For my blog today I am abridging a recent British Medical Journal 'Opinion' piece (14/01/21)

People with an intellectual disability should be prioritised for vaccination

by Keri-Michèle Lodge, Christian Brown, and Sheila Hollins.

The covid-19 pandemic continues to magnify the unacceptable health inequalities faced by people with a learning (or intellectual) disability (ID). The latest incarnation of this group’s seeming invisibility to policy-makers is the decision not to prioritise them adequately during the vaccination programme.

Last year Public Health England found that between the ages of 18-34, the death rate of people with ID from covid-19 was 30 times higher than for people in the same age group without a disability. The overall death rate for people with ID was estimated to be up to 6.3 times higher than the general population. This has been compounded by the inappropriate application of blanket “do not attempt cardiopulmonary resuscitation” orders on people with ID during the pandemic. Yet despite clear evidence of the disproportionately negative impact of covid-19 on people with ID, this group is not being prioritised for vaccination.

The Joint Committee on Vaccination and Immunisation (JCVI) considers that prioritisation should “maximise benefit and reduce harm” and “mitigate health inequalities.” Yet government policy ... has not prioritised covid-19 vaccination for all people with ID. People living in care homes for older adults have been made the first priority, yet people with ID, despite sharing many of the same risks as this group from living in congregate settings, have been treated in a more haphazard way. 

As it stands, most people with ID are a lower vaccination priority than healthy adults aged 65 and over. This prioritisation has been established despite the fact that a person with ID may find it difficult to understand and follow guidance on hand hygiene, social distancing, and wearing a face covering, or that their day to day care arrangements may provide opportunity for viral transmission via peripatetic care staff. We also know that people with ID may experience difficulties accessing in-person or virtual healthcare for covid-19 symptoms as a consequence of diagnostic overshadowing (whereby their symptoms are erroneously attributed to their ID) and discriminatory attitudes. Given all this, it is difficult to justify why a person with ID should be a lower priority for vaccination than an otherwise healthy older adult without ID.

We suggest that the government should follow the example of Germany, where people with ID, along with all employees of institutional services or community services in the disability sector and all people aged 70 or older, are being offered vaccination as a priority. 

As in Germany, we think it’s important that all people with ID are part of these prioritisation efforts. People with a mild or moderate ID face similar health inequities to those with a severe or profound ID. 

The decision to prioritise a group for vaccination is not simply a scientific exercise, it is an ethical one too. Given the profound health inequalities already faced by people with ID, everyone on existing GP registers of people with ID, along with their carers, should be prioritised in the covid-19 vaccination programme.

GF - If we really want to 'Build back better'  then all issues of health inequalities for people with learning disabilities should be seen as an urgent priority!

The importance of social interaction in learning and development

The importance of social interaction in learning and development

With the issue of children being kept out of school being currently debated, and trying not to take sides on how and when all children will be allowed back into their classrooms, I have revisited some of the work of educational theorist Dr Barbara Rogoff. 

From Rogoff's point of view a child's individual cognitive development is 'embedded in the practical and routine activities of daily life', this development being seen to happen due to a child becoming increasingly immersed in a supportive and expanding 'social world'. Thus learning happens when a child is structurally embedded 'in a system of interrelations with other people', without there necessarily being any 'explicit focus on instruction or guidance'. 

Below I set out some quotes from Barbara Rogoff's book 'Apprenticeship in Thinking: Cognitive Development in Social Context’ (1990 - OUP, Oxford), which sets out her views on the contextualised and socially situated nature of learning, and which I think are pertinent to us as Intensive Interaction practitioners (although for those of us working with or caring for adults, where it says 'children' I think we could justifiably substitute 'learner of any age'). 

‘Children’s cognitive development is an apprenticeship – it occurs through guided participation in social activity with companions who support and stretch children’s understanding of and skill in using the tools of culture.‘ 

‘Children’s cognitive development has until recently been considered a solitary endeavour, with little examination of the contexts in which and about which children learn ... the roles of the individual and the social world are mutual and not separable ... children’s thinking and development are supported and stretched in the immediate social contexts in which [they] are involved’ 

Rogoff's view on learning is that it is best described ‘... as a process in which caregivers’ and children’s role are entwined, with tacit as well as explicit learning opportunities in the routine arrangements and interactions between caregivers and children.’

