Hot Spots and Hot What’s in Sensory Modulation Interventions

Mental Health Units, Emergency Departments and other hospital and care environments are places where higher levels of aggression and frustration can occur. Within these environments there can be specific locations/areas which have an even greater concentration of aggression and frustration. These locations can be described as Hot Spots. (Gillespie et al 2018).   In the safe wards literature, the physical environment is one of six domains or categories of factors that can give rise to flashpoints, which have the capacity to trigger conflict and/or containment.  (Bowers, 2014).

This article will explore how to identify Hot Spots (and Hot What’s) and some solutions to address them.

To assist with identifying Hot Spots:

1.       Listen to lived experience reports and complaints of locations/areas on the units that have negative sensory or other aspects. Eg noisy scraping of chairs in kitchen,  loud alarm near nursing station.

2.       Use a map of the unit and mark any incidents on the map. Any area that contains a greater frequency of incidents is considered a Hot Spot (Cygnet 2024).

Once the Hot Spots are identified, the next step is to identify the Hot What’s – meaning what sensory or other input is problematic and resulting in the area becoming a Hot Spot.

Hot What’s can be identified by:

1.       Listening to lived experience reports and complaints of problematic sensations

2.       Completing a sensory audit of the Hot Spot/s, for example identify the sensory input of that place. Using the sensory audit ‘sensory input in mental health units’ might be a good starting point.

3.       Completing a sensory audit at the time or not long after the incident. Using the sensory audit tool ‘Sensory Factors in the home environment’ might be helpful.

Solving Hot Spots and Hot What’s:

After identifying the location of the Hot Spots and the Hot What input, it is important to then identify locally achievable solutions. Options to consider include -

1.       Change the sensory input (eg replace loud alarms with vibration alarms)

2.       Reduce the sensory input for the individual (eg supply sensory modulation items to reduce sensory input such as earplugs, personal scents* to mask other scents. ). Scent needs to be personalised and self applied/not diffused through public spaces. Refer to blog for more information:

3.       Support the individual to move away from the input (eg to go outside for a break, offer a different room or a different ward that does not contain the problematic input).

A similar process could be used in a range of different environments including schools, support facilities and housing/accommodation options.

Case Study

An outcome of training conducted by Sensory Modulation Brisbane for Cygnet Health Care in the UK  has been greater identification of Hot Spots. The Cygnet OTs were able to identify Hot Spots and then develop sensory modulation plans to change the sensory input or make other changes (eg move the person to another room or space). This process resulted in a significant decrease in  seclusion and restraint incidents.

 Definition

Hot What’s = Sensory Modulation Brisbane term to describe the sensory input that is present at hot spots.

 References

Bowers L. Safewards: a new model of conflict and containment on psychiatric wards. J Psychiatr Ment Health Nurs. 2014 Aug;21(6):499-508. doi: 10.1111/jpm.12129. Epub 2014 Feb 19. PMID: 24548312; PMCID: PMC4237187.

Cygnet 2024. Sensory Modulation Brisbane completed training at Cygnet and an outcome of this training was greater identification of hot spots. The Cygnet OTs identified hot spots and developed sensory modulation plans to change the sensory input or make other changes.

Gillespie A, Reader TW. Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety. Milbank Q. 2018 Sep;96(3):530-567. doi: 10.1111/1468-0009.12338. PMID: 30203606; PMCID: PMC6131356.

Safe Wards: https://www.safewards.net/model/technical

Using a Safety Tool or Personal Safety Plan in Emergency Departments or Mental Health Inpatient Wards.

Safety Tools are being found to be very useful in emergency departments and on mental health inpatient wards, as they incorporate aspects of trauma informed care and also provide some options for using sensory modulation in the hospital environment.

Safety Tools are sometimes also known as personal safety plans. Many hospitals have their own versions, developed in collaboration with consumer consultants.

A safety tool includes;

Warning signs of anger or distress

• This section often includes internal sensations and also body language signals that others could observe.

Triggers

• This includes sensory and personal triggers. When discussing a safety plan with clients, it can be a safe way to identify triggers without needing to discuss the trauma.

• For example a client once said that she couldn’t stand the feel of metal. It was not necessary to re-traumatise her by asking why or what the event was, as this was not the focus of the inpatient unit. Instead clinicians were able to know that this was something that was best avoided so that she was not triggered.

Using our senses to calm and soothe

• This section can list the sensory modulation items or spaces available on an impatient unit. This is useful as it also is orientating clients to what is available.

• Clients can identify likes, dislikes or items that can be useful to calm them.

• Often the sections are divided into each sense.

• The options available on a ward need to be screened for safety considerations.

An example of a Personal Safety Plan is available in the Sensory Modulation Resource Manual.