Abstract
This project examined existing applications of the SAFE PLACE model using a grounded theory approach to identify common themes that occurred during individual sessions as a means of validating or refuting the core principles proposed by the model. Themes of communication, management and engagement of activities, expression of emotion and affect, and interpersonal interactions provided preliminary validation of the model.
Primary Author and Speaker: Teresa May-Benson
Contributing Authors: Alison Teasdale
Occupational therapists (OTs) with sensory integration training are increasingly asked to treat children with SPD who also have complex trauma and attachment disorders (Champagne & Koomar, 2012). The SAFE PLACE intervention model (May-Benson & Sawyer, 2015) includes concepts from sensory integration, attachment theory, and complex developmental trauma. “SAFE” means Sensory Attunement-Focused Environment, representing the use of safe, supportive, developmentally appropriate, sensorimotor activities and environments that promote play and fun in children’s physical and emotional development. “PLACE” means Playfulness, Love, Acceptance, Curiosity and Empathy reflecting qualities of mindful engagement used to facilitate secure attachment and healing in the child and family. “SAFE” and “PLACE” together highlight the process of establishing and maintaining an environment and experience of safety and stability for the child which promotes processing of traumatic reactions. The SAFE PLACE model has five primary characteristics: 1) collaborative model of care, 2) provided in a sensory-rich treatment space with flexible pairings of participants, 3) implements core concepts of sensory integration, attachment, trauma, mindfulness, 4) parent involvement in sessions supports provision of emotional and physical safety, and 5) outcomes focus on child sensory integration outcomes, co-regulation and attachment repair between parent and child, and traumatic healing. This project examined existing applications of the SAFE PLACE model to identify common themes which occurred during individual sessions as a means of validating or refuting the core principles proposed by the SAFE PLACE model.
A qualitative grounded theory process was used to review existing videos of six collaborative sessions (4 treatment, 1 consult, 1 evaluation) involved an OT, mental health professional (MHP), a child and parent believed to use SAFE PLACE principles. Sessions included 5 children, 5 parents, and 3 trained OTs and MHPs. 4 independent OTs with doctoral or advanced masters degrees, 18–40 years experience and expertise in trauma and attachment reviewed and independently recorded observations occurring during each session. Observations were transcribed, coded for themes using QDA Miner Lite, and cross-validated by 2 researchers. Inter-observer coding agreement was excellent with percent agreement 79.9 to 93.8% and exact code agreement of 67.2 to 82.7%.
4 primary themes were identified with actions varied by role of participant:
Communication. Verbal and non-verbal communications occurred among participants including directing, storytelling, questioning, etc.
Management and Engagement of Activities. OT and MHP managed aspects of the activity, e.g. presented activities, assisted child, changed activities, and set up equipment. Child engaged in activities and invited adults to participate.
Expression of Emotion and Affect. OT and MHP encouraged and praised child, celebrated child’s achievements, expressed positive emotions through words and affect. Parent expressed positive emotions and affect and some refusals, upset, or distress. Child expressed emotions and affect, e.g. increased or avoidant eye contact, screams, smiles, or laughter.
Interpersonal Interactions. Individuals moved physical placement in relation to others, e.g. allow one person increased proximity to child or equipment, distance proximity, or close proximity action such as touching the child. For child and parent interactions also involved non-engagement, rejection or ignoring, approaching, accepting suggestions, and following.
This study provided preliminary validity of key SAFE PLACE characteristics. It provides a model for validating constructs of other OT interventions as a step toward evidence-based practice.
Champagne, T., & Koomar, J. (2012). Evaluating Sensory Processing in Mental Health Occupational Therapy Practice. OT Practice, 17(5), CE1-CE9.
May-Benson, T., & Sawyer, S. (2015). An Intervention Manual for SAFE PLACE. Newton, MA: OTA The Koomar Center.