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Community Based

Sensory Friendly Time Partnership:

Child Engagement

& Parent Perceptions

Emily Barnard, Tyler Bilinovic,

Paige Brown, Chelsea Craft

Cleveland State University | College of Health Sciences

MOT Class of 2018

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HAVE YOU EVER BEEN OVERSTIMULATED?� HAVE YOU EVER BEEN OVERSTIMULATED?

HAVE YOU EVER BEEN OVERSTIMULATED?� HAVE YOU EVER BEEN OVERSTIMULATED? ��

�

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Introduction

GoBabyGo/CSU & Cleveland Children’s Museum partnership
What is “Sensory-Friendly Time”?

Decreased visual and auditory stimulation
Preparatory stories and maps
Low traffic times
Additional volunteers
“Pop-up sensory havens”
Movement and hands-on opportunities

(Silverman & Tyszka, 2017; Fletcher, 2018)

Empirical attention is warranted to validate effectiveness

(Bodison & Parham, 2018; Reynolds, 2017).

· To meet this community need, GoBabyGo at CSU has partnered with the Cleveland Children’s Museum to bring in their supports and distinct knowledge in working with children with developmental differences directly into the community.

· GoBabyGo uses assistive technologies for children with mobility restrictions to enhance their ability to independently explore their environment – and most importantly, play.

· GoBabyGo brings their harness system and adapted life-size cars DIRECTLY into the community at various events so children can enjoy playing independently OUTSIDE of the therapy clinic!

· While the children’s museum was closed for major renovations, the museum partnered with GoBabyGo to offer their sensory-friendly time programming on campus, at CSU.

· So, what is Sensory Friendly Time? Across the US there is an emerging trend towards offering specialized “sensory-friendly” events at community venues such as museums, movie theatres, zoos, and concert halls, where sensory stimulation and expectations for participation are modified to fit diverse needs. A few examples are listed here:

· While the strides in this type of programming are great, little empirical attention has been given to prove the effectiveness of these modifications in meeting the needs of families. Is it working, and can it be better?

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Purpose

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Parent Perceptions

Survey parent understanding/ feelings of the event.

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Future SFT

Program sustainability

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Student Perceptions

Excluded from data collection.

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Cleveland Children’s Museum

Ongoing CSU collaboration to enhance community programming for children with mobility and sensory differences.

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Child Engagement

Track child behavioral responses to sensory-based activities.

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Sensory Friendly Time

The purpose of this pilot study is to evaluate the experiences of children, and caregivers participating in Sensory Friendly Time through the GoBabyGo program at Cleveland State University.

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EMILY

The purpose of our observational study was to evaluate the experiences of children and caregivers participating in SFT through the GoBabyGo program at Cleveland State University.
We continue to collaborate with Cleveland Children’s Museum to enhance community programming.
We aimed to collect objective and subjective data during SFT about the sensory preferences and behaviors of participants in response to the activities they choose to participate in
We also evaluated parent perceptions and expectations for SFT
Initially student perceptions of volunteering at SFT were going to be captured, but decided to focus on parent perceptions in this current study.
The information gathered from this study will be used by GBG program staff to increase engagement and satisfaction with this community-based offering.

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Inquiry #1

Does the intensity or nature of sensory stimulation incorporated into community activities result in differences in observable behaviors, affect or responsivity for participating children in relationship to the activity’s sensory properties?

We needed to know:

Why is this a relevant question to ask?
What are the behaviors we should be observing? What should we expect?
What are the activity properties children typically respond to?

So for our particular research endeavor, the question we sought to answer is this:

Does the intensity or nature of sensory stimulation incorporated into community activities result in differences in observable behaviors, affect or responsivity for participating children in relationship to the activity’s sensory properties?

In other words, when at SFT, do activities with high tactile stimulation cause children to wake up and engage, or do those activities cause over-arousal and push them into the red zone?

To answer this question, we needed to survey the literature to see what information could guide our efforts.

We needed to know:

Why is this relevant?
What should we be observing that indicates success?
What are the activity properties do children usually respond to?
Have other researchers found significant differences?

