30 Jun

Thoughts From a Therapist: Ideation Inspiration

Originally published on Sensory Integration Education on 29 October 2021.

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over 10 years of experience working with children and adults with a range of learning disabilities and autism. This month, Anna considers the ideation inspiration:

“You know the famous ASI quote from Schaaf (2013): “Keep the goals in your head, activities in your pocket and fun in your heart”? That one. Well I feel like sometimes I’m missing something. Goals – check. Fun – check. Activities – … I try!

“Of course I’ve got all my go-to activities – “Oh wow! I love how you’re standing on the swing – maybe we could surf over some waves/ sail on our pirate ship/ fly to a far away land on your magic carpet?” But sometimes I get stuck. 

“When I learnt to drive, I really struggled to hold all the new motor plans and ideas I was learning in my mind – clutch, mirrors, gear stick, steering wheel. I feel like that’s how ASI can feel to me sometimes – busy trying to remember all the different parts. Thinking of my goals whilst frantically trying to think how I can wind in an activity that meets the goal, aligns with the child’s current motivation in play and targets areas of the fidelity measure also. Even though I’m not new to ASI intervention, it’s still an intensive brain workout! 

“‘My’ best ideas typically come from the little people I work with. Alongside pilfering 5-year-olds’ ideas, I also use Pinterest. However, one of the most helpful things I’ve done was spending an afternoon with other ASI-trained OTs playing in an SI room, showing each other how we used equipment and the games we played. Us adults often need permission to play more – so take this as your permission slip to go play!”

Schaaf, R.C. 2013 (March). Occupational therapy using sensory integration for children with autism: Strategies and evidence from a RCT. Paper presented at the South Carolina Occupational Therapy Association Annual Conference, Charleston.

30 Jun

Thoughts From a Therapist: Individuality

Originally published on Sensory Integration Education on 30 January 2022.

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over 10 years of experience working with children and adults with a range of learning disabilities and autism. This month, Anna considers individuality:

“You know the saying, ‘if you’ve met one autistic person, you’ve met one autistic person’? I’ve been reflecting on this recently. The person-centred, creative and totally individualised nature of OT is part of why I love it. Being able to truly listen to the stories of families, pull it together and make sense of things in a new way as part of the assessment process, tailoring recommendations to each person (hence reports taking so much admin time), creating programmes that are meaningful to the individual, and then designing therapy sessions to maximise the fun (although these plans rarely come into fruition due to the beautiful person-led nature of ASI but that’s anotherthought!).”

“I love it. It isn’t a quick process though and I don’t miss being within statutory services and the time pressure this creates.”

“It also means that when creating recommendations from an assessment, despite it being a thorough process, we still end up taking our best guess to figure out what will work. And, because everyone’s so individual, it doesn’t always work. Take transitions for example – the amount of notice time each person needs before a transition is so individual. Some people need a day in advance, others an hour, and some, 3 minutes or less!”

“So, when carefully crafting our recommendations, it’s so important to bear in mind that each family or client will need to cherry pick and adapt them to their own needs. This is such a valuable step of the therapeutic process – I tend to give my reports out with this proviso, as working through the recommendations afterwards together can be such a productive step before starting therapy.”

30 Jun

Thoughts From a Therapist: What My Last Mentoring Session Taught Me

Originally published on Sensory Integration Education on 30 March 2022.

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over 10 years of experience working with children and adults with a range of learning disabilities and autism. This month, Anna reflects on a recent mentoring session:

“This month has posed a reflective opportunity for me. I’m incredibly lucky to have Virginia Spielmann as my mentor, and in a recent session, she set me the target to ‘get comfortable with not knowing’. This came out of me repeatedly deflating when she gave me ideas. I would sigh and say: ‘Ohhh why didn’t I think of that!’ At the end of our session she reflected this back to me. Rather than celebrating the acquisition of new, helpful knowledge, I’d berate myself for not knowing. It was because I felt I should know the answers already, and by not knowing the answers, I was letting my clients down.

“So, from this came the target to ‘get comfortable with not knowing’. It’s a bit ironic as I regularly talk about the importance of being honest and open about the limits of our knowledge as professionals. But when it comes to SI, I put myself under extra pressure to know everything. But actually, I’ve got an incredible network of people around me. The value of talking things through (whether in supervision, informally or peer support) is huge. No one person has all the answers. Particularly in SI where the research and theory is developing so rapidly. So I’m unsure why I put myself under pressure to achieve the impossible here!

