Sensory Integration Education

Welcome back to our feature series on the Early Adopters of Sensory Integration. For this edition, we caught up with Jenny French, physiotherapist and sensory integration practitioner. Jenny tells us about her own historic pathway through sensory integration and her significant contribution to the development of sensory integration within the UK. Through this series, we are aiming to capture the legacy of sensory integration and document how it has evolved over the years. 

It sounds so strange to be included as one of the ‘early pioneers’ of sensory integration. My journey has lasted about 45 years! It was a privilege to attend the Sensory Integration Education conference in November 2019 in Birmingham and meet up with friends and colleagues, some of whom I had not seen for very many years. The buzz and enthusiasm made me feel so welcome. Thank you SIE! 

My introduction to sensory integration came about following a series of almost accidental contacts with innovative physiotherapists working in paediatrics in the 1970’s. What emerged was an unfolding journey of discovery which brought me into contact with some of the most exceptional occupational therapists, physiotherapists, speech therapists, behaviour therapists, psychologists and teachers imaginable. These encounters changed my therapy practice for the rest of my working life. The journey evolved as more colleagues, both nationally and internationally, became interested in sensory integration and undertook research that enriched clinical practice.

The cumulative effect of this work, based on the ground-breaking work of Dr. Jean Ayres, impacted on the lives of thousands of children over the ensuing years. My contribution to the story is small, but the historical pathway outlined below helps put into perspective how much change there has been in therapy practice over the ensuing years.

I qualified as a physiotherapist at Guys Hospital in 1970. My first job was at the Princess Margaret Hospital in Swindon, which had a hospital school. Children could be hospitalised for many months. They were being treated for conditions like spina bifida, polio, or chest conditions like cystic fibrosis. I was thrown in at the deep end and so started my career in paediatrics. It was this experience that taught me so much about observing and listening to children – an essential requirement for sensory integration practice.

In 1971, I gave birth to my son. He was only a few weeks old when I was asked to go back to work as there was such a shortage of paediatric physiotherapists. This profession was in its infancy, but we were already in short supply. At this time children’s services, health, education and social care were delivered ‘silo’ style following a medical model.

I quickly understood child development could not be based on any one service or any one philosophy. Provision of care needed to be ‘linked up’ in order to provide continuity and all round support for children. Recognition that a ‘silo’ mentality created a waste of resources, professional defensiveness and gaps in child protection led to an era of multiagency working. In 1974, after the birth of my daughter I moved to Devon, working with the ‘Devon and Exeter Spastic Society’. This was a boarding school offering outreach across the county. The school catered for children with cerebral palsy and I began learning about the importance of team working alongside other paediatric healthcare professionals. We learnt together about motor skills, neurology, emotional and social development and the importance of a child and family centred approach. I completed training in Bobath and learnt so much more about neurology and brain function. Little did I realise how important that fundamental knowledge of child development and neurology would be in understanding the theory of sensory integration.

At this point, it was clear that little work on SI was being done in the UK, in fact there was much criticism and scepticism about SI. Much of the criticism was based on the limited research evidence and SI was considered the latest treatment craze. However, even though things now are very different, demonstrating the efficacy of SI still rests on the shoulders of clinicians.

By the mid 1970’s, health had undergone yet another reorganisation. Child development centres had been set up, and physiotherapists, occupational therapists and speech and language therapists would further consolidate their working practices. This was a key factor which, especially with SI, would make a difference in a child’s overall assessment and treatment.

In the late 1970’s, I had become a national committee member for the Association of Paediatric Physiotherapists, which was part of the Chartered Society of Physiotherapy. At this time, more children were being labelled as ‘clumsy children’, a term which was recognised to do more harm than good. Children had to have a ‘diagnosis’ in order to access treatment. A range of more descriptive diagnoses followed including Developmental Coordination Disorder, Sensory Motor Disorder, Autism and ADHD. If more accurate assessments had been available, many of these children’s sensory processing difficulties may also have been identified. When the Southern California Sensory Integration Test (SCSIT) was introduced it undoubtedly changed the way we observed, assessed and treated children. From the mid 1970’s, Jean Ayres seminal work was being recognised more widely outside the USA and the SCSIT became available in different countries. However, in the UK the introduction of this new approach was still frequently met with scepticism. However, our group was determined to learn more about this approach. At this time, there was no specialist equipment available. Ramps and scooter boards had to be built and suspended equipment was adapted from what was available in gyms. You could always recognise an SI therapist! Most importantly they needed to own an estate car. It would be packed to the gunnels with a slide, ramps, a heavy box of chains and suspension hooks, exercise balls, mats and much other paraphernalia! We needed to know a handy man who could build, adapt and mend our equipment and we needed to be ‘in’ with schools and centres that had suspension points on which to hang our nets and swings!

