Therapy

Two main types of direct work are utilised by the BUSS team; the 4 stage model, which involves families coming to see us at the Oakdale Centre in Harrogate, and Remote BUSS,  which makes it possible for families who live further afield to access the intervention without having to travel.

 

Four Stage Model

At Oakdale, we provide the BUSS intervention as a Four Stage Model. This encompasses a combination of psychoeducation, individual assessments, personalised exercise and activity plans, follow ups, reviews and reports. The purpose of the intervention is to improve the sensory integration of the child, develop good bodily regulation and build parent and child relationships. This provides a platform for the development of emotional regulation, relationships and learning.

The Four-Stage Model works well for nursery and school-age children as interorganisational support is available from all facets of a child’s life. The most active participants in a BUSS intervention are the parents, carers and the team itself, but opportunities are available for schools, nurseries and social work professionals to aid in the child’s development. The BUSS screening toll can be completed to help professionals understand an intervention more thoroughly and begin to notice body regulation and movement.

 

 A Description of the Four Stage Model

Once a referral has been received by the Centre, one  member of the BUSS team will have a telephone consultation with the family. This is to partly check that BUSS is the right therapy at this time, but mostly to begin to understand what the families’ hopes and expectations of the intervention are. It’s also an opportunity to learn more about the child or young person who has been referred and therapists will ask what is known about the child’s early life and experiences, how things are currently and what the concerns of the family are, as well as discuss the screening tool upon completion.

The first step of the BUSS referral is an introductory training day for parents to become acclimatised to the workings of the BUSS model. Parents, carers and any adoption or social work professionals will be invited to take part in this training.

The morning of the session will develop the understanding foundational sensorimotor systems in typical development, and explore the impact of early neglect and adversity on a child’s development. Emphasis will be placed on the participants honing their perceptive skills to understand the children in their care on bodily level; focusing on movement capabilities to give inclination to any possible developmental deficiencies.

During the lunch break parents will have an opportunity to meet the BUSS practitioners they will be working with as well as other parents who they might see as part of undergoing BUSS therapy with their child.

During the afternoon portion of the session, parents and educators will practise the activities prescribed as part of the BUSS model. Not only will this develop the knowledge of these games to be used with children in the future, but time will be given to enhance the participants’ awareness of child development as a sequential process. This will be crucial as the therapy continues.

The second stage of the BUSS Four-Stage model is that of the Assessment. This involves a BUSS accredited practitioner liaising with parents and children to assess the condition of the child’s foundational systems. This will take place within a fortnight of the Introduction day. Collaboration forms the foundation of the BUSS therapeutic method, as practitioners and parents will work together to formulate the best course of action for the child. Knowledge gained from the Introduction day will be utilised to help assess the child’s vestibular, proprioceptive and tactile systems. Parents hold the most acute knowledge of their child, and so great care will be taken to include parents in the therapy process. This will determine what the best course of action should be.

The BUSS practitioner will then write a summary of their observations and a comprehensive programme of activities for the parents  and child to work through over the next month. In addition to this, a video diary should be kept by the family, documenting activity practise and any changes in their child’s developmental behaviours. This should be accomplished at least twice over a four-week period.

The third stage of BUSS, the Follow Up, will comprise of a two-hour group session organised by a BUSS practitioner for up to four family groups. This will take place one month after the Assessment. Parents attending will be asked to share the nature of any changes in their child in relation to the BUSS programme and discuss any challenges they have faced since starting the model.

After hearing from the parents, the BUSS practitioner will construct an individual programme for each child to follow in the coming weeks.

The fourth, and final formal, stage of the BUSS Four-Stage model is the Reassessment, taking place two months after the original Assessment. This will follow a similar format to the third stage, assessing how far the families and their children have come following the prescribed activities. From this session, support will be given on a case-by-case basis. Guidance will be given for as long as the family requires it, requiring a written report to be completed on their child’s progress, handed to the BUSS practitioner. Additional, practical guidance is available too. For families local to the Leeds area, Sarah Lloyd hosts a weekly BUSS gym club in conjunction with Leeds Gymnastics Club, with attendance not limited to a set number of sessions.

Schools involved with a BUSS intervention should attend to the child at least once per term, to make sure that the child is adhering to the prescribed therapies and exercises.