“The same week as my session, I watched Brené Brown’s Netflix special ‘The Call to Courage’ (would recommend!). The take-home message is you cannot be courageous without being vulnerable. Learning to be vulnerable at work is challenging – I’m great at it when I know it’s something outside of my scope of practice. I’m learning to try it when it’s within my scope! My hope is that we can all let people know what we don’t know, ask questions (even the ones we think are silly!), be honest with clients and colleagues, and be kind when they do likewise and make a world where it’s okay to be human. That in turn gives our clients some powerful role-modelling of how it can be a safe place to open up and be vulnerable.”

30 Jun

Thoughts From a Therapist: Working at an Environmental Level

Originally published on Sensory Integration Education on 28 April 2022.

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over 10 years of experience working with children and adults with a range of learning disabilities and autism. This month, Anna reflects on a recent mentoring session:

“This term I’m taking on an exciting project. Rather than individual assessments and therapy, my independent OT practice has been commissioned by the NHS to work with 12 local schools with the aim to reduce levels of exclusion of neurodiverse students. The remit has been broad and I’ve been given free reign to design and implement what the OT input in this project looks like. The brief specifies it is not to work with individual students, but not much beyond this.

“I’ve found the concept incredibly liberating. Working at an environmental level feels so logical as an OT. I spend a long time writing recommendations for individuals OT reports. Realistically, as OTs, we know that our recommendations can all too often get buried in piles of other reports and paperwork, and teachers already have so much on their To Do lists, that things end up getting overlooked. 

“Instead, this term I get to work with staff and look at environment, culture, approaches and blend in new ways of working, environmental adaptations and staff consultation to really shift things for whole schools.

“I’m offering training, consultations, school site visits and video call support. I’m currently pondering offering short video content too, to recap or introduce key approaches, resources or ideas.

“My first reaction when approached about this project was “I can’t – I haven’t got the time!” But then I realised, if it works, it will save time overall. It will allow so many more students to benefit, rather than just those we assess individually. I look forward to updating you all on how I get on!”

30 Jun

Thoughts From a Therapist: An Update on My Autism in Schools Project

Originally published on Sensory Integration Education on 24 May 2022.

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over 10 years of experience working with children and adults with a range of learning disabilities and autism. This month, Anna reflects on an Autism in Schools project she is working on: 

I’m halfway through the Autism in Schools project, which I wrote about last month, and it’s been an interesting and eye-opening experience. Before I started the project, I was wondering how I’d manage the demand from schools for support around individual students. As this project is to work at an environmental level with the school rather than individuals, I wondered if there would be a conflict – as typically whenever I go into schools for observations of students, there are multiple other students whom staff want me to see too.

Instead, I’ve been surprised to find that the main things schools have been asking for is support to create sensory friendly environments and ideas for strategies. I’ve had such a fabulous half-term liaising with SENCOs and Inclusion Leads, giving advice on how to create calm spaces and movement spaces, Calm Toolkits and reframing ‘bad behaviour’ as dysregulation.

One challenge is the physical space constraints some schools have. The contrast is stark between schools that have enough space to create new environments and those which are struggling to find room for their pre-existing nurture and pastoral activities. To manage some of this, I’ve been working with mainstream secondary schools on creating a Calm Toolkit that includes discrete calming strategies that can be done with no or minimal sensory equipment within the classroom. This approach has the triple advantage of providing age-appropriate strategies that the students don’t feel self-conscious about; keeping students in their lessons rather than needing to leave for a break; and managing tight demand on space.

Next week is half-term here and I’m setting up a pilot Movement Space in a school – I’m separating ‘calm spaces’ and ‘movement spaces’ as I find it helps create more purposeful use of space and fosters understanding of the different types of regulation children need at different times. I’m off to chop up some foam to make a big crash pad and inflate some inner tubes now – I can’t wait to see the room come together!

30 Jun

Thoughts From a Therapist: The Chasm Between Primary & Secondary Schools

Originally published on Sensory Integration Education on 26 August 2022.

