Sensorium 5: The Facilitator

The Facilitator

A highly motivated facilitator observes and offers guidance to the user in a MSE room. The MSE is purposely unstructured where it is not necessary to be an “expert,” yet it is necessary to emphasize the need for careful observation of the user in order to recognize, register, and translate signals (Hulsegge & Verheul, 1987). The MSE room should never be used when a facilitator is not present to interact and assist the user. The facilitator must (a) be empathetic and caring, (b) have an understanding of the user’s sensory interests or “sensory diet,” and (c) know how to introduce the sensory stimulation to the user to assist in changing brain arousal and behavior. All this leads to increased enjoyment, focus, motivation, and learning. Learning occurs when the user is provided the opportunity to experience and be assisted in accessing equipment that provides pleasure and enjoyment. Generally, if a facilitator is close to the individual user, such as a parent or caregiver, the needs of the user are intuitive (Hulsegge & Verheul, 1987). It is important that the facilitator promotes a social space for the individual. Communication begins with being aware of self, one’s needs and desires; being aware of others; and wanting to share ideas. The use of an MSE should promote a sense of self, through communication in an empathetic environment, thus creating social development. Facilitators must perceive themselves as instruments of the environment to be interacted with and by choice of the individual user.

It is important for the facilitator to become familiar with the MSE room, the various elements of the room, and pieces of equipment in the room. It is suggested that the facilitator spend some time alone in the room using and “playing with” the equipment so as to be most familiar with the equipment prior to bringing an individual into the room.

Identifying the Needs of the User (Observation and Assessment)

Prior to entering the room the facilitator needs to identify the interests, desires, and needs of the user or have an understanding of the user’s sensory diet (sensory interests). If the facilitator is close to the user, the facilitator most likely already has an idea of the likes and dislikes of the user. If the facilitator does not know the individual well, some questions can be asked of the caregiver and the individual observed to identify sensory needs and interests. Children with profound intellectual disabilities are very individualistic and there are no standard instruments to identify the needs of these children. Thus, observation and exploring the history of the child is important. Individual Education Plans (IEPs) may also provide some insight to the child’s sensory diet.

One way of assessing a child is play-based assessment (Linder, 1993) where the child is observed at play. In play-based assessment the child is in control and the adult acts as a facilitator. It is the child who makes the rules and the adult’s responsibility is to provide guidance built on well-established, mutually trusting, and respectful relationships with the child (Linder, 1993). Play-based assessment is very similar to the MSE protocol.

Another area of assessment is a parent/caregiver’s interview and questionnaire where general and specific information about the child is sought (see Appendix C – Sensory Diet Exercise). Parents/caregivers are people who are likely to know the most about the individual and the interview helps delineate the social context of the individual. A semi-structured, open-ended question interview technique allows caregivers increased freedom of expression (Pagliano, 2001). The interview should consist of questions about the individual’s personality, temperament, interests, likes, and dislikes. Such as, is the individual outgoing or shy? What activities does the individual enjoy? What amount of physical activity does the individual get? What motivates the child to act? Does the individual adapt easily to change? Through the interview, insight into the individual’s sense ability is sought. What music and/or sounds does the individual like? What aromas and taste does the child like and dislike? Does the child appear tactile defensive? When the interview has been completed a written report should be provided to the parents/caregivers to check its accuracy.

When the staff includes a team of different experts who work together to form a sophisticated think tank, the support, development, and learning of the individual is improved dramatically (Pagliano, 2001; Ferguson & Young, 2000). By working together staff members can share their expertise and achieve greater success than would otherwise be possible when working alone.

Presenting the Room to the User

Human beings are organisms that respond to change. For example, every sensation produces a potential for change (Messbauer, 2006). The facilitator’s very presence is an element of change and influences everything in the environment for the user. If the goal is to allow the person opportunity for personal growth, learning, or relaxation, the facilitator must help only where needed according to the user’s ability and must also block out unwanted stimuli. Remaining silent (facilitator not talking) gives the user the ability to perceive, adjust, and control the environment. It is important to reduce demands by ensuring that the facilitator remains initially quiet/silent. The facilitator needs to recede and blend into the background and let the environment do the talking.

When introducing the room to an individual it is important always to provide comfort, controlling the external environments such as noise levels and temperature. Introducing the room in a consistent, sequential order provides a comfortable environment. The room should have enough equipment turned on to be useful to the individual. Too much turned on can be over-stimulating, creating confusion and disorganization. Too little turned on may be under-stimulating. For some children only one or two pieces of equipment might be used, for other children with low arousal, it might mean that the whole room gets turned on, but always in a sequential order.

