Sensory Integration Education

Diana Henry, one of the authors of the SPM-2 and author of the SPM Quick Tips, kindly shared more information about the new edition of the assessment due for release at the end of 2020. Diana’s occupational therapy career began with the study of Sensory Integration in 1975 under the mentorship of Lorna Jean King, who expanded on the work of Dr. Jean Ayres. One of Diana’s missions throughout the years has been to bring sensory integration and processing to the key stakeholders on the team: the parents, teachers, students, administrators and other health professionals. She began with Tools for Teachers, Tools for Students, the Tool Chest, and then collaborated on Tools for Infants, Tots, Parents, Teens and yes, even Tools for Pets. 

Diana’s husband Rick, has been an instrumental member in her team and has accompanied her on the road for 11 years whilst teaching and educating about sensory integration. One of Diana’s highlights from the recent AOTA Conference was meeting the SIE team where we had the opportunity to hear about the new SPM-2 assessment at the WPS stand with a special ‘meet the author” session. It was wonderful to connect with Diana and we look forward to meeting again soon. 

The SPM-2 - (Author(s): Diane Parham, Cheryl Ecker, Heather Miller Kuhaneck, Diana A Henry, Tara J Glennon)

The SPM-2 is an updated, norm-referenced assessment tool with substantial normative data, allowing for evaluation of sensory integration (SI)/ sensory processing, praxis, and social participation. The SPM2 will have normative data on typically developing children and data for clinical samples. The SPM-2 systematically assembles information about sensory processing from infancy through adulthood in natural environments. It facilitates intervention planning across the lifespan using a team-based approach. Specific forms include those for infants, preschool age, school-age, adolescent, and adult ages. Each age range includes forms for varied informants (including caregivers, teachers, and self-report) which can be compared in varied settings (e.g., day care, home, school environments, and a driving form).

The re-standardization of the Sensory Processing Measure, including the expansion of age ranges from birth through adulthood, allows occupational therapy practitioners the ability to systematically assemble information regarding specific aspects of sensory integration/ processing, including modulation, praxis, and social participation. Diana reported that updating assessments is normal practice in order to ensure that the assessment is moving with the times. While the authors have still kept many of the items on the SPM that therapists will be familiar with, many more items have been added to reflect the changes in children’s play and occupations. Practitioners will appreciate the timeliness of such an instrument, thus contributing to their scholarship, currency in the field, and ability to support occupational engagement for individuals of all ages.

Practitioners rely on carefully developed assessment tools to help them understand their client’s performance concerns to develop effective interventions. To meet this charge, assessment of sensory processing skills in a variety of contexts is important. The SPM-2 allows OT practitioners to consider the sensory factors that might be impacting the occupations, personal interests, performance patterns, roles, routines, and patterns of engagement which were identified during the occupational profile portion of the OT evaluation as described on page 13 of the OT Practice Framework (AOTA, 2014), McGuire, & Metzler 2016).

Based on theory developed by A. J. Ayres, the SPM-2 helps the practitioner to discern whether sensory modulation or praxis issues are affecting participation from infancy through adulthood. The SPM-2 is a reliable and valid assessment developed through a rigorous psychometric process, suitable for clinical and research purposes, and supporting occupational therapy as a science-based profession. The tool is easy to administer and score using either paper or online administration, facilitating full inclusion of all team members.

The new SPM-2 provides practitioners with a reliable and valid way to gather information regarding sensory processing across the lifespan, with new forms developed for infants (including a parent form to understand the impact on co-occupations), adolescents (with self-rating, parent, and teacher forms), and adults, in addition to the previously available preschool and school age forms. Additional new forms allow rating of caregivers and the driving environment. New scale development allows for varied cross comparisons between raters providing a more comprehensive picture of a client’s performance.

The SPM-2 allows for gathering of information about the impact of SI on family, school occupations and routines. SPM2 raters provide information about an individual’s responses and behaviors during feeding, hygiene, play/leisure, school activities, work, caregiving, driving, and other occupations throughout the day. For families of children with SI issues and comorbid autism spectrum disorder (ASD), the most common family- identified goals are ADLs and social participation (Schaaf et al., 2015), areas that the SPM2 evaluates. Driving is another important occupation for social participation. Adolescents and adults with diagnoses such as ASD/ADHD frequently obtain driver’s licenses, but they may struggle with driving (Curry et al., 2017). Use of the SPM-2 enables practitioners to assess SI issues related to driving and communicate how these issues impact driving performance.

