Running head: COMPREHENSIVE SENSORY-BASED PROGRAM

Comprehensive Sensory-based Program

Primary Childrens Hospital Outpatient Services
Heather L. Ashton
University of Utah

Needs Analysis
Introduction

COMPREHENSIVE SENSORY-BASED PROGRAM

This paper proposes a comprehensive, occupation-based outpatient

program for children with sensory-related issues. Although occupational
performance is affected across multiple domains for this population, it can be
difficult to access effective sensory-specific treatment. In an effort to provide
meaningful client- and evidence-based occupational therapy programming, a
needs analysis and literature review were performed and will be described
herein.
Description of the Setting
Community setting and history
This program is to be administered by Primary Childrens Hospital, a notfor-profit hospital providing health services in Idaho, Nevada, Utah, and
Wyoming. This wide geographical area brings an average of 180 patients per day
to the hospital, from a diverse cultural, religious, ethnic, and socioeconomic
population. The hospital originated as a childrens ward that was added to LDS
Hospital in 1911, and was inspired by the sight of a child walking down the street
using crutches. An emphasis on providing health care designed specially for
children is manifested in the Primary Childrens simple mission and philosophy
statement, The Child First and Always. In 1977, Primary Childrens joined an
agreement with the University of Utah School of Medicines Department of
Pediatrics to become a teaching hospital, which made it possible to offer
additional specialties and to increase focus on innovation
(intermountainhealthcare.org).
Target population and current services

COMPREHENSIVE SENSORY-BASED PROGRAM

Primary Childrens Hospital offers services to children from birth to age 21

with specialties ranging from neurology to podiatry, and everything in between.
Pediatric Rehabilitation services utilize a multidisciplinary approach. Clinical
teams are comprised of masters and doctorate level clinicians from the
disciplines of occupational therapy, physical therapy, audiology, and speech
language pathology.
Occupational therapists currently treat children in both inpatient settings
and five outpatient clinics located in Salt Lake, Riverton, Taylorsville, Bountiful,
and Ogden. Treatment sessions are approximately 53 minutes. Patients are seen
for issues relating to arm and hand use, activities of daily living, sensory
integration, swallowing and feeding, handwriting, visual perception/visual motor,
and adaptive equipment use.
Funding
Primary Childrens Hospital policy mandates that no one can be turned
away based on ability to pay, ethnicity, religious/cultural beliefs etc. In fact, over
six million dollars is provided each year in free services
(intermountainhealthcare.org). Financial assistance is rewarded on the basis of
income and individual circumstance. In outpatient rehabilitation, most of the
patients are covered through Medicaid and/or private insurance.

Data Collection
Methods used

COMPREHENSIVE SENSORY-BASED PROGRAM

Data gathering was performed through interviews with clinical manager

Theresa Golley, OTD and education specialist Heather Welch, OTR, and through
observation of several therapy sessions. Unfortunately, it was not possible to
meet with parents and patients for interviews due to staff preference.
Administrative perspective
I prepared a list of questions (see Appendix A) for the preliminary meeting
with Dr. Golley and Ms. Welch. They reported that their most pressing demand is
to revamp their sensory program. Their needs are threefold: to increase the
efficiency of sensory intervention in order for patients to achieve individual goals
more quickly, to accommodate new patients in a timelier manner, and to provide
a greater variety of therapeutic options.
Dr. Golley and Ms. Welch reported a consensus among the therapists that
they were not meeting the needs of the population through traditional 1:1 therapy.
Patients often return to the clinic to address the same goals multiple times due to
poor carryover. Therapists want to be more effective in assisting their clients to
generalize the skills they learn during therapy sessions, and in turn improve
outcomes.
They elaborated on the difficulty of incorporating new patients into their
already packed therapy schedules, with an average of a 61-day waiting period for
an evaluation, and then an additional 30-day waiting period after that to make a
therapy appointment. They reported that there has been a recent uptick in the
number of clients referred to the clinic, whether that be due to physicians or

