Intensive Interaction: is it ‘different paths, but with same goal’ or ‘the same path, but with different goals’ 

I was recently reading an online piece about my beloved football team 'Uddersfield Town. The obviously very clever (and/or very pretentious) sports journalist quite surprisingly quoted the renowned German philosopher Friedrich Nietzsche. He did this in respect of the different ways of playing football that the very successful 'Uddersfield Town manager had used with his team (be patient, this blog will eventually get around to Intensive Interaction at some point). 

Remember - after a few years in the footballing wilderness 'Uddersfield Town are now on a journey to the upper-reaches of the the English Premier League (and have recently beaten Manchester United - a team followed mainly by fans who journey from outside Manchester!)

Anyway,  the quote he used was this:

‘Many are stubborn in pursuit of the path they have chosen, few in pursuit of the goal’

All well and good, I hear you ask, but what has this to do with Intensive Interaction?

Well, I recently got a copy of a book on using Intensive Interaction strategies with people with late stage dementia. This book, called 'Adaptive Interaction and Dementia' by Dr Maggie Ellis and Prof. Arlene Astell, sets out their case on 'how to communicate without speech' with people with late stage dementia by referencing strategies set out by both Hewett & Nind, and Phoebe Caldwell in their respective books on the approach. 

In chapter 3 of this book, 'I Hear You Now - Collaborative Communication', Ellis & Astell set out what they see as contrasting conceptualisations of Intensive Interaction, and the person with whom the approach is used. In referencing the works of Hewett & Nind they say that 'some practitioners consider the focus of II to be on teaching the 'pre-speech fundamentals of communication'' and identify 'the communication-impaired partner [as] the learner'. They contrast this view of of II with that of Caldwell, which posits 'the caregiver or professional as the learner, attempting to 'learn the language' of their partner'. Interesting views I'm sure you'll agree.

Where do I stand on this: well I see the merits of both positions. With any collaborative  social endeavour learning goes on on both sides - but, I think, possible so at different points in the II intervention. Initially I see a 'social inclusion aspect' of an intervention where the practitioner learns how to adapt to the communication impaired partner's preferred and available means of social expression. But then I hypothesise a developmental process subsequent to successful social inclusion* - and I don't discount this even potentially for people with late stage dementia. 

However I don't see any developmental aspect for people with late stage dementia as necessarily being reliant on any retention, via short term episodic memory, of recent engagements with II (which may effectively be absent for some people with late stage dementia). However I do see there being the potential that repeated practising, and therefore neural accessing, of previously retained understandings of 'pre-speech fundamentals of communication' through II, could have a cumulative effect of improved access to those social understandings and associated social functioning.

I think this because of a paper Intensive Interaction: to build fulfilling relationships, by Charly Harris  & Emma Wolverson (Journal of Dementia Care, 2014), which pointed to some small but noticeable cumulative  improvements in the duration and ease of initiation of social engagement, over time, for some people with late stage dementia when using Intensive Interaction (although admittedly from a  small scale study).

This brought to mind another philosophical quote that I have liberally used myself over recent years, this time by Plato (who's being pretentious now, eh!) who apparently said that 'The greater part of instruction is being reminded of things we already know'! - Teaching being mainly about building upon the current knowledge base i.e. in II building on the current but potentially latent social skills and understandings that a person already has, and which are not being used to the maximum potential.

So, perhaps the two potential paths of II are not actually separate then, perhaps they are just temporal stages on the same path, and after successful social inclusion it is a journey that we go on, and learn on, together. Surely it is the pursuit of the universal goal of improved social engagement and connectedness (over both the short and longer term) that is the thing that we should be most stubborn in pursuing!

(p.s. I think that philosophy must be the new 'rock & roll' - even non-pretentious, cheeky-chappy, cockney comedian Micky Flanagan quoted existentialist philosopher Kierkegaard on Desert Island Discs last week - so its not just me!)

(*see: Firth, G. (2008) ‘A Dual Aspect Process Model of Intensive Interaction’, British Journal of Learning Disabilities, 37(1), p.45-49.)

Looking under the bonnet of Intensive Interaction - thinking about the mechanics of social interactivity

Quite often recently I have found myself referring to the central contention of a paper by Philip Schweigert (communication consultant/instructional lead at the New Mexico School for the Blind and Visually Impaired). This paper, 'Understanding the importance of the Partner in Communication Development for Individuals with Sensory and Multiple Disabilities' was published in the journal Perspectives on Augmentative and Alternative Communication (2012, Vol. 21, 167-173).

In this paper Schweigert points us very simply (which is why I like it) to the four requirements for successful communication: 

1. a 'means of expression' to communicate with (for us IIers that's via the Fundamentals of Communication)

2. a sender of a communication (well yes, obviously)

3. a receiver of that communication (no s*** Sherlock!)

but then, most interestingly of all (I think) ... 