During my time with the APCP, I was a member of the post registration education committee. This gave me a wider window on early research where I first heard about the work of Jean Ayres. Those influential colleagues I referred to earlier came from many diverse backgrounds. Many of us had already been using the rudiments of SI and were involved in small group training and had started presenting our experiences at local and national conferences.

The next stepping stone in my learning came as a result of a study tour in California where I stayed with Pat Wilbarger. Here I met many SI therapists and was introduced to the concept of sensory diets and brushing techniques. I travelled to Denver to meet Lucy Miller who was working on the Miller Assessment for Preschoolers (MAP) at the time and back to Torrance to see SI in action, visiting various clinics to see the innovative way occupational therapists had set up their treatment areas. It is impossible to describe the overwhelming enthusiasm and commitment of the therapists and the amazing support they provided. I was only sad Jean Ayres had passed away a few years previously, as I never was able to meet her.

The Development of SI 

During the early 1980’s myself and other like-minded colleagues set up the Sensory Integration Association (SIA). We eventually produced a newsletter called ‘Sensor’. Our journey led to more organised training programmes where theory, assessment and clinical observations were the central themes. Our meetings were organised at the SENSE headquarters in Ealing, London thanks to Judith Peters and from here we coordinated our teaching programme and shared our many experiences. As Chairperson and founder member of SIA (UK), I again met some innovative colleagues. On the committee we were privileged to have Dr. Greg Kelly, from Northern Ireland, Inge Gregorius from New Zealand, and Sue Keam (who later took over the chair) and others later including Joy High. Joy already had several years experience using the SCSIT test and working with children in South Africa. She was a great bonus and she went on to be a huge inspiration to therapists across the West Midlands and beyond.

At this point, we heard about the work of Liz Stephenson and Elizabeth Fairgrieve. Courses had run in the USA for several years and as therapists returning from the USA, they set up their own training programmes and organisations. We all worked in isolation from one another initially, where four distinct groups emerged. The Sensory Perception group (SPG), SIA UK, British Institute of Sensory Integration (BISI) and Irish Sensory Integration Association ISIA. Now a diversity of SI training was available, and it became increasingly difficult for therapists to choose which SI pathway they would like to follow.

It was 1995 when our next major event took place. I was invited to attend a meeting at the College of Occupational Therapists on behalf of the SIA group. In attendance were Liz Stephenson Elizabeth Fairgrieve, Sidney Chu, Eadaoin Breathnach and Dido Green. Our focus was to find a way to collaborate with one another finding mutually agreed pathways for accreditation in SI training. One of the main questions was whether we should follow the US model and find ways to all become SIPT trained or whether we should find our own accredited training pathway. The Sensory Integration Coordinating Committee (SICC) met to work out the processes. That first joint meeting at COT opened the door to a new chapter, but reaching consensus took more than 2 years!

Pictured from left: Liz Stephenson and Jenny French 

The next big question was how to move forward? A smaller group was nominated to ease communication, one rep from each group Liz Stephenson from SGP, Sue Keam represented SIA and Eadaoin Breathnach represented the Irish Sensory Integration Association (ISIA). This amalgamating committee process was completed by 1995 and a new newsletter SINet advertised the first joint foundation course. Training that was initially delivered with support from our American colleagues. Then there was the introduction of co-teaching by a representative from each of the four groups. It gave us the possibility of sharing our joint expertise, developing new courses and, for me, the beginning of a lifelong friendship with Liz Stephenson and Elizabeth Fairgrieve.

Pictured from left: Elizabeth Fairgrieve and Jenny French

All our efforts over the preceding years had been focussed on finding ways to assess and treat children using standardised assessments and treatment carried out by rigorously trained and accredited therapists. Accreditation was high on the agenda and in 1998 the first courses were accredited at the University of Liverpool. Following on from this, I took up a post at the University of Wolverhampton working in the School of Education. This was the beginning of a new chapter for me or was it?

And now back to my continuing journey taking up the story in the 1980’s!

In 1983, it was still early days and only very few physiotherapists and occupational therapists had heard of SI. At this time, I worked in a Special School in Mansfield and was lucky enough to meet a Physiotherapist from Denmark who, like me, had already been exploring SI and had some knowledge of the SCSIT. Her name was Bette Berents and she both influenced me and challenged me to find new ways to assess children in order to better identify the specific treatment and support they needed. We introduced some sessions for children at a local hospital in Sutton in Ashfield.  

