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Trauma Informed Symposium of

Wisconsin

Sensory Connection to Trauma and

Treatment in Youth

April 12th

, 2017 Oshkosh, WI

Karen M. Moore, OTR/L

&

Angela Balzarini-Leonhart, OTR/L

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Karen M. Moore, OTR/L 476 Timber Lane, Franconia NH 03580 E-mail: karenmoore@sensoryconnectionprogram.com Website: www.sensoryconnectionprogram.com Karen Moore is an occupational therapist, a graduate of Worcester State College, who worked in mental health at Worcester State Hospital and on the Acute Adult Psychiatric Unit at UMASS Medical Center. Her career long commitment to the study and use of sensory modalities for treatment in psychiatric care culminated in the writing of her book The Sensory Connection Program: Activities for Mental Health Treatment (2005). She developed a sensory-based treatment group which is a popular group for patients with cognitive and language difficulties which continues to run daily at UMASS. She led a clinical research project on the efficacy of using the Wilbarger Protocol, an intensive sensory treatment program, with patients with psychiatric diagnoses along with sensory defensiveness, PTSD, and self-injurious behaviors (Moore & Henry, 2002). Over the years Karen has presented on sensory related treatment to hospitals, behavioral units, community programs, college programs, nursing homes, and numerous occupational therapy conferences including MAOT, NHOTA, OTAC and SSOT/SK. She lectures on the use of sensory related treatment strategies throughout the country and provides consultation on the development of sensory rooms and program groups. Karen newest book is entitled The Sensory Connection Program: Curriculum for Self-regulation: Group Treatment for Emotional Regulation, Crisis Intervention & Stress Management.

Angela Balzarini-Leonhart, OTR/L 52 Oliver Ave S. Minneapolis, MH 55405 Email: balzarinileonhart@gmail.com

Angela Balzarini-Leonhart is an Occupational Therapist who specializes in the use of Sensory Intervention and Self-Regulation strategies. Angie is a graduate of St. Catherine’s University OT program. She received her BS in Psychology at Northern Michigan University. Angie currently works as an OT Lead and Sensory Intervention Consultant for the MH Department of Regions Hospital in St. Paul MN. Angie was an integral part in the development of the sensory program at Regions. She is the first OT in the state of Minnesota to have the title MH Sensory Intervention Consultant. She has assisted in writing grants and has shared her sensory knowledge for the inpatient mental health sensory program setup and logistics. Angie has trained interdisciplinary staff and implemented sensory programs throughout the hospital and the organization. Angie is active in MOTA SIG presenting for both the Chronic Pain, Mental Health specialty groups and the 2015 Annual Conference. She is also active with NAMI and OTAMMHS, which advocate and support OT’s work in mental health settings in the state of Minnesota. In the past 2 years, Angie has had the honor of presenting with Karen Moore, from the Sensory Connection Program. She has had the pleasure of sharing her wealth of clinical experience utilizing sensory approaches at trainings in Minnesota, Wisconsin and recently in Denver, Colorado.

Participants in this training have permission to make copies of the pages of this handout to

use for educational and clinical purposes within their program or facility.

More resources, free games and activities, and a comprehensive and updated list of

references are available on the Sensory Connection Program Website.

http://www.sensoryconnectionprogram.com/index.php

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Make Your Own Tool Box

As the SCP workshops progress, use this form to keep track of ideas that will

make sense to use in your clinical setting so that you can develop your own

personalized tool box.

Mouth Tools

Hearing Tools

Smell Tools

Eye Tools

Body Tools

Hand Tools Doing Ideas

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Learning About Calming and Alerting

This worksheet is to help you identify when calming or alerting sensory input is needed and also the general

characteristics that make sensory input calming or alerting for most people. Remember that reactions to

sensory input are very personal. What one person finds calming another person might find alerting. It is

important to experiment and see what works for you.

Calming is needed when you are: Upset

Anxious

Angry

Overwhelmed

Tense

Feeling stressed

In need of relaxing

Alerting is needed when you are: Unable to focus

Feeling “out of it”

Having negative thoughts

Dissociating

Having flashbacks

Feel sleepy or sluggish

In need of pepping up

Calming Input is usually: Mild/soft

Slow

Rhythmic

Simple

Familiar

Expected/predictable

Soothing

Undemanding

Containing positive associations

Alerting input is usually: Strong/pronounced

Fast paced

Non-rhythmic

Complex

Novel

Surprising/unpredictable

Irritating

Demanding

Containing negative associations

Copyright © 2015 Karen M. Moore

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Symptoms of Distress

Stop!!!! These are signs that a person is having

difficulty tolerating the activity

Acting out

Anxiety

Excuses

Confusion

Irritability

Resistance to activity

Defensive behaviors

Lightheadedness

Increased perspiration

Flushing or pallor

Shortness of breath

Over arousal

Paranoia

Fearful expression

Copyright © 2011 Karen M. Moore

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DEEP BREATHING EXERCISES

Deep breathing, also called diaphragmatic breathing; it is the most basic relaxation

exercise. By breathing slowly and deeply from the abdomen a person can enter a deep

state of relaxation anywhere, anytime, with no special equipment or training. It works

best if it is practiced on a daily basis. Even a few breaths can help the body to calm

down. Ideally you should work up to ten and then twenty minutes of deep breathing

each day.

Make yourself comfortable. You can lie down on your back with the head supported by

a pillow and possibly another pillow under the knees. One drawback to this position is

that people fall asleep. This can be used to your advantage at night, but it is not a full

deep breathing experience unless you remain focused on the breathing. You can also sit

in the lotus position with the legs crossed in front or in a semi lotus position with one leg

extended. Sitting on a pillow makes this position more comfortable for some people.

You can also sit in a chair. It is important to be comfortable.

