The purpose of the intervention is to improve a child’s sensory integration, develop good bodily regulation and build parent / child relationships, thereby providing a solid platform for the development of emotional regulation, relationships and learning.
Involving the team around the child works well for nursery and school age children because, while the key agents of change are parents and carers, it can be helpful for schools or nurseries to be involved and supporting the work where they can.
All families who are referred to the BUSS team at the Oakdale Centre are invited (with their Social Workers if that’s helpful) to watch a brief webinar which offers both a chance to meet the team and a crucial introduction to the BUSS model. We also encourage an exploration of the website, which is another great source of information about the model and this way of working. Parents and carers will also be sent some questionnaires by Megan Pollard, our BUSS administrator, to complete which will help their practitioner begin to build a picture of the child’s foundation systems. This will include a BUSS screening tool. When these are completed and returned to us, we will allocate a BUSS practitioner to begin to work with the family as soon as possible. Before meeting with the family, the practitioner will review all the information from the screening questionnaires, the referral form and any other assessments provided.
Our first contact with all families is a phone or ZOOM consultation between a BUSS practitioner and the child’s parents/carers. We’re happy for supporting social workers to be part of this call if that feels helpful. This will allow for discussion of the BUSS model, gathering the child’s history/process of adoption or care, review of the screening tool and other measures, and consideration of how the child’s difficulties manifest at home and in other settings. This discussion will allow the practitioner to begin to build a picture of an individual child’s level of sensory processing and functioning at home and in other settings.
This is also an opportunity to answer any questions about BUSS and to think about the practicalities of working together – the when, the why and the how.
To make a full assessment, the BUSS practitioner must be able to see the child doing specific activities. This can be done face to face at one of our centres (either in Halifax or Harrogate) or in the remote intervention, by the practitioner reviewing videos that the family sends via a Dropbox link. To facilitate this, families will be given clear instructions (including links to video demonstrations on YouTube) for games and activities to do with their child that they will record and send to us securely. This allows the practitioner to continue to build an understanding of the child’s foundation sensorimotor systems. In both instances, the activities will be based on information from the screening questionnaires, the referral and discussion with parents (and the adoption support social worker).
The BUSS practitioner will then write an initial assessment report identifying any under-development in the child’s foundation sensorimotor systems. They will recommend tailored activities to meet the needs of the child and family system to start to build underdeveloped sensory processing systems, within the context of the parent – child relationship. The report will include a breakdown of games and activities that can be done at home and those that can be done at school if appropriate and will include links to YouTube video clips to give ideas about how the games or activities can be done.
In both face to face and remote interventions, parents/carers will be asked to record their child in action doing the recommended activities and to upload the footage to Dropbox for the practitioner to review. There will be regular telephone or video conference sessions to review the videos of the child doing the activities, usually offered fortnightly. The practitioner will then send summary letters with recommendations of further sensory integration activities and play for parents, (school) and child with instruction videos. There is an expectation that parents (and schools if appropriate) will video at least one session a week of them working with the child using the games and activities and send these to the BUSS practitioner. This allows the practitioner to be sure that the level of challenge is right and that the technique is correct in order to build underdeveloped systems.
This is supported by the offer of a monthly parent-led support group. An important part of the programme is the use of groups to support and empower carers/parents as they work to build their child’s sensory processing. These groups are facilitated by parent mentors who are trained and part of the Oakdale BUSS team, and supervised by Katie Wrench, Head of Clinical Services.
Midway through the intervention we will have a more formal review of progress, either with a phone / video call with parents (and children if they want to be involved in the call) OR a face to face session with parent and child. The practitioner will then write a mid way report with recommendations for further activities for the next stage of improving sensory processing.
There are then two further fortnightly check ins, supported by optional parent mentor-led support groups.
We have a final phone or video call with parents (and child if they want to be involved in the call or part of the call) OR a face to face session with parent and child to review progress made, assess any further work to be done, suggest activities to consolidate achievements, and provide a final summary report including sensory integration activities and play for parent/carer(s) and child moving forward.
The intervention typically is offered over 3-4 months and, for most families, this will be as much support as they need – they will have made significant progress in rebuilding their child’s underdeveloped sensorimotor systems and feel confident enough to continue independently with some guidance from the BUSS practitioner about next steps. A small number of families, usually where the child has been significantly impacted by FASD or drug use in utero, may need ongoing direct support. In this case we would make recommendations about what further work might be indicated.
The BUSS (Building Underdeveloped Sensory Systems) model is based on the understanding that early adversity means that, while babies and young children have missed out on good, nurturing relationships, it’s likely that their bodies have also missed the sorts of movements that go hand in hand with those relationships. Babies who feel safe and happy do lots of moving and have lots of positive, safe experiences of touch and nurture. Babies in frightening situations (in utero and once they’re born) don’t have these same touch experiences and because they’re not thriving and being stimulated, they don’t move nearly as much as typically developing children and as such their foundation systems can be compromised.
These systems are what helps us to feel confident in our movements; they mean that we have good head, neck and shoulder strength, as well as a strong core. Our movements are generally fairly smooth and well co-ordinated and we might use our eyes to look where we’re going, but we don’t have to watch our feet when we’re coming downstairs or our hand when we’re writing to check they’re doing the right thing. Click here to find out more about stages of early motor development and how they form a foundation for later stages of development.
Sometimes children and young people can talk about how they feel their body works for them. More often, children learn ways to compensate and use other parts of their bodies to make up for the parts that don’t work so well. It’s useful to begin to notice how your child is doing things. We’re really good at noticing what they’re doing, but it’s good to get used to noticing how they’re doing it. This is harder than it sounds and isn’t something that we’re used to doing – we’re used to children just being able to ‘do’ things and progress from one stage of development to the next without having to really analyse how they’re doing it, so don’t worry if it takes a while to adjust to doing this.
