Sensory Integration Education

Ciara McGill (Nee Feehan), is an Advanced Practitioner Occupational Therapist in the community adult learning disability team within the Southern Health and Social Care Trust in Northern Ireland.

Ciara has always had a passion for working with children with a diagnosis of autism and those with behaviours that challenge. She completed voluntary work in this area and the area of sensory integration alongside her rotational post until a post became available within her preferred field of Autism. In 2010, an opportunity arose within the Health Service Executive (HSE) and so she moved to work within the Louth Autism/ Early Intervention Team. This is where Ciara began to further develop her skills and expertise in the area of Sensory Integration (SI). This led to her completing a range of specialist courses and embarking on the SI Masters pathway.

In 2014, following the completion of SI module 4 she was funded to complete a poster presentation which was displayed at the SI conference in Finland. In 2015, she moved jobs to adult learning disability services, where she is employed at present. Within her new role, Ciara completed a master’s module through the University of Ulster in seating and complex needs alongside her sensory integration modules. In 2016, she received the Postgraduate Diploma SI award for ‘Outstanding Student and Academic Excellence.

Having worked for several years in paediatric services the move to adult learning disability services presented a range of new challenges. For example, Ciara previously had the luxury of treating individuals with sensory difficulties in a fully equipped SI gym whilst the new service had limited treatment space and equipment. In addition, many of the adult clients displayed substantial sensory modulation difficulties and presented with significant challenging behaviour. Therefore, the ability to bring them to a treatment facility was often compromised.

For adults with a learning disability, Ciara reported that the individuals’ environment and compatibility with other people appeared to have a significant impact on their sensory presentation. Alongside these factors, there was the added complexity of some individuals requiring restrictive interventions (physical, mechanical, chemical restraint and/or seclusion) as a last resort.

Following sensory integration observations of adults with a learning disability and severe challenging behaviour on her caseload, she had hypothesised that some individuals were showing a preference for restraint and many were presenting with sensory difficulties especially in relation to sensory over responsiveness in the tactile system. In her opinion she felt that some individuals were eliciting restraint from their carers to relieve sensory abnormalities and/or anxiety.

Ciara sought guidance from colleagues, policies and procedures and she completed an online mentorship with Susanne Smith-Roley. She also completed an in-depth literature search. Through completing an in-depth literature search, Ciara found a significantly limited amount of research on the use of sensory integration to manage challenging behaviour for adults with a learning disability in the community. She explained that this is because existing research is within an institutional setting and does not reflect the move to community care. Furthermore, most of the research focuses on children but sensory integration difficulties are life-long and do not just affect children with a learning disability. Therefore, she felt there was an obvious need to research this area as she hoped it would better inform her Occupational Therapy practice.

Ciara completed her Masters in Sensory Integration Therapy through the University of Ulster and graduated in December 2019 with a First-Class Honours (1:1). As part of her research project she worked in collaboration with Dr. Cathal Breen a University of Ulster lecturer. Their research is entitled, ‘Can sensory integration have a role in multi-element behavioural intervention? An evaluation of factors associated with the management of challenging behaviour in community adult learning disability services.’

Ciara advised that best practice in challenging behaviour recommends a multi-element approach and use of Positive behaviour support as a preventative strategy as opposed to restrictive intervention (NICE 2015). Positive behaviour support involves functional analysis, but it does not specifically focus on sensory integration difficulties as a contributing factor to challenging behaviour (McGill & Breen 2020). Therefore, due to the significantly limited amount of research on the use of sensory strategies to manage challenging behaviour for adults with a learning disability in the community, literature based on behavioural intervention was also included in their review study.

Ciara outlined the format as follows. Firstly, a systematic search of the literature was completed and seven relevant studies were identified. Then these studies were critically appraised and analysed. Out of the seven intervention studies included in their review, two studies used sensory integration therapy, three employed multi-element behavioural intervention, one utilised environmental stimulation within a multifactor behavioural intervention approach and one used sensory strategies within a structured behavioural intervention programme.

Their review concluded that the use of restrictive intervention is still an issue in practice and most of the studies appraised stressed the problem of placing individuals with severe challenging behaviour in the community. Ciara was delighted with these findings as they really reflected the clinical issues she was facing. However, the most exciting part for her was that their research concluded that behavioural studies have successfully utilised sensory integration strategies to manage challenging behaviour in a community setting for adults with a learning disability. This is something that she has always believed but it was fantastic to be able to confirm it and share it.

Ciara has had her research published within the British Journal of Learning Disabilities. This is the official Journal of the British Institute of Learning Disabilities (BILD). She is delighted to have her research published in an international, multi-disciplinary team journal which will reach a worldwide audience. Their research is available to access via early view format before it is placed within a journal issue.