to focusUnable to focus

SleepySleepy

Needs to be energizedNeeds to be energized

Handouts page 3

Decisions ‐ Decisions

What kind of input does What kind of input does this fellow need?this fellow need?

CALMING OR CALMING OR ALERTINGALERTING??????

What Type of Stimulation Does She Need?

Is she depressed?

I h h i i d Is she hypersensitive and

over stimulated?

Is she agitated?

Decisions ‐ Decisions

What type of stimulation does this child need?need?

Is she sedentary and have poor environmental awareness?Is she sensory sensitive and withdrawn to avoid

stimulation?Is she highly over stimulated to the point of shutdown?

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Always start with calming techniques

“Emotional dysregulation can result in two paradoxical responses that are flip sides of p p pthe same coin.”- Karen Moore, 2005

External Senses

Smell (grounding, aromatherapy, hygiene products)

Taste (exploration, grounding, comfort foods) “When it comes to chocolate,

resistance is futile”- unknown

Vision (art, bubble lamps, fiber optics)

Hearing (music, therapeutic listening, white noise)

Light Touch (fidgets, tactile input)

Primitive, Protective & PowerfulPrimitive, Protective & Powerful

Feeds directly into limbic systemFeeds directly into limbic system

Good for groundingGood for grounding

THE SENSE OF SMELL

Good for groundingGood for grounding

We form associations (pleasant memories or We form associations (pleasant memories or flashbacks and dissociation)flashbacks and dissociation)

Protective and informativeProtective and informative

Connected to vestibular system (ear ache Connected to vestibular system (ear ache causes dizziness)causes dizziness)

The Sense of Hearing

Sounds can be soothing or activating Sounds can be soothing or activating depending on beat, volume, and personal depending on beat, volume, and personal taste.taste.

Loud noises can be upsetting and some Loud noises can be upsetting and some people have trouble recoveringpeople have trouble recovering..

Unifying Sense/ProtectiveUnifying Sense/Protective

Linked to Vestibular senseLinked to Vestibular sense

The Sense of VisionThe Sense of Vision

Provides environmental Provides environmental awarenessawareness

Responses to visual stimulation are not universal.

Smell and taste are linked

Strong tastes can be used for

The Sense of TasteThe Sense of Taste

grounding

Oral Motor Input

People turn to “comfort foods” when they are upset.

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Oral Motor Sense is a combination of flavor, texture, Oral Motor Sense is a combination of flavor, texture, temperature and movements of lips jaw and facial musclestemperature and movements of lips jaw and facial muscles

Oral Motor SenseOral Motor Sense

temperature, and movements of lips, jaw, and facial musclestemperature, and movements of lips, jaw, and facial muscles

Pound for pound the jaws are the biggest proprioceptors in Pound for pound the jaws are the biggest proprioceptors in the bodythe body

People seek oral motor stimulation to help with comfort, People seek oral motor stimulation to help with comfort, attention, and overall attention, and overall organizationorganization

Input activates the vagal system through the cranial nerves Input activates the vagal system through the cranial nerves and supports social engagement systemand supports social engagement system

The Sense of Touch

Skin is the largest sense organ

Montague 1968

Touch has powerful effects on emotions p

Influences limbic system

Basis of body image/boundaries

With proprioception

Handout for Hand Massage p. 8

Events that occur in the body

Activated by internal stimuli i hi h b d i l

Interoception

within the body or visceral sensation

Visceral sensations reach our self awareness and impact mood and our sense of well-being.

Keeps the body erect. Drives equilibrium responses.

Gives awareness of body position and

The Vestibular Sense

Gives awareness of body position and movement in space (Ayres, 1979).

Receptors are located in the ears and there are strong ocular connections. (Hence dizziness with earaches and carsickness)

Vestibular Stimulation Ideas for Clinics, Play Areas and Classrooms

Rocking Chairs/Gliders

Swings

Therapy Balls/Chair balls

Exercise Band Rowing

Head Rolls

Movement Activities

Walking/Pacing

Activated by movement or Activated by movement or compressing or stretching a jointcompressing or stretching a joint

Tells where body parts are in spaceTells where body parts are in space

ProprioceptionProprioceptionDeep Pressure & Movement SenseDeep Pressure & Movement Sense

Tells where body parts are in space Tells where body parts are in space and in relation to one anotherand in relation to one another

Increases endorphins if input is Increases endorphins if input is strong and sustained (runners high)strong and sustained (runners high)

Rarely overloading to sensory systemRarely overloading to sensory system

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Sensory Powerhouses‐Organizing Input

Vestibular Proprioception Deep Pressure Touch

Kids Need Physical Outlets

When the heart is pumping the endorphins are flowing!