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Literature Review Highlights

Child Engagement

What we found:

Children with sensory differences benefit from participating in leisure and recreational activities (Dunn, 2007; Watts, Stagnitti, & Brown, 2014).
Sensory processing deficits directly affects a child’s ability to play (Benson et al., 2006).

Distinct play preferences based on sensory processing pattern (Ismael et al., 2015)
Over-responsiveness is an issue (Cheng & Bogget-Carsjens, 2005)

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In the Literature...

Modification of the sensory environment may increase participation:

Kinnealey et al. (2012) - classroom environment

soft, halogen lighting and sound absorbing walls

Cermak et al. (2015) - dental environment

deep pressure, rhythmic music, dampened visuals

Silverman & Tyszka (2017) - museum environment

“sensory havens”, preparatory stories/maps/schedules

Little knowledge translation to the community framework (Miller et al., 2009).

· We also found moderate evidence that modifying the sensory environment may increase participation:

· Kinnealey and colleagues looked at the classroom environment (soft, halogen lighting and sound absorbing walls)

· In 2015, another group explored modification of the dental environment (deep pressure, calm rhythmic music, dampened visual stimulation) and found that these strategies helped lessen the reaction to the incredibly high sensory experience of going to the dentists office.

· There are researchers at Salus University who are actively exploring this topic looking at the museum environment. They have found that having “sensory havens” and using preparatory methods truly do enhance the museum experience for children and their parents.

· Again, these strides are great, but there is only a very small pool of evidence translating our sensory processing knowledge from the classroom and clinics into the community framework (Miller et al., 2009).

· There is more work to be done – but this is happening! New studies that look specifically at community experiences are popping up as we speak.

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Methods

Develop an observation tracking tool
Educate and train CSU PT/OT student observers
Conduct clinical observations
Convenience sampling recruitment
Participant age: 7 mo - 10 yrs

So, to answer our research question we developed a behavioral observation tracking tool to conduct clinical observations of children’s play behaviors in response to different types of activities during Sensory Friendly Time .
We educated and trained CSU PT/OT student observers in the use of the tool and in understanding sensory behaviors
Students used the tool to observe children engaging in activities and games with peers, family members and CSU student volunteers. Sensory Friendly Time programming included activities such as: driving adapted cars, free play at a water bead sensory table, coloring and craft activities. Activities were held on campus at the GBG lab, at the Cleveland Zoo and at the newly renovated Cleveland Children’s Museum.
Convenience sampling was used to recruit participants for the study: children who attended SFT were presented with the opportunity to participate upon arrival where informed consent was obtained from their caregiver.
Participant age ranged between 7-120 months or 10 years.

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Data Collection

Affect
Responsivity
Zones of Regulation
Engaged in the activity as it was intended
Who the child interacted with
Include activity modifications

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Observation Checklist

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Data Analysis

40 participants; n=199 observation sheets
Extensive coding process for activity analysis
Data entry into Excel
Intra-rater reliability testing
SPSS chi-square testing (alpha level of <<.05)

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Activity	Activity Name	Brief Description	Codes
1	Fishing Poles	Paper fish with magnet attached were picked up off of the floor using “fishing rods” made of sticks and magnets.	Act_Sound 1 Act_Sight 2 Act_Touch 2 Act_Move 3 Act_Compl 2
3	Under the sea craft activity	Child will use crayons and markers to make a paper plate fish using fish template. Child will glue popsicle sticks to back of plate. Child could also choose to make magnet fish using construction paper, markers, and magnets.	Act_Sound 0 Act_Sight 2 Act_Touch 3 Act_Move 0 Act_Compl 3
4	Scavenger Hunt	Children received a map of where to go and then traveled to each station to receive a sticker.	Act_Sound 1 Act_Sight 3 Act_Touch 2 Act_Move 3 Act_Compl 3
5	Water Beads Table	Children reached their hands into a container filled with water beads.	Act_Sound 0 Act_Sight 3 Act_Touch 3 Act_Move 2 Act_Compl 1

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Results | IRR Data

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Results | Observation Data

Least likely to score a BLUE ZONE rating with:

medium activity complexity (df=12, p=.000, LR=.026)
high movement intensity (df=12, p=.000, LR=.042)
high tactile stimulation (df=12, p=.000, LR=.004)

Displayed the least amount of NEGATIVE AFFECT with:

high tactile stimulation (df=12, p=.008, LR=.122)

Displayed the least amount on NEUTRAL AFFECT with:

medium movement intensity (df=18, p=.045, LR=.030)

Next, after all of our data was collected and collapsed over the course of 7 months, a chi-square test was performed to examine the relationship between the intensity of sensory stimulation and the observable behaviors of children displayed while they engaged in the activities. We used an alpha level of .05 for all statistical tests.

