Sensory Ladders

The session

This session focused on addressing health inequalities through two compelling presentations that connected through themes of sensory integration, displacement, and providing practical tools for supporting vulnerable populations. 

Kathryn Smith, a director at ASI WISE, opened the session by introducing Sensory Ladders as versatile tools that support social justice from mental health services to conflict zones. She traced the development of these tools back to her early career experiences in South Africa, where she worked with traumatized and displaced individuals in a setting with multiple language barriers. Facing these challenges as a new graduate with limited resources in the pre-Google era, Smith needed to develop approaches that could traverse language and cultural differences. 

Smith explained how Sensory Ladders evolved from ‘sensory levels’ she created in 1999, which were later refined through her work with clients in Cornwall. The concept centres on the idea that ’sensory integration is everyone's business’ – acknowledging that all humans are sensory beings who can benefit from understanding their sensory needs. Sensory Ladders serve as visual tools that help people identify and communicate their levels of regulation, making them particularly valuable for those who struggle with verbal communication or experience language barriers. 

What makes Sensory Ladders particularly powerful for addressing health inequalities is their accessibility. Smith emphasised that they are available for free globally and that ASI WISE is currently working on translation projects to make them available in multiple languages. During COVID-19, these tools proved especially valuable, with Smith's team running weekly training sessions to help therapists support families during lockdowns. The tools have since been deployed in conflict zones including Gaza, Israel, and Ukraine, supporting displaced people and those experiencing trauma. 

Smith highlighted that formal sensory integration training isn't required to use Sensory Ladders effectively. They bridge ’top-down‘ cognitive behavioural approaches with ’bottom-up’ sensory integration techniques, making them accessible to a wide range of practitioners and suitable for incorporation into various therapeutic frameworks. 

Julia Bush then presented her research on the occupational impact of forced migration from Ukraine to the UK. Bush explained that the Russian-Ukraine war has caused the fastest-growing displacement crisis in Europe since World War II, resulting in nearly 6.5 million Ukrainian refugees being recorded globally, (The UN Refugee Agency 2023).  

Through a qualitative phenomenological study, Bush interviewed two Ukrainian women who shared their experiences of leaving behind rich, fulfilling lives in Ukraine and facing numerous barriers to occupational engagement in the UK. The participants, given pseudonyms Anna and Jasmine, described vibrant pre-war occupational lives that included professional careers, social connections, and leisure activities. 

Bush's research identified several key challenges refugees face in the UK. These included barriers to employment due to non-transferable credentials, language and communication difficulties, financial constraints limiting leisure activities, and significant mental health challenges resulting from trauma and displacement. Anna poignantly expressed the constant pain she carries: ’We can smile and every day we happy here... but nobody knows that there's always pain in my soul. We wake up with that and we go to sleep with that.’ 

Despite these challenges, Bush's research revealed powerful adaptive strategies employed by the participants. Both women found healing through horticulture, with Anna describing gardening as ’like meditation.’ Jasmine found meaning through volunteering at a food bank, noting it "was a great experience... you do something good." The study also highlighted how displacement, while traumatic, can create opportunities for new occupational identities to emerge. Anna expressed aspirations to study archaeology, something she had been discouraged from pursuing when younger. 

Bush emphasised that her research revealed a stark contrast between the collectivist culture of Ukraine and the individualistic culture predominant in the UK, which shapes occupational choices and motivations. She noted the important role of narrative reasoning in working with refugee populations, stressing the value of gathering occupational histories and developing cultural understanding to inform therapeutic interventions. 

Both presentations illuminated how occupational therapy approaches can address health inequalities by providing accessible tools and understanding the lived experiences of vulnerable populations. Smith's Sensory Ladders offer practical resources that can be used globally across language barriers to support regulation and mental health. Bush's research provides valuable insights into the occupational challenges faced by refugees and highlights the transformative potential of new occupational engagements in supporting adaptation and resilience. 

The session concluded with rich discussions about the applications of these approaches. Smith emphasised that sensory integration concepts are relevant to everyone, not just therapists, and can be combined effectively with other therapeutic approaches like CBT. Bush highlighted the importance of cultural sensitivity in occupational therapy practice and suggested that early intervention by occupational therapists could make a significant difference for refugees and asylum seekers before they experience occupational deprivation. 

Together, these presentations demonstrated how occupational therapy can contribute to social justice through accessible tools, cultural understanding, and approaches that honour individuals' occupational histories and aspirations. By addressing sensory needs and supporting meaningful occupational engagement, therapists can help mitigate health inequalities experienced by those who have faced trauma, displacement, and significant life disruptions. 

References 

The UN Refugee Agency (UNHCR) (2022) Fastest Growing Refugee Crisis in Europe since WWII.  Hong Kong: UNHCR. Available at: https://www.unhcr.org/hk/en/news/ukraine-fastest-growing-refugee-crisis-europe-wwii