Prior to entering the room, the facilitator should review the information gathered from the play-based assessment and parent interviews. In some settings, the facilitator may want to write objectives to be achieved. The purpose of objectives is to: (a) reinforce all skills identified in the assessment, (b) encompass the person’s strengths and needs, (c) focus on learning and development, (d) ensure that a high level of enjoyment and interaction is experienced, (e) provide the person with opportunities for control and achievement, (f) prevent repletion and assist staff in providing variety for the person, (g) share information with other staff to promote a team approach, (h) give structure to the session and (i) provide a tool for evaluating the person’s skills (Ferguson & Young, 2000).

The MSE room is designed so that the facilitator can enter and share the experience with the user. Time should be spent introducing preferred sensory stimuli and sharing the experience with the user. As the session develops, sensory modalities (visual, auditory, tactile, olfactory, or proprioceptive) can be introduced to increase the repertoire. This approach appears to increase sensory awareness, improving perception of sensory components in the general environment (Pinkney, 1997). Messbauer (2006) provides a protocol of initiating equipment to obtain the most engagement that consists of the following:

Prior to entering the room

1. Determine the music and effect wheels to be used. If the music of interest cannot be predetermined, select classical or baroque music. Be sure the volume is not too loud.
2. Set up the CD player and projector to change through three different pieces of music (based on your objectives for the user).
3. Prior to starting the MSE experience have the dimmer spot light turned on all the way so that the environment is similar to that of their normal environment.
4. Set the stage prior to entering the room, telling the individual what to expect and that it is “OK to have fun and play.”
5. Remove shoes (both yours and theirs if they cannot do it themselves). This signals a change is about to happen and it is also more comfortable and keeps the room clean.

Entering the room

1. Have the music on as the user enters the room.
2. Escort the individual into the center of the room (equipment is off and regular lighting is on). Do not tell them to “sit down” or instruct them in any way.
3. Remain silent and speak only when spoken to; use nonverbal communication as much as possible and if you must speak, speak softly.
4. You may need to give an individual some direction or permission to do something, as many of these individuals have been conditioned to not touch things.
5. Blend into the background and get below their eye level.
6. Step back and slowly start the room sequence protocol
7. At any time an individual’s wish to leave and terminate the experience must be honored and respected.
   1. Turn on the bubble tubes.
   2. Wait two minutes and start to dim the spotlight slowly; as you do this turn on the projector with a multicolored liquid wheel. Do not rush the experience! Waiting for the user’s response and action is key.
   3. Wait two minutes. The next move is up to the individual! Be patient and quiet and stay out of the individual’s personal space and below their eye level. The individual may move around and explore/find a comfortable spot to stand or sit down or lie down or seem to do nothing. Observation of the individual should reveal which piece of equipment maybe turned on next or if any further equipment needs to be utilized at this point.
   4. Wait two minutes and turn another piece of equipment on based on the user’s interest.
8. Continue the above room sequence and observe the individual’s sensory interest; identify the equipment piece that can be used as the motivator.
9. Identify the relaxation process in the individual. Look for signs of deep breathing, loss of muscle tension, changes in speed of locomotion/movement, etc.
10. Identify the individual’s nonverbal communication for enjoyment and its level (intensity) and/or frequency depending on the sensation they are receiving.
11. During this period of adjustment by the individual use the projector and tempo of the music to match the general arousal level and change it to calming.
12. If the individual has remained in a comfortable position and appears relaxed, just let the gentle and unobtrusive atmosphere prevail. Let the individual set the pace. However, you do not want someone to sleep, so if this is starting to happen turn on another piece of equipment for stimulation.
13. The number of pieces of equipment used in the first session depends on the individual’s level of arousal or relaxation level. You may not achieve relaxation for a number of sessions until the environment is perceived as safe and it is considered comfortable by the individual. It is important to remain consistent and constant with your actions and with use of the equipment.
14. At about 30 minutes into a session you want to reverse your order of turning equipment off slowly. The regular room lights should be the last to be turned on at the end the session.
15. Once the individual feels safe and exhibits signs of relaxation on a continuous basis, prepare the room to offer small contingencies for the individual to adapt to, for instance:
    1. Set the timed delay to go off after ten or fifteen minutes ( the timed delay should be varied after the first initiation of this step)
    2. When the piece of equipment goes off be positioned near the individual, still say nothing, wait for their response.
    3. In most cases the individual will seek you out to “solve the problem” by communicating they want it on by engaging you in some fashion; establishing eye contact, taking your hand, and pointing are examples. Thus, a long and trusted relationship can develop. Become a play partner and build upon the success.
    4. Keep setting up the environment to offer contingencies that now place you between individual and reward, in order to further develop the relationship.

The equipment chosen by the user becomes the primary motivator that will be interfaced with control devices and utilized to help shape the behavior after the individual is empowered, and perceives the environment as safe.

Done