We found that:

Children were least likely to score a blue zone�rating with activities that had:

medium complexity (df=12, p=.000, LR=.026)
high movement intensity (df=12, p=.000, LR=.042)
high tactile stimulation (df=12, p=.000, LR=.004)

Children displayed the least amount of negative affect with:

high tactile stimulation (df=12, p=.008, LR=.122)

And lastly, children demonstrated the least amount on neutral affect with activities with:

· medium movement intensities (df=18, p=.045, LR=.030)

The themes that emerged from this slide suggest that activities with high tactile input, high movement requirements and moderate problem solving properties appear to have particular relationships with child affect and low levels of alertness.

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Does the intensity of sensory stimulation result in different observable behaviors?

Conclusion

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Moderate to high sensory threshold for tactile, vestibular and cognitive engagement

Activity selection matters...

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Leveled sensory environment

Intensity matters...

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Provide optimal sensory engagement

Collaboration matters...

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Inquiry #2

What are the parent perceptions of the effectiveness of a community-based interprofessional program providing sensory friendly activities for children with special needs?

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Literature Review Highlights

Parent Perceptions of Occupational Therapy

Lack of Research done
Semi structured interviews
Key themes from the research
Positive thoughts
More research needs to be done

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Methods

Pilot survey with mixed method design

5 point likert scale
Open ended responses

Purpose: Assess the effectiveness of an embedded community-based interprofessional education program using parent perceptions of integrated community events.
Qualtrics.com

survey results to determine the parent perceptions on the effectiveness of the SFT program. All of the questions on the survey were worded positively to prevent any confusion for the parents and for our data collection.

Likert scale ranges from strongly agree to strongly disagree

Four open-ended response questions were also included if the respondents wanted to elaborate on the program.

Survey was distributed following each event online through the qualtrics website while maintaining confidentiality

To fully understand the effectiveness of the program, the questions were grouped into themes by using qualitative analysis, where a mean could be calculated using SPSS; Individual and multiple group analysis were completed;

ANOVA was used for the group comparison analysis to find the total scores for each of the question groups and descriptives in order to find the mean differences and significance.

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Question Groupings:

Individual and multiple group analysis

Children’s Response to Sensory Friendly Time
Interactions With Others
Mobility Supports
Sensory Activities
Child Participation
Family Participation
Knowledge About Sensory Friendly Time
Accessing Community Services

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Comparisons Of Interest

Child Participation vs. Child Responses to SFT
Child Participation vs. Sensory Activities
Child Participation vs. Family Participation
Child Participation vs. Interactions with Others
Child Participation vs. Accessing Community Services
Family Participation vs. Interaction with Others
Accessing Community Services vs. Knowledge About Sensory Friendly Time

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Results

34 surveys sent out, 10 were completed

29% response rate

Statistical significant difference across all groups

(F_7,22 = 3.008, p < .05)

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Results

Statistical significant difference across all groups (F_7,22 = 3.008, p < .05)

Only one comparison group of interest was statistically significant (p < .05)

Child Participation vs. Sensory Activities

(mean difference of -13.5)

Another comparison group that was not one of our groups of interest was also significant (p < .05)

Sensory Activities vs. Interactions With Others (mean difference of -11.9)

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Survey Interpretation

Results suggest that survey respondents generally…

try to attend community events
understand what SFT is and when it is offered
believe their child is able to participate in the events along with their sibling
believe their child enjoys participating in the event

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Survey Interpretation

In addition:

The current availability of sensory based activities may not have been appealing/met the needs of all children
The children were engaged in the mobility supports when appropriate
Interactions with students/therapists/teachers/other children are seen as beneficial
There are a variety of reactions following SFT

