Evaluating the effects of Intensive Interaction ... hmmm, yet more twaddle musing!

At a recent evaluation meeting I attended, one of my colleagues reminded us all of the potential for basic 'type I and type II errors' that we should always remain wary of. A 'type I error' (for some reason they always seem to use roman numerals for this) comes from the measurement of, and subsequent belief in, an effect that isn't actually present (a false positive): so this means that you end up thinking that what you're doing is working, when it isn't. A 'type II error' is a failure to detect some kind of effect that is actually present (a false negative): so this means that you end up thinking that what you're doing isn't working, when it is. 

All well and good so far - especially if what you are measuring is clear in its nature, relatively easy to observe, and straightforward to quantify. However, these kinds of errors are less easy to take account of if what you are looking to measure is potentially unclear (or multifaceted) in its nature, and far from straightforward to quantify.

This lead me to muse a bit on the potential for these kinds of errors being at play in any evaluation of our Intensive Interactions work: both formally (via some kind of structured recording/evaluation system), and informally (by we ourselves forming subjective judgements on the effects of our practice). 

But, whilst thinking about the evaluation of Intensive Interaction, it is my view that while the practice will be the same (enacted via the Fundamentals of Communication, being 'process central', following 'Nind's 5 central features', etc), the effects of Intensive Interaction may actually lie in  at least 3 different domains, and that is just for the recipient (it also has significant outcomes for the practitioner as well). I have previously used the term 'Dual Aspect Process Model' to describe Intensive Interaction (British Journal of Learning Disabilities, 2009*) to differentiate the outcomes into two domains or aspects:

1. Social Inclusion - this being evidenced in short term improvements in sociability as both recipient and practitioner develop and improve their social engagement (often via the reclaiming of latent social skills and understanding on the part of the recipient).
2. Developmental Progression - evidenced in the longer term acquisition or extension of social skills and understandings as new social experiences are accommodated by the recipient and new learning takes place.

However, I now also think that there is a third potential outcome of Intensive Interaction for some recipients, and this is a 'therapeutic aspect' (Berry et al, 2013*). This paper states that Intensive Interaction can be used to 'establish psychological contact with people who are difficult to reach'. Being in 'psychological contact' with someone is obviously going to be a positive psychological experience, and the lack of that kind of affirming contact is potentially damaging to anyone's psychological well-being. Indeed in the above paper the authors see the potential for '... an evidence-based therapy for people who are unable to access traditional psychotherapies but may be in great need of experiencing psychological contact and connectedness'. 

So, back to where I started - the evaluation of Intensive Interaction therefore becomes potentially problematic in that we need to be clear in which of these 3 domains we wish to measure any outcomes, before we even set out to find suitable systematic methods with which to make those measures, otherwise we may be liable to type II errors - not detecting the positive outcomes we may be facilitating by our use of Intensive Interaction. Finally I have one last thought on this issue of evaluation ... that whilst firmly believing in the rigorous use of robust systematic methods for gathering evidence of the effectiveness of interventions, I always have one profound worry, which is this: 

Do we, across all disciplines and services, knowingly prioritise and therefore more readily  legitimise less plausible interventions (i.e. those that are often more abstracted from the natural model, or somewhat removed from truly person-centred ways of working), simply because these interventions lend themselves more easily to more hard-edged, quantitative methods of evaluation (than say Intensive Interaction)? ... and if we do (which in reality we do do), is that right and proper? 

*Firth, G. (2009) ‘A Dual Aspect Process Model of Intensive Interaction’, British Journal of Learning Disabilities, 37(1), p.45-49.

*Berry, R., Firth, G., Leeming, C. & Sharma, V. (2014) ‘Clinical psychologists’ views of Intensive Interaction as an intervention in learning disability services’, Journal of Clinical Psychology and Psychotherapy, 21 (5), p.403-410.