COMPREHENSIVE SENSORY-BASED PROGRAM

parents becoming more aware of the services that are available through
occupational therapy.
Lastly, they regretted that due to their current billing and scheduling
structure, they were unable to provide group intervention and parent education.
Dr. Golley spoke of an occasion she had witnessed in another setting where two
children had been able to connect through such group sessions. It was the first
time the children had had an opportunity to play with someone who they felt truly
understood them, and they became best friends. This was a rewarding
experience for the children, therapists, and families involved.
Providing education and social support for parents is also lacking in
current programming. Dr. Golley and Ms. Welch reported that parents often do
not know where they can take their children in the community that will be
sensitive to their sensory needs. Furthermore, parents dont have a place where
they can gather, whether virtually or in person, to meet with other parents who
have children with sensory issues to discuss their struggles and insights. This
peer support gap is a missed opportunity to share advice and experience. They
also want a way for parents to return to the clinic for check-ups to address new
issues or circumstances.
Intervention observations
During three therapy sessions, I was able to observe therapists working
with children with sensory needs. I was able to see first-hand how barriers to
sensory organization affected each childs performance in skill areas such as
gross motor planning and execution, fine-motor movement, sustained attention,

COMPREHENSIVE SENSORY-BASED PROGRAM

social interaction, and emotional regulation. While the therapists moved around
the room interacting with and observing the child, they also tried to involve and
educate parents; which wasnt always an easy task. The patients safety is the
clinicians top priority, as well as providing therapeutic interaction. That makes it
difficult to give the parents direct attention and to fully explore concepts and
questions. Additionally, the parents were often distracted by the necessity of
providing supervision to their other young children, and so were unable to take
notes on what they wanted to remember.
Student perspective
I witnessed strengths of the occupational therapy program and team at
Primary Childrens. Dedicated, passionate, and competent therapists provided
specialized therapy to each patient. During informal faculty introductions,
therapists were supportive and expressed excitement regarding program
expansion. I was impressed with the drive of those in management to be
innovative and push for change rather than maintain the status quo.
Another strength I observed during clinic visits was that several of the
locations provided a large sensory-style gym, which was hugely advantageous to
therapy sessions. Conversely, individual treatment rooms became quite small
with the therapist, patient, parent, younger sibling, and several students present.
The clinics seemed to be well stocked with activities, tools, and play equipment.
The staff offices also had many informational resources and assessments to
draw from. Overall, the environment was supportive, friendly, and positive.
Literature Review

COMPREHENSIVE SENSORY-BASED PROGRAM

Sensory Processing
General information
Sensory processing refers to the neural organization and classification of
sensory information in the environment in order to form a behavioral response
(Brown & Nicholson, 2011). Theory behind the concept of sensory processing
originated with an occupational therapist named Jane Ayers, who developed the
Sensory Integration frame of reference. Ayers (1979) postulated that sensory
integration involved a purposeful, goal directed response to a sensory
experience (p.6). When an individual craves a certain stimulus, or is over or
underresponsive to stimuli and it interferes with their ability to participate in
everyday activities, a sensory modulation disorder may be present (Brown &
Nicholson, 2011).
The etiology and prevalence of sensory-related issues are current
subjects of study. Research by Owen et al. (2013) presented results of diffusion
tensor imaging (DTI), which showed abnormal posterior white matter
mircrostructure among children diagnosed with Sensory Processing Disorder
(SPD), and abnormal posterior cerebral white matter among children with
sensory-related behaviors. Regarding the prevalence of sensory processing
disorders in the United States, estimated rates range from 5.3-16.5% (Ahn,
Miller, Milberger, & McIntosh, 2004; Ben-Sasson, Carter, & Briggs-Gowan, 2009),
and up to 55.9% in low-income settings (Gourley, Wind, Henninger, & Chinitz,
2013). These numbers indicate that there is a need and demand for evidencebased, sensory-specific treatment.