During initial SPM development, a primary intent was to create a tool that could facilitate team communication across and between client environments. The new SPM2 forms allow even greater collaboration between individuals involved in a client’s life and care. Additionally, practitioners appreciate the significant impact of context specific information in order to understand the full scope of a client’s functional engagement in life activities. The SPM-2 allows for greater understanding of a client’s performance due to concurrent assessment in multiple contexts offered through the multiple SPM2 forms. This allows for greater understanding of the impact of sensory contextual features on the client’s performance. The concept of assessment within the natural environment is the core of our professional responsibility.

Diana explained the main driving force behind revising and expanding the SPM assessment:

The SPM was published in 2007 and the SPM-Preschool in 2010, over 10 years ago. It is best practice to update assessments and re-standardize to fit the changing times and demographics During the process, we as authors discovered changes related to the impact of new technology on play, school and work, so we had to update our items to fit. For example the use of tablets in many of the environments. We also wanted to expand the age groups to include individuals from across the lifespan. We have known for some time now that sensory processing challenges are often evident in infancy. We also now know that sensory processing challenges can be seen in adolescence as well as in adulthood. Knowing that plasticity continues throughout life as practitioners, we can help our adult clients better understand their sensory processing strengths and challenges so they can have an impact in their neurophysiological growth through the strategies, activities and environmental adaptations they develop.

Interested in contributing to the upcoming collection of strategies for the SPM-2 Quick Tips? 

Would you like to share your favorite interventions/strategies that you use in practice? If yes, they can email Diana at [email protected]

If your strategy is chosen, your name will be included in the acknowledgments section as a contributor to the SPM-2 Quick Tips.

Diana strongly believes that international collaboration leads to a rich variety of ideas. Best of Luck!

Some important information:

- The SPM-2 will have both an online and paper format. For the online format, you can email a link to parent, caregiver or teacher and they can complete the assessment in this manner. The link will bring you through to a platform and you can track the person’s progress on filling in the assessment form.

- There will be one comprehensive manual that will cover all of the forms across the lifespan.

- Therapists will have the option to purchase forms separately based on their clinical needs.

- There will be a way to compare record forms - for example if parents who are separated complete the home forms individually, there will be different ways to compare the reports meaningfully.

SPM-2 Quick Tips (Author: Diana Henry)

Empowering stakeholders when addressing SI within their individual contexts is critical, and the SPM-2 Quick Tips™ process answers this need [3]. AOTA [4], the Individuals With Disabilities Education Improvement Act of 2004 [5], and the Affordable Healthcare Act and Centers for Medicare and Medicaid Services policy [6] all identify best practice as involving the family in goal setting and intervention. When addressing SI the stakeholders are pivotal in supporting the child for improved behavioral and functional outcomes throughout the child’s life, beyond the treatment room. In addition to clinic and school models, the SPM-2 Quick Tips clinical reasoning process makes it a natural fit for best practice in Data-Driven Decision Driven Making (DDDM) [7] so interventions continue throughout the child’s normal routines. 

The SPM-2 Quick Tips focuses not only on the objective of addressing underlying deficits through ASI® intervention or sensory-based strategies but it also targets the following seven objectives:

1- Improve sensory- motor functions

2- Educate to support functioning

3- Promote self-advocacy and empowerment

4- Develop adaptations and accommodations

5- Use cognitive or behavioral strategies

6- Teach new skills

7- Address the sensory integration and processing patterns of others.

This diagram provides a visual representation of the process involved in using the new SPM-2 online assessment and SPM quick tips. (Hippa secure - refers to data security when using the platform)

1- The therapist has the option to send an email to a parent or teacher which will include a link to the platform and not the assessment form. When the parent/teacher receives the email and clicks on the link, the form will then be shown. This avoids the need to send forms back and forth through email. You are instead emailing them a link and people work on the platform.

2- The online platform allows you to know if the person has opened the assessment, whether they have started to complete it, and when they have finished it.

3- Once the assessment is finished, you can click on “score”, and the assessment is scored automatically for you.

4- Once you receive the results, you can begin your clinical reasoning and you can refer to the SPM-2 Quick Tips which is another product available for online purchase.

5- This will integrate the results from each item of the SPM-2 together. Each item has several tips, and there is the choice to sort the tips by what it is you want e.g. you can sort all the tactile over responsive items and it will present the relevant tips related to this.

6- Once you click on the tips, it creates an intervention report form which explains why you selected the tips you did as it relates back to the items on the assessment. This ties in with explaining Data-Driven Decision Driven Making intervention. Informing caregivers that there is a reason why certain sensory systems are targeted and what drove your clinical reasoning is captured in this way.

ONLINE WORKFLOW