Bette and I talked about SI constantly and learned about the SCSIT. We experimented, comparing our existing assessment tools with our clinical observations and set up a special clinic. Children were referred by our paediatrician and school medical officers. Teachers had been included in our early workshops and had seen the change in the children after treatment. This helped enormously as they also began to understand the issues of poor sensory processing for children in the classroom and were also able to support families more regularly than we could.

Learning and becoming proficient with standardised tests was no mean feat! Acquiring the original test was costly, especially as we had no budget for resources. Then the challenge of practising on one another to become proficient which I have to say did have moments of great hilarity especially in tests requiring cross laterality or balance aptitude! Alongside the SCSIT we used other tests like Bruininks/Oseretsky, De Gangi Berk and Stott-Henderson.

Bette was very clear that unless we could provide an evidence base for our work and demonstrate the efficacy of any new treatment our efforts would be meaningless. Bette’s enthusiasm was what kept me going.

So............... Off to Sheffield University where, under the guidance of Bunny Le Roux, Statistician, she and I completed our Statistics and Research methods modules! As we gained confidence, we extended our training sessions both to help teachers identify the children most needing SIT and also to help them understand children’s difficulties and behaviours, especially as many of this group of children were victims of bullying and class room under-performance. 

A further big question of course was whether our treatment made any difference. Bette and I set out an ambitious research project entitled – “An Evaluation of Sensory Integration Therapy in the Treatment of Clumsy boys”. We completed many applications for a grant to support our research. In 1986 that we successfully received funding from our Health Authority. Work on this research, which was completed in 1988, was sadly never published as Bette moved back to Copenhagen and I changed my job.

In 1992, I returned to the USA to complete another neurology course and the SIPT training. At the time, the SIPT training was held in various locations which included Theory and Neurology in Albany and New York with the test practical held in Albuquerque, New Mexico. It was certainly an adventure.

In 1997, I had moved to the University of Wolverhampton. By this time, Joy High had authored the “Cool Kids” programme and had achieved her masters. Greg Kelly had gained his doctorate and later Judith Peters had completed her PhD. Joy, Liz and others worked alongside Judith Peters playing their part working on validating the movement ABC for use in the UK.

Pictured: Jenny with Dr. Greg Kelly at the SIE Autumn conference in November 2019

There was one more chapter in my SI career that occurred while I was at the University of Wolverhampton, School of Education. It started in 1998 where I had the opportunity to teach not only on education modules, but also on the special needs’ modules, along with some courses relating to children with SEND and autism. Two opportunities presented themselves; Firstly, the Local Authority was looking for Short Break schemes to support children on weekends, after school and during the school holidays. Of course, with my SI background this was an opportunity not to be missed. Families required additional support and the children required continuity in their daily routines, their choice of activities which supported their learning.

Secondly Myself, my husband and my son set up a Social Enterprise CIC providing after school and holiday clubs for children with complex needs including a large cohort with autism. All aspects of the programmes were based on the principles of SI. SI was what underpinned every aspect of the scheme. Every child was assessed by a therapist using a combination of clinical observations, sensory tests, social and behaviour scales, child interviews (to ascertain what the child themselves would like to achieve) and parent assessment before they were accepted on the schemes. Each child had a ‘passport’ that included results of specialist assessment and treatment, recommendations, targets and reviews. The therapists provided up to an hour individual ASI treatment for those children assessed to most benefit from SI. The volunteers (trained Buddy’s) carried out the therapists’ and specialist teachers’ instructions. Timetables were set up which enabled the child to have an individual SI therapy session as part of their daily programme. We worked in large multi-room settings, at first at the university and then in local special schools that already had a high level of equipment available.

These schemes were well received by children, families and schools. The programmes were set up within the context of the children’s school targets and therapy goals risk assessments. These schemes ran until 2014.I retired in 2015.

My early partner in crime Bette Berents still works more than full time and also works for the Danish Physiotherapy association. Bette says, ‘I forced her to give talks about SI and later on to lecture on courses’! I think we forced each other and so our passion for SI grew. I saw it at the SIE conference in Birmingham with so many young and not-so-young therapists passionate about their own learning journeys! It’s been strange to reflect on a long working career – what a privilege to have met Bette Berents, Liz Stephenson, Elizabeth Fairgrieve and so many others and to have a job both fun and rewarding, but also sometimes frustrating and challenging! We are indebted to the work and career of Jean Ayres.