COMPREHENSIVE SENSORY-BASED PROGRAM

Occupational Performance and Participation

Introduction
As occupational therapists seek to provide family- and client-centered
care, it is essential to determine what the concerns are of parents who are
seeking treatment for their children. Schaaf et al., (2015) analyzed the goals of
160 parents of children with sensory processing difficulties, and conducted
interviews to assess the strengths and weaknesses of their child in order to
determine which issues were of greatest concern. Results indicated that parents
identified activities of daily living (ADL), play, and social participation as top
priorities.
ADL & Instrumental Activities of Daily Living (IADL)
Sensory issues impact a childs ability to perform ADLs, which can include
tasks such as brushing teeth, getting dressed, and eating a variety of healthy
foods. Koenig and Rudney (2010) performed a systematic literature review
including 35 studies to determine the impact of sensory integration issues on
ADL and IADL functional performance. Findings indicated that self-care, eating,
dressing, mobility, and functional behavior was noted as being problematic
compared to typically developing peers. Research by Chien, Rodger, Copley
Branjerdporn, and Taggert (2016) and Bar-Shalita, Vatine, and Parush (2008),
indicated that children with sensory processing issues were found to experience
lower participation levels in daily care activities.
Play and social participation

COMPREHENSIVE SENSORY-BASED PROGRAM

Sensory processing issues have also been found to affect one of the most
important occupations of children; play. Children with sensory issues
demonstrate lower levels of social play and complexity of social play, respond to
fewer social cues, and experience more frequent conflict during play than
typically developing peers (Cosbey, Johnston, Dunn, & Bauman, 2012).
Furthermore, sensory overresponsivity can compromise social participation due
to discomfort related to the unpredictable and changing sensory input that comes
with social play (Ben-Sasson, Carter, & Briggs-Gowan, 2009). Sensory issues
also influence choice of toys and type of play, as children seek to meet their
sensory needs (Mische-Lawson & Dunn, 2008).
Parenting and family roles
The aforementioned areas of concern can certainly impact family routine,
and parents of children with sensory needs can feel at a loss as to how to handle
these challenges. Cohn, May-Benson, and Teasdale (2010) performed a study
with 248 parent participants of children with SPD, with the intention of
determining whether sensory-related behaviors in their children (avoiding eye
contact, being uncooperative, or having temper tantrums or poor frustration
tolerance p.179) correlated with parental sense of competency. Results
indicated a significant relation, with higher rates of challenging behaviors
corresponding to lower sense of competence. The article concluded with a
recommendation to address not only social behavior of children, but also the
needs of parents during therapy intervention.

COMPREHENSIVE SENSORY-BASED PROGRAM

10

If addressing the concerns of parents is important, it is valuable to then

delve further into what those concerns are. A qualitative, grounded approach
study by Cohn (2001) focused on understanding the points of view of parents of
children with sensory processing difficulty. Following the conclusion of
occupational therapy intervention, parents were asked to identify the outcomes of
occupational therapy that they valued. For their children, the parents wanted to
see improvement in abilities, activities, and reconstruction of self worth. For
themselves, the parents valued understanding their childrens behavior in new
ways, which facilitated a shift in expectations for themselves and their children,
having their parenting experience validated, and being able to support and
advocate for their children (p. 285).
Existing Programming
Program methods
Several programs addressing occupational participation and parental
competency have been implemented with positive results. One such program
conducted by Dunn, Cox, Foster, Mische-Lawson, and Tanquary (2012) involved
contextual intervention, which focuses on activity environment, sensory
processing patterns, and daily routines. Participants were children with autism
spectrum disorder (ASD), among whom rates of sensory-related issues are
reported to be between 45-90% (Ben-Sasson et al., 2008). Ten one-hour
outpatient sessions were provided by two occupational therapists to families over
a 12-15 week period, with the intention of increasing occupational participation
and parent competency. During the sessions, parents were coached using

10

COMPREHENSIVE SENSORY-BASED PROGRAM

11

reflective discussion, and assisted in identifying different strategies to implement

in the home. Results showed that children significantly increased their
occupational participation, and parents reported improved competency.
Flanagan, Hampton, Sullivan, Miller, and Schoen (2015) released early
findings of a study to be published, regarding an outpatient therapy program that
also incorporated parent education. Ninety-eight children were engaged in
sessions occurring three to five times weekly for 30 sessions. Parents
participated in individual therapy with their child, and also attended six education
sessions for parents only. Intervention was composed of DIRFloortime a method
created from the sensory integration frame of reference, cognitive-behavioral
tactics, and integrated listening systems. Results showed significant
improvement in all measured areas, with greatest improvement shown in ADL
and IADL.
A caregiver knowledge and competency program devised by Gee and
Peterson (2016) also offered results to support a parent education component.
The program lasted for six weeks, with pre- and post-tests given to parents to
measure self-perceived and actual knowledge of sensory processing information,
and self-rated sense of competency for managing sensory-related behaviors.
Sessions were comprised of an icebreaker activity, review of previous
information, and a PowerPoint presentation. Results indicated an increase in
parents competency and knowledge, as well as perception of self-efficacy.
Finally, although evidence for group interventions involving children with
sensory-specific issues is not available, a group social skills intervention program