I’ve been reflecting on my time in schools over the summer. As I think lots of us have been, I’ve been shifting away from behaviour based strategies for a while now (such as recommending the use of reward charts, praise, stickers), shifting to a more relationship based approach using curiosity, labelling emotions and collaborating with young people.

What filled me with hope is seeing this being embedded in primary schools (5-11 years), with staff developing trusting relationships with the children in their classes and taking a wider view of ‘behaviour’ to truly see what is being communicated. This was, on the whole, a stark difference to secondary schools (11 -16 years). For young people on the SEN register, accommodations were often made for them so they didn’t have to follow the rest of the school’s behaviour policy. But – I was left feeling that there’s some missing piece here – for those children not on the SEN register but still struggling.

In my cosy therapy bubble world, lots of us have shifted away from behaviour-based strategies to more attuned, nurturing approaches. It was so reassuring to see this in practice in primary schools. But the leap to secondary school entailed things like lining up for uniform checks, walking in silence, ‘no tolerance’ policies with being sent out of classrooms and very strict rules with very little room for flexibility. I was left wondering if this approach is necessary? Perhaps a vital part of growing up and learning to follow rules to be able to be successful in wider society? Or is there some middle ground that we need to find?

Building relationships between staff and students in secondary schools is so much harder. Teachers have hundreds of students they see for 1-2 hour a week, rather than a class teacher that they spend the majority of their time with. I don’t have any answers but I do have questions. Is a culture shift needed here? What would that look like? How quickly can staff establish trusting relationships with young people who are finding it hard to follow the rules?

For those of us specialising in sensory integration, we often see the children who are falling between the gaps. Who may not have any diagnoses but, for a variety of reasons, struggle to keep up and fit in. Maybe increased rule following is just a developmental shift that needs to happen at this age? Or maybe there’s an environmental issue here that could be setting some young people up to fail?

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over 10 years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts From a Therapist: Concrete Operations and Communication Needs

Originally published on Sensory Integration Education on 27 September 2023.

We are thrilled to welcome back our regular contributor, Anna Willis, Occupational Therapist and Advanced Practitioner in Sensory Integration, with her Thoughts From a Therapist series. In this article, Anna discusses concrete operations and communications needs.

Hello – I’m back! Maternity Leave Round 2 has whizzed past in a cloud of nappies and chaos, and I’m starting to pick myself back up and dust my OT brain off. Switching between mum-mode and work-mode is slightly easier this time, as I’d already started to get used to that from my first time returning to work, albeit in a strange Zoom-based world. Given it was the summer of 2020, and everyone else had been online for months, I felt like the new kid at the party, not knowing how to mute myself, virtual meeting etiquette, sharing my screen and so on! However, I’m still finding the usual work-life balance to be elusive.

Having my brain at capacity already has reminded me of attending training years ago, where the trainers mentioned that if parents are stressed (which, despite our best efforts, they usually are during assessments, to a degree), they are functioning in ‘concrete operations’, as per Piaget’s stages of cognitive development. This means they need things WRITTEN DOWN. When working with stressed parents, caregivers or clients, we give so much verbal advice and expect people to remember it, action it and integrate it into their lives.

Recently, I went away with my family and spent a large chunk of time telling my 3-year-old not to lick surfaces of trains/ trams/ bollards – it took me until the airport on the way home to figure out she needed some more oral input. It’s literally my job to give this sort of advice, and yet, in the moment, I couldn’t access that part of my brain. I could have done with someone to prompt me to use my sensory knowledge. 

So this is a reminder to myself, and to you if you need it: take time to understand how each client needs information presented and expect that it may need to be repeated. Emails, post-it notes, reports, WhatsApp messages, visuals pinned to the fridge, voice notes – whatever! Individualising how we give advice makes a difference, and expecting that it may need repeating several times can support more successful interventions.

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over ten years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts From a Therapist: All That Glimmers

Originally published on Sensory Integration Education on 31 October 2023.

We are thrilled to welcome back our regular contributor, Anna Willis, Occupational Therapist and Advanced Practitioner in Sensory Integration, with her Thoughts From a Therapist series. In this article, Anna discusses the popular term “glimmers”.

