Evidence-based sensory resource for new school-based OTPs: program development and evaluation

Education is a fundamental childhood occupation, and difficulties in sensory processing can present challenges for children to be successful in the learning environment. Sensory-based interventions (SBI) are widely used in school-based occupational therapy when working with students identified with sensory processing needs following evaluation. Thompson-Hodgetts and Magill-Evans (2018) found that 98% of the pediatric occupational therapy practitioners surveyed who work with children with autism spectrum disorder have used sensory-based strategies with their students. With sensory-based strategies often being utilized with the pediatric population, it is imperative that occupational therapy practitioners (OTPs) have access to current, robust research to facilitate evidence-based practice (EBP).

Watt and colleagues (2023) explored the effect of SBIs on behavior and the impact of intervention on classroom engagement through a scoping review. After examining 19 studies, they found that students who cannot self-regulate through managing their own behavior struggle to perform in the classroom. SBIs that promote self-regulation can aid students in engaging in multiple occupations within the school context, including play, social communications with peers, and task completion through cultivating fine motor skills and attention in the classroom. SBIs should be highly personalized due to the individualistic nature of sensory processing, which creates challenges to the generalizability of studies into their efficacy.

When entering school-based practice, OTPs are expected to be experts within this realm of special education related services, ready to provide evidence-based recommendations to assist children with self-regulation and attention within the classroom environment. Charles and Glennon (2020) found that only 52% of 284 surveyed OTPs learned about SBI through a college course, whereas 64% learned through continuing education classes and 60% learned through occupational therapy journals. It can be inferred, therefore, that many OTPs learn about SBI through their own self-initiated learning after graduation from occupational therapy school. In fact, Thompson-Hodgetts and Magill-Evans (2018) discovered that OTs with fewer than 5 years of experience recommend SBI for fewer students.

New OTPs to school-based practice may express a less robust knowledge base and awareness of evidence-based sensory strategies that are appropriate for the school environment than more experienced practitioners. Providing a resource to bridge this knowledge gap is imperative for providing effective sensory strategies to facilitate self-regulation and participation in classroom tasks. Improved behavioral regulation and participation in the classroom are beneficial for children, teachers, and the overall learning milieu. Although many practitioners seek out continuing education courses and professional journal articles to supplement their knowledge of EBP, providing a resource that defines evidence-based sensory strategies will increase the efficiency of gathering this information to utilize within the school environment.

Program Description

Although SBIs are widely used in school-based occupational therapy when working with students with sensory processing needs, many new school-based OTPs, including some in the first author’s school system, express lack of familiarity with them. The need for an efficient resource tool is apparent. Our specific aims were to:

• Provide a resource tool for new occupational therapists (OTs) to facilitate the use of evidence-based SBIs with students.
• Improve new OTs’ knowledge, competence, and confidence with SBI recommendation and facilitation.
• Through the use of evidence-based SBIs, facilitate students’ improved participation and self-regulation in their school occupations.

We developed an evidence-based resource tool for new school-based OTs and collected pre- and post-intervention survey data via a web-based, self-completion questionnaire, regarding participants’ response to using the resource and their confidence with facilitating evidence based SBI. The pre-intervention survey was completed by six school-based OTs with 5 years or fewer of school-based experience, working in elementary, middle, and high schools. We gathered data on their current use of SBIs, and their knowledge, confidence, and competence levels with providing recommendations and facilitating SBIs in the school setting.

The evidence-based resource tool was established through a web-based platform and disseminated to the participants via email. This resource included evidence-based sensory intervention recommendations based on a student’s specific sensory needs, with sensory needs and recommendations broken down by vision, hearing, proprioception, interoception, and vestibular senses, paired with corresponding behaviors seen in the school environment. Evidence-based strategies were provided for particular sensory needs and behaviors, with instructions for their use. Examples of strategies include noise attenuating headphones and sound absorbing wall material to increase attention in the student who is auditory over-reactive; chewing gum or eating a crunchy snack, doing yoga, and jumping on a trampoline to increase seat time for the student who is proprioceptive seeking; using calm colors, decreasing clutter, and providing a refuge space to improve visual attention in the student who is visually over reactive; and therapy ball seating, slow linear swinging, rapidly bouncing an exercise ball, and jumping on a trampoline to increase seat time in the student who is vestibular seeking (see Figure 1). A link to a data sheet was posted at the bottom of each page of the resource (see Figure 2), so participants could systematically evaluate a child’s response to the SBI. A link to the Motivation Assessment Scale was included in the resource, to assist participants in identifying particular behaviors as sensory based. The Motivation Assessment Scale and Motivation Assessment Scale II are rating scales that are designed to assist in identifying the motivation behind a challenging behavior in individuals with developmental disabilities (Texas Education Agency, n.d.).