Endorphins help our body fight stress!

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Power SystemsActivities

Glider Rocker/Swing

Therapy Ball

Yoga, Tai Chi & Qi Gong

Weighted collars/lap pads

Thera‐Band Exercises

Deep pressure vestsDVDs

Candy/Gum

Deep Breathing

Full back massager

Hand held vibrator

Weighted blankets

p p

Bean Bag tapping

Yoga Mat

Exercise Machines

Massage with scented lotion

~ Heller, S. (2002)

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Preferences are Personal

Always give choices!!

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Take some time to explore the sensory activities. Mark in your tool kit the ideas that you could use in

Discovering Sensory Preferences

y yyour clinical setting.

Think about the input that you enjoy and compare it to the experiences of others – what you enjoy others may find aversive.

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Lack of Training Can Lead to Negative Experiences

Understand calming versus alerting stimuli

Know when to back off

Honor preferences (sensory treatment is very personal)

Is this sensory or behavioral?

Is the patient ready to assess sensory needs?

Plan sensory spaces carefully

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Anxiety Light headedness

Symptoms of Distress

STOP! These are signs that the person is not tolerating the activity.

Excuses Increased sweating

Confusion Flushing

Irritability Shortness of breath

Resistance to activity Over arousal

Defensive behaviors Nausea

Paranoia Fearful expression

Handout p. 4

Abdominal Breathing

Take a deep breath, it calms the mind

Often used as the first strategy for calmingOften used as the first strategy for calming Often used as the first strategy for calmingOften used as the first strategy for calming

Keep it simple: 4 deep breathsKeep it simple: 4 deep breaths

Practice togetherPractice together

Handout for Deep Breathing p. 5

Incorporating Incorporating Sensory Snacks Sensory Snacks in the in the DayDay..

Swinging bike ride rocking chair Swinging, bike ride, rocking chair

Soft or heavy blanket

Fidget, coloring, puzzles

Scented lotion and quick hand massage

Massage of shoulders or “hand hugs” up the arm

Lifesaver's, chewy, crunchy food

Water bottle

Music

StressStress Management StrategiesManagement Strategies

Make environment comfortable Eliminate Bothersome inputAdd pleasurable input

Plan daily doses of strong sensory inputWalk, stretching, yoga, work out activitiesheavy back-pack, dancing, bicycling

Plan relaxation “rituals”Deep breathing, meditation Luxurious bath, fragrant candle and musicRead by the fireplace Good for “sleep hygiene”

Sensory Cart

A sensory cart is one way to provide accessible sensory equipment.

Ideally it should be out on the unit where clients canIdeally it should be out on the unit where clients can access it readily.

Handout with items and a brief description of items should be laminated and attached to the cart.

All staff should be trained on how to support clients in the use of the items.

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SCP Curriculum has directions and handouts for a Sensory Cart

What is a Comfort Space or Room?

Soothing wall paint colors

Calming pictures, Picture books or Murals

Comfortable seating Comfortable seating

Weighted Collars and Lap pads

Relaxing Music and Sound Machines

Visual Relaxation Videos, Dim Lighting and Lava Lamps

Aromatherapy

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Dedicated space/room or corner of a room

Comfortable chair

Items chosen by the individual for nurturing

Individualized Comfort“Safe” Space

y gand self-regulation

Items might include CD or music, art or picture books, “Heavy Duty” animal, blanket, weighted lap pad, manipulatives, tasty treats, grounding supplies, scented lotions.

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Wish list for comfort space p. 27; worksheet p. 34 – 35.

Sensory or Comfort Rooms

They provide a laboratory to learn selfThey provide a laboratory to learn self--regulation coping regulation coping skillsskills!!

