Snoezelen in global perspective

 

The international use and effectiveness of snoezelen in children and adults with Profound Intellectual and Multiple Disabilities.

Some first ideas about an international research project

 

October 21th 2016

 

Annette van der Putten, Faculty of Behavioural and Social Sciences, department of Pedagogy and Educational Sciences, unit of special needs education and youth care, University of Groningen, the Netherlands.

 

Introduction

 

Snoezelen, also referred to as multi-sensory stimulation is originally developed in the support of people with severe and profound intellectual disabilities in the 70ties of the last century (Verheul, 2016). The term is a neologism consisting of a contraction of the words ‘snuffelen’ (to explore) and ‘doezelen’ (to relax) and aims at the individual access to multisensory experiences. Eventually, snoezelen was conceived as a leisure activity with the main goal relaxation. However, later on, a shift was made into the active engagement of the person with disabilities to explore and enjoy the different stimuli that supposed to be tuned to the preferences of the individual (Verheul, 2016). To achieve this, staff has to offer stimuli in a selected way and reduce unnecessary stimuli at the same time. Furthermore, staff have to create the right environment in which the person with severe or profound disabilities get the opportunity to choose or indicate which stimuli are preferred.

 

Throughout the years, snoezelen is not only implemented in the support of people with severe and profound intellectual disabilities (Hogg, Cavet, Lambe & Smeddle, 2001; Lotan & Gold, 2009), but also in other settings such as psychogeriatric care (Lancioni, Cuvo & O’Reilly, 2002; van Weert, van Dulmen, Spreeuwenberg, Benzing & Ribbe, 2005), the support of people with developmental disabilities (Lancioni, Cuvo & O’Reilly, 2002) and the rehabilitation of children with traumatic brain injury (Hotz, Castelblanco, Weiss, & Kuluz, 2006). In these fields, several studies are conducted into the effectiveness of snoezelen and positive results were described as well as in the persons with disabilities as in the staff. For example, Lotan and Gold (2009) described positive effects such as a reduction of challenging behaviour and to a lesser extent an increase in adaptive behaviour in children and adults with intellectual disabilities or developmental disabilities. Boyle and colleagues (2003) reported a reduction of psychotropic drug use in people with dementia living in nursing homes where snoezelen was implemented (Boyle, Bell & Pollock, 2003). De Weert, van Dulmen, Spreeuwenberg, Bensing and Ribbe  (2005) found an improved working life (less time pressure, stress reactions, perceived problems and emotional exhaustion) of nurses in dementia care. Moreover, the implementation of snoezelen resulted in an improved person- centred approach of these staff  (van Weert, Janssen, van Dulmen, Spreeuwenberg, Bensing & Ribbe, 2006).

However, the majority of these studies show methodological problems that limits the internal and external validity of the results found (Lancioni, Cuvo en O’Reilly 2002). For example, hardly any control conditions were used, studies were carried out with a limited number of sessions and outcome data were mainly descriptive. In some studies, the specification of the intervention method was rather vague (Lotan & Gold) or it was unclear to what extent the interventions implemented was (theoretically) based at the original theoretical foundation (Hogg, Cavet, Lambe & Smeddel, 2001).  , Studies primarily focus on within session effects instead of post intervention or long term effects (Lancioni et al., 2002). Finally, studies hardly focussed on more functional outcome variables and quality of life.

 

Aim and research questions

 

The central aim of a new international project is an analysis of the application and the effectiveness of snoezelen in the original target group: children and adults with profound intellectual and multiple disabilities.

 

The research questions are:

 

 1. What is the application of snoezelen in international practice?

 

 2. Which effects are reported of snoezelen in different target groups?

 

 3. Which effects are seen in children and adults with profound intellectual and multiple disabilities?

 

 4. Which effects are seen in supporting staff of children and adults with profound intellectual and multiple disabilities?

 

 

Method

 

Research question 1

A large scale international survey will be conducted in order to get insight of the different practices  (e.g. the support of people with intellectual or developmental disabilities, people with dementia, (special) education, addiction care).

An online survey will be developed within the scope of the current project and distributed by the members of the International Snoezelen Association- Multi Sensory Environment (ISNA- MSE).

We want to know in which target groups snoezelen is implemented, which activities are executed (type, duration and frequency), and for what reasoning. Moreover, we want to how supporting staff is educated and how they evaluate their support.

 

Research question 2

In order to gather knowledge about the application (settings and population), but also into the effectiveness (what variables are used) of snoezelen, a literature review will be carried out. With the use of the databases MEDline, Phychinfo, ERIC and Cinahl and with use of the search terms ‘snoezelen’ and ‘multi-sensory environments’ studies into the effectiveness will be retrieved. Studies will be analysed by population (type, age and number), methodological quality and effects described.

 

Research question 3 and 4

Based on research question 1 and 2, we will have an overview of the application and expected effects of snoezelen in different target groups. With this information, we want to set up different small scale studies into the effects of the implementation of snoezelen in children and adults with profound intellectual and multiple disabilities and their staff.

 

Participants: People with profound intellectual and multiple disabilities. These people are characterised by profound intellectual disabilities (estimated intelligence quotient less than 25 points, or a developmental level of 24 months) in combination with severe of profound motor disabilities (Nakken & Vlaskamp, 2007).

 

Intervention: based on the information of research question 1 and 2, the intervention of snoezelen, training of staff and the implementation strategy will be described and structured.

Design: small scale internationally based studies with single- subject designs with alternating treatment periods extending over a relatively long time period (Lancioni  et al., 2002). Effects were measured within sessions but also post sessions and long term. Treatment periods will be modified (AB0AB1AB2AB3) etc.

 

A is the control condition such as baseline (no intervention) or other (general) stimulation activities such as outdoors activities or general sensory events (See Cuvo, May & Post, 2001).

 

B are intervention sessions in which different aspects will be manipulated such as stimulus preference assessment and evaluation within the intervention sessions.

 

Outcome measures people with PIMD: e.g. alertness, challenging behaviour, engagement, well-being (indices of happiness) and quality of life.

 

Outcome measures staff; quality of support (type of activities, person centred support), knowledge about the sensory preferences of the person with PIMD and work satisfaction.

 

Outcome measures will be further specified based on literature review. Within session effects will be measured as well as post session effects.