11

COMPREHENSIVE SENSORY-BASED PROGRAM

12

targeting eight adolescents with Asperger syndrome offered useful information.

Barnhill, Cook, Tebbenkamp, and Myles (2002) piloted a 12-week social skills
training (SST) program which provided weekly one-hour sessions including direct
instruction, modeling, role-playing, emotional expression recognition, and
finished with two-three hours of activities that took place in the community. This
provided an environment with less structure, and allowed for a more realistic
setting in which to practice social participation. The seven male participants all
reported that they were able to make at least one friendship among the other
group members, and expressed the intention to continue the association after the
program ended.
Outcome measures
Many outcome measures were utilized to gather data reported in the
literature. The assessment that was implemented most extensively to determine
whether participants met inclusionary criteria, and to aid in goal setting was the
Sensory Profile (Ahn, Miller, Milberger, & McIntosh, 2004; Bar-Shalita, Vatine, &
Parush, 2008; Chien, Rodger, Copley, Branjerdporn, & Taggart, 2016; Cohn,
May-Benson, & Teasdale, 2011; Cosbey, Johnston, Dunn, & Bauman, 2012;
Dunn, Cox, Foster, Mische-Lawson, & Tanquary, 2012; Gourley, Wind,
Henninger, & Chinitz, 2003; Owen et al., 2013; Schaaf et al., 2015).
Other measurement tools included the Adaptive Behavior Assessment
System (ABAS-II) (Flanagan, Hampton, Sullivan, Miller, & Schoen, 2015),
Behavior Assessment System for Children (BASC-2) (Flanagan, Hampton,
Sullivan, Miller, & Schoen, 2015), Canadian Occupational Performance Measure

12

COMPREHENSIVE SENSORY-BASED PROGRAM

13

(COPM), Goal Attainment Scaling (Dunn, Cox, Foster, Mische-Lawson, &

Tanquary, 2012), Child Behavior Checklist (CBCL) (Ben-Sasson, Carter, &
Briggs-Gowan, 2009), Parenting Sense of Competence (PSOC) (Cohn, MayBenson, & Teasdale, 2011; Dunn, Cox, Foster, Mische-Lawson, & Tanquary,
2012), Parenting Stress Index (Dunn, Cox, Foster, Mische-Lawson, & Tanquary,
2012), Participation in Childhood Occupations Questionnaire (PICO-Q) (BarShalita, Vatine, & Parush, 2008; Chien, Rodger, Copley, Branjerdporn, & Taggart,
2016), Playground Observation Form (Cosbey, Johnston, Dunn, & Bauman,
2012), Sensory Integration and Praxis Tests (Cohn, 2001; Schaaf et al., 2015),
and the Sensory Over-Responsivity Scales (SensOR) (Ben-Sasson, Carter, &
Briggs-Gowan, 2009).
Regarding other sources for measurement, Cordier et al., (2016), reported
that the quality of child-report measures of occupational performance is low, and
that more research is needed before existing measures should be implemented.
Schaaf et al., (2014) recommended the use of both qualitative and quantitative
methods to gather data concerning the area of sensory integration.
Summary
Interviews conducted during the needs analysis phase revealed missing
components of the sensory program at Primary Childrens outpatient
rehabilitation, which is currently comprised only of individual therapy. Therapists
feel that they have not been able to offer a comprehensive treatment package
that would address parents as well as children, in order to engender skills that
are effectively generalized to environments beyond the clinic to be maintained in