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Discussion

Low Sensory Activities rating
Attending the event
Sensory Activities vs. Child Participation
Child Participation vs. Child Response to SFT
Child Participation vs. Family Participation
Child Participation vs. Interactions with Others

1. The Low Sensory Activities rating could have resulted from parents being unclear on which activities were considered sensory friendly by researchers

2. The comparison between accessing community services and knowledge about SFT was not significantly different; however findings suggest that there could be other barriers that limited attendance not only knowledge or comfort level

3. Child participation was rated higher which could suggest that the sensory activities were not meeting the child’s needs yet many parents rated the sensory-based activities to be the child’s favorite which again suggests that parents were unclear of which activities were sensory friendly

4. Child Participation vs. Child Response to SFT were similar suggesting that positive responses were comparable to positive participation during the event; which overall indicates that events are perceived as beneficial for both the child and family.

5. There was not a significant difference between Child/Family Participation vs. Interactions with Others which shows that all interactions during the event were seen as a positive experience

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Limitations

Inherit differences amongst the parent perceptions
No online access
Lack of time to complete the survey
Difficulty accurately choosing the choice best representative of his or her perceptions

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Future of Sensory Friendly Time

SFT is important to the community & should continue to offer adaptive supports & modified exhibits
Utilize similar marketing strategies to increase community knowledge
Include parents/families in programming
Enhance parental education on activities provided
Continue monitoring effectiveness of program
Advocate for the role of OT

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Implications For Occupational Therapy

Communication and collaboration with parents and families is important to increase the understanding of the therapeutic process.

Parent-therapist collaboration allows for gains made with the therapist to also be encouraged within other contexts.

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Questions?

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References

Benson JD, Nicka MN, Stern P. How does a child with sensory processing problems play? (2006) The Internet Journal of Allied Health Sciences and Practice, 4(4), 4.

Cheng, M., Boggett-Carsjens, J. (2005). Consider sensory processing disorders in the explosive child: Case report and review. Canadian Child Adolescent Psychiatry Review, 14(2), 44-48.

Cermak, S. A., Stein Duker, L. I., Williams, M. E., Lane, C. J., Dawson, M. E., Borreson, A. E., & Polido, J. C. (2015). Feasibility of a sensory-adapted dental environment for children with autism. American Journal of Occupational Therapy, 69, 6903220020.

Dunn, W. (2007). Supporting children to participate successfully in everyday life by using sensory processing knowledge. Infants & Young Children, 20(2), 84-101.

Kinnealey, M., Pfeiffer, B., Miller, J., Roan, C., Shoener, R., & Ellner, M. L. (2012). Effect of classroom modification on attention and engagement of students with autism or dyspraxia. American Journal of Occupational Therapy, 66, 511–519. http://dx.doi.org/10.5014/ajot.2012.004010.

Fletcher, T. S. (2018). Contributing to sensory-friendly events from a to z. OT Practice 23(7), 24–25. https://doi.org/10.7138/otp.2018.2307.sensory

Fletcher, T. (2014). Supporting individuals with special needs at the Dallas Museum of Art. OT Practice 19(5), 12–20.

Ismael, N. T., Mische Lawson, L.A., Cox, J.A. (2015). The relationship between children’s sensory processing patterns and their leisure preferences and participation patterns. Canadian Journal of Occupational Therapy, 82(5), 316-324. doi: 10.1177/0008417415577421

Miller, L.J., Anzalone, M.E., Jane, S.J., Cermak, S.A., Osten, E.T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. The American Journal of Occupational

Silverman, F., Carr Tyszka, A. (2017). Forming partnerships to develop sensory-friendly community programs. SIS Quarterly Practice Connections, 2(1), 7-9.

Silverman, F., & Tyszka, A. C. (2017). Centennial Topics—Supporting participation for children with sensory processing needs and their families: Community-based action research. American Journal of Occupational Therapy, 71, 7104100010. https://doi.org/10.5014/ajot.2017.025544

Watts, T., Stagnitti, K., & Brown, T. (2014). Relationship between play and sensory processing: A systematic review. American Journal of Occupational Therapy, 68, e37–e46. http://dx.doi.org/10.5014/ajot.2014.009787