Understanding Sensory Integration and Sensory-Based Interventions in School-Based Occupational Therapy

An interior view of a sensory gym equipped with soft mats, swings, and other sensory tools, designed for therapeutic use by children with sensory integration challenges.

As a new therapist, I had no idea that Sensory Integration (SI) differed from Sensory-Based Interventions (SBIs).

Now, as an experienced therapist, it can sometimes be difficult to hide my emotions when a teacher, parent, or even better, an advocate suggests that using a fidget or a wiggle cushion in the classroom is Sensory Integration.

Let’s be honest. Sensory Integration has never been a simple intervention to learn and understand. To most, it looks like facilitated play in a brightly colored padded room (see image above). And the fact that every toy at Target is being marketed as a “sensory toy” does not help. That said, OT practitioners must understand and be able to communicate to parents and educators the difference between interventions that incorporate sensory experiences and Sensory Integration implemented with fidelity.

This article aims to clarify the differences between SBI and SI and discuss the research and implementation behind both.

Defining Sensory Integration Intervention

Sensory Integration (SI), rooted in the work of Dr. A. Jean Ayres, is a specialized approach focused on the neurological process of organizing sensory input. This specialized intervention is designed to help children with sensory processing difficulties develop adaptive responses to sensory stimuli.

The core principles of SI intervention include individualized assessment and treatment based on patterns of behavior associated with various sensory stimuli - tactile, vestibular, proprioception, and vision (to a slightly lesser extent) being the primary focus. SI also requires specialized training and certification for practitioners to learn hot to identify and treat these patterns in order to improve performance in all kinds of occupations. In 2014-15, I was trained in SI through the USC+WPS SIPT program. The program no longer exists, but there are still at least three organizations in the US providing Sensory Integration education based on the original works of Dr. Ayres. They are:

• CL-ASI

• USC

• STAR Institute

Research supports the effectiveness of SI intervention in improving sensory processing and functional outcomes for children in clinical settings, but mainly with a service frequency that is unrealistic in school settings.

SI is not easy to implement in the school setting.

Per the SI Fidelity Measure first published in 2008, the primary tenets of SI are that therapy must be provided by a therapist with appropriate post-professional training in SI theory and practice, as well as mentorship from an experienced therapist. The therapy must occur in a safe environment, with proper equipment and space to allow for physical activity and sensory experiences.

Comprehensive assessment reports must also be provided, and the intervention must involve regular communication with parents and teachers to discuss the course and impact of the therapy. The process elements include ensuring physical safety, presenting a variety of sensory opportunities, supporting sensory modulation, challenging motor control and praxis, collaborating with the child in activity choices, tailoring activities to present the “just-right” challenge, ensuring the child’s success in activities, supporting intrinsic motivation to play, and establishing a strong therapeutic alliance.

As you can see, it’s a lot more than providing a teacher with a sensory diet, fidget toys, or some GoNoodle videos.

To learn more about SI, I suggest starting with the Fidelity Measure and checking out the resources listed below. While research has long centered around clinic-based services, research on effectiveness and feasibility in the school setting is slowly trickling out.

Defining Sensory-Based Interventions

Sensory-based interventions (SBIs), on the other hand, involve the use of specific sensory techniques and environmental modifications to influence behavior and attention. Unlike SI intervention, SBIs do not necessarily require specialized training and can be implemented more easily by teachers and other school staff under the guidance of an OTP. SBIs often include strategies such as sensory breaks, weighted vests, and sensory-friendly classroom modifications.

The AJOT article “Specific Sensory Techniques and Sensory Environmental Modifications for Children and Youth With Sensory Integration Difficulties: A Systematic Review” discusses the application of SBIs and their impact on children with sensory processing issues. These interventions are typically less intensive than SI interventions and can be integrated into students' daily routines. SBIs aim to provide sensory input in a controlled manner to help children maintain an optimal level of arousal and focus.

It is important to note here that few SBIs have research to support their effectiveness. However, many are quick to use the research in SI to deduce that SBIs are also effective. As the primary providers of SI and SBIs, we must be careful in how we discuss them to avoid causing further confusion.

Implementation in School Settings

When considering the implementation of these interventions in school settings, several factors need to be addressed.

Feasibility of SI Intervention

Implementing SI intervention in schools can be challenging due to the specialized training required for practitioners. Certified SI therapists need access to specific equipment and a dedicated space to conduct therapy sessions. Time and scheduling constraints also pose significant challenges, as SI intervention often requires one-on-one or small group sessions that can be difficult to fit into a school day.

However, the benefits of SI intervention are well-documented. In 2023, the study “A Sensory Integration Intervention in the School Setting to Support Performance and Participation: A Multiple-Baseline Study” demonstrated the positive outcomes of SI therapy for children with sensory processing disorders in a collaborative protocol with both individual sessions and teacher consults. Despite the fiscal and environmental challenges, schools that invest in SI intervention can see significant improvements in their students’ sensory processing and overall functioning.

Feasibility of Sensory-Based Interventions

SBIs are generally more feasible to implement in school settings due to their flexibility and lower resource requirements. These interventions can be easily integrated into classroom routines and do not require specialized training for implementation. Teachers and aides can be trained to use sensory strategies effectively, making SBIs a practical choice for many schools.