Rogoff also shares her view of communication, which she sees as being 'by its nature ... an intersubjective process of shared understandings' ... 'based on a common focus of attention and some shared presuppositions that form the ground for communication.’ That sounds to me like a good description of Intensive Interaction!

So, Rogoff concludes that what is seen as 'individual activity' is actually based on a foundation of shared, social participation: ‘Under conditions of cooperation, an activity that is initially shared by those participating in it emerges as an original and fundamental foundation for the development of individual activity.'

I would see Rogoff's view on children's learning to be equally applicable to any learning of the earliest, most fundamental communication understandings and abilities, entered into, or continued on at any age; e.g. via Intensive Interaction. Importantly Rogoff sees the individual and social world as educationally inseparable; any such learning only being achievable within an interactive process, carried out 'in collaboration with others', where I think most importantly of all she points out that 'knowledge itself originates within an interactive process…’. 

So, I suppose I am clumsily trying to point out that all learners, children and adults, who are currently missing the socially inclusive, collaborative interactions (made available via Intensive Interaction) with peers and caregivers (and yes, teachers as well!) are missing out on the most formative, most defining, most socially and psychologically important learning available to us all as humans. 

When we come out the other side of this pandemic, when we create a new normal, when we build back better, let's not forget what's become increasingly evident - the vital educational and psychological importance of those socially supportive and nurturing 'interrelations' with all of those around us!

Please continue to take care ... of yourselves and each other.

Intensive Interaction as a psychological therapy

Again this week for my Blog I am relying on the good work of others to illuminate us on the use of Intensive Interaction in a particular field - and as last week, that is the field of psychological therapy. So, below I have abridged an article from 'The Psychologist' by Cathy Harding and Ruth Berry (both being, quite predictably, psychologists themselves); this article also includes a report on the 'therapeutic' use of Intensive Interaction by one of the authors. 

So, here it is:

Intensive Interaction as a psychological therapy 

by Dr Cathy Harding & Dr Ruth Berry 

from The Psychologist (2009) Vol 22.

At the broadest level, Intensive Interaction is consistent with three major schools of psychological thought – humanistic psychology, attachment theory and positive psychology. All these approaches share a core tenet that positive human relationships are crucial to our sense of self-worth, ability to realise our potential, and our psychological well-being.

Intensive Interaction ... has the potential to function as a powerful therapeutic intervention for people who struggle to use words to express their emotional state and for whom social interactions are difficult. 

More direct evidence ... comes from the case studies of Nind (1996) and Kellett (2000, 2003, 2005) ... Nind’s study involved six residents of a long-stay hospital, and Kellett’s ... involved children from three community special schools. Both researchers ... provide support for what can be seen as psychotherapeutic changes.

Typical of the cases is Jacob (Kellett, 2003), who is reported to have shown significantly decreased levels of self-injury and stereotypical behaviours pre- to post-intervention. In addition, the staff who knew him well saw him as a much happier child and described a change in his personality: they ‘had discovered a delightfully humorous, mischievous side to his character that they had not known before’. In psychotherapeutic terms, it can be suggested that the Intensive Interaction Intervention enabled the one-to-one worker to develop a meaningful relationship with Jacob and that this promoted his psychological well-being (made him happier) and enabled him to show his potential (humour and mischief).

There are a handful of case studies with clinical psychologists as authors ... [which] have yielded promising evidence for the psychotherapeutic potential of Intensive Interaction with adults with severe or profound levels of learning disability and chronic problems of withdrawal and/or self injury. The Elgie & Maguire (2001) study involved a client, Anna, a 39-year-old woman with a profound learning disability who was blind. She was extremely isolated and had self-injured since childhood. Thrice weekly Intensive Interaction sessions were seen to result in her spontaneously reaching out to her therapists, a behaviour that had not been observed during the six-month baseline period, and that was ‘interpreted as indicating the development of an emotional bond and a satisfying relationship with [her therapists]’.