Remote BUSS

As well as providing a face-to-face service with the BUSS model, the team have developed Remote BUSS, an accessible means of acquiring the same high-level of care without leaving the home. For some families, being able to do things from their own home might work better for them, perhaps because they live a long way away from a BUSS practitioner or because it might be a better fit for their family. In the wake of the Covid Pandemic, this is especially relevant. 

It is important to note that families taking part in a Remote BUSS intervention have to be motivated for it to be successful. In order to deliver this system of therapy effectively, regular contact with both BUSS practitioners and parent mentors is crucial. As well as this, however, regular updates have to be sent to the BUSS team in order to monitor progress and be able to formulate the best plan for the child. To facilitate this, the team possesses a BUSS Dropbox for families to send videos to us securely (confidentiality is paramount: please refer to our privacy policy for more detail). If families do not feel comfortable sending videos, or if children are very resistant to being filmed by their parents, then a face-to-face intervention is recommended.

All families who are referred to the BUSS team at the Oakdale Centre complete a screening tool, and for families who do not already possess it we will send a copy of the book: Improving Sensory Processing in Traumatised Children (Lloyd, 2016). This will give a brief understanding of the BUSS model before an intervention begins.

Parents and Social Workers can also watch a recorded 45 minute webinar which gives a brief introduction to the BUSS model. Any questions from any of these information sessions can be answered at the first consultation session.

The first contact will comprise of a phone consultation between a BUSS practitioner and parents. This will allow for a dialogue to be opened between these two parties, working collaboratively to create a preliminary sketch of a future BUSS-oriented therapy plan.  Adoption-support Social Workers are welcome to be involved at this stage. This will also give the first inclination of whether the parents would like to pursue this method of therapy.

In order to build an accurate picture of a child’s developmental state, the BUSS practitioner will ask for a family to capture and send video footage of their child performing simple tasks, such as writing, drawing or walking up and down stairs. A link to the BUSS team’s Dropbox will be provided for any prospective parents. For the practitioner, the footage will illustrate what status the child’s foundational systems are in, judging what possible intervention method could be enacted. For families unsure of what activities they should document, the BUSS team can provide examples to help. 

Combining the information gleaned from the first contact and video footage provided by the family, the BUSS practitioner will compose a personalised programme for the family and child to follow over a fortnight. Nominally, this will include a written report of the status of the child’s sensorimotor systems, a brief summary of the BUSS model and an outline of the activities to be accomplished in the future. Videos of the activities outlined will also be provided. A second phone consultation can be arranged to discuss the initial report.   

Progress within the BUSS model will be monitored through the contact that families maintain with their BUSS practitioner. Conventionally, this will involve further footage being sent to the BUSS Dropbox, the subject of which will be updates on the activities prescribed as part of the practitioners’ report. In order to maximise the aid given, the team would recommend bi-weekly updates with contact for practitioners to propose ideas, modifications and suggestions.

Part of this regular contact, a formal contact will be made, termed the ‘Midway’ call, to offer guidance with families about any changes the BUSS practitioner feels need to be changed. This will typically occur after three contact sessions have been made, but can be made earlier if the family specify to. At this point, new information regarding the child’s development will be tabled and new strategies will be constructed if needed.

From first-hand research, an average of seven contact sessions have been sufficient for families and children to attain as much input as they require. When the family are confident that no further intervention is needed, the BUSS practitioner will write a summary report comprising of any further advice and work that they feel may be helpful for the family to practise. If any additional BUSS sessions are required or indicated the prospect will be discussed with families and adoption social workers.

Whether you are thinking about the  Four-Stage Model or the Remote BUSS program, these next sections will be applicable to you:

The BUSS model is based upon the understanding that early adversity in children can lead to unhealthy relationships and absent developmental stages. Children who have received nurturing and caring relationships with those around them tend to avoid experiencing these developmental shortcomings, as they are made to feel safe and happy with the environment around them. For children coming from environments that are unsafe, frightening or abusive (whether in utero or once they are born), the key stages of tactile and proprioceptive development are missed, leading to future problems in maturing to adolescence. This is what the BUSS model centres its work around: the idea that these developmental stages can be rebuilt  post-trauma to ensure that a child can grow naturally.

Click here to find out more about stages of early motor development and how they form a foundation for later stages of development.

Noticing gaps in a child’s foundational systems

For some children and young people, dialogue surrounding how their body works for them occurs naturally. More common than this, however, children will learn to compensate for areas of their bodies that do not work as intended, resulting in physical changes in how they accomplish certain tasks. This is how the BUSS team perceives, preliminarily, any developmental breaches. It is important to note, as a parent or carer, how a child executes tasks that adults may take for granted. Analysing how a child moves through developmental stages is not an easy mindset to reach, but with the help of the BUSS team it is achievable.