Sometimes it’s easier to start with yourself – notice what your body is doing as you sit or stand reading this. Where are you getting your stability from? If you’re sitting down, are you leaning against something? If you are, just try sitting up and notice what changes. I’m hoping that you can sit up, with your feet on the floor, and aren’t having to use any other parts of your body to get enough stability to stay in that position. Hopefully you’re not needing to lean across the table to hold yourself up or move around lots to just help your body know where it is.
If you can, just get up now and try to analyse how you did that. If you’re sitting at a table, did you use the table to help push yourself up? Where did the power for the movement come from? If you did push up, just sit down again and try again, this time just using your body to get up. Again think about that – which part of your body would you say ‘led’ the movement? Sometimes I think it’s useful to visualise a ‘line’ like the one you see on a TV screen when it’s a photo finish of a race and they’re analysing which runner crossed the line first. If you had an imaginary line when you’re standing up, which part of your body would cross the line first? Last? All of these things can be helpful in beginning to notice how we’re moving.
Once you’ve got used to noticing how you move, just try and observe how your child is moving, perhaps when they’re playing outside or at a playground with peers (without developmental trauma) and see how they’re holding themselves and moving about. You can get good information from noticing everyday things at home, like how they come downstairs, carry a glass of juice, sit at the table to eat dinner, write, walk and run around.
It’s helpful to notice what the quality of the movement is like. Do they move in a fluid, well-coordinated way? Does their body seem well synchronised so they’re able to do what they want to do without bumping into things or tripping over? Is there a smoothness about the movement? Sometimes it’s helpful to start by thinking about yourself and how you move – because we’re so used to children progressing from one stage of development to the next without us really having to give it any conscious thought.
It’s also useful to think about whether their body is giving good, reliable signals about things like whether they’re hungry; when they’re full; if they can taste what they’re eating and enjoy a range of different tastes and textures. Other clues can come from thinking about what sort of state of mind they’re in most of the time – are they able to stay in the moment of an experience and enjoy what’s happening or cope when they don’t know something; do they seem quite comfortable in themselves; or do they seem vigilant and stressed, as if they’re expecting something bad to happen.
The BUSS team at Oakdale work with children and young people from babies onward. We’re always keen to intervene as early in the life of a child / family as possible. For babies and children whose experience of the intrauterine environment might have been a stressful one, it’s never too early or too soon!
While every BUSS intervention will be unique to each child undertaking it, we thought it might be helpful to give a flavour of some of the activities that may be suggested as part of a programme of work. Sarah, along with her daughter Ally, have made several videos that we hope will give you some idea of what a BUSS intervention might include.
Reflecting on this activity, Sarah says, “I rarely meet children who have had early experiences of abuse and neglect who possess good feeding experiences. The whole festival of feeding and weaning is a very complex interaction and the BUSS model tries to break the activity down into its component parts. Very simply, we could think of feeding as nourishment, but also a way of building oral strength and strengthening the parent-child relationship. The BUSS model uses games like this to build oral strength and to put experiences of fun and nurture alongside earlier feeding experiences. As you’ll see, it is a short, easy activity that is designed to be fun for parents and children to do together and may be part of a wider programme of activities.”
Commando crawling can be a great way of building upper-body strength and in getting the body to work as an integrated unit – the right- and left-side of the body working together. However, it’s important to make sure that this activity is at the right level for each child and that they have the pre-requisite skills for this to be the right level of challenge. There’s more information about why the BUSS model uses ‘Commando crawling‘ in this section.
All families supported through a BUSS intervention are invited to complete before and after measures. Our experience has been that by the end of the intervention, we see significant improvement in a child’s bodily awareness, core strength and stability, co-ordination and ease of movement. These changes in bodily regulation often facilitate positive changes in emotional regulation and relationships, as can be seen in the testimonies from parents and carers.
We would argue that building bodily regulation is a good starting point for any intervention and find that children are better able to make use of psychological therapies once they are better regulated on a bodily level. This makes sense in terms of brain function and development and the earlier in the life of the child that we are able to intervene, the shorter the intervention tends to be.
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“The impact so far on our daughter is remarkable. Our main concerns were around the way she manages her emotions, mainly at school and when playing with other children. She can feel very angry very quickly at seemingly small things. She also struggles to sit still and can’t cope with unpredictability. These were impacting on her friendships and her learning.”
“We were struggling to understand how this physical work could help her emotionally, but the improvement so far has been remarkable. We have noticed that her reactions to unexpected situations are much more measured, school has fed back that she is calmer when she is there and that they can reason with her much more easily, she seems to be able to stay in the moment a little longer and generally seems less angry and frustrated all round. We will be continuing with great gusto and hoping that the improvements will continue!”
“My own personal understanding of what’s going on with my child and what they need is incredible. I have learned so much in the last few months and become really creative in how to use the sensory integration techniques in everyday life. Taste tests, exercise balls, balancing and combat crawling fun games that have been adapted to suit my child.”
“For her to feel comfortable walking down the stairs without being afraid was the biggest accomplishment I can think of, and in a very short space of time. I would definitely highly recommend this work; an essential understanding of what has been missed or gotten stuck and how it affects the body.”
"I think it's worked brilliantly and I've found it easier to fit into my life in terms of childcare and work commitments.
“It’s amazing that something that’s so completely life changing can be so much fun!”
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