SUZANNE M. WHITE
M.A. OTR/L, FAOTA
Sensory Regulation for Children and Teens in Behavioral Health Sections
In keeping with the short-term inpatient nature of children and teens behavioral health unit, the following assessment are conducted:
World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0 Children and Youth 36-item) is the DSM-5 Axis V replacement of function. The WHODAS 2.0 is grounded in the conceptual framework of the International Classification of Functioning, Disability and Health (ICF) and captures a child's level of functioning in six major life domains: cognition; mobility; self-care; getting along; life activities; participation in society. Link
The Social Profile: Children's & Adult Version assesses developmental interaction skill levels among children aged (18 months to Adult) during group activities. Link
Children’s Kitchen Task Assessment (CKTA) assesses executive function components in children ages 8-12 through the performance of a novel task (i.e. making play dough). It informs the caregivers and staff of the cue level needed for the child to successfully complete self-care activities, and other activities associated with childhood learning and development. Link
The Sensory Profile-2 Child is a caregiver questionnaire used to assess sensory processing patterns and their potential to interfere with participation in daily routines and social interactions among children aged 3-14. Link
DO-EAT: Performance-based Assessment Tool for Children provides a standardized way to assess children’s sensory-motor skills, executive function skills, and behavioral and emotional skills during the performance of typical daily tasks for children ages 5-8. The tasks consist of putting on an apron, making a peanut butter sandwich, preparing a cup of chocolate milk, and completing a certificate. Link
Weekly Calendar Planning Task- Adolescent Version yields in-depth data on performance of a complex, cognitive instrumental activity of daily living, organizing a weekly calendar, as well as assesses executive function for ages 16-21 Link
The Comfort Room
Children of the behavioral health unit exhibit challenging behaviors, such as aggression and defiance that could be improved through the use of self-regulation strategies. The Comfort Room is the primary environment of unit used to deescalate the children in lieu of physical or chemical restraints. Child-centered interventions are developed by observations and standardized assessments of the children’s emotional dysregulation and their motivating interests.
Based on sensory processing theory, the room provides a dedicated space to help the children learn and practice self-regulation techniques. The sessions are structured to provide child center play, consistency, expectations for safety, recognition of emotional states, exposure to a variety of soothing sensory stimuli, and an opportunity for learning smoother transitioning behavior. These interventions use calming sensory techniques and equipment, such as gross motor exercise (e.g. therapy ball exercises, dance, yoga stretches), sensory equipment (e.g. vibrating mats, weighted blankets, fidgets, scented lotion, lighted equipment), music, cardboard box imaginary play and art projects. Additionally, the Care’s group “relaxation techniques to control feelings” coping skills are practiced and reinforced. The sessions assist the child in developing an organized response to internal and environmental sensory stimuli. The children learn positive self-regulatory techniques that they could use in varying contexts, such as in school, home and within the community.
Occupational therapy possesses unique knowledge of functional standardized assessments and client-centered interventions to effectively address social, cognitive, sensory, and/or motor impairments that may affect a child’s quality of life. Beginning in 2015, the State University of New York Downstate Medical Center’s Occupational Therapy Program assigned to a children and teens behavioral health unit focuses on the children’s interests and takes their strengths into account to develop a treatment plan that would address their functional deficits while maintaining their confidence and motivation. In each occupational therapy interaction, the therapeutic activities were modified to give the child a just-right challenge to optimize therapeutic benefit.
Occupational therapy provides assessments and treatment plans that support the team’s greater understanding of a child’s occupational strengths and areas of concern by standardized testing and observation of the child as they actively engage in the milieu. The evaluation referral is to further understand of the symptoms and behaviors that undermine the child’s daily functions. Some reasons for evaluation are to:
Gain an overall score of functional difficulties due to health/mental health conditions
R/O sensory procession issues related to diagnosis
Determine cognitive strategies used to support executive function and self-regulation
Delineate levels of social skill development
Provide post discharge recommendations
Social Skills Interventions
Occupational therapy addresses social interaction skills; such as verbal
and nonverbal communication, taking turns, eye contact, active listening,
and empathy. Knowing the child’s developmental social skill level allows
skill deficits to be addressed through the organization of planned
group activities, which included board games, art projects, imaginative
play, and group exercise. The social skills interventions were used in
efforts to optimize the children’s positive interactions with their
peers on the unit, within their families and their communities.
Overall, occupational therapy uses activity interventions to address emotional regulation within individual and social contexts that aimed to further improve the child’s ability to master functional skills and gain self-understanding. Consequently, this improved emotional regulation may positively influence their social skills and relationships. This is important for minimizing altercations and increasing functionality. The following section contains excerpts from the occupational therapy documentation of observations, interventions, and the children’s responses to the interventions.