Sensory Rooms:Coping, Calming and Comfort

Must reflect:

PurposePurpose

Developmental Age

Safety Issues

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Sensory Room Thoughts

Make sure it is a POSITIVE place (never use of “time outs)

Use pro-actively (never wait for a meltdown)

Allow time limited opportunities to use it “when needed”pp

Provide a timer

Good for downtime

If needed – make it a regular part of the day

Be careful not to support “escape” behaviors

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Aspire Clubhouse

Workshop II


Angie Balzarini‐Leonhart, OTR/L


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Chauncy HallInnovative Ideas

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Calming and Alerting Tags

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Recipe for a Self‐help Space

Chill RoomChauncy Hall

Recipe for a Self help Space

Take an empty room next to the classroom

Add a rug, a beanbag chair and a video rocker

Add a few simple sensory tools

Allow kids to use it when needed to chill out

Voila! You have a simple “sensory room”

Chauncy HallSensory Room

50Adolescent Unit – Westborough MA

And then there’s pets……….

51Full time therapy dog at Chauncy Hall in Westboro MA

Animals and AutismAdvance (2011) 27, (17)

Chauncy Hall “What Helps?” Board

On going education on sensory approaches

Staff roles models use of strategies

Suggestions for Residential Treatment

Provide personal sensory kits

Provide daily opportunities for sports or exercise

Develop a chill/calming room

Teach relaxation or mindfulness techniques

53Handouts p. 17

Robbie is a 19 year old African American male

Primary Diagnosis: Autism, Mental Retardation, Explosive Personality Disorder, Intermittent Explosive Disorder

Secondary Diagnosis: Adult Neglect/Abandonment- Biological Mother perpetrator of maltreatment and neglect

Case Study‐ Robbie

Mother perpetrator of maltreatment and neglect

Family members report patient is demonstrating increasing destruction of property and violence toward family members.

Patient was placed in seclusion and restraint upon arrival on the MH inpatient unit for impulsive and unpredictable behaviors.

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Symptoms:

Unprovoked agitation

Out of control

Impulsive

Symptoms and Triggers

Triggers:

patient becomes vocal and will holler

patient places his arm near an item or person

patient runs to room and slams door

at his school program he is triggered by noise and light

Sensory Interventions:

aromatherapy (orange) soft fabric, fidgets, toy maze

Deep Pressure Vest Weighted Blanket

Glider rocker Comfort Roommassage chair

CD player (R&B, harp, 50's classic pop rock)

Sensory Diet: The above interventions offered and encouraged in a predictable schedule using communication cards and picture

schedule.

School Based Interventions

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Is there clutter?

How Sensory Friendly is Your School?

Is the lighting comfortable?

Is it noisy?

Are there places kids can go for quiet time?

Do you have rocking chairs or chair balls?

Are there attractive elements – art work, soothing sounds, sensory activities available?

Making “Quiet Space”

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Control Noise

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Hydration

“Having a water bottle at one’s desk is probably one of the most effective sensory‐related interventions that could benefit a child with sensory disturbances.

Moyes 2010

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Oral motor input

Fidget widget

Hydration

Alerting input – helps focus

Provide Exercise

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People with special needs are often easily overwhelmed and they are working harder just to keep up.

Plan for Quiet Times for Re‐charging

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Provide Strong Sensory Input Breaks

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Remember the rule:Children can focus for 1 minute per year of their life. Expect a six year old to sit for six minutes without a break.

Classroom‐based physical activity (using active games and movement) improves classroom behavior reduces fidgeting

Using Games and Movement for Teaching

classroom behavior, reduces fidgeting, improves concentration, increases time on task and also results in lower BMI rates and obesity.

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Donnelly, J.E., Lambourne, K. (2011) Classroom‐based physical activity, cognition, and academic achievement. Preventative Medicine 52, S36‐S42

Humming/singing

Slap Clap

Provide Sensory Snacks

Slap Clap

Self‐Hug

Figure Eights

Full Body Joint Compression

Koosh Toss

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Sensory Tool Box or Basket

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Tool Time!!!

Step 1: Identify Problematic Situations

Step 2: Engage in Sensory Exploration

Step 3: Create Toolbox

Step 4:Make Connections

Handout pages 10 ‐ 1168

Tool Time!!!

See the Tool Time Protocol in your handout package.

This process helps to identify tools for problematic situations and to teach children when and how to use them.