* * * * * * * * * * * * * * * *

Close your eyes and put your hands gently on the stomach in order to feel the

breaths. Inhale deeply through the nose feeling the abdomen expand as you

breathe in. Pause, and then slowly exhale with your mouth and lips puckered as

if blowing bubbles. That helps to slow down the breathing. Exhale until the

lungs feel empty.

Continue to breathe in and out slowly and deeply—in through the nose and out

through pursed lips. Make sure the stomach expands and contracts with the

breaths; if the shoulders rise and fall instead, your breathing is still shallow and

only expanding the chest area.

One way to make the breaths more rhythmic is to count to four slowly as you

inhale, pause, and them exhale slowly to the count of four.

Focus on your breathing. When your thoughts wander, just bring them back to

focus on the breathing. If worries come into your mind, just set them aside and

refocus. This becomes easier with practice.

Each time you breathe out, try to relax the body a little bit more. If a particular

area is tense, focus on relaxing it as you exhale.

Continue to breathe for just a few minutes or as long as twenty minutes. When

ready to stop, open your eyes slowly and continue a few more breaths and

remain still for a few minutes before returning to other activities.

The more you practice, the more helpful the breathing exercises will become. It

is easier to utilize them in times of stress if you have practiced regularly.

Copyright © 2012 Karen M. Moore

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How to Give a Hand Massage

You can give a patient or family member the gift of relaxation,

calming and pain relief with a 10 minute hand massage! Sit down so

that you can comfortably hold the other person’s hand in front of

you. Put a small amount of lotion or oil on your palms and rub them

to warm up. Start with effleurage - firm stroking motions using the

palms of the hands, moving from fingers to wrist on both sides of the

hand. This can be repeated at intervals throughout the massage to

keep the skin warm. Now, work through the following moves:

Supporting the hand with one of your palms, make small, firm circular motions of your other thumb in their palm, concentrating on the muscles near the thumb and little finger, and the base of each finger. Do this as firmly as they want.

Do a similar movement using the knuckles of one hand. Turn their hand over, and use your index finger to make small circles

down the gaps between the tendons on the back of the hand, finishing by gently pinching the web of skin between the fingers.

Starting at the knuckle of each finger and thumb, make small circles down to the fingertip with your thumb, and then gently pull on the finger as you let go.

Hold the whole hand by the sides with both hands, so your thumbs are next to each other on the back of the hand (this is hard to describe in words). Gently pull your hands apart and down over the back of their hand, as if trying to separate it out. Repeat a couple of times.

Turn the hand back round. With their fingers facing towards you and your hands facing palms up, interlace your ring and little fingers of each hand with the gaps between their fingers and thumb, and then use your thumbs to firmly massage their palm and wrist.

Releasing the grip used above, make small circles up their fingers from the underside of the knuckle to the tip, again pulling off at the ends.

Finally, finish off by doing more effleurage followed by pressing their hand between your palms and pulling towards and then off from their fingertips.

Copyright © 2016 Regions Hospital

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Weighted Eye Masks

Help improve your sleep by; blocking out light, providing weight to relax the muscles of the eyes,

and inviting in the relaxing smell of lavender (optional).

Supplies needed

1 piece pattern material- precut and sewn (image to the right)

1 piece cream material- precut and sewn

Needle & Thread

Measuring cup

Pellets

Lavender (optional)

Directions

1. Choose material.

Consider personal preference of texture and pattern.

2. Fill with pellets, ranging from 1 cup to 2 cups, depending on how heavy you would like the

mask.

3. *Optional add up to 1/4 cup of lavender. Use less if you prefer more subtle aroma.

4. Hand stitch open end of eye mask. Fold in edges around complete circle. Loop stitch

around end of material back in (about 1/8 inch)

5. Place bag inside choosen material. Enjoy rest and relaxation!

Copyright © 2016 Regions Hospital

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My Body Feelings Chart

What emotion are you feeling? Anger Fear Anxiety Agitation Other:____________________

Tune into your body. Put a big dot on the body below to show where you are “feeling that emotion.”

Use the boxes to help explain what you are feeling.

Neck and Shoulders

Pain

Tight

Head

Pain Dizziness

__________ ??

Skin

Sweaty

Cold

Itchy

Legs

Shaking

Weak

Throat

Dry

Hoarse

Burning

Heart

Fast Beat

Pounding

Tightness

Stomach

Fluttery

Sick

Growling

Lungs

Panting

Short of Breath

Fast Breathing

Copyright © 2015 Karen M. Moore

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Difficult Emotions

What is a difficult emotion for you to handle?

Is it anger or fear or frustration or feeling out of control or feeling humiliated or something else?

Write your emotion in the box.

10

9

8

7

6

5

4

3

2

1

Where you feel this emotion? Show where on the character below.

Emotion Scale Rate your emotion.

10 = strongest 1= weakest

Cause of this emotion:

____________________________

____________________________

____________________________

____________________________

_______________________

Describe how you feel?

____________________________

____________________________

____________________________

____________________________

____________________________

____________________________

____________________________

____________________________

___________________________

What can you do?

____________________________

____________________________

____________________________

____________________________

____________________________

____________________________

____________________________

____________________________

____________________________

____________________________ Copyright © 2015 Karen M. Moore

From the Sensory Connection Program Curriculum for Self-Regulation

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Tool Time Protocol

T-T is a quick way to signal that it is time to use a tool for calming or alerting.

Appropriate tools must be identified ahead of time for common problematic

situations. Education and practice must be provided so that a connection is

made between a behavior and a good tool choice. Tools must be available in

the classroom Tool Kit or in a personalized tool kit or fanny pack.