13

COMPREHENSIVE SENSORY-BASED PROGRAM

14

the long-term. Families often return to the clinic because they have been unable
to successfully implement strategies. Part of that difficulty likely stems from the
chaotic and short amount of time in which parents have to glean information
during the therapy sessions.
Research literature shows that incorporating a parent education
component leads to positive outcomes both in the sense of competency of the
parent, and increased positive behaviors and goal achievement in the client
(Dunn, Cox, Foster, Mische-Lawson, & Tanquary, 2012; Flanagan, Hampton,
Sullivan, Miller, & Schoen, 2015; Gee & Peterson, 2016). In short, a more
educated and better-supported parent can affect the occupational performance
and participation of their child. And yet, the parent population in the current
system is underserved.
Another missing piece of the current program is the opportunity to address
social interaction. Group therapy is not covered by insurance, and so has not
been seen as an option at Primary Childrens even though social participation
and play are top concerns of parents (Schaaf et al., 2015), and are reduced in
children with sensory issues (Cosbey, Johnston, Dunn, & Bauman, 2012).
Research shows that a focus on social interaction enables children to make
connections and establish friendships (Ben-Sasson, Carter, & Briggs-Gowan,
2009). This has also been the experience of Dr. Golley, who reported witnessing
similar positive outcomes in her own profession experience.
As Primary Childrens Hospital seeks to put the child first, it is important to
incorporate evidence into programming to provide the best care, and to listen to

14

COMPREHENSIVE SENSORY-BASED PROGRAM

15

parents when determining what is most important for them and their children.
Although therapists have been able to address the area of ADL and IADL
participation, which was identified as another concern of parents (Schaaf et al.,
2015) through individual therapy, other areas of concern have not been similarly
addressed.
Program Proposal
General description
Note: This paper is to be read in combination with a paper authored by
Kelli Garfield, which focuses on additional services offered to parents and
children such as an online forum and community sessions.
Program overview
The needs analysis and literature review revealed valuable services
missing from the current sensory program at Primary Childrens Hospital; namely,
parent education and social participation. Literature revealed positive,
occupation-based outcomes for this type of programming in both the child and
parent. Increasing the scope of existing programming through incorporating
these areas will assist Primary Childrens Hospital to ensure best care, and to
realize their mission of putting the child first.
To this aim, the proposed program offers a didactic parent education
course providing an introductory-level overview of sensory processing, sensory
modulation, environmental and lifestyle adaptation, and parenting skills/behavior
management. A dedicated parent education program that is free from distraction,
would provide a preferred environment for parents to learn more about their

15

COMPREHENSIVE SENSORY-BASED PROGRAM

16

childs condition and how to best support them. Social participation will be
addressed through group therapy sessions incorporating play. This will enable
children to practice sensory modulation skills in a safe and guided space, and in
a manner more purposeful and meaningful to them. Group therapy also affords
the therapist an opportunity to observe the social interactions of each child in a
more natural environment.
Several assessments will be utilized to serve as outcome measures.
Currently, therapists perform the Sensory Processing Measure or Sensory Profile
and assess sensory motor skills during the initial evaluation. Including the COPM
during the initial evaluation and then again at discharge will enable comparison of
parents satisfaction levels regarding change in occupational performance. To
determine program efficacy for parent participants, the Parenting Stress Index
(short form), and the Parenting Sense of Competence Scale will be administered.
Rationale for occupational therapist
Occupational therapists core objective is to enable clients to participate in
the activities they need or want to do, despite disability or illness. This is
accomplished through analyzing the transaction between a person (with their
accompanying skills and physical abilities), the demands of the chosen task, and
the individuals contexts and environments (AOTA, 2011). Thus, the domain of
occupational therapy is a good fit for the needs of children with sensory issues,
who have difficulty being successful in tasks such as self-care, social
participation, and role competence due to sensitivity to their sensory
environment. Occupational therapists are able to look at the child holistically to

16

COMPREHENSIVE SENSORY-BASED PROGRAM

17

provide a treatment plan that addresses each component of this transaction.