Lovell et al. (1998) offered sessions of Intensive Interaction to a 53-year-old man, W, who had lived in institutions since the age of nine and who was seen by nursing staff as one of the most withdrawn people in his hospital. A variety of measures indicated that during the Intensive Interaction sessions W initiated more contact with the therapist, showed more interest in people and enjoyed the interaction. Anecdotal evidence supported these findings: ‘[n]ursing staff commented that during the intervention period W appeared happier and more willing to interact than he had before’.

Our own case study ... ‘Susan’ ... shows many of the features typical of children who have experienced ‘global neglect’ such as hyperarousal, difficulties forming meaningful relationships with others, and lack of impulse control. She has displayed severe self-injury and aggression towards others since early childhood, and we can hypothesise that her early attachments and subsequent ‘care’ in institutions led to these behaviours becoming the only ways that she could draw a consistent and predictable response from her social environment.

Past records stated that Susan liked drawing, so we took paper and crayons to our sessions. Susan immediately engaged with us, requesting that we draw particular objects such as flowers, faces and cars ... The activity expanded into sharing songs when Susan started to sing ‘Round and round the garden’ as we drew flowers, and her expressed vocabulary expanded as the sessions progressed. For example, she requested ‘more petals’ on a ‘sunflower’. 

The sessions of Intensive Interaction seemed to provide Susan with human contact that she enjoyed and within which she could exercise control in a safe way (for example, telling us what to draw). This relational context may have provided the basis for her using an increased vocabulary – perhaps ... we had earned her trust that we would not respond negatively to her speaking (this had previously been discouraged). It was possible to find a way of being with Susan that encouraged her potential rather than controlled her. The sessions also highlighted that Susan wanted to engage others and could do so very skilfully ... Both therapists felt that there were moments of connectedness, especially when Susan held up her drawings to us and we all shared in her pleasure in them.

So, overall the authors are making a strong case that Intensive Interaction has a positive i.e. a psychologically 'therapeutic' effect across all the cases discussed - which will come as no surprise to those of us who have experienced the positive effects of the approach, both for the person and for ourselves.

INTENSIVE INTERACTION AND POSITIVE PSYCHOLOGY - an article by Jana Standford

I was recently in some discussion with a psychologist who was wanting to look at Intensive Interaction from a 'therapeutic' and positive psychology perspective. I was then reminded of a article we published in our Intensive Interaction Newsletter (Issue 35) by Jana Stanford who was then working in a voluntary capacity for our Leeds & York Partnership NHS Trust. Although I still find it quite an intellectually challenging read, it does contain some very keen and worthwhile insights e.g. about being able 'to explore the self-perspectives of people with learning disabilities on their own happiness'! 

I have copied this article below, as on rereading it I felt it still holds a lot of relevance for our approach looking forward into 2021 and beyond - perhaps particularly so in framing the perspectives of future Intensive Interaction research. So here it is (and, like me, you may want to read it a couple of times to get its full effect):

INTENSIVE INTERACTION AND POSITIVE PSYCHOLOGY

A review exploring the links between positive psychology and Intensive Interaction 

By Jana Sandford 

In the book 'Understanding Intensive Interaction: Context and Concepts for Professionals and Families’ Berry (2010) points to the connections between the emphasis of Intensive Interaction upon building fulfilling relationships and positive psychology's emphasis upon the importance of relationships in promoting optimal functioning. 

Berry sees Intensive Interaction as consistent with the positive psychology framework, especially in the shared emphasis on practitioners observing and assessing a person with intellectual disabilities in terms of their interactive capabilities and 'strengths', and the production of a 'Strengths and Needs Plan' (p. 133 & 168). This is concerned with building on a client's existing repertoire of skills and looks to develop areas where a person's skills are less evident but potentially available within a responsive social environment. Berry emphasises that this positive approach can help to counter the tendency to see people with a learning disability only in terms of deficits.

Harding and Berry (2009) present Intensive Interaction as consistent with humanistic psychology, attachment theory and positive psychology, as all these approaches share a belief that positive human relationships are crucial to our sense of self-worth, our ability to realise our potential and our psychological well-being. In Harding and Berry's view, Intensive Interaction has the potential to become a therapeutic intervention for people who experience difficulty in the use of words to express their emotions and who struggle with social interactions. 