Step 1: Problematic Situations

Brainstorm common problematic situations with the individual and or classroom teachers and care

providers. Prioritize several problems needing calming or alerting sensory input. Choose one

problem or lump together several problems that might respond to the same activities.

Step 2: Sensory Exploration

Provide opportunities to try a wide variety of sensory tools. This can happen in one session or

several or throughout several days. Allow individual to identify what is helpful. Note what they

identify and what others have noticed as helpful.

Tools can include activities such as a “Doing Break” or “Quiet Time Break.” See suggestions for the

tool box including mouth tools, hearing tools, hand tools, eye tools and doing tools.

Step 3: Create Toolbox

The toolbox can be an individual box or possibly a sensory toolbox in the classroom. It might be best

to put tools in an individual box to start. Person can have additional tools in their own sensory Fanny

Pack. Tools must be easily accessible. Consideration needs to be given to tools that can be a

distraction to other students. Make large cards with words or pictures to designate “Doing Tools.”

These might include doing some chair pushups or kneel standing on the chair to do work.

Step 4: Making Connections

Help individuals make the connection between a problematic behavior and the need for a tool. Keep

language simple and age appropriate. Use non-verbal communication whenever possible (it will be

less disruptive and embarrassing in the classroom). Practice using tools. Provide support as needed

initially and work towards independence.

Copyright © 2011 Karen M. Moore

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Tool Box Items for Tool Time

Mouth Tools Sweet hard candies Sour candies Gum Lollipops Fire/Hot Ball Crunchy snack Veggie sticks or raisins Coffee stirrers Refrigerator tubing (hardware stores) Water bottle with straw

Body Tools Pressure belt (sports stores) Lycra Hug - (handouts) Weighted animal Weighted vest Weighted lap pad Weighted blanket Snug Tube (Lycra Tube) Vibrating bug or disk Massager tools Cozy Comforter (Shoulder pad - handouts)

Hearing Tools MP3 Player or IPod (special music/sounds) Metronome Humming (make card) Sound machine Rain stick Small fan (white noise) Ear plugs Clackers ball (internet)

Eye Tools Oggz (internet) Strobe ball or wand Picture book Photo of someone special or pet Sunglasses (shut off distracting input) Glitter wand Sand timer Liquid motion toys

Doing Tools (Make large cards to represent these tools) 4 deep breaths Sit on hands or legs Kneel-stand (kneel on chair, foot on floor) Chair push-ups Doodle Hum, whistle or sing Massage hands Go to a quiet place Rock or swing Take a walk Self-Hug Drum, tap or snap fingers Push against the wall Joint compression (stand, hang hands on head, bounce on heels gently) Sit on therapy ball Jumping jacks Rub gently on clothes - really feel it!

Hand Tools Fidget widgets & tangles Koosh balls Stress balls Finger mazes (catalogs) Beanbag Hand cream Fabric square Smooth stone or shell Silly putty or Theraputty Squigglets (Fuzzy bracelets) Small wrist weights Worry bead bracelet Fiddle rings Silicone bracelets or rings Snap bracelets Slinky

Copyright © 2011 Karen M. Moore

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Sensory Kit for Clinical Outreach in the Community

This kit is designed for mental health providers to take with them into the

community to help when they meet clients for assessment or treatment. It has a

selection of tools for calming, alerting organizing and grounding.

Oral Motor Items

These can help in many ways for calming and organizing and helping with

attention.

Gum, lollipops, hard candies, small bag of pretzels or nuts, coffee stirrers or straws to chew on

Fidget Widgets

These help clients relax during the appointment and may improve their ability to communicate.

Fidgets can actually be used during the interview. Selection of four or more choices is

recommended.

Stress ball, squiggle or worm ball, tangle, smooth stone, rubber band bracelet

Focused Activity

These can be used while the person is waiting for the appointment or used as a motivator when the

appointment is over.

Hand held Simon Game, glitter wand, small note pad and pencil for doodling, Thinking Putty

Strong Sensory Input

Lycra Hug for calming can be effective for someone who is upset to use during the interview.

Exercise band can be used to set up a one or two man “rowing motion” that is very compelling and

organizing and might be particularly helpful for adolescents.

A Koosh Ball can be used to toss back and forth in a rhythmic pattern which can be engaging and

calming.

Bean bag for tapping firmly on the hands, arms, shoulders, legs and feet (never on the head or

stomach area).

Grounding Items

These provide very strong sensory input that can help to break up a dissociative episode, trouble

with flashbacks or breaks in reality orientation.

Hot “fire” balls, Altoids, smell canister

Copyright © 2014 Karen M. Moore

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Fanny Packer

Teacher & Parent Handout

Fanny packs or sensory kits provide a way to have appropriate sensory tools available as needed for

calming and alerting. These suggestions feature “quiet” tools that can be brought to school.

Individualize choices. Practice identifying situations and possible tools.

Calming Tools can be helpful when you are: losing control, feeling anxious or overwhelmed, being

over stimulated, feeling angry, facing a difficult appointment or time of the day, feeling upset or just

needing to relax.

Helpful calming tools include: gum, stress ball, fidget widget, smooth stone to feel, sweet hard

candy, water bottle with straw, coffee stirrer to chew on, soft square of cloth to feel, finger maze,

silly putty, beanbag, “bendables,” shaped silicone wrist bands, rubber novelty bracelet, giant fiber

noodle, fragrant hand cream, worry bead bracelet, picture of loved one, sun glasses

Alerting Tools can be helpful when you are: unable to focus, having difficulty paying attention,

needing to work but feeling drowsy, needing to be more aware of the environment, needing to be

energized.