The term “Glimmers” is a relatively new one to me that I’ve seen popping up over the past year or so. This refers to those little moments of joy throughout the day, that make you feel better, peaceful or joyful. I love this concept so much, and the term! For me, the word conjures up images of sparkles and magic, which fits perfectly with the way it’s being used here. Things like the crunch of leaves, the smell of autumn, a click of the kettle or the cold, smooth feel of a shiny pebble.

A Glimmer is the exact opposite of a trigger, and fits seamlessly into the work we so often do on emotional regulation. I refer to a “toolkit” of strategies for calming down, and I initially wondered whether the term Glimmers could be used interchangeably here. I decided not, as Glimmers aren’t just for calming. They’re also just unexpected moments. However – someone’s Glimmers could definitely be in their toolkit, and noticing what your own personal Glimmers are gives an excellent springboard for so much discussion, from interoceptive conversations about how it feels in your body, to a better sense of self and an insight into your own preferences.

When working with the senses, we first need to have a strong understanding of our own profiles as therapists, so why not spend some time noticing what your Glimmers are this month and see where it leads?

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over ten years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts From a Therapist: Are You Sitting Comfortably?

Originally published on Sensory Integration Education on 28 November 2023.

In this month’s Thoughts From a Therapist article, Anna Willis, Occupational Therapist and Advanced Practitioner in Sensory Integration, discusses the importance of sitting.

Seating – something I constantly talk about as an OT and it really does make SUCH a difference when you get the right seat for the child (or adult). Functionally, we need to sit comfortably to work at a desk, to eat food at a table, to do craft activities at a table or to enjoy a meal out with our friends and family. If we think about all the hours children are expected to sit at school, it becomes obvious why it’s such a big deal.

I know from personal experience recently with my 4-year-old daughter the difference it can make, even for little ones with no sensory needs. I found myself falling into the trap of Auto-Parent rather than using my Therapy Brain again (See here for another excellent example of my error!) and asking my daughter to ‘sit on [her] bottom’ and ‘sit still’ (not things I would ever recommend as a therapist!). 

Eventually, I remembered to get her a footstool (with a big box on top so her feet actually reached) and used a booster seat (I like this Lionheart one) and – like magic – she could eat her dinner in half the time.

With so many new and exciting seating options popping up (hello ErgoErgo!* New to me anyway – how have I not seen this before?!) there’s all sorts of fancy and fun seats that can be explored and conversations that can be started. Sometimes though, you just can’t beat a cardboard box with cushions in for little ones who need a cosy squish whilst sitting on the carpet.

A word of caution though! Make sure you don’t fall into what I like to refer to as the Jelly Trap. Children need GOOD CORE STRENGTH to cope with wobbly seats (wobble cushions, gym balls, wobble stools, I’m looking at you). If you’re recommending movement seating, make sure you understand why the child is seeking movement. (If they are wobbling because they don’t have the skills or strength to stay still, putting them on a wobbly surface is like putting jelly on a jelly i.e., not very effective at getting it to stay in one place). These then become good therapeutic activities – ones to do to build skill, but not at the same time as academic learning.

So have fun exploring all the sitting options out there and make sure to think about the why of wiggling.

*Southpaw is a SIE Preferred Supplier

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over ten years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts From a Therapist: Desensitisation

Originally published on Sensory Integration Education on 29th June 2021

I was asked to write a blog on my reflections on the STAR Summit’s Virtual Conference but now I feel it doesn’t begin to do it justice really. There were so many interesting talks – and as I say in the article, not by those I had expected.

Something I’ve been mulling on since but didn’t go into detail about was desensitisation. A few speakers mentioned that goals to work on toleration of sensation shouldn’t be encouraged. This had me thinking about children I have worked with on tolerating wearing various items of school uniform using ASI (which is obviously child-led, fun and collaborative in its’ essence!). I justified this by thinking that I would never ask for a child to purely tolerate wearing something for X number of minutes whilst the child’s nervous system was in distress. But is it okay to use ASI to desensitise tactile over responsiveness with regards school uniform? Should we instead be looking to facilitate more inclusive sensory environments – such as focusing more on working with schools to create inclusive uniform policies? Or perhaps a mix of both?

Have a read of my blog post for SIE if you haven’t already – it’s an exciting time for SI therapists and we’ve a real role to play in shifting the narrative when working with autistic children and adults.