Important in the background of these discussions is the work of Seligman (2002) who proposed three roads to happiness. Firstly, the 'pleasant life' - positive emotions based on sensory pleasures or momentary emotions. Secondly the 'good life', Peterson and Seligman (2004) – achieved through the application of a number of virtues and strengths: wisdom and knowledge, courage, humanity, justice, temperance and transcendence. Along this road, people use their strengths and personal talents each day, working, playing and relating to others. Thirdly, the 'meaningful life' is achieved when a person's strengths are used in the service of something larger than the individual. Seligman suggested 'flow' as another road to happiness.

The concept of 'flow' was developed by Csikszentmihalyi through his studies of the creative process. Flow can be described as the moments when we 'lose track of time' through being engaged and absorbed in working on a task at the right level of challenge to our skills. For Csikszentmihalyi (1988) 'the universal precondition of flow is that a person should perceive that there is something for them to do and that they are capable of doing it. Optimal experience requires a balance between the challenges perceived in a given situation and the skills a person brings to it. […] To remain in flow, one must increase the complexity of the activity by developing new skills and taking on new challenges. […] People describe flow as a process of discovering something new. […] Flow typically occurs in clearly structured activities in which the level of challenges and skills can be varied and controlled.' (p. 30-31)

Linking the fields of positive psychology and learning disabilities, Dykens (2006) published the first review exploring the relationship between positive internal states of people with learning disabilities and the emerging science of positive psychology. Dykens suggested that future research and practice could be based on positive internal states, including happiness, contentment, hope, engagement and the strengths of people with learning disabilities. Dykens showed how aspects of positive psychology could be applied to research and practice in the field of learning disabilities.

Dykens summarised the concepts and approaches of positive psychology. Contrary to the usual focus on 'what is wrong with people', positive psychology asks questions about what contributes to people being happy, thriving and doing well. Dykens briefly describes the major movements in learning disabilities research and practice and reviews how those contribute to happiness. The Quality-of-Life Movement's examination of internal satisfaction has the potential to influence the study of happiness in people with learning disabilities. Where the Dual Diagnosis Movement focused on identifying and improving negative behaviours and symptoms, Dykens emphasises the importance of examining the well-being of people with learning disabilities, how they might become hopeful, grateful, engaged and happy. 

The Personality-Motivation movement linked research on intrinsic and mastery motivation, which could lead to a deepened understanding of issues of well-being and happiness. Family Research focused on families with children with learning disabilities revealed that the 'stress-and-coping model' (perceiving that families are stressed and are coping as best as they can) fits better than a psychopathology model (with the assumption that families are psychopathological). Family research found many positive aspects, including some families' descriptions of positive transformations for themselves and their family, views that having a child with learning disability is not easy, but leads to a fuller and richer life. Positive psychology might be able to contribute to explanations and further research assessing the full range of effects associated with having a family member with a learning disability.

Dykens' contribution, linking positive psychology and learning disabilities research and practice, includes a number of questions and suggestions for further research directions e.g. to explore to what extent people with learning disabilities show flow, engagement, and strengths. In Dykens' view, flow holds much promise in thinking about interventions and motivation. Dykens suggests that if people with learning disabilities were provided with opportunities that invite flow, then growth and happiness might result. The first step is to identify where, when, how often and under what conditions flow occurs. Dykens invites positive psychologists to work together with researchers and practitioners in learning disabilities in order to evaluate the happiness and well-being of people with learning disabilities, who are often excluded from mainstream studies. Dykens suggests that such collaboration might lead to valuable research findings related to positive emotions, engagements, strengths and virtues. 

Dykens identified that, regardless of their aetiology, positive emotions, flow and strengths exist in people with learning disabilities and suggested the need to develop novel tools to explore the self-perspectives of people with learning disabilities on their own happiness. Dykens asks questions relating to the 'meaningful life', positive psychology's path to happiness for people with learning disabilities. 