Eventually the teacher will be able to give the simple cue and the child will respond by going to their toolbox and choosing an appropriate tool.

The Tool Box Handout provides suggestions for mouth, hearing, hand, eye and “Doing Tools.”

Handout pages 10‐11

Must be Guided at First

May need to be supervised

Sensory Exploration

May need to be supervised

Keep track of helpful modalities

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If a person

is sleepy and needs to be more alert……

Guiding Choices Activity

is sleepy and needs to be more alert……

suggest exercise band rowing

is in heightened alertness after a gym class…

suggest sitting in a beanbag chair with a heavy duty dog on the lap.

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Individual Sensory Kits

Developing kits teaches sensory coping strategies in a concrete way.

Taking home a kit helps with carryover of skills.

Scool tool kit can be kept in the classroom and can cotain larger items such as a weighted lap pad or theraband for desk leg.

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Brainstorming Kit Ideas

What will the kit be used for?

P i tt ti t k h l Paying attention at work or school Staying awake in the car Relaxing before bedtime Dealing with anxiety Helping with sobriety Grounding

What items will be helpful?

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Sensory Kit for Clinical Outreach in the Community

Oral Motor Items

Fidget Widgets

Focused Activity

Strong Sensory Input

Grounding Items

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Page 12

Meltdowns and Catastrophe

Feeling Overwhelmed

D d T Hi h

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Demands are Too High

Sensory Overload

Person is trying to preserve “inner self”

Feeling scared

Angry feelings are normal and can be managed.

Anger sets of “fight or flight” response – become aware of physiological responses.

Identify triggers

Anger Management

Identify triggers.

Start with physiological coping skills (deep breathing, relaxation, counting activities).

Discuss and practice prosocial ways to deal with anger.

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Kellner, M., & Bry, B. (1999) The effects of anger management groups in a day school for emotionally disturbed adolescents. Adolescence, 34 (136), 645‐651.

Anger management

Anger Management Magnet Creative Therapy Associates, Inc.

Sensory Approaches to Anger Management

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Anger Management and self‐regulation group helps children identify symptoms of anger and strategies for anger management. Maas, Mason & Chandler (2008)

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Angry feelings are normal and can be managed.

Anger sets of “fight or flight” response – become aware of physiological responses.

Identify triggers

Anger Management

Identify triggers.

Start with physiological coping skills (deep breathing, relaxation, counting activities).

Discuss and practice prosocial ways to deal with anger.

Kellner, M., & Bry, B. (1999) The effects of anger management groups in a day school for emotionally disturbed adolescents. Adolescence, 34 (136), 645-651.

Alert Program and Atwood’s Exploring Feelings Program

An 8‐week‐long use of the Alert Program® within the classroom setting for 7 children with emotional

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for 7 children with emotional disturbances demonstrated improvement on all measures as compared to the control group.

Barnes, K. J., Vogel, K. A., Beck, A. J., Schoenfeld, H. B. & Owen, S. V. (2008). Self‐regulation strategies of children with emotional disturbance,

Williams, M. Shellenberger S. (1996) How does your engine run?:Leaders guide to the Alert Program for self‐regulation

Rage

ExtremeEmotion

Scale of 8‐10

Angry

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Cause or EventInternal Feeling or Body Response

HOW ANGRY ARE YOU?

Very Upset

Scale of 5‐7

Irritated

Upset

Scale of 2‐6

__________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Handouts p. 9

Sensory Driven Behaviors and

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ySensitivities

Sensory Driven BehaviorsSensory Driven Behaviors

Sometimes behaviors have a sensory Sometimes behaviors have a sensory component.component.

S ki g d id t b h i S ki g d id t b h i Sensory seeking and sensory avoidant behaviors Sensory seeking and sensory avoidant behaviors can be misleading.can be misleading.

Many Many sensory behaviors are seen in autistic sensory behaviors are seen in autistic spectrum spectrum disorders.disorders.

ADHD ADHD has sensory has sensory implications.implications.

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What Could It Mean?

Young man continuously throwing himself down on the flfloor.

Adolescent insisting on lying on the floor during groups and sometimes discussions

Young man with PDD refusing to change clothes and shower

Child acting out when going to lunch

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Be a Sleuth

Start considering sensory possibilities

When behaviors seem in explainable

When an outburst “comes out of the blue”

When tried and true interventions don’t seem to work

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Identifying Sensory Sensitivities Handout p. 36.