Helpful alerting tools include: gum, sour candies, small Koosh balls, fidget widgets, film canister

with cotton ball with strong smell, mini bag of pretzels, crunchy snacks, pencil with something silly

on top to stroke the face, coffee stirrers to chew, piece of “refrigerator tubing” to chew or tangle

Identify typical situations needing calming:

Calming suggestions for Fanny Pack:

Identify typical situations needing alerting:

Alerting suggestions for Fanny Pack:

These suggestions are specially identified for:

_______________________________________________________________________________ Name

Copyright © 2011 Karen M. Moore

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What Helps?

Activity

This activity is designed to help people identify helpful

strategies for different emotional situations. Two situations

are chosen. Pictures from the attached sheets are cut out to

represent various helpful strategies. They are glued under

the chosen situations. When completed this poster should

be made available to staff, family members or care

providers so that they can help the person choose helpful

coping strategies when they are in an emotional crisis.

This activity can be printed out in color from the Sensory

Connection Program website on the Free Activities page.

http://www.sensoryconnectionprogram.com/free_activities.php

What Helps? Situations include: When I’m Angry, When I’m Overwhelmed, When I’m Upset, &

When I’m Scared. Choose two situations and using the What Helps? Activity printout; list 5 possible

activities under each situation for your case scenario.

What Helps?

When I’m ________________________

What Helps?

When I’m _________________________

1.

2.

3.

4.

5.

1.

2.

3.

4.

5.

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Learning About Mantras

According to the Merriam Webster Dictionary a mantra is a sound, word, or phrase that is repeated by someone who is praying or meditating or a word or phrase that is repeated often or that expresses someone's basic beliefs. A mantra can be sung or recited or repeated silently in the mind. It is used as an object of concentration that has a spiritual connection. Activity 1: the OM Mantra The OM is an ancient chant consisting of three sounds a and u and m. It is believed that the sound OM brings us in resonance with the universe. OM vibrates at 432 Hertz which is considered the natural musical pitch of the universe.

Try sitting in a comfortable position in a chair or in a yoga posture and hum the OM mantra drawing out the sounds for as long as you can. Feel the vibration. Focus on the connection to the universe – to all beings. Repeat the chant over and over for approximately five minutes.

Activity 2: Discover your own Mantra.

A Mantra can also be a word or phrase that is meaningful and powerful to you. Sit quietly for a few minutes and think about some words that come from your “core being.” These words should help you to be a better person or to help you appreciate the person that you are or help connect you to others. Form your thoughts into a short powerful statement.

A few examples: “I know I can, I know I can, I know I can.” “Trust the quiet within.” “It all comes down to love.” “And all will be well, and all will be well, and all will be well.” “I am strong, I will get through this.” “I love God and God loves me.” Write down your mantra on the line below. Repeat your mantra several times a day whenever you feel the need to revitalize or to refocus. My personal Mantra _____________________________________________________________________________________

Copyright © 2015 Karen M. Moore

From the Sensory Connection Program Curriculum for Self-Regulation

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Idea Cards for Non-Tool Based Sensory Activities

Cut up the Idea Cards along the solid lines. They can be laminated if they are going to be used frequently. They

can also be used to give to people as reminders of activities that might be useful or passed out and used as a

group game.

Chair Pushups (Work up to 5)

Grip the sides of a straight chair and use arms to

lift the upper body slightly off the seat of the

chair.

Foot-Flexes (Try 5)

Point toes and then flex feet and hold for a few

seconds to give a little stretch to the lower leg,

relax.

Trunk Turns (Try 5)

Place hands on top of head and turn slowly to

one side and then the other, stop in center

position.

Sun Breaths (Try 6)

While seated straighten to feel the “tall” spine;

place hands on thighs palms down; as you inhale

lift hands a few inches; as you exhale bring

palms back to thighs

Full Body Joint Compression (1 slowly)

In a standing position place hands on top of

head, “bounce” 10 times by lifting heels and

then gently bouncing them down on the floor.

Upper Body Joint Compression (1)

Place hands on table or wall and lift heels of

palms up and down, gently “bouncing” 10 times.

Slap and Clap (10 times - change pattern)

While seated slap thighs and then clap hands

with a rhythmic beat; try various patterns such

as slapping once, clapping twice…

Walk and Slap (10 – 20)

Walk forward while lifting leg high and slapping

it, step down and lift opposite leg and slap it - try

slapping on the same side and then cross over

and slap on opposite thigh.

Hand Press (5 times)

Press palms of hands together firmly (prayer

position) hold to the count of five and release

and relax . Repeat

Glider/Slider (2 times)

Extend arms, cross just above wrist, clasp hands;

slide hands slowly down legs towards floor, relax

and let natural stretch happen; slowly return to

seated position

Copyright © 2014 Karen M. Moore

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Suggestions for Sensory Approaches to Treatment in

Adolescent Residential Treatment

Upon admission, work with adolescents to develop a personal sensory kit so that helpful sensory input items are available when needed. Making the kit provides a learning opportunity to send a message that it is the youth’s responsibility to learn good self control but staff will be there to help and support them in this process.

Provide ongoing education on sensory approaches.

Give staff as well as adolescents opportunities to try sensory activities and identify sensory preferences.

Encourage staff to role model the use of sensory strategies.

Bring sensory items to meetings and groups and have them readily available when needed.

Offer daily opportunities for exercise and sports activities.

Use games to reinforce the “social engagement system” and teach social skills.

Offer groups that teach self-regulation skills that include the use of sensory input. Help students pair levels of anxiety or anger with internal sensations. Make groups interactive and fun.

Teach and practice relaxation techniques such as deep breathing and mindfulness so that youths experience a sense of internal control.

Offer sensory rich groups such as pet therapy, Yoga classes, art therapy and sensori-motor groups.

Develop Safety Plans that identify signs and triggers and helpful and harmful interventions. Ask youth to identify several coping strategies that he or she is willing to try in crisis. Make this information readily available.