Dykens challenges positive psychologists and Learning Disability researchers to explore what combination of intellect, heart, soul, and strength are necessary to leading a meaningful life and to evaluate the happiness and well-being of people with learning disabilities. Dykens suggests that such collaboration might lead to valuable research findings related to positive emotions, engagements, strengths and virtues.

In conclusion, a review of the above literature suggests that positive psychology can offer a number of valuable insights and questions that could usefully be explored in relation to Intensive Interaction, most especially the concept of flow and the emphasis on strengths.

By Jana B. Sandford, MSc, volunteer at the Intensive Interaction project, Leeds.

References:

Csikszentmihalyi, M. & Csikszentmihalyi, I., (1988). Optimal experience. Psychological studies of flow in consciousness. Cambridge: CUP.

Csikszentmihalyi, M. (1996). Creativity. Flow and the psychology of discovery and invention. New York: HarperCollins Publishers.

Dykens, E. (2006). 'Toward a Positive Psychology of Mental Retardation'. American Journal of Orthopsychiatry. 76, (2), 185-193.

Firth, G., Berry, R. & Irvine, C. (2010). Understanding Intensive Interaction. London: Jessica Kingsley Publishers.

Harding, C. & Berry, R. (2009). 'Intensive interaction as a psychological therapy'. Psychologist. 22, (9), 758-759.

Seligman, M. (2002), Authentic happiness. New York: Free Press.

Seligman, M., Steen, T. A., Park, N. & Peterson, Ch. (2005). 'Positive Psychology progress'. American Psychologist. 60, (5), 410-421.

 NATIONAL INSTITUTE FOR HEALTH RESEARCH (NIHR)

The National Institute for Health Research (NIHR) is calling for applications to conduct a research study into the clinical effectiveness, cost-effectiveness and broader impact of Intensive Interaction, 'in order to ensure that children and young people with PMLD receive a communication intervention that is based on a robust evidence base'. I have copied the details of the proposed research below:

(From: https://www.nihr.ac.uk/documents/20130-intensive-interaction-for-children-and-young-people-with-profound-and-multiple-learning-disabilities/26001)

20/130 Intensive Interaction for children and young people with profound and multiple learning disabilities

Introduction

The aim of the HTA Programme is to ensure that high quality research information on the clinical effectiveness, cost-effectiveness and broader impact of healthcare treatments and tests are produced in the most efficient way for those who plan, provide or receive care from NHS and social care services. The commissioned workstream invites applications in response to calls for research on specific questions which have been identified and prioritised for their importance to the NHS, patients and social care.

Research question

What is the clinical and cost-effectiveness of Intensive Interaction for improving communication in children and young people with profound and multiple learning disabilities? 

1. Intervention: Intensive Interaction plus standard educational and speech and language practice in educational settings and at home. The intervention and its possible components including the role of primary caregivers and families, should be clearly described.  
2. Target group: Children and young people with profound and multiple learning disabilities (PMLD). Exact inclusion criteria to be defined and justified by applicants. Applications are encouraged which include recruitment from geographic populations with high disease burden which have been historically underserved by research activity in this field.
3. Setting: Community.
4. Comparator: Standard educational and speech and language practice in educational settings and at home to be clearly described and defined by applicants. 
5. Study design: A randomised controlled trial with an internal pilot phase to test key trial processes such as recruitment and adherence. Clear stop/go criteria should be provided to inform progression from pilot to full trial. 
6. Important outcomes: Communication skills. Quality of life.
   Other outcomes: Social and emotional engagement; education outcomes; carer outcomes; service user/carer acceptability; challenging behaviour; self-harm; treatment fidelity; adverse effects; social care outcomes; cost effectiveness. Where established Core Outcomes exist, they should be included amongst the list of outcomes unless there is good reason to do otherwise. 
7. Minimum duration of follow-up: One year.
   Longer-term follow up: If appropriate, researchers should consider obtaining consent from participants to allow potential future follow-up through efficient means (such as routine data) as part of a separately funded study.

Rationale

Children and young people with profound and multiple learning disabilities (PMLD) are also likely to have other complex health conditions, a need for high levels of support with most aspects of their everyday lives and great difficulty communicating. Though facing daily challenges, it is without doubt that children and young people with PMLD can lead meaningful and happy lives. Their ability to communicate their feelings, likes, dislikes, wishes and needs to caregivers is an essential part of achieving a good quality of life for them and their families.

