I thought long and hard about what I wanted to talk about for the month of May. We've had very interesting articles from Michelle Shapiro, Gillian Hotz and Jason Stahl about the excellent research opportunities that they are doing with Snoezelen in their organizations. Then I wondered, what if I talk about how Snoezelen develops within a facility? Surely it is equally important to recognize its emergence within an organization's attitudinal and architectural and landscape, so to speak.
The title of the article is taken from the promotional campaign for our new children's treatment centre, where we are due to move in December 2005. What started back in 1899, as a rehabilitation home run by wealthy society matrons for fifteen children, has evolved into one of the leading children's treatment centres in the world, with nearly 6500 clients a year and over 750 staff. Many memories are held within our current outpatient walls, which in a sense chronicle the changing attitudes towards pediatric rehabilitation and treatment for children with disabilities and special needs. In 1994, we merged with the Bloorview Hospital, thereby combining the history of the two institutions.
Today we're building a $100-million facility in Toronto which brings together state-of-the-art technology with a design that draws on the natural elements of the surrounding ravine. Hence the title : 'What stories will be told in our five storys?' which points the way towards the future.
How Snoezelen developed at Bloorview MacMillan
In terms of looking at the development of Snoezelen at Bloorview MacMillan, I have to give credit to Anita Marcotte, a graduate student from the University of Manitoba, Canada. Anita made a very profound observation that really made me think. She suggested that based on her reading of the literature from both Canada and Europe, she found that there were basically two models of Snoezelen development, which she called the Assimilative Model and the Accommodative Model.
The Assimilative Model referred to those facilities which incorporated either sensory stimulation or a multi-sensory room into their facility without much change in the physical, social or structural organization of the facility. The staff making used of the multi-sensory room tended to be physical/occupational therapists or nurses with specialized training. In this context they were the main personnel using the approach and used it as a sensory stimulation component of an overall activity program, like pet therapy or horticulture, which is offered at a specific time on a specific day and with specific residents.
On the other hand, facilities following an Accommodative Model seemed to try to fit existing activity programs within an overall sensory stimulation program. This approach may include physical, social and/or structural changes of varying degrees. Such facilities may have had an existing multi-sensory environment or had their program evolve over time in this direction of a multi-sensory environment. In this context, the majority of staff are generally trained in sensory stimulation and can present it anywhere at anytime and to anyone.
Where does Bloorview MacMillan fit in on the Snoezelen model of development? Are we Assimilative or are we Accommodative? Be patient with me and let us take a walk back in time as we try to puzzle it out!
The Snoezelen story at Bloorview MacMillan started nearly fifteen years ago, with a mother by the name of Barbara McCormack. Her infant daughter, Sarah was born with severe disabilities and was a client of Bloorview Hospital. Barbara had the opportunity to experience a Snoezelen room for the first time, during a visit to the U.K to see specialists for Sarah's condition. While in the Snoezelen room, Sarah's unprecedented response to the equipment provided the catalyst that started the Snoezelen ball rolling. Barbara McCormack then advocated for and obtained the rights to distribute Snoezelen equipment in Canada.
In 1992, Canada's first Snoezelen room was opened at the Bloorview Hospital at the in-patient unit. In 1994, Bloorview Hospital merged with the Hugh MacMillan Rehabilitation Centre to become Bloorview MacMillan Children's Centre. A year later, a community based Snoezelen room was opened at the outpatient MacMillan site through funding from Ronald McDonald's Children's Charity. Fast forward six years to 2001 when hockey player Mats Sundin, donated money to purchase a Snoezelen cart that was hugely popular with the unit 3 which included chronic and palliative care clients. That same year also marked the debut of the first Snoezelen pool in North America at the MacMillan site, an extremely successful venture that provided community clients with a unique therapeutic and recreational option.
Over the years, the combined efforts of dedicated Therapeutic Recreation, Child Life Staff and Early Childhood Specialists meant that Snoezelen has become an accepted mode of treatment for clients. Fair enough, you might ask, but is this level of acceptance reflected in the new facility? First, we need to look at what the new Centre is going to be like!
The changing face of Bloorview MacMillan Children\'s Centre
According to the information posted on the Bloorview MacMillan website http://www.bloorviewmacmillan.on.ca, the logistics of the new facility are as follows:
It will be a 343,000 square foot facility, with state-of-the-art accessibility features. A compact, five-story facility with elevators will make it easy for children with disabilities and their families to get around.
The new building will incorporate nature and technology to make Bloorview MacMillan Children's Centre the first health-care facility in Canada to recover and re-use rainwater normally lost to the storm drain system. Rainwater will be collected through drainpipes from the sloped roof, balconies, the roof and runoff from the turf on the north side of the building.
Outdoor space will be used for playgrounds and therapeutic programs and be shared with the community.
The main floor will house the Bloorview MacMillan Children\'s Centre School, a comprehensive education and resource centre, and conference centre.
Clinical rehabilitation programs will be on the second floor; 24-hour client care will be located on the third floor; Clinical technology services (e.g., orthotics, seating), communication and writing aids, and research/rehabilitation engineering will be located on the fourth floor.
Family accommodation and administrative services will be located on the fifth floor.
There will be a research institute, the first in North America dedicated to exploring ways to enhance the care and quality of life of children and youth with disabilities.
And then of course, there will be SNOEZELEN!
Snoezelen in the new facility
As in the old facility, there will be two Snoezelen rooms : one will be located on the second floor that serves outpatients and the other on the third floor for inpatients, including the Snoezelen cart. The Snoezelen pool will be on the first floor.