Assess the environment and make sure it feels nurturing and safe.

Develop a Sensory Room and work with staff and clients to make sure it is well used.

Encourage adolescents to develop their own “safe space” where they can retreat when upset or anxious.

When interacting with a youth that is upset: make eye contact, modulate your voice and use reassuring body language, bring the person to a safe place, refocus on familiar things and sensations, engage in a simple activity (tossing a ball, having tea, playing a Kazoo, walking together). When the youth is calmer, help facilitate the use of identifies coping strategies.

Copyright © Karen Moore 2011

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PAUSE

CONNECT

ENGAGE

ANGRY?

FRUSTRATED?

UPSET?

UNSAFE?

Copyright © 2015 Karen M. Moore

From the Sensory Connection Program Curriculum for Self-Regulation

20

Crisis Intervention Steps: Pause! Connect! Engage!

Note: These are just suggestions. There is no “cook-book” answer. Make a connection. Assure safety. Be

positive. Reward small progress. Give choices. Don’t rush. Person may need to calm down before accepting

usual sensory strategies. Progress may not be linear. Be flexible.

Pause! (Think! Use gesture of pointing to head to signal thinking)

Connect!

Bring the person to a safe space

Make a connection - Make eye contact - Lower voice - Show empathy - Hold hand or

put hand on shoulder.

Reflect back what you see (Wow, you really seem very upset about something.)

Assure safety (You are safe. You have supports. You will get through this.)

Identify feeling (angry, frustrated, hurt, worried, scared, unsafe, disappointed,

shamed) How bad is it on scale of 1 - 10?

Connect feeling with physical body sensation (Describe what the body is feeling: rapid

heart, feeling flushed, stomach pains, chest tightness, rapid breathing.)

Reflect back (That must be very terrible for you - feeling so hurt.)

Assure safety

Bring to present - Focus on touching clothing - describe it.

Engage!

Ask what might help

Try a known or obvious strategy (Pace around together, toss a Koosh ball back and forth,

do something rhythmic like “slap-clap,” use a smell box)

Try 4 deep breaths together

Assess progress. How bad is it now on scale of 1 - 10?

Ask what usually works - check chart

Offer two choices from things person identified (You want buy in.) (Should we try some pushups or a

weighted blanket?)

Person may not be ready - continue to pace around.

Assess progress. How bad is it now? Give positive feedback.

Suggest known strategies again. Give choices. If person is calm enough, invite to Sensory Room.

(Would you like to hold the vibrating pillow or try Spandex hug?) Engage in activities with the person.

Listen if person is ready. Reflect emotion (I can see that you are bothered by this).

Not the time to solve the problem. Acknowledge self-control. Offer to address the problem at

another time.

If needed repeat steps.

Copyright © 2015 Karen M. Moore

Copyright © 2015 Karen M. Moore

From the Sensory Connection Program Curriculum for Self-Regulation

21

Grounding Strategies Worksheet

Grounding techniques are strategies that are useful when a

person is experiencing dissociative episodes (loss of touch with

the body, time, and the environment), psychotic thinking,

suicidal thinking, flashbacks, thoughts of self-harm, negative

thinking, extreme anxiety, or panic attacks.

Grounding techniques use some type of compelling sensory input

to bring a person back to reality and to the present moment.

They help reorient a person by bringing back an awareness of the

body and the immediate surroundings.

Grounding strategies should be started at the first sign of

trouble. In order to determine the most effective strategies,

preferences need to be explored.

This is a list of common strategies. Put a star beside the ones that you think might be helpful for you. Some

strategies are more powerful than others. As you try them rate the strategy power or helpfulness on a scale

from 1 - 5 with 1 being very low power and 5 being the highest power.

Strong Input Strategies Helpfulness Activity Strategies Helpfulness

Smell a perfume canister Doodle

Smell a scented handkerchief Fidget with something

Suck on hot balls/strong mints Hold someone’s hand

Chew a large wad of gum Write yourself a caring message

Suck on a popsicle Bounce a ball over and over

Chew crushed ice Toss a Koosh ball

Hold a bag of crushed ice Squeeze a stress ball

Stamp feet hard Write in a journal

Clap hands hard Sing along with a song

Do vigorous exercise Phone a friend

Pace or walk briskly Play Solitaire or Sudoku

Snap a rubber band on wrist Do a crossword or word search puzzle

Take a cool shower Do a coloring, art, or craft project

Do heavy work Do a detailed jigsaw puzzle

Making a Perfume Canister for Grounding

Equipment: Small plastic film canister, cotton balls, strong perfume Directions: Several cotton balls are placed in the film canister. Several drops of a strong perfume are dropped onto the cotton and the cap is replaced making sure it is on tightly. To Use: The canister can be kept in a pocket or pocketbook. When a person feels like a dissociative episode is coming on, he or she opens the canister and takes a whiff of the perfume.

Copyright © 2014 Karen M. Moore

22

What Helps? – Core Crisis Intervention Strategies

Four Deep Breaths

Walking or Pacing

Vigorous Exercise

Weighted Blanket

Weighted Lap pad or Weighted Animal

Gum or Pop or Oral Motor Tool

Smell Box or Strong Smell

Hot “Fire” Balls (candy)

Hard Work

Swinging or Rocking

Bouncing on a Therapy Ball

Using a Stress ball or Koosh

Wrapping in Spandex Hug/Blanket

Wrapping in a Warm Blanket

Focused Activity

Holding Ice in a plastic Bag

Beanbag Tapping

Writing in a Journal

Sucking on a Popsicle or Ice Chips

Quiet Safe Space

Being with a Caring Person

Playing an Instrument/Humming

Hugging a Vibrating Pillow

Exercise Band Rowing

Copyright © 2014 Karen M. Moore

23

Developing a Crisis Intervention Plan

Intervene early Identify Signs and Triggers Identify Helpful Strategies Have a Plan Contract for action “When I am upset I will………….…….” Post the plan where children and care providers can see and

use it!