To begin critically analysing a child’s method of accomplishing tasks, let us begin by guiding you, the reader, through an assessment of your own methodologies. Take into account the position that you are in reading this text. If you are sitting, check where you are obtaining your stability from, do you lean against something? If you were to stand up, do you need to provide yourself with additional leverage in order to reach a standing position? Should you be reading this standing, take note on where your support is coming from. Do you utilise a table, a chair, a counter-top? Hopefully, you do not need to lean across a table to hold yourself up, or move around to help your body know where it is.

If it is possible, try moving around the space around you and analyse the movements needed to rise from a position to begin traction. What leverage did you use to start your body into motion? If you struggle without using a solid object to aid in movement, think about the parts of your body that led you to move. Draw an imaginary line in the centre of the room, then walk over it. Which part of your body crosses that threshold first? This is just the beginning of critical assessment focused on the body’s movement to ascertain developmental breaches.

Utilising this data about yourself, apply it to children that you may know or take care of. The way that they move, from carrying objects to playing with other children, can all give invaluable information about the condition of their foundational systems. The BUSS team employs this information to create a program of activities designed to remedy the specific stages that may be missing in a child, ensuring that as they move in to adolescence and adulthood they are in full command of their faculties and tactile systems. 

As well as looking at a child’s physical wellbeing, information can be gleaned from the psychological condition that the child is in. Communication surrounding hunger, taste and texture can reveal developmental shortcomings, as well as the state of mind that a child can be in for the majority of the time. Stress, anxiety and anger can all be clues towards the signs of a larger problem that the BUSS team can help salve. 

Age range

The BUSS Team work with children and young people from an age starting with babies onward. We are determined to intervene as early in the life of a child and family as possible, as this is when developmental stages are still being met and can be repaired comfortably.

 

We have examples of early, middle childhood, and adolescence interventions, which you can find here

While every BUSS intervention will be unique to each child undertaking it, there are a few activities that remain universal to helping rebuild developmental stages. For the reader, the activities might be hard to envisage, and so Sarah Lloyd, along with her daughter Ally, have made several videos outlining potential activities that a child may be prescribed as part of a BUSS intervention. 

BUSS Activity- Bubble Mountain!

Sarah Lloyd, speaking about the psychological and physical effects this activity has: “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.”

BUSS Activity: Getting Started with Commando Crawling

Stomach crawling, or ‘Commando crawling’ is an efficient way of building upper-body strength and aids in getting the body to work as an integrated unit – the right- and left-side of the body working together. There’s more information about why the BUSS model uses ‘Commando crawling‘ in this section. 

All families undergoing the Four-Stage Model are invited to complete before and after measures.  Over the time that these have been being used, they have shown significant improvement in a child’s bodily awareness / proprioception, core strength and stability, co-ordination and ease of movement. These changes in bodily regulation have facilitated positive changes in emotional regulation and relationships, as can be seen in the accounts written by parents and carers.

As this is a relatively new  model for practice, a lot of the children and families that we work with have already been through more traditional psychological therapies. We would argue that building bodily regulation is a good starting point for any intervention and find that, where children have been engaged in psychological therapies, they are better able to make use of these once they are more 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.

For both BUSS interventions, the Four-Stage Model and the Remote BUSS program, the fees are £1250.00, plus VAT.

For some children and young people, more sessions than the standard will be needed. In these cases, pricing for the additional sessions will be worked out on a case-by-case basis after the initial intervention, in consultation with the family.

Other therapeutic support

There are occasions when neither the four stage model nor Remote BUSS are the best fit for a family and we are happy to discuss alternatives. You can get in contact with us by emailing info@BUSSmodel.org.

Please click on the button below to download  the BUSS Referral Form.

Completed referrals can be returned to info@bussmodel.org

Feedback from parents who have been through the BUSS Model:

“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.”

Adoptive Parent

“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!”

Adoptive Parent

“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.”

Foster Carer

“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.”

Adoptive Parent

"I think it's worked brilliantly and I've found it easier to fit into my life in terms of childcare and work commitments.

A Parent that has done Remote BUSS

“It’s amazing that something that’s so completely life changing can be so much fun!”

Foster Carer

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