In October 2002, Bloorview MacMillan Children's Centre launched 'Water Snoezelen' a new and innovative community program, described as the first of its kind in North America . It is certainly the first pool in Canada and the United States to utilize an entire therapy pool to promote the concept of 'Water Snoezelen'. Thanks to tremendous staff support and community involvement, the Bloorview MacMillan Snoezelen Pool Program has quickly become recognized as a unique facility. It has been responsible for improving the quality of life of clients; encouraging community participation; and setting a challenge to other health and recreation centres to provide a similar facility for their community clients. The Snoezelen pool is accessed by Bloorview MacMillan's Occupational Therapists, physical therapists, the Integrated Education/Therapy Program, as well the wider community of parents and associations for people with disabilities.

I. BACKGROUND: Where to Start?

In the beginning, when it was proposed that a Snoezelen pool be developed at the Centre utilizing the existing therapy pool, the initial concerns were practical. The entire pool deck area not including the changing rooms, is approximately 27m X 27m square and 18m high. The existing pool area comes equipped with a separate changing room and has a wheelchair transfer stand for non - mobile clients as well as a ramp to facilitate wheelchair access to the water. The new equipment would have to accommodate the existing therapy pool structure, as therapists and swim instructors needed be able to use pool for regular sessions. This equipment would also have to be portable since the entire Centre is scheduled to be re-located by 2006. The everyday temperature of the water is 94 degrees Fahrenheit, so the equipment chosen had to be resistant to heat and humidity.

Favorable factors were that the therapy pool was ideally located in an enclosed area which allowed the lighting to be dimmed so as to enhance the effect of the Snoezelen equipment. Additionally, the layout already featured a Wizard of Oz theme with hand-painted murals of Dorothy and her friends. The fantasy effect was further enhanced by a ceiling high rainbow which spans the entire width of the pool. The presence of a vibrant and energetic Aquatics staff would provide ongoing supervision of the swimmers, as well as the housekeeping staff who would be able to keep up with the anticipated increase in volume of clients.

II. EQUIPMENT SELECTION: What works best?

In April 2002, a Children's Treatment Centre funding of $10,000 CAN enabled the purchase and installation of Snoezelen equipment. After much discussion with our suppliers at Flaghouse Canada , the following Snoezelen components were installed: a six foot bubble tube, 2 sets of fibre optics, a Moonbeam projector, three spot light projectors with revolving colour wheels, two sparkle nets, and an underwater speaker. Mirrors were strategically placed in a corner of the pool area and at the base of the Maxi Bubble tube. Flaghouse Canada donated two miniature bubble tubes, a fibre optic spray and a glow in-the-dark parachute.

{mospagebreak}The primary concern was lighting. In Canada , all provinces are required to have standards to regulate the safety of community recreation facilities. Because this type of program required the reduction of the overhead lighting in an aquatic environment, the Ontario Lifesaving Society did an inspection to ensure that we were not compromising client safety. The recommended guidelines included: strategic placement and choice of equipment to provide the minimum lighting levels; limiting the number of clients accessing the pool and on deck; ensuring that there was a suitable caregiver/client ratio; and standard emergency procedures. Those concerns will be addressed in more detail in section (III) 'Developing a Snoezelen Pool Program.'

The Snoezelen equipment was carefully selected in order to appeal to the visual, tactile and auditory senses. The main objective was to create an environment that radiates calm and comfort, resulting in an atmosphere of total relaxation, and reducing the client's level of anxiety in water. The combination of the medicinal benefits of the heated therapy pool, the sensory elements of Snoezelen, and staff trained in the Snoezelen philosophy would ensure that clients received the maximum benefit from the session.

In order to ensure that the base of the pool would be adequately lighted, three Revolving Spotlights were strategically placed in various areas around the pool and aimed directly on the surface of the water. A Moonbeam Projector which casts brilliantly colored geometric shapes was installed for the same purpose. Two Sparkle Nets were hung high up, near the ceiling and provided quite a bit of light for the deck area.

In terms of providing visual stimulation and interest, the Maxi Bubble Tube was filled with miniature fish that floated gaily up and down the tube as the colors changed. Directly below it, the enclosed Fibre Optics were draped into the water, which provided a tactile and visual experience for clients. A mirror was installed on the base, so that clients could gently push the 'shimmering curtain' aside and view themselves in the mirror. The two Miniature Bubble Tubes were placed in the diagonal opposite corner, with tall mirrors behind them, to enhance their visual effect. Fibre Optics were draped between the two tubes and onto the pool deck.

A portable Underwater Speaker was placed in such a way that clients could touch it, and directly feel the vibrations being emitted. The music selection included a variety of classical selections, a lively tropical rhythmic beat and 'vibro-music'. This was particularly effective when it was combined with the El Mushroom Spotlight which was sound responsive. It allowed clients who were deaf/hearing impaired with residual vision to 'feel' and 'see' music. Water toys such as tactile 'grab balls' with raised bumps, squirt toys, 'jingle balls' and rubber rings, all contributed to the fun atmosphere in the Snoezelen Pool.