Children and young people with PMLD communicate in ways such as facial expressions, vocal sounds and body language. To facilitate their communication, they must be supported by a well-trained communication partner who understands their means of communication and can identify and use effective ways to communicate with them. The inability to communicate successfully can result in children and young people with PMLD exhibiting behaviours such as stereotypy, screaming to express frustration or discomfort, self-injuring or withdrawing from interaction.

Core and Essential Service Standards for Supporting People with PMLD published in 2017, states that staff should be trained in appropriate total communication approaches to maximise expressive and receptive communication for children and young people with PMLD. Although there is a range of communication interventions in use, the evidence base for them is inadequate and there are uncertainties about their clinical and cost effectiveness.

In 2014 the James Lind Alliance Childhood Disability Research Priority Setting Partnership identified uncertainties about the timing and intensity of speech and language therapy as one of its top priorities. Further work including an NIHR funded scoping study of current practice and perceived research needs, identified the need for speech and language therapies to be evaluated: Intensive Interaction was identified as the priority intervention for evaluation.

Intensive Interaction uses pre-verbal communication techniques to build a relationship between the person with PMLD and their communication partner. There are measures which are specifically designed for use with people with limited communication such as the Communication Complexity Scale.

Therefore, the HTA programme is now interested in commissioning research into the clinical and cost effectiveness of Intensive Interaction in order to ensure that children and young people with PMLD receive a communication intervention that is based on a robust evidence base. Consideration should be given throughout to how the intervention will be rolled out.

Applications should be co-produced, demonstrating an equal partnership with service commissioners, providers and service users (or their advocates) in order to provide evidence and actionable findings of immediate utility to decision-makers and service users. Applicants may wish to consult the NIHR INVOLVE guidance on co-producing research.

Additional commissioning brief background information

A background document is available that provides further information to support applicants for this call. It is intended to summarise what prompted the call and the existing evidence base, including relevant work from the HTA and wider NIHR research portfolio. It was researched and written on the basis of information from a search of relevant sources and databases, and in consultation with a number of experts in the field. If you would like a copy please email htaresearchers@nihr.ac.uk.

Making an application

If you wish to submit a Stage 1 application for this call, the online application form can be found on the Funding opportunities page. To select this call, use the filters on the right of the screen or search using the call name and/or number.

Your application must be submitted on-line no later than 1pm on the 31st March 2021. Applications will be considered by the HTA Funding Committee at its meeting in May 2021.

Guidance notes and supporting information for HTA Programme applications are available by clicking the links.

IMPORTANT: Shortlisted Stage 1 applicants will be given eight weeks to submit a Stage 2 application. The Stage 2 application will be considered at the Funding Committee in September 2021.

Applications received electronically after 1300 hours on the due date will not be considered.

For commissioned topics, the Programme strongly discourages the practice of the same co-applicant joining more than one competing team. There may be unusual circumstances where the same person could be included on more than on application eg a lead from a named charity or a unique national expert in a condition.

For such exceptions (i) each application needs to state the case as to why the same person is included (ii) the shared co-applicant should not divulge application details between teams and (iii) both teams should acknowledge in their application that they are aware that one of their co-applicants is part of a competing application and that study details have not been shared.

Should you have any queries please contact us by email: htacommissioning@nihr.ac.uk

 Looking to the future with (a bit of) optimism - at last! 

With the recent news that two separate but similar COVID-19 vaccines (Pfizer/BioNTech & then Moderna) have early Phase 3 (the final 'trial' phase) results indicating efficacy rates of around or above 90% ... well, I have found myself feeling a bit, but just a bit, more optimistic these last few days (despite now having to self-isolate myself for 14 days with my mum who has just tested positive herself!).

But, and I do feel that there is a bit but coming, I worry that we in our Intensive Interaction community have a massive job in front of us - not just to crack on from where we left off, but initially to gain back our undoubtedly lost 'social and emotional' ground, and fully reconnect with those important people and services around us. I also feel that we will have to contend with some very necessary (in infection control terms) caution in fully returning to all our Intensive Interaction practices, 'pure and simple', in all circumstances. 