SENSORY DEFENSIVENESSSENSORY DEFENSIVENESS

Hypersensitive Hypersensitive –– low thresholdlow threshold

Abnormal reactions to things most people wouldn’t notice.

Abnormal experiences of sensory experiencesAbnormal experiences of sensory experiences

Increased startle reflexIncreased startle reflex

Avoidance and control issuesAvoidance and control issues

Some input can feel painfulSome input can feel painful

SelfSelf‐‐injurious injurious behaviors commonbehaviors common

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Sensory SensitivitiesWhat Can We Do?

Eliminate it

Avoid it

Get used to it – slowlyy

Work around it

Use a sensory tool

Change the time

Prepare yourself

Relax after

Tell someone – ask for help

87Page 37

Work with your partner of group to come up with some possible suggestions for some varied situations.

Making ConnectionsWhere do We Begin?

p gg

Remember that what you choose may not be the preference of the client so you will almost always be offering choices.

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Diagnostic Concerns and Sensory Issues

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Chronic hypervigilance

Dissociative Disorder and Borderline Personality Disorder

g

Constant struggle with feeling unsafe

Dissociation – state of non‐feeling

Distorted pain experiences

Hypersensitivities

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Overly Quiet/Withdrawn

Easy to overlook

Always start with Calming!!!!!

Person may be shut down or overwhelmed

Storm may still be raging inside

Just being with the person might help

After comforting try engaging in Koosh Ball toss

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Depression

“Just hold my hand.”

In acute stages person may be in shut‐down

Use calming input to start

Move on to mildly alerting input

Comforting input is essential – teach self‐soothing

Encourage movement and exercise

Upset/Agitated

Deep breathing

Try calming input andstrong organizing sensory input.

Walking or pacing

Stress ball/Toss Koosh

Theraband rowing

Listen to calming music

Rocking

Weighted blanket

Disorientation/DissociationFlashbacks/Suicidality

Person is not connected to reality

Use Alerting Input or Strong Organizing Sensory Input

Person may be scared or even traumatized

Use Grounding Strategies

Use Heavy Work or Exercise or Weighted Modalities

Strong input to the body helps bring the person to the present

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Psychosis

Be careful

May have to wait until meds kick in

Sensations may feed psychosis

Gi h id iGive them some space – avoid surprises

Try walking (pacing) with person

Provide grounding

Increase strong sensory input

Provide reassurance

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Anxiety

Often arises from feeling unsafe

Bring person to quiet place, make a connection, lower voice, humm together, do deep breathing, toss ball together, pace or walk together.

Help person find environmental or auditory “Safe Space.”

Make a cue card

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Peter is safe!Peter has friends!

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Easily over stimulated

ADHD and SENSORY PROCESSING DISORDERS

Anxious

Inordinate effort to perform tasks

Poor body awareness and stability

Perceive things differently from other people

Kinnealey (2007) www.sinetwork.org/aboutspd/response.html

People use self‐stim behaviors to keep regulated.

Rocking

Self‐Stim Behaviors

W ll d it ti !Rocking

Smacking lips

Hand flapping

Humming/self talk

Putting objects in the mouth

Hair twirling

Leg wiggling

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We all do it sometimes!

Is it working for the person?

The behavior is a clue as to what is working for the person

Don’t take anything away “cold turkey”

Finding Alternatives to Self‐Stim Behaviors

y g y y

Wean away slowly by substituting something similar and rewarding use of new technique.

Look at the reason behind the self‐stim

Do they need some down time?

Do they need to rev up with exercise?

Are the demands too hard?

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Sensory Connection to SELF‐INJURY

Soldiers in war who were the most wounded needed the least morphine

With repeated experiences of pain – body resets pain level –faulty adjustment

People often report they do not feel pain

People report that after self‐harm they feel calmer

Self‐injury is hard to stop because IT WORKS100

It can be a mal‐adaptive calming technique

Why Self‐Harm?

