The Implementation and Impact of Sensory Modulation in Aotearoa New Zealand Adult Acute Mental Health Services: Two Organisational Case Studies
Azuela, Gilberto Flores
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Background: Sensory modulation is an emerging approach that aims to reduce distress and agitation in mental health service users, and potentially avoid the necessity for coercive practices such as seclusion and restraint. However, there has been limited research exploring the implementation of sensory modulation at an organisational level and the impact on seclusion and restraint use within the New Zealand context. Design: An exploratory mixed methods case study design was used to investigate the implementation and impact of a sensory modulation programme in two New Zealand inpatient mental health services. This study had three key objectives: (1) Describe the existing practices, norms, beliefs, and policies related to de-escalation and the reduction of seclusion, and the factors that shaped these; (2) Explore how key organisational and staff factors (including policies and practices related to de-escalation and seclusion reduction) influence sensory modulation implementation; and (3) Examine the impact of using a sensory modulation programme within the acute mental health services. Pattern matching and cross-case analyses were used as analytic techniques to examine the findings in relation to theoretical propositions and the research questions. Findings: Multiple contextual factors influenced the implementation of the sensory modulation programme within the acute mental health services. Strategies found to support implementation were identified at environmental, organisational, group, and individual staff levels. Aspects highlighted as being particularly important included taking an inter-professional approach in leadership and training, rostering flexibility, and leeway in staffing levels to support training attendance and responsiveness to crises. Similarly, the impact of sensory modulation was found to occur at multiple levels of the organisation, but particularly at the level of individual staff and service users. Conclusion: The complexity of factors that influence the implementation and outcomes of the sensory modulation approach within an inpatient setting make determining the effectiveness of the approach challenging. However, the general principles and strategies identified in this study offer useful insights for the design and implementation of future sensory modulation programmes.