Some particular aspects of our Intensive Interaction practice may need to be more gradually reintroduced for some people - both practitioners and recipients alike (and I am not assigning roles within those two categories; sometimes I have felt that I am the recipient of some Intensive Interactions, sometimes the practitioner!). It may be that it will take some of us (practitioners and recipients alike, as above), some time to reclaim our natural, confident and intuitive style of engagement whenever PPE and social distancing are deigned to be unnecessary - and that won't be any time soon, especially so for our more vulnerable people. 

Aspects of skin-to-skin contact, or very close proximity, or say, using breath rhythms on someone's cheek, spring to mind as aspects of practice that may still be some way off in some care and educational contexts. Also, some people may have now got used to us being less hands-on, seeing us in some version of PPE, sensing our increased social distancing (Hands, Face, Space!), and so may need time to gradually readjust to less strict infection control procedures; as may we as practitioners. 

It may also be that in the short/medium term the financial resources available to us may become tighter, both in public and private domains; some money may be redirected to physical health and recuperation issues, not social or emotional aspects of care. It may even be that in some services some roles may not be restored post furlough, and some services may take this opportunity [sic] to radically restructure. In many respects, the future looks uncertain; the 'new normal' may not be a mirror image of the old one - especially so at first.

But however daunting it might seem currently, when we can we need to get our Intensive Interaction fully back out there. The sight of vulnerable loved ones being parted by the virus has been truly heart-breaking, and I feel that there is therefore a societal yearning to reconnect socially and emotionally with all those important to us. 

During this pandemic it has been clearly evident that never before have so many people across society (even our now Covid-accustomed Prime Minister) had to acknowledge how vitally important positive, intensive, social interactivity really, profoundly, absolutely is ... for health as well as for the sake of love and happiness! It has been taken for granted for too long (although not by us). 

But when we do get the chance to fully get back out there, we will need to be understanding about some people's (and some service's) reluctance to move quickly in getting back to some kind of 'normal', new or otherwise; but it is essential that we do so, for so many people's sake. 

 A new Intensive Interaction research paper has just been published by the British Journal of Learning Disabilities. Below I have presented the abstract of the paper; the full version is now available as an 'early view' on-line version at https://doi.org/10.1111/bld.12355

A qualitative study of the practice‐related decision‐making of Intensive Interaction Practitioners

 by Graham Firth, Megan Glyde and Gemma Denby

British Journal of Learning Disabilities First published: 06 November 2020

 

https://doi.org/10.1111/bld.12355

Abstract

Background

This study looked to investigate the sometimes conscious and sometimes intuitive decision‐making processes of Intensive Interaction practitioners. More specifically, this study set out to develop a rich description of how practitioners make judgements when developing a dynamic repertoire of Intensive Interaction strategies with people with severe or profound learning difficulties and/or autism, how this decision‐making process is enacted in practice and what issues inform such decisions.

Materials and Methods

This research followed a “Template Analysis” qualitative methodology, informed by semi‐structured interviews with 13 experienced Intensive Interaction Practitioners (who had completed the Intensive Interaction Coordinators course as administered by the Intensive Interaction Institute). The participants included the following: speech and language therapists, parents, teachers, residential care staff and managers, and a clinical psychologist.

Results

The findings of this study indicate why and how certain decisions are made by experienced practitioners before, during and after engagement in Intensive Interaction. Such decision‐making is indicated as sometimes being intuitive in nature, sometimes more conscious, sometimes moving between the two cognitive states as differing issues arise.

Practitioner decision‐making was focused on a number of issues, including specific learning or care “agendas”; practitioner confidence and knowledge; environmental considerations; individual learner characteristics and behaviour; learner attention, “attunement” and arousal levels; building a shared “repertoire”; and issues of available time.

Conclusions

The issue of how novice Intensive Interaction practitioners may best be supported to more quickly and confidently develop improved Intensive Interaction practices is discussed, proposing the development of a cyclical process of experiential learning and supported reflection.