It can be a mal adaptive calming technique

It can be stress related

It can be a medical condition (toothaches, headaches, urinary infection, earaches)

It can be frustration with inability to communicate

(try a picture communication board)

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l k h hl k h h

Look Beyond the Behavior Look Beyond the Behavior –– and and Ask Why! Ask Why! Tina ChampagneTina Champagne

People seek what they People seek what they need need –– adaptively or adaptively or maladaptivelymaladaptively

(Dunn, 1997; Hanschu, 1995)(Dunn, 1997; Hanschu, 1995)

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Aspire Clubhouse

Workshop III


Angie Balzarini‐Leonhart, OTR/L


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In a survey of children and adolescents with severe emotional disturbances 84% of 39 educators identified

Games Teach Social Skills

emotional disturbances 84% of 39 educators identified problems with play and leisure (Grisham, Cook & Crews, 2004)

Skills include cooperation, assertion responsibility, empathy, and self‐control

According to the poly‐vagal theory of Stephen Porges, games stimulate neural circuits related to social engagement

104Not video games!

Pushing Game

105

What’s going on here? What would Porges say?

Tailgate Games

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Who could you go to if you are feeling upset?

What could they say?

Ho co ld the help?

Who Could You Go To?Game for Supports

How could they help?

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At a party

On the unit

In the community

At school

When with friends

On an outing

When visiting

Who Has the Ball of Responsibility?

Staff has itStaff has it

We share itWe share it

You have it!You have it!

Responsibility

Good self-control is having the ball in your court!

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Develop a Crisis Intervention Plan

Intervene early

Identify Signs and Triggers

Crisis Intervention

y g gg

Identify Helpful Strategies

Have a Plan

Contract for action “When I am upset I will………….…….”

Post the plan where children and care providers can see and use it!

See Handouts p. 22 ‐ 25

Be proactive

Teach skills early

Basics of Success Follow the research……

Introduce sensory room and sensory items

Know your patient

Trauma history??

History of aggression??

Respect preferences

Create safety zone

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LeBel et al, 2010; Huchshorn, 2004; Sutton & Nicholson 2011; Scanlan, 2010; MacDaniel et al, 2009; Porges, 2011

Deep Breaths

Vigorous Exercise

Wrap in a Warm Blanket

Core Strategies

Wrap in a Warm Blanket

Weighted Blanket

Rocking/Swinging

Grounding Strategies (Smell box, Hot Balls)

See Handouts p. 20

Non‐Tool BasedSensory Strategies

Chair pushups

Foot‐flexes

Jumping jacks (highly activating)

Pacing/walkingPacing/walking

Upper body joint compression

Full body joint compression

Kneel‐stands

Stamp feet or loudly clap hands

Rhythmic slap/clap activity

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Page 16 Can be used as a game. More ideas on SCP website – Free Activities

Pause – Connect – Engage

113Page 18 and 37

Something’s wrong.

Step back. Take a moment to think.

Was there a trigger?

Pause

gg

(bullying, humiliation, boredom, restrictions, frustration)

Was there a sign?

(agitation, threats, yelling, withdrawal, self‐injury)

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What Are the Triggers?What Are the Triggers?

Feeling scaredFeeling scared

ConfusionConfusion

H miliationH miliation

Someone being meanSomeone being mean

Wanting Wanting to to go homego home

Changes Changes in in staffstaff HumiliationHumiliation

BoredomBoredom

DisappointmentDisappointment

FrustrationFrustration

Teasing from Teasing from PeersPeers

Being over tiredBeing over tired

Changes Changes in in staffstaff

Changes in Changes in routineroutine

YellingYelling

NoiseNoise

Trouble at homeTrouble at home

Being left aloneBeing left alone

Handouts p. 23

What Are the Signs?What Are the Signs?

Kicking/hitting thingsKicking/hitting things

PacingPacing

Signs of AngerSigns of Anger

Self Self InjuryInjury

Temper Temper tantrumstantrums

WithdrawalWithdrawal Signs of AngerSigns of Anger

Yelling or swearingYelling or swearing

UncooperativenessUncooperativeness

Extreme AnxietyExtreme Anxiety

ArgumentativeArgumentative

Clenched fistClenched fist

WithdrawalWithdrawal

Emotional Emotional labilitylability

Being meanBeing mean

ThreatsThreats

Upset stomachUpset stomach

Laughing or gigglingLaughing or giggling

Handouts p. 22

Reach out to someone you trust!

Connecting with the right person shuts off the “fight or

Connect

flight” mode

Who would you go to….. At home? At school?