The transfer and development of the Snoezelen installations to the new building took careful thought. Along with Montgomery Sisam Architects Inc., Flaghouse Canada and ChildLife, we carefully considered just exactly what we wanted. No more trying to "make-do" with existing space: of having to accommodate the awkwardness and inappropriateness of the community Snoezelen room which is open to all ages, located within a playroom; or having no place to plug in ventilators; or constantly moving floor mats because there was no wheelchair path.
How about a place to hang up coats and place your boots? Done. Could we have the Snoezelen coordinator's office placed before the approach to the community Snoezelen room so that she can monitor all the clients going in? Not a problem. Why not have recessed cupboards to store the cleaning materials to reduce visual clutter? That's an excellent idea! Can we make sure that the rooms will be soundproof - all those overhead hospital pages can be really annoying and disrupt the experience. O.k. we can do that, but then what about client safety? Well, let's have phones built in that connect directly to Reception and security and also an emergency alarm system that is very visual so that caregivers will be aware of the need to exit the room quickly. What about the music in the room : it is a problem to have speakers on only one side. Well, then, we'll make sure that the rooms will include an audio system that will provide evenly amplified and distributed music The discussion went back and forth until all the details were hammered out. While the Snoezelen rooms in the new facility won't be significantly expanded, the design and overall approach will be much improved.
A similar process took place for the Snoezelen pool. All existing Snoezelen features will be transferred to the new therapeutic pool. A noise dampening finish and wall angles will eliminate the loud noises normally found inside a natatorium. Built-in, underwater speakers and lighting controls will enhance the Snoezelen experience. A new, exciting feature that will be found in both pools is a "bubbler" comprised of underground pipes that will blow air bubbles in the water which will provide a wonderful sensory experience for swimmers. The therapeutic pool will also feature a fiber optic cable located in the pool wall.
Both the Snoezelen pool as well as the larger swimming pool will be fully accessible, complete with chair lifts. Instead of ladders to get in or out of the deep end, there will be a graded entrance and exit area. The floor design has a gentle slope encompassing different levels - with each level featuring its own unique bright colored tiles. A ramp in the shallow end will allow pool chairs to be used to get children and others in wheelchairs in and out of the water. Additional features include bench seating that incorporates hydrotherapy fittings for relaxation and physical stimulation, and a deck with a raised tile that will enable bathers who are visually impaired to identify the pool area. Water temperatures will be 36oC in the therapeutic pool and 32oC in the recreational pool.
A moment of reflection amidst the bustle
But on top of all this, as lovely as it to have our Snoezelen facility ensured in the new building, what is even more encouraging is the fact that certain restorative elements are included throughout. If Snoezelen is about providing sensory stimulation and elements of relaxation to improve the quality of life via pleasant sounds and music, the use of light, appealing aromas, contrasting textures, and other sensory arousal techniques, then the new facility certainly has those aspects in abundance
According to the lead architect, Terry Montgomery, of Montgomery Sisam Architects Inc., the design of the new building attempts to create: "the atmosphere of a retreat within the city. For the child transferred here from an acute-care hospital, we wanted to create a restful, welcoming atmosphere that connects the building with the surrounding ravine, has lots of natural light and is made up of a series of places that have character and personality."
For example, there will be lots of natural light throughout the building. Terraced gardens will dug out of the building, with trellises and landscape that create outdoor areas for programs. The new cafeteria will have large floor-to ceiling windows that overlook the ravine. A door from the cafeteria will connect patrons to the ravine garden, where there will be seating for those who wish to eat outdoors. Swimmers in the larger of the two pools will enjoy the water by natural light, thanks to windows that will line the top of the south wall of the pool deck. Day time swimming will be a more pleasant experience with the bright sun shining in. No small thing in a country where we only experience four months of summer!
Additionally, there will be pieces of art or sculptures that will serve as dividing space or as landmarks to help orient visitors. For example, on the second level, a huge saltwater aquarium, filled with beautifully colored fish and coral, will divide the family lounge and waiting area into two zones, creating an oasis of calm and beauty. Comfortable seating and quiet places will ensure that families get a chance for a moment's respite amidst the bustle of clinics and doctor's visits.
Multimedia artwork will be installed through all levels and program areas including the gardens and terraces. They will be designed to engage all senses and provide opportunities for discovery, play and inspiration. In many cases, they will be set low so children in wheelchairs can enjoy them. For example, one of the many intriguing installations is the Wheelchair Throne, which will combine art, rehabilitation and habilitation technologies to create a fantastical, interactive chair that children and adults can "test drive."
So, what came first, the chicken or the egg?
Fourteen years ago, we started with a Snoezelen room. Over time, we added a second room and more equipment such as the Snoezelen cart and Snoezelen pool. We have gradually incorporated Snoezelen as part of the supportive therapy to allow staff to identify client needs. The number of staff trained in the use of the room has expanded from the sole designated therapist, to include Therapeutic Recreation staff, Child Life, Early Childhood specialists and the teaching staff in the Centre's in-patient school and Integrated Education Therapy program.
Referring back to the question of whether we fit the Assimilative or Accommodative model, I believe that Snoezelen at Bloorview MacMillan is along a continuum of development. We have always had beautiful gardens, and a vibrant creative arts component. However, as the new facility clearly demonstrates, those aspects have been incorporated as part of the defining architecture of the building. "Snoezelen-like" elements have become intertwined in the facility, all aimed towards replenishing the spirit, which would point clearly to the Accommodative model of development. It is a beautiful thing to see, and the end is not yet in sight!
- Lorraine Thomas as an author of Worldwidesnoezelen.com
- The website of Bloorview MacMillan