Adolescents and Children

A crisis intervention plan should be developed over several

sessions with the child or adolescent. Adolescents can have more

input and for the plan to be effective they need to be invested in

the plan. The pictorial “Safety Tool” developed by MASS

Department of Mental Health might be the most helpful for

brainstorming with younger children. An Adolescent tool

developed by MASS Department of Mental Health can also be

useful. The following SCP tools are designed to be used when there

is additional time to brainstorm signs and triggers. In order to

identify helpful strategies the child or adolescent should try various

activities in the Sensory Room or those available in the classroom.

The crisis intervention plan developed should be readily available

as a reference. Ideally adolescents may learn to recognize possible

signs and triggers and develop the habit of seeking help from

teachers or staff in order to deal with difficult situations. Younger

children should be encouraged to recognize signs of trouble but

adults, teachers and care providers will need to be attuned to signs

and ready to help the child identify and try helpful strategies.

24

SCP Crisis Intervention

What Are the Warning Signs?

Check things that are signs that you may lose control.

o Sweating

o Crying

o Loud Voice

o Bad Thoughts (self or others)

o Clenching Fists

o Wringing Hands

o Biting Arm or Body Part

o Banging Wall or Furniture

o Throwing Things

o Withdrawal/Isolation

o Giddy/Laughing

o Rocking

o Suicidality

o Agitation

o Pacing

o Can’t Sit Still

o Being Rude

o Signs of Anger

o Yelling

o Uncooperativeness

o Extreme Anxiety

o Argumentative

o Flashbacks

o Self Injury

o Temper Tantrums

o Withdrawal

o Emotional Swings

o Dissociation

o Disruptiveness

o Threats

o Other

Do you have warning signs that are not listed? Describe. ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What are the most worrisome signs? ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Ask a staff person, friend, or family member what signs they notice

before a crisis: ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Copyright © 2007 Karen M. Moore

25

SCP Crisis Intervention

What Are the Triggers?

What are some of the things that make you upset, or scared, or cause you to go into

crisis?

o Being touched

o Loud environment

o Yelling

o Evening time

o Darkness

o Flashbacks

o Certain time of day

o Being humiliated

o Teasing

o Demands from others

o Being ignored

o Being isolated

o Having nothing to do

o Feeling overwhelmed

o Nightmares

o Not being able to sleep

o Being restrained

o Seclusion

o Build up of anxiety

o Panic attacks

o Certain place (explain)

Changes in routine, staff, room (explain)_______________________________________

Not having control, choices or input (explain)___________________________________

Being around men or women (which?)_________________________________________

Time of year (when? Anniversary of event?)____________________________________

Reminders of bad experiences (explain)________________________________________

Contact with person who is upsetting (explain)__________________________________

Going outside – large open spaces (explain)____________________________________

Closed doors – feeling claustrophobic_________________________________________

Auditory or Visual Hallucinations____________________________________________

Psychotic thinking or Mania (explain)_________________________________________

Paranoia – thinking someone is following you or talking about you (explain)__________

Symptoms of illness (explain)_______________________________________________

Other (explain)___________________________________________________________

________________________________________________________________________

________________________________________________________________________

Ask a friend, family member, or staff person if he/she has noticed anything that seems to

set you off or precedes crisis.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Copyright © 2007 Karen M. Moore

26

SCP Crisis Intervention

What Helps?

Identify things that help you calm down and regain self-control. You may want to

fill this worksheet in as you experiment with various sensory input and other

strategies.

o Medication

o Being with a caring person

o Grounding Strategies (see

handout)

o Smell box

o Holding Ice

o Sucking on Hot balls, Altoids,

Popsicle

o Aromatherapy

o Chewing gum/sucking on candy

o Snacking

o Warm or cold drink

o Sucking thick liquid with a straw

o Listening to Music

o Relaxation tapes

o Sound machine

o Deep breathing/mindfulness

exercise

o Looking at art or beautiful books

o Watching a funny or calming

video

o Watching a lava lamp/bubble

tube

o Wrapping up in a blanket

o Wrapping a Lycra fabric tube

around body

o Weighted blanket

o Weighted animal

o Weighted lap pad, vest, or hat

o Vibrating dog or pillow

o Using a beanbag chair and a

warm cover

o Warmed lap or shoulder pad

o Beanbag tapping/brushing

o Squeezing a stress ball

o Hugging a pillow

o Fidget widgets, Koosh Balls

o Tossing or bouncing a ball

o Bouncing/rocking on therapy ball

o Rocking in a chair or glider

o Swinging

o Exercise band rowing

o Pacing

o Walking or jogging

o Hot or cold shower

o Warm bath

o Yoga or a movement routine

o Time in the CCC (Sensory)

Room

o Choosing something from the

Sensory cart/box

o Voluntary time in the quiet room

o Talking with a friend

o Talking with a staff person

o Calling a family member

o Keeping busy

o Helper tasks (cleaning etc.)

o Hard work

o Writing in a journal

o Coloring or painting

o Doing art work

o Doing puzzles/word

search/crosswords

o Reading

o Stroking or playing with a pet

o Other

o Other

o Other

Copyright © 2007 Karen M. Moore

27

Crisis Intervention/Safety Plan Summary

Triggers that often cause problems leading to crisis

Signs or Symptoms of possible crisis

Who are the people that you can go to when you are experiencing difficulty?

What helps? Name at least four strategies that you are willing to try.

1.

2.

3.

4.

What doesn’t help?