117

Who Could You Go To? Game

Use a stress ball

Do deep breathing

Engage

Do something positive

Do deep breathing

Pace or walk

Rock in a chair

Do a puzzle or activity

Exercise

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PauseSignal person to think

ConnectBring to a safe place

Pause – Connect – Engagefor staff

Bring to a safe place

Make a connection (eye contact, smile)

Assure Safety

EngageAsk what might help

Use common strategy (deep breaths, pace)

Page 18 and 37

What Helps?

Activity is designed to help identify and Activity is designed to help identify and communicate helpful strategies.communicate helpful strategies.

When I am angry?

When I’m scared?

When I’m in a bad mood?

Individualized poster is made using pictures Individualized poster is made using pictures of sensory activities and coping strategies.of sensory activities and coping strategies.

Poster is made available in the classroom or Poster is made available in the classroom or sent home to communicate helpful sent home to communicate helpful strategies to others.strategies to others.

120

What Helps? Game on SCP Website

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Fanny Packer

Fanny Packs or Sensory Kits can be developed in school or at home

Review situations that might need calming or alerting for lindividual

Practice using different tools and identify the most helpful activities

Make kits at school or provide suggestions for home.

121

This is a good way to involve families!

Page 13

Read the study for Marty or Casey

Using Handouts Identify What Helps?

Case Study Lab

Using Handouts Identify What Helps?

Using the Handouts Identify tools for a sensory kit or back pack (pages 10 ‐ 12)

Fanny Packer Handout (page 13)

Self‐Regulation Workbook

I Tried It Activity

Safety Zone Tool

C f t S Pl Comfort Space Plan

Sensory Sensitivities Discovery

Paus Connect Engage Worksheet

Circuit Breaker for Crisis Intervention

Handouts p. 28 ‐ 39

Keep an “I Tried It” list of possible activities in the Sensory

Room.

Each time a child tries a new activity have them check it off

“I Tried It” Activity

and perhaps put a star beside favorite activities.

Give a reward when all the activities have been tried (stress

ball or sensory tool)

124

Page 29 Find this tool on the SCP Website

What makes you feel upset(Circle all that make you feel sad, mad, scared or other feelings)

MA DMH Safety Zone ToolsTriggers Tool

Being touched Too many people

Loud noises Yelling Being alone

Available on-line -http://www.mass.gov/eohhs/gov/departments/dmh/restraintsecl

usion-reduction-initiative.html

What happens to my body when I am angry, scared or upset(Circle all that apply)

MA DMH Safety Zone Tools

Warning Signs Tool

Loud voice Upset Stomach Being Hyper Crying Being mean



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MA DMH Safety Zone Tools

What helps you feel better? (Circle all that apply)

fidgets games Weighted animal

readingsports



Comfort Space Plan

Dedicated space/room or corner of a room

Comfortable chair

Items chosen by the individual for nurturing and self‐regulation

Items might include CD or music, art or poetry books, “Heavy Duty” animal, blanket, weighted lap pad, manipulatives, tasty treats, grounding supplies, scented lotions.

Page 34- 35

128

Work with parents

Use Comfort Space Planworksheet

Find a location

Comfort Space Plan

Find a location

Make suggestions for items child seems to enjoy

Decide how the space will be used

10 minutes morning, afternoon & evening

before or after school or work

before of after appointment or stressful event

before bed

129

Pages 33- 34

S S iti iti Di W k h t

Bothersome Sensory Input

Sensory Sensitivities Discovery Worksheet

What Can You Do?

Page 36 - 37

Pause (for warning signs or triggers)

Pause – Connect – EngageWorksheet

Connect (seek/accept help)

Engage (do something positive)

Page 38

Take control and you help Take control and you help that daythat day

SelfSelf‐‐ControlControl

that day.that day.

Teach control and your help Teach control and your help lasts a lifetime.lasts a lifetime.

132

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Try it Try it –– You will like it!You will like it!

Sensory approaches make sense!Sensory approaches make sense!

Sensory activities are fun!Sensory activities are fun!

Documents

Workshop I II and III combined - Reach...3/10/2017 5 Oral Motor Sense is a combination of flavor, texture, temperature and movements of lips jaw and facial muscles Oral Motor Sense,