4. a 'topic' i.e. something of mutual interest to communicate about ... so now "hhhmm" I am thinking: what is our topic when engaging with someone with Intensive Interaction?  

This on the surface looks like a variation on the Means - Reasons - Opportunities model (Money, D. 2002) that is already very useful and widespread across learning disability communication training. But the more specific 'topic' aspect of Schweigert's paper is the part that I find most attractive: 

‘The topic is something to communicate about… experiences help the child formulate interests. They provide motivation and topics for interaction. It is important to remember that the experiences we are describing here do not initially develop in social isolation.'

So, when we are joining in with someone's activity, sociably reflecting back aspects of their behaviour or vocalisations, using touch and other fundamental communication channels, what is the topic of such a conversation?  

Well I suppose the topic is the person themselves and our shared experiences (current and past) with them ... we are talking to, and with them, about them, and about our interest in them, and our interest in the things they are currently doing. Surely for most of us, 'we' and our experiences are the main thing we generally like to talk about. We like to engage in a process of sociable (but generally functionally useless) chit-chat: and we like to do this a lot, especially with those around us who are genuinely interested in us and our well-being.  

So if Intensive Interaction is the 'means of expression' it can also form the basis of the 'topic' as well ... two aspects in one, because it is the 'how' of how we are communicating, and it is the content (or topic) based on our 'in the moment' shared experiences, with these being a reflection of the person and their current (often pre-symbolic) behavioural repertoire. 

I also think that this can be in stark contrast to the situation where our people can so often be talked about ... not to or with ... but by other people, between other people.

Interestingly, also taking a more overtly developmental perspective, Schweigert states that: 

‘Before we can talk about symbolic communication for children with multiple and sensory disabilities, we must consider their presymbolic foundation and specifically their communicative intent. In order for such learners to develop an understanding of communication and their ability to influence others through their own behaviour, they must demonstrate a means of expression that others can detect and respond to. Means of expression must encompass not just the symbolic forms, but also the presymbolic forms. Behaviours such as a slight turn of the head, orientation of the body, change in respiration, or opening/closing of the eyes that are more subtle and difficult to detect also must be considered’.

I'm not sure if he knows it, but that looks a lot like Intensive Interaction!

x

'Developing best practice: developing best practitioners'

As I had repeatedly and shamelessly flagged up over the last few weeks, last Thursday we held our 13th annual UK Intensive Interaction Conference here in Leeds. I'd like to think that it lived up to it's reputation as a 'relaxed, friendly, meaningful' (Hewett, D. 2017) gathering of like-minded Intensive Interaction practitioners and advocates.

The focus of this year's conference was 'Intensive Interaction: Developing best practice: developing best practitioners' - which was a stroke of luck, as that was the title we'd given it on the flyer! I would just like to thank the chair and the speakers for their considerable efforts on what turned out to be a brilliant day. 

Thanks therefore to: Amandine Mourière (Chair and II Institute Associate), Cath Brockie (LD residential service owner), Ben Smith (specialist behaviour team leader), Lucy Golder and Julia Barnes (teachers), and Lynnette Menzies (Speech & Language Therapist).

Dave Hewett kindly remarked that: 'The expertise on display from the presenters was well, more than impressive, particularly since, apart from Graham, they were conference first-timers or with little experience on the podium. Praise them please, they uphold the finest traditions of what it is to be an Intensive interaction practitioner' - high praise indeed: it doesn't come much better than that!. 

If you would like to see a short illustration of the quality of their presentations, then go to: https://www.facebook.com/dave.hewett.71/videos/10154856997401123/ 

Here, I will give just a brief summation of the concluding point of my own presentation. It was my strong contention that to develop Intensive Interaction best practices and best practitioners:

We need to understand the value of structured and shared reflection in learning:

'learning from experience' should really mean ‘learning from reflection on experience’.

Without a clear process to support reflection on our Intensive Interaction experiences, we are unlikely to develop our Intensive Interaction practices, both individually and collectively, to their full potential. 

But learning from 'reflection on experience' doesn't happen by accident: we need to have, or make available, an on-going process of supportive, dare I say 'nurturing' (there I've said it), feedback to enable regular constructive reflection on our current practices - that's what will make us better at doing what we need to do, and to do it better (if that makes sense!).

p.s. I have also just got my NHS Intensive Interaction webpage back on-line. This is really important to me as my old one was cited in the UK Department of Health strategy document: 'Valuing People Now: a new three-year strategy for people with learning disabilities’. It was cited as one of only 2 places to go to get further information on the approach. (Mind you, you only get to the Intensive Interaction bit once you'd laboured past 7 voluminous pages of introductions, with glossy 'in my Sunday best' photos of 2 secretaries of state, 6 government ministers and a National LD Director!). Anyway, my new NHS 'branding & style format compliant' webpage can now be accessed at:

https://www.leedsandyorkpft.nhs.uk/advice-support/intensive-interaction/ ... why not take a look.