|By Kelly Beins, OTR/L
Reviewed by Rebecca Knowles, OTD, OTR/L, RYT
The ability to regulate one’s emotions is foundational for healthy development and functioning in a multitude of domains, including social engagement. Yet, many autistic people struggle with social engagement and emotional regulation for myriad reasons.
The Safe and Sound Protocol (SSP) is one practical and evidence-based way providers may effectively support clients to build both sets of skills.
A newly published study found that the Safe and Sound Protocol (SSP), combined with other interventions, helped improve the social communication and behavioral skills of a 20-month-old child with moderate autism spectrum disorder (ASD) (Squillace, Lopez & Cohn, 2022).
In this single-subject multi-baseline design study, published in the Journal of Occupational Therapy, Schools, & Early Intervention, the SSP was delivered for 30 minutes per day for 10 days and, following an eight-week pause in listening, was used again for another 16 days. Improvements were found in language, listening, processing facial expressions, emotional regulation, as well as some behaviors such as social interactions, transitions, sleep and play. These improvements remained at the time of follow-up three months after completing the entire program.
In addition to the significant successes for the client in this study, there are some key takeaways that are potentially relevant to SSP providers — and those who may be interested in becoming certified — working with people of many ages and with varied client populations:
The caregiver was significantly involved throughout delivery.
In this case, the caregiver was a parent and while they had to be involved due to the nature of the research design, it’s worth noting the value the caregiver brought to the client’s SSP experience and success.
The caregiver reported on the client’s functioning before, during, and after delivery of the SSP.
In this way, the provider was able to access observations from the home setting. While the researcher notes parent bias as a limitation of the study, parent report is indicative of what often takes place in practice: providers integrate caregiver reports with their own observations, which helps to reduce bias and improve reliability of interventions.
The client was closely monitored.
In this case, the provider met with the caregiver after each session to discuss observations, as well as at weekly caregiver-only meetings. While this high level of monitoring was likely for the sake of research and may not need to be as high for some lower-complexity clients, this approach to monitoring (consistent communication between provider and caregiver) supports decision-making around delivery of future sessions.
Psychoeducation was individualized to support client and caregiver readiness for SSP delivery.
In this case, the provider met with the client and caregiver face-to-face for one session before delivery began, and incorporated feedback throughout the program. This helped prepare the client for delivery, and ultimately supported better outcomes. Other research has found that psychoeducation that includes feedback to caregivers, especially when it references social behaviors, is strongly associated with better outcomes (Chikersol et. al, 2020).
This new research not only shows improvements in social function as a result of the SSP, but also lends insight to the role that caregiver involvement can play in supporting positive outcomes of SSP delivery for any client.