III. DEVELOPING A COMMUNITY SNOEZELEN POOL PROGRAM:

Since clients of all ages from the community would be accessing the pool, we had to ensure that stringent guidelines were in place. We have a screening process in place whereby the following questions are asked: 'Is this his or her only opportunity for leisure? If there are behavioral issues does this pose a risk to himself/herself and to others? What is his/her sensory needs?' We carefully match clients by age, physical mobility and sensory needs. Separate sessions are held for children and adults. The numbers per session were reduced to a maximum of four clients who had to be physically accompanied into the water by a parent or a worker. All the sessions are supervised by a lifeguard in the pool and a staff person on deck (See Appendix for copy of pool program flyer. A fee based community based program operates two days a week and prospective clients are required to book sessions in advance).

As the reduced of lighting meant reduced visibility both on deck and in the pool, we developed protocols such as keeping the overhead lights on until everyone is in the pool, and ensuring that the lights are back on when clients are exiting the pool. In order to transition the end of the session, we also have a dimmer switch that allows the light to come on gradually over a five minute period, as a signal that the session is coming to an end.

An important component of the Snoezelen pool session is the presence of the lifeguard. However, this person must be someone who has been trained in the Snoezelen philosophy and is experienced in dealing with many different groups with various levels of disability.

{mospagebreak}IV. THERAPEUTIC BENEFITS:

The primary goal of the Bloorview MacMillan Snoezelen Pool program is to provide a stable and relaxing environment where clients of all disabilities can benefit. It is hoped that the unique environment allows the clients of the Centre and the community a break from their therapy schedules; an opportunity to develop their social skills in a contained environment; and to encourage the development of motor skills and communication. In particular, I refer to an article by Helmut Wrede of the German Snoezelen Foundation: 'It is our aim to enable people with mental or physical handicaps to enjoy fearlessly, the element of water so that they can relax and then broaden renew their body experience.' (Presented at the 3rd World Snoezelen Congress, 1999, Toronto, Canada). Among the other benefits that we have found with the Snoezelen Pool:

• The warm water helps to release endorphins for pain relief, and relaxes tight muscles
• The pool allows clients with limited mobility to experience greater ease of movement and independence even with caregiver support and lifejackets
• The reduced overhead lighting can assist in calming clients who have sensory defensiveness
• Sometimes the deep pressure of the lifejackets helps to calm agitation
• Water offers clients the right amount of sensory stimulation without sensory overload
• It represents the creation of an environment whereby the therapy occurs naturally and not by design ; it offers relief from a heavily programmed daily schedule
• We match the 'water toys' to the client population using the pool e.g. interactive squirt toys for mobile clients; tactile 'grab balls' for those with limited hand movement; 'jingle ball' for those with low vision; floating mat for those who need to feel more secure in the water by lying on top of a barrier
• The Snoezelen Pool provides an environment where there is a controlled and secure environment to facilitate client's first introduction to water e.g. child with low vision
• The Snoezelen Pool allows parents and caregivers a chance to benefit from the calming environment
• The Snoezelen Pool provides opportunities for socialization for both parents and children where they can meet others with similar needs and share information.

Last but not least, the Bloorview Macmillan Snoezelen Pool Program is all about; COMMUNITY! We pride ourselves on providing a community focused delivery where we support healthy lifestyles in a supportive and interactive community. In the past year we have had 12 community agencies access the Snoezelen Pool Program. Individual parents make up 39% of the total number of clients. Agencies that access our facilities have a wide variety of clients and includes all ages and disabilities . They include: Bob Rumball Centre for the Deaf , Canadian National Institute for the Blind; Courtice North Public School; DLC Residential Services; Griffin Centre for Autism; Kerry's Place Autism Services; Geneva Centre for Autism; Montage Support Services; Reena Foundation; Salvation Army; and Toronto Association for Community Living. Other facts to note are:

• The majority of the Snoezelen pool clients are children under the age of 15 (76%)
• However, there is a growing population of older clients over the age of 35 years (24%)
• Significantly, 35% of Snoezelen Pool clients have a diagnosis of autism

{mospagebreak}V. WHAT'S NEXT?

Obviously, we want to continue developing and sharing this wonderful resource with the community. Based on the response that we have received in the past year, we would like to offer weekend sessions in order to accommodate clients who cannot fit into regular program scheduling. We also envision creating specific time slots for different populations, for example: infants; children under the age 10 with Autism; teens with Autism; Young Adults and Older clients. Another consideration is utilizing research to determine the physiological and psychological effects of the Snoezelen pool as opposed to a regular therapy pool session. For example, a potential partner could be the Ontario College of Massage Therapists. In order to ensure the long term viability of program we will need to secure ongoing funding for equipment maintenance and e nsure staff support. Ongoing dialogue will be needed to ensure continuous improvement and innovation. But like Dorothy in the Wizard of Oz, we firmly believe that 'Over the Rainbow'..[is] where dreams come true!'