Background/aim
Sensory approaches in mental health are designed to assist consumers to regulate physiological and emotional arousal. They have been highlighted as non-invasive, self-directed and empowering interventions that may support recovery-oriented and trauma-informed mental health practice and may assist in efforts to reduce the use of seclusion and restraint. Over recent years, there has been a substantial increase in research in this area. However, there has not yet been any attempt to map and summarise this literature.

Method
A five-stage scoping review was conducted. Four databases were searched for literature evaluating sensory interventions implemented in mental health settings.

Results
A total of 17 studies were included in the final review. A range of sensory approaches was evaluated and a range of outcomes measured. In general, consumers reported reductions in distress associated with engaging in sensory interventions. Results in terms of reduction of seclusion and restraint were mixed, with some studies reporting a decrease, others reporting no change and one reporting an increase. Methodological limitations in the studies reviewed mean that results should be interpreted with caution.

Conclusions
Although there is emerging evidence for the usefulness of sensory approaches in supporting consumers’ self-management of distress, there is less evidence for sensory approaches supporting reductions in seclusion and restraint when used in isolation. More research is necessary, but sensory approaches do appear safe and effective. Services wishing to reduce seclusion and restraint should implement sensory approaches in conjunction with other strategies to achieve this important outcome.

Sensory approaches in mental health: A scoping review.

Purpose Sensory approaches to mental illness are increasingly prominent in occupational therapy. Despite indicators of efficacy, a paucity of literature supports these approaches. This article provides a scoping review of research on the relationship between sensory processing and mental illness. Method Using Arksey and O'Malley's (2005) framework, we mapped this area of research and identified gaps in the knowledge base. We searched PubMed, CINAHL Plus, PsycINFO, OTseeker, and the Cochrane Library using the terms sensory and mental health. Results We found a growing body of neuroscientific research, primarily using electroencephalography and functional MRI, that links atypical neurosensory activity to mental illness. The occupational therapy literature has primarily focused on the efficacy of sensory rooms in psychiatric inpatient settings. Conclusion Research on the efficacy of sensory approaches needs to be expanded, including on how atypical sensory processing in adults with mental illness affects meaningful occupational participation.

Linking Neuroscience, Function, and Intervention: A Scoping Review of Sensory Processing and Mental Illness

Although the term self-regulation is appearing more frequently in the occupational therapy literature, the extent to which it is consistently conceptualized is not clear. The aim of this scoping review was to examine how the term self-regulation is used by occupational therapists in research and practice literature. A total of 58 publications that included occupational therapy and self-regulation in the title, key words, or abstract were identified. Self-regulation was not explicitly defined by more than half of the authors. Four theoretical orientations seem to guide conceptualization: synactive development, sensory integration, cognitive-behavioral theory, and self-regulation theory. Conceptualization differed according to the population, levels of strategy use, source of strategy implementation, and desired outcomes. A lack of definitional clarity and conceptual consistency of the term self-regulation was noted. Use of an explicit definition in relation to an identified theoretical framework is recommended to promote intra- and interprofessional communication, education, and research.

Scoping Review of Self-Regulation: What Are Occupational Therapists Talking About?

Topic
Restraint and seclusion (R/S) reduction initiatives require multimodal efforts, particularly proactive approaches to facilitate patients’ regulation. Sensory approaches are an increasingly popular method for helping patients self-regulate. A plan-do-check-act quality improvement model was used to measure practical aspects of a newly implemented sensory room on an adolescent psychiatric inpatient unit.

Purpose
This article describes an adolescent unit's implementation processes and methods used to evaluate a sensory room and its impact on R/S use, staff–patient relationships, and patients’ aggressive behaviors.

Sources Used
Selected multidisciplinary literature on sensory rooms and R/S reduction, adolescent unit staff/patient surveys, and institutional quality metrics.

Conclusions
The use of a sensory room intervention substantially decreased patients’ distress and reduced R/S use and aggressive behaviors. Improvements were also found in patient and staff members’ sense of safety. No differences in the quality of staff–patient relationships were found based on sensory room use. An increase in the durations of R/S did occur and was attributed to a few patients who were “high users” of R/S. Considerations for continuous program improvement and research are discussed.

Evaluation of the use of a sensory room on an adolescent inpatient unit and its impact on restraint and seclusion prevention

The application of sensory modulation approaches in mental health settings is growing in recognition internationally. However, a number of barriers have been identified as limiting the implementation of the approach, including workplace culture and a lack of accessible and effective sensory approaches training. The aim of this project was to investigate the efficacy of providing this training through a custom-designed e-learning package. Participants in the present study were predominately nurses and occupational therapists working in mental health settings in Queensland, Australia. Data were collected from 121 participants using an online survey. Significant improvements were found between pre- and post-training in participants' real and perceived levels of knowledge, their perceived levels of confidence, and their attitudes towards using sensory modulation approaches in mental health settings. The findings of the study suggest that the custom-designed sensory approaches e-learning package is an effective, accessible, acceptable, and usable method to train health professionals in sensory modulation approaches. As this study is the first to analyse the efficacy of an e-learning sensory approaches package, the results are considered preliminary, and further investigation is required.

Preparing mental health professionals for new directions in mental health practice: Evaluating the sensory approaches e‐learning training package

In this study, the authors assess the effectiveness of education on the consistency of use of sensory rooms within a large mental health facility. Eleven staff and thirty-six clients received additional multimodal education in sensory strategies, the use of the sensory rooms on their assigned units, and the link between the rooms and clients' personal crisis intervention plans. Staff knowledge and room usage rates were analyzed pre- and post-training. The authors found statistically significant increases in staff knowledge post-training and increases in the use of the sensory rooms by study participants. The results support the effectiveness of training which uses hands-on, population-specific strategies.

Brenda A. Martin

Papers

Effect of Training on Sensory Room and Cart Usage