Signature _______________________________________________________Date______

Copyright © 2015 Karen M. Moore

From the Sensory Connection Program Workbook for Self-Regulation

28

Wish List for Comfort Space and Sensory Solution Equipment

When others ask, “What can I do?” or “How can I help?” perhaps they could help you purchase one of these items. Items can be used for a personal sensory kit or comfort space or to make the home environment more comfortable. Having tools available helps to support self-regulation, self-soothing and stress reduction. Think about the things that you found helpful. Mark or circle items that will be helpful. Put a star beside the ones that are a priority.

o Rocking chair, glider, or large beanbag chair

o Weighted blanket, lap pad, or weighted animal

o Exercise equipment (Bosu Ball, exercise bands, medicine ball, yoga mat, hand and leg

weights)

o Scented items: perfumes, lotions, pillow sprays, toiletries, soaps, candles

o Squares of fleece fabric

o I Pod or CD player

o Relaxation CDs (Steven Halpern also offers CDs specifically designed to promote

sleep and inner peace http://innerpeacemusic.com).

o Mindfullness CDs (Dr. Kabat-Zinn (www.mindfulnesscds.com).

o Visual tools (liquid motions toys, glitter wand, L.E.D. Spinner, lava lamp, fiber optic light)

o Crossword puzzle, Word Search or Sudoku books

o Adult Coloring Books (www.doverpublications.com)

o Art supplies

o Stress balls, Kooshes, fidget widgets, squiggle balls beanbags

o Moonsand, Silly Putty, modeling clay, or Crazy Aaron’s Thinking Putty

o Craft items (Wikki Sticks, Geoboard and elastics, Looper Loom and loops, stamping projects)

o Jewelry and bead supplies

o Sound machine or frame drum

o Chinese hand exercise balls

o Mini Simon Game

o Mouth tools (gum, hard candy, pops, pretzels, licorice, plastic straws)

o Vibrating massagers or massage seat cushion or vibrating pilow

o Spandex hug made from 18” Spandex bathing suit material

o Journal or small notebook

o Grounding items (smell canister, cinnamon hot balls)

o Picture books, travel books, art books, inspirational books

o Games (cards, Jenga, Etch-a-Sketch, board games)

o Fanny pack to keep items

o Gift certificate for a massage

o Membership to a gym

o Lessons for cooking, art, crafts, photography

Note: Most of the items can be purchased at discount stores or through Amazon.

Copyright © 2014 Karen M. Moore

29

You

Name_________________________________________________________

Need to Be in Control of your Own Emotions!

What Can You Do? How Can We Help?

Respect Yourself!

Respect Others!

Others Will Respect You!!!!

This packet uses with permission and gratitude two Safety Zone Tools developed by

MA Department of Mental Health.

30

I TRIED IT!!!

Name________________________________________________________________________________________________

As you try each activity, put a score in the box from 1 (no help) - 10 (extremely helpful).

Deep Abdominal Breathing Walking or Pacing Weighted Blanket Heavy Therapy Animal Spandex Hug Rocking Chair Swing Cozy Comforter Halo or Weighted Cap Activities/Puzzles Bosu Ball

Comfort/Sensory Room Massaging Mat Vibro-acoustic Mat Bouncing on Therapy Ball Jumping on LoLo Ball Fidget Widgets Smell Canister or Scents Yoga or Meditation Listening to Music Exercise Bands Weighted Lap Mat Warm or Cool Bath or Shower

Copyright © 2008 Karen M. Moore

31

What makes you feel upset? (Circle all that make you feel sad, mad, scared or other feelings)

Touch See

Being touched Too many people Darkness

Hear

Loud noises Yelling Thunderstorms

Other

Missing someone Being left alone Being surprised Having a fight with a friend

Not having visitors Being hungry Being tired Someone being mean

Being sick Certain time of year Certain time of day/night Having my bedroom door open

Anything else that makes you feel upset? ________________________________

NOTE: The following are general triggers for people

Being told what to do rather than asked; Being told no rather than being given choices.

Massachusetts Department of Mental Health Safety Tool - August 2006 (adapted)

Massachusetts DMH Safety Zone Tools Triggers Tool

32

What happens to my body when I am angry, scared or upset?

(Circle all that apply)

Cry Clench teeth Loud voice Red/hot face Laughing/giggling

Being mean or rude Swearing Racing heart Breathing hard Wringing hands

Clenched fists Upset stomach shaking or tapping Jumping up and down or stamping feet

Rocking Hyper Running or pacing

Massachusetts Department of Mental Health Safety Tool - August 2006 (adapted)

Warning Sign Tool Massachusetts DMH Safety Zone Tools

33

What helps you feel better? (Circle all that help you)

Touch

Writing Fidget tools Games Holding ice

Bath or Shower Stress ball or clay Weighted animal

Any other objects you touch or hold that help you feel better? ______________________

See

Reading Watching TV Looking at pictures Using a computer

Any other objects you like to look at that help you feel better? ______________________

Movement

Using a rocking chair Swinging Dancing Sports (kickball, basketball, soccer, etc)

Any other movements you like that help you feel better? ______________________

Massachusetts Department of Mental Health Safety Tool - August 2006 (adapted)

Safety Tool Massachusetts DMH Safety Zone Tools

34

Hear

Talking on Listening Singing or Quiet place Counting the telephone to music humming to ten

Do you prefer music that is: Loud or Soft

What type of music do you prefer: ________________________________________

Any other sounds or noises that help you feel better? __________________________

Pressure touch

Massaging mat Sitting in a bean bag chair Using a weighted blanket Weighted cap or halo

Yoga or meditation Exercise Sitting on a therapy ball Getting a hug

Any other activities that help you feel better? ______________________________________

(Examples: blowing bubbles, deep breathing, etc.)