Insights from the AJOT article “Understanding How School-Based OT Practitioners (OTPs) Perceive Sensory Integrative and Sensory-Based Interventions: Knowledge Base and Practical Application” highlight the ease with which SBIs can be incorporated into school environments. These interventions can be tailored to the needs of individual students or applied to the entire classroom to create a sensory-friendly learning environment. The cost and resource considerations for SBIs are also lower compared to SI intervention, making them an attractive option for schools with limited budgets.

Collaboration and Teamwork

Successful implementation of sensory interventions (SI and SBI) in schools requires collaboration and teamwork among OT practitioners, teachers, staff, and parents.

Working with Teachers and Staff

Effective communication and training are essential for integrating sensory strategies into the classroom. Teachers and staff need to understand the purpose of these interventions and how to implement them correctly. Having at least a basic understanding of Sensory Integration Theory can also be beneficial for teachers. Regular meetings and in-service training sessions can help ensure that everyone is informed and working towards common goals.

Involving Parents and Caregivers

Parents and caregivers may also play a role in supporting sensory interventions at home. Some parents may already have some insights into SI as a result of their child receiving services outside of the school environment. Providing them with strategies for home carryover and consistency may enhance the effectiveness of sensory interventions, but be sure to check in with them and see if another therapist has already given them a home program. If applicable, you may be able to contact the student’s clinic/home-based OT to consult or collaborate with.

Workshops and informational sessions can help parents understand sensory processing issues and how to support their children outside of school. They can also help you in advancing the role that OT plays at your school.

Challenges and Solutions

Implementing sensory interventions in schools is not easy. SBIs, and SI especially, come with their own set of challenges, but with the right strategies and support from staff and parents, these can be overcome.

Common Obstacles in Implementing SI Interventions

Challenges such as limited resources, time constraints, and the need for specialized training can hinder the implementation of SI interventions. Solutions include advocating for funding, creating flexible schedules, and providing professional development opportunities for staff.

I was very fortunate to take a job at a school district that paid for me to earn my SIPT certification. In fact, that was a big part of why I took the job. In the interview, the director of special education told me they had a SIPT kit and that a new school was being built with funding for a sensory gym. Since they had those two components in place, they were very willing to send me to the training.

In another district I worked for, parents helped to fund one sensory room. The district also funded two others, including one built as part of a grant-funded behavioral program.

Addressing Challenges with SBIs

While SBIs are easier to implement, they still require proper planning and support. It is crucial to ensure that teachers and staff are adequately trained and have access to necessary resources.

When implementing SBIs (and SI, for that matter), regular monitoring and adjustments to the interventions are necessary. You, the teacher, and/or classroom paraprofessionals need to collect data and adjust the program accordingly.

SBIs often include both proactive and reactive sensory interventions. Proactive interventions are those that aim to prevent a student from experiencing dysregulation (e.g., using a stress ball before and during a difficult activity). Reactive interventions may include a calming area the student can retreat to after becoming dysregulated.

The Wrap-up

Understanding the differences between sensory integration interventions and sensory-based interventions is essential for school-based OT practitioners. Both approaches offer valuable strategies for supporting students with sensory processing challenges, but they differ in terms of implementation and resource requirements. By leveraging the strengths of each approach and working collaboratively with teachers, staff, and parents, we can create a supportive and sensory-friendly learning environment for all students.

Additional Resources

For further reading and training opportunities, consider exploring certifications, workshops, and online courses related to sensory integration and sensory-based interventions. At the OT Schoolhouse, we offer the following courses (all of which are included with an OT Schoolhouse Collaborative Membership):

Certificate Programs in Sensory Integration

References

Colleen Cameron Whiting, Sarah A. Schoen, Linda Niemeyer; A Sensory Integration Intervention in the School Setting to Support Performance and Participation: A Multiple-Baseline Study. Am J Occup Ther March/April 2023, Vol. 77(2), 7702205060. doi: https://doi.org/10.5014/ajot.2023.050135
Gloria Frolek Clark, Renee Watling, L. Diane Parham, Roseann Schaaf; Occupational Therapy Interventions for Children and Youth With Challenges in Sensory Integration and Sensory Processing: A School-Based Practice Case Example. Am J Occup Ther May/June 2019, Vol. 73(3), 7303390010p1–7303390010p8. doi: https://doi.org/10.5014/ajot.2019.733001
Rochele Charles, Tara Glennon; Understanding How School-Based OT Practitioners (OTPs) Perceive Sensory Integrative and Sensory-Based Interventions: Knowledge Base and Practical Application. Am J Occup Ther August 2020, Vol. 74(4_Supplement_1), 7411505260p1. doi: https://doi.org/10.5014/ajot.2020.74S1-PO9800
Sensory Integration Approaches for Children and Youth in Occupational Therapy Practice. Am J Occup Ther November/December 2023, Vol. 77(Supplement 3), 7713410230. doi: https://doi.org/10.5014/ajot.2023.77S3004
Stefanie C. Bodison, L. Diane Parham; Specific Sensory Techniques and Sensory Environmental Modifications for Children and Youth With Sensory Integration Difficulties: A Systematic Review. Am J Occup Ther January/February 2018, Vol. 72(1), 7201190040p1–7201190040p11. doi: https://doi.org/10.5014/ajot.2018.029413