They offer this same capability to parents, who must take many factors into
consideration when parenting their child with sensory needs.
Furthermore, occupational therapists involved in pediatric care often
specialize in providing sensory intervention and indeed, the concept and model
originated with an occupational therapist. The profession of occupational therapy
offers a rich and dynamic research community that produces information and
recommendations for best care practices relating to these issues. Occupational
therapists are consumers of this information, and utilize it to provide evidencebased care. Therefore, it is recommended that occupational therapists provide
direct services, using a collaborative approach involving parents.
Occupational
Word did not find any entries for your table of contents.ustice
This program addresses occupational deprivation, which is described as
a state of prolonged preclusion from engagement in occupations of necessity
and/or meaning due to factors that stand outside the control of the individual
(Whiteford, 2003, p. 222). As discussed previously, children with sensory
processing issues experience decreased occupational participation due to
biologically based factors, which are outside of their control. Parental roles and
occupational engagement are also affected. Townsend and Wilcock (2004) draw
attention to the right of all human beings to develop through participation in
occupations for health and social inclusion (p. 81), yet children with sensory
issues are limited in their choices due to decreased ability to successfully

17

COMPREHENSIVE SENSORY-BASED PROGRAM

18

respond to their environment. Providing sensory-specific programming to develop

the skill set of these children and their parents will expand occupational options.
Theoretical Foundation
Person-Environment-Occupation (PEO) Model
The PEO Model (Law et al., 1996) compliments this program and intended
population, as it states that occupational performance is the result of the complex
dynamic interaction between the person, environment, and occupation. The
overall outcome for PEO is increased congruency and satisfaction due to
improved balance and transaction between these elements. For children with
sensory processing issues and their parents, congruency and level of satisfaction
in occupational performance is often negatively impacted.
PEO postulates that affecting change in the person, environment,
occupation, or transaction can lead to increased performance, but it is easier to
decrease environmental barriers than to change aspects of the person. This
program recognizes the importance of environmental adaptation, and as such is
a major component of parent education. PEO also points out that occupational
performance is affected by the persons beliefs about environment and
occupation, so understanding their characteristics and attributes contributes to
more effective intervention. The client-based emphasis inherent to this program
will ensure adherence to this concept.
Sensory Processing Model
The Sensory Processing Model (Dunn, 1997) focuses on increasing
occupational performance through adapting responses to sensory input, and

18

COMPREHENSIVE SENSORY-BASED PROGRAM

19

adjustment of the sensory environment to compliment the needs of the child.

Sensory therapy is described as addressing vestibular, proprioceptive, olfactory,
auditory, vision, and tactile senses. This model suggests that therapeutic
interactions utilizing play (a key element of individual and group therapy
sessions) contribute to increased sense of control, motivation, confidence,
mastery, and ability on the part of the child.
Furthermore, the sensory processing model indicates that positive
experiences and motivation are catalysts for sensory integration, and a pattern of
successful occupational performance experiences contributes to positive
changes in mastery, self-assurance, and fulfillment. These outcomes correspond
to desired outcomes for children set forth by parents in Cohn (2001), namely
improvement in abilities, activities, and reconstruction of self-worth. Through
Primary Childrens sensory program, children will participate in these specialized
therapies, and parents will acquire tools to identify environmental barriers and
increase adaptive responses.
Social Participation Model
The overall outcome of the Social Participation Model is to promote
successful social participation and communication (Olson, 2009). It suggests that
social participation and acceptance level increases as the child learns to regulate
physical and emotional responses to their environment, and that arranging
opportunities for social interaction is essential for learning social skills. This
model is a good match with the proposed program due to the emphasis on
improving social interaction through group therapy and parent education.

19

COMPREHENSIVE SENSORY-BASED PROGRAM

20

The social participation model also proposes that increasing

understanding of the reasoning behind a childs difficult temperament will result in
more positive interaction, and implementation of a routine in the home to manage
the childs frustration during difficult tasks will lead to increased calm and
cooperation. And finally, helping the parent to learn how to teach healthy social
habits to their child and incorporate them into family routines will lead to greater
participation. These postulates underscore the importance of a family-centered
plan.
Goals and Objectives
Goal 1: To empower parents of children with sensory needs through increased
knowledge and understanding, improved sense of competency and social
support, and decreased stress.
Objective 1: By completion of parent education sessions, 80% of parent
participants will create a personalized sensory toolbox for their child.
Objective 2: By discharge, 80% of parent participants will increase sense
of competency as measured by Parenting Sense of Competency
assessment.
Goal 2: To improve the ability of children with sensory needs to achieve success
in meaningful activities and tasks through completion of comprehensive, sensorybased programming.
Objective 1: By discharge, 80% of child participants will independently
implement strategies to improve sensory responses on 3/5 occasions as
measured by parent report or therapist observation.