Figure 1. Example of Page From Online Sensory Resource

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Figure 2. Sample Data Sheet

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Program Outcomes

The post-intervention survey collected after 8 weeks addressed the OTs’ response to using the resource, as well as their knowledge, confidence, and competence levels with providing recommendations and facilitating SBIs after utilizing the resource tool. Four OTs with 2 to 5 years of experience completed the post-intervention survey. The participants identified the resource as somewhat helpful in identifying SBIs, as well as the included interventions being somewhat effective in assisting students with their sensory needs. The participants responded that the resource was very straight-forward, clearly identifying the desired behavior, problem, and solution; it contained simple visuals and easy to read language rather than paragraphs; and addressed the primary behaviors related to learning readiness. One participant noted that continued needs include the “lack of ability to provide the intervention in a comprehensive school setting (e.g. significant need for proprioceptive and vestibular input, therefore there would be too much instructional time missed, significant sensitivity to many triggers which cannot be altogether eliminated in a school setting).” Suggestions for improving the resource included: providing more guidance or suggestions about how to implement and monitor each SBI; expanding the resource to include other needs relative to school-based occupational therapy, suggesting which intervention to trial first; and adding a link for teachers to educate them on sensory needs. Barriers to effective provision of SBIs in the school setting were identified as staff inconsistency, few funds for buying materials, and significant student sensory needs that require excessive time out of class.

Implications for Occupational Therapy

Post intervention data identified the continued need for an effective resource for new school-based OTPs. The expansion of the resource to include more sensory profiles, as well as a link to a teacher presentation on student sensory needs, would be beneficial for meeting the identified needs of these therapists, and development is underway. One of the four therapists who completed the post-intervention survey, who has 3 years of experience in school-based practice, identified increased feelings of competence in recommending SBIs, which suggests that the resource may be effective in increasing knowledge, competence, and confidence of its users. This tool appears to be most effective for therapists with 3 years of experience or less; however, continued data collection is to be conducted.

Conclusion

Entry-level occupational therapy education includes minimal content on SBI, despite it being a leading area of practice and research in the profession (Schaaf et al., 2015). Although the literature has reported that teachers value collaboration with OTs (Benson et al., 2016), most OTPs have little information to guide them in determining student sensory needs, teacher training needs for student sensory-based behaviors in the classroom, and development of training programs using teacher-preferred methods. The development of a resource for OTPs to utilize for facilitating evidence-based SBI can further be used as a training and consultation tool within the scope of consultation with teachers in the school environment.

References

Benson, J. D., Szucs, K. A., & Mejasic, J. J. (2016). Teachers’ perceptions of the role of occupational therapist in schools. Journal of Occupational Therapy, Schools, and Early Intervention, 9, 290–301. https://doi.org/10.1080/19411243.2016.1183158

Charles, R., & Glennon, T. (2020). Understanding how school-based OT practitioners (OTPs) perceive sensory integrative and sensory-based interventions: Knowledge base and practical application. American Journal of Occupational Therapy, 74, 74115052601. https://doi.org/10.5014/ajot.2020.74S1-PO9800

Schaaf, R. C., Schoen, S. A., May-Benson, T. A., Parham, L. D., Lane, S. J., Smith Roley, S., & Mailloux, Z. (2015). The Issue Is—State of the science: A roadmap for research in sensory integration. American Journal of Occupational Therapy, 69, 6906360010. http://dx.doi.org/10.5014/ajot.2015.019539

Texas Education Agency. (n.d.). Motivation Assessment Scale. Texas Autism Resource Guide for Effective Teaching. https://www.txautism.net/evaluations/motivation-assessment-scale

Thompson-Hodgetts, S., & Magill-Evans, J. (2018). Sensory-based approaches in intervention for children with autism spectrum disorder: Influences on occupational therapists' recommendations and perceived benefits. American Journal of Occupational Therapy, 72, 72032050201-72032050208. https://doi.org/10.5014/ajot.2018.024729

Watt, H. M., Cox, G., DeHerrera, M., Podgorny, S., Fortuna, J., & Cantwell-Jurkovic, L. (2024). Sensory-based interventions in school-based occupational therapy: A scoping review. Journal of Occupational Therapy, Schools, & Early Intervention, 17, 731–754. https://doi.org/10.1080/19411243.2023.2275562

Amy Leatherman Cowell, OTD, OTR/L, has been an OT in multiple practice settings during her 22-year career, but primarily in the school-based setting for more than 10 years. She is currently enrolled in the Administrator I certification program through Towson University, in Towson, MD.

Barbara Demchick, ScD, OTR/L, FAOTA, has been a Pediatric Occupational Therapist working with children of all ages and their families for 48 years. She is a long-time occupational therapy educator and is currently Professor Emerita at Towson University.