Smell

Any smells that help you feel better? _____________________________________________ (Examples: peppermint, popcorn, cookies, flowers, etc.)

Taste

Any certain tastes that help you feel better? _______________________________________ (Examples: chewy, crunchy, salty, sour, spicy, etc.)

Are there times that it is important or helpful for you to eat? __________________________

Massachusetts Department of Mental Health Safety Tool - August 2006 (adapted)

35

Comfort Space Plan

A Comfort Space is a personalized place to rest and relax and to calm down throughout the day and

especially before and after work, school and stressful events. Ask others to respect your need for quiet

time when you are using this space. Circle or check your answers below to help you design your space.

Where will it be located?_______________________________________________________

What type of chair?

What tools for smell?

scented creams

pillow spray

smell canister

room freshener

scented soaps

What tools for taste and oral-motor?

gum

pops/hard candy

fruit

pretzels/nuts

hot fire balls

What tools for sound?

iPod/ music

sound machine

Simon Game

drum/instrument

Kazoo

What tools for vision?

Liquid motion toy

Beautiful books

Oggz Spinner

Kaleidoscope

36

What tools for pressure touch?

Weighted blanket

vibrating pillow

Lycra “hug”

beanbag

weighted animal

What fidget widget tools?

Koosh balls

prayer beads

Silly Putty/clay

stress ball

Tangle

What doing activities?

puzzle book

art/coloring books

Needlework/crafts

journal

cards

When do you plan to use your comfort space?

10 minutes in morning, afternoon and evening to chill out.

Before school or work.

After school or work.

Before doctor’s appointment or party or stressful event.

After going to something stressful.

Before bed to relax and unwind.

Name___________________________________________________Date__________________

Share this plan with family and care providers so that they can help you develop a Comfort Space. You

may not be able to find these exact items but something similar should be available. This activity is to

get you thinking.

Copyright © 2015 Karen M. Moore

From the Sensory Connection Program Curriculum for Self-Regulation

37

Sensory Sensitivities Discovery

Sometimes there are things in the environment or situations that really bother our senses but no one else seems

to notice. Our reaction can be mild to severe. If we can identify these bothersome experiences there may be ways

to eliminate them or at least minimize them. Read through the common irritants below and circle any that bother

you. Beside the circle put an M for mild or an S for severe.

Vision

Bright lights * dim lights * flashing lights * flickering lights * darkness * strobes * changing light *

flat light * fast moving images * riding in a car (looking out windows) * other (_________________)

Hearing

Loud noises * fluorescent lights * crowd noise * too many people talking * yelling * quiet *

fireworks * base drums * background noise * certain music (explain:__________________)

Smell

Perfume * bathrooms * bad odors * food smells * scented candles * incense * pet food *

other (__________________)

Taste/Oral Motor

Lumpy food * strong tastes * messy food * mushy foods * chewing * cold drinks * hot food *

sour tastes * other (__________________)

Touch

Being touched * hugs * touching things * being too close to people * sticky/messy stuff * dressing*

certain clothing * walking barefoot * showering * face washing * brushing teeth * sweating *

messy stuff * bare skin * other (______________________)

Moving/balance

Exercise * bumpy surfaces * stairs * spinning * riding in a car * heights * moving quickly *

carnival rides * swinging * darkness

Spaces

Small spaces * open spaces * crowds * high places * closed doors * lunchrooms * stores *

being alone * other (_________________________)

Name___________________________________________________________Date_______________

Copyright © 2015 Karen M. Moore

From the Sensory Connection Program Curriculum for Self-Regulation

38

Sensory Sensitivities – What Can We Do?

Tell someone – ask for help.

Eliminate it.

Avoid it.

Work around it.

Use a sensory tool.

Change the time.

Prepare yourself.

Relax afterwards.

Copyright © 2015 Karen M. Moore

39

Pause – Connect - Engage Worksheet

Pause! (for warning signs or triggers) Describe a situation which should make you pause because you are overly angry, upset, frightened or approaching emotional crisis. What triggers the situation and what are the signs that you are having trouble?

Connect! (seek/accept help) Describe a healthy “connection” that would help you to calm down (helpful staff person, family member, teacher, clergy, pet). What can this person to do to help you?

Engage! (do something positive) Describe three coping strategies that you could try to get yourself back in control.

Copyright © 2015 Karen M. Moore

From the Sensory Connection Program Curriculum for Self-Regulation

40

Circuit Breaker for Crisis Intervention

Name the feeling: (upset, mad, scared, angry)

I feel it in my (stomach, shoulders, lungs, head, heart,

bowels)……

On a scale of 1 to 10 (1 = low, 10 = high) my

emotional response level is at a………

I am going to reach out to ___________________________for support.

I am going to try……

Four Deep Breaths

Humming a tune

Saying a mantra

Pacing in a figure eight.

I am safe now. I can calm down. All will be well.

10

1

Copyright © 2015 Karen M. Moore

From the Sensory Connection Program Curriculum for Self-Regulation

41

GOAL SETTING

Integrating Sensory Approaches: What are your priorities? Where will you

begin? What will work in your clinical setting?

What components of the SCP make sense to you?

Identify one or two Long Term Goals for Integration of sensory

strategies into your clinical setting.

Identify several short term goals for integrating sensory strategies

into your clinical setting.

SCP Components

Sensory Kit for Your

Clinic

Personal Sensory Kits

for Children

Teaching about

Interoception – Body

Chart Handout

What Helps? Activity

Sensory Kit in the

classroom or nurses

station

Crisis Intervention

Plan

Pause, Connect, Plan

approach

Planned Quiet Time

and Sensory Input

Breaks

Teaching Games for

self-regulation

Sensory/Comfort

Spaces or rooms

Sense-ability Group

Environmental

Changes

42

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