20

COMPREHENSIVE SENSORY-BASED PROGRAM

21

Objective 2: By discharge, 80% of child participants will increase

occupational performance as measured through COPM in 4/5 goal areas.

21

COMPREHENSIVE SENSORY-BASED PROGRAM

22

References
Ahn, R. R., Miller, L. J., Milberger, S., & McIntosh, D. N. (2004). Prevalence of
parents perceptions of sensory processing disorders among kindergarten
children. American Journal of Occupational Therapy, 58(3), 287-293.
American Occupational Therapy Association. (2011). Definition of occupational
therapy practice for the AOTA Model Practice Act. Retrieved from
http://www.aota.org/~/media/Corporate/Files/Advocacy/State/Resources/P
racticeAct/Model%20Definition%20of%20OT%20Practice%20Adopted
%2041411.ashx
Ayres, A. J. (1979). Sensory Integration and the Child. Los Angeles: Western
Psychological Services.
Barnhill, G. P., Cook, K. T., Tebbenkamp, K., & Myles, B. S. (2002). The
effectiveness of social skills intervention targeting nonverbal
communication for adolescents with Asperger syndrome and related
pervasive developmental delays. Focus on Autism and Other
Developmental Disabilities, 17(2), 112-118.
BarShalita, T., Vatine, J. J., & Parush, S. (2008). Sensory modulation disorder: A
risk factor for participation in daily life activities. Developmental Medicine
& Child Neurology, 50(12), 932-937.
BenSasson, A., Cermak, S. A., Orsmond, G. I., TagerFlusberg, H., Kadlec, M.
B., & Carter, A. S. (2008). Sensory clusters of toddlers with autism
spectrum disorders: Differences in affective symptoms. Journal of Child
Psychology and Psychiatry, 49(8), 817-825.

22

COMPREHENSIVE SENSORY-BASED PROGRAM

23

Ben-Sasson, A., Carter, A. S., & Briggs-Gowan, M. J. (2009). Sensory overresponsivity in elementary school: prevalence and social-emotional
correlates. Journal of abnormal child psychology, 37(5), 705-716.
Brown, C., & Nicholson, R. (2011). Sensory Skills. In C. Brown & V. C. Stoffel
(EDS.), Occupational Therapy in Mental Health: A Vision for Participation
(1st ed., pp. 280-281). Philadelphia: F. A. Davis Company.
Chien, C. W., Rodger, S., Copley, J., Branjerdporn, G., & Taggart, C. (2016).
Sensory Processing and Its Relationship with Children's Daily Life
Participation. Physical & occupational therapy in pediatrics, 36(1), 73-87.
Cohn, E. S. (2001). Parent perspectives of occupational therapy using a sensory
integration approach. American Journal of Occupational Therapy, 55(3),
285-294.
Cohn, E., May-Benson, T. A., & Teasdale, A. (2011). The relationship between
behaviors associated with sensory processing and parental sense of
competence. OTJR: Occupation, Participation and Health, 31(4), 172-181.
Cordier, R., Chen, Y. W., Speyer, R., Totino, R., Doma, K., Leicht, A., ... &
Cuomo, B. (2016). Child-Report Measures of Occupational Performance:
A Systematic Review. PloS one, 11(1), e0147751.
Cosbey, J., Johnston, S. S., Dunn, M. L., & Bauman, M. (2012). Playground
behaviors of children with and without sensory processing disorders.
OTJR: Occupation, Participation and Health, 32(2), 39-47.

23

COMPREHENSIVE SENSORY-BASED PROGRAM

24

Dunn, W. (1997). The Impact of Sensory Processing Abilities on the Daily Lives
of Young Children and Their Families: A Conceptual Model. Infants &
Young Children, 9(4), 23-35.
Dunn, W., Cox, J., Foster, L., Mische-Lawson, L., & Tanquary, J. (2012). Impact
of a contextual intervention on child participation and parent competence
among children with autism spectrum disorders: A pretestposttest
repeated-measures design. American Journal of Occupational Therapy,
66(5), 520-528.
Flanagan, J., Hampton, S. R., Sullivan, J., Miller, L. J., & Schoen, S. (2015). A
Retrospective Pretest/Posttest Study of Occupational Therapy Intervention
for Children With Sensory Challenges. American Journal of Occupational
Therapy, 69(Supplement_1), 6911515056p1-6911515056p1.
Gee, B. M., & Peterson, T. W. (2016). Changes in Caregiver Knowledge and
Perceived Competency Following Group Education about Sensory
Processing Disturbances: An Exploratory Study. Occupational Therapy
International, 23(4), 338-345.
Intermountain Primary Childrens Hospital (n.d.). About: The child first and
always. Retrieved from
https://intermountainhealthcare.org/locations/primary-childrenshospital/hospital-information/about/
Koenig, K. P., & Rudney, S. G. (2010). Performance challenges for children and
adolescents with difficulty processing and integrating sensory information:

24

COMPREHENSIVE SENSORY-BASED PROGRAM

25

A systematic review. American Journal of Occupational Therapy, 64(3),

430-442.
Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The
person-environment-occupation model: A transactive approach to
occupational performance. Canadian Journal of Occupational Therapy,
63(1), 9-23.
Mische-Lawson, L., & Dunn, W. (2008). Childrens sensory processing patterns
and play preferences. Annual in Therapeutic Recreation, 16, 1-14.
Olson, L. (2009). Chapter 10. A frame of reference to enhance social
participation. In Frames of reference for pediatric occupational therapy.
(Third Edition). Kramer, P., & Hinojosa, J., Eds. Philadelphia: Lippincott:
Williams, & Wilkins.
Owen, J. P., Marco, E. J., Desai, S., Fourie, E., Harris, J., Hill, S. S., ... &
Mukherjee, P. (2013). Abnormal white matter microstructure in children
with sensory processing disorders. Neuroimage: clinical, 2, 844-853.
Schaaf, R. C., Burke, J. P., Cohn, E., May-Benson, T. A., Schoen, S. A., Roley, S.
S., ... & Mailloux, Z. (2014). State of measurement in occupational therapy
using sensory integration. American Journal of Occupational Therapy,
68(5), e149-e153.
Schaaf, R. C., Cohn, E. S., Burke, J., Dumont, R., Miller, A., & Mailloux, Z.
(2015). Linking Sensory Factors to Participation: Establishing Intervention
Goals With Parents for Children With Autism Spectrum Disorder.

25

COMPREHENSIVE SENSORY-BASED PROGRAM

26

American Journal of Occupational Therapy, 69(5), 6905185005p16905185005p8.

Townsend, E., & Wilcock, A. A. (2004). Occupationaljustice and Client-Centred
Practice: A Dialogue in Progress. Canadian Journal of Occupational
Therapy, 71(2), 75-87.
Whiteford, G. (2003). When people cannot participate: Occupational deprivation.
In C. Christiansen & #. Townsend (Eds.), An introduction to occupation:
The art and science of living (pp. 221-242). Upper Saddle River, NJ:
Prentice Hall.

26

COMPREHENSIVE SENSORY-BASED PROGRAM

27

Appendix A
What

is the funding source for services?

Medicaid
Private insurances
Private pay

What

services are currently provided?

ADL
Fine motor
Gross motor
Sensory
Eating issues
Cognitive
Visual perceptual

What is the age range of occupational therapy patients?

Ages 2-18
Are there areas of programming you would like to strengthen or
improve?
Sensory program
What

are the specific issues you see with your areas of concern?
No opportunity for group sessions or parent education
No way for parents to connect with each other
Difficult for new patients to get in for an appointment; slots are
already taken by patients who are regulars

What are your plans for the future?

Move children through the program to provide appointments for
new patients, then have them return for a check-up appointment
if they have a major change
Offer four 1:1, four group, and 6 parent education sessions with
parents being required to attend education sessions before child
can enter program
Establish partnerships with community organizations for outings
Goal of program being ready by summer 2017

27