When 'recording' Intensive Interaction engagements, whose attainment are we actually 'recording’?

This Blog follows on from my last two: the first setting out my view on our collective potential to 'unconsciously and unquestioningly project too much confidence into a set of sometimes quite crude numbers' (14/05/18), and the second on the issues I thought important to consider when setting out to 'record' or collect data on the use of Intensive Interaction e.g. the proposed audience, the efficiency, the range of applicability, the scope to capture all levels of developmental progression, etc (21/05/18) .


However, as I was writing these blogs, and generally when I discuss 'recording outcomes' (and services are undoubtedly under ever more pressure to record 'outcomes' of educational and/or therapeutic interventions) I always wonder exactly whose 'outcome' or 'attainment' it actually is that ends up being recorded ... because obviously there are always two communication partners involved in any Intensive Interaction engagement (No s**t Sherlock! as I like to say).

So that poses us a question - are we measuring the individual attainment or social communication outcome of the person we are working with (the learner or service user, or family member) or are we measuring the quality of the Intensive Interaction practice of the practitioner which will support or scaffold the social communication attainment of the person we are working with? ... or more likely, actually almost certainly, some combination of both? 

And if it is some combination of both, how much weight should we give to any perceived individual attainment of the learner, service user or family member, compared to the level or quality of the Intensive Interaction practiced with them? ... interestingly (well, to me anyway) this view also links to my previous blogs of 19/03/18 and 26/03/18 about the level or degree of someone's social impairment being mediated by the good social engagement practices of those supporting them!

This is often where the strong driving force of service/organisational need to record everything as an individual attainment or outcome, often in terms of crude and poorly defined numbers, rubs up badly against any sensible person's more rounded view that all social attainments or outcomes are, and can only ever be, the product of social engagements between more than one individual person.

However, those of us who have the pleasure of working in services (educational, residential, clinical) will be required to input some 'recordings' of some data into some system (increasingly electronic) ... as if it were an individual attainment or outcome. So what do we do ... how do we best play the system to get the genuinely best individual outcome for our people i.e. continuous access to good quality Intensive Interaction? 

That is a difficult question to answer precisely, but I suppose the best way generally is to record attainment and/or outcomes as individual achievements (as required by the system), but to do so secretly knowing that any such 'individual achievement' can only be made real within and through regular Intensive Interaction of the highest quality ... the better we are as practitioners, the better the quality and/or effectiveness of the Intensive Interaction, the better supposed individual attainment or outcome for the individual learner, service user or family member ... I think.

 Some Intensive Interaction 'recording’ issues to think about

Following on from last week's blog which set out my position on the human bias which can 'unconsciously and unquestioningly project too much confidence into a set of sometimes quite crude numbers' (14/05/18), in this blog I thought I might set out what I think is generally important when considering which recording regime (or formats) might most usefully collect information/data on the use of Intensive Interaction.

When considering a recording regime (e.g. a combination of recording formats) to be used during an Intensive Interaction intervention (or just during its general use), I think there isn't a simple 'one size fits all' system. Instead I think that there are various stages of an Intensive Interaction intervention (or its general use) that might require the use of different recording formats.

At the start of an Intensive Interaction intervention a systematic collection of information might be required about what a person does: in what way(s) they behave, what kinds of actual or potentially sociable activity seem to positively motivate them, and in what way(s) they might be socially communicative (either currently or potentially).

As an intervention progresses, the systematic collection of both objective and subjective information might then be required on how sessions are developing, which kinds of interactivity are working well, and which aren’t. Some types of recording might be used to evidence the levels of engagement attained by the person with whom we are interacting, and others formats used to support a reflective analysis on a practitioner’s individual practice. It might also be useful to systematically record any new ‘interactive’ developments that the person evidences.

Additionally, when thinking about which recording formats to use, and when, the following issues might be usefully considered:

     ·   the purposes and potential audiences for any information or data collected should be made clear to those people who are doing the recording. 

     ·   any recording format should be both broadly applicable and efficient i..e. quick, clear and flexible enough to record an interactive episode, or at least some important aspect of an interactive episode, of any participant engaging in Intensive Interaction.

      ·   any recording regime should be able to show a person’s development or progress over time, even if such progress is only incremental and/or inconsistent i.e. it should help build a picture of the person’s interactions over an extended period of time, rather than just giving a one-off and potentially misleading snapshot.

      ·  any recording regime should be able to evidence any new or novel interactive occurrences.

Another (perhaps ulterior) consideration for using a systematic recording regime is that it can provide good evidence of the quality (and quantity) of Intensive Interaction service provision, and thus clearly indicate compliance with a number of specific CQC or Ofsted outcomes (and thus help gain that all important 'Outstanding' rating).

Finally, any recording regime should also ideally include regular video recording, to provide comprehensive and easily accessible evidence of Intensive Interaction attainment and progression, and also help individual practitioners and services use and record Intensive Interaction in the most effective and most consistent ways possible.  

The human bias to numbers? Do we unconsciously make the numbers fit the activity, or the activity fit the numbers?

A recent works e-mail that I had forwarded to me has given me some real (actually metaphorical) food for thought about the credence we perhaps unintentionally give to things that are represented as numbers, or in numbers. There is something about their exact and (apparently) clear nature that seems to imbue numbers with a some sort of robust certainty ... a clarity and concreteness that we all tend to project into or onto them, and their use. 

This is where my thoughts were stirred from their usual slumber (this is sadly degenerating into a series of very mixed metaphors) as the email I received contained numbers representing the clinical ‘Contact Activity' of me and my fellow staff working across our CLDTs. What struck me was the wild variation in this represented ‘activity’, with my count being disappointingly low (I had always suspected that I was either lazy, incompetent, or both; and now I and many of my colleagues have the hard edged quantitative numbers to prove it!). 

But the nub of my thoughts were this: 

Do these numbers reflect something that is actually really real i.e. real in the sense of reflecting something that actually exists in the real/concrete world (the one in which we all live, and not just the subjective world we all inhabit in our own minds) - well yes, to some degree, obviously! 

…but then I asked myself exactly what do these numbers represent or reflect? As with many quantitative recordings or measures ... can we be exactly sure what each of these numbers represent? So I then asked myself these questions: 

a. is exactly the same thing being recorded (e.g. ‘Contact Activity') by multiple recorders in each and every instance i.e. are all the recordings of precisely the same thing? ... and also, 

b. are all the instances of this precise same thing actually recorded? ... and then I asked,

c. are the recordings of these apparently exact same things being interpreted in exactly same way by the outside observers when they read these numbers and individually create their own meaning from them (i.e. that I am lazy and/or incompetent)? ... and then (stick with it, there's a chance it might be interesting), 

d. is this interpretation the same as all the multiple recorders thought the numbers meant? i.e. is what is coming out with these numbers exactly the same as what went in with these numbers? and finally: if so, or if not, how would we know? 

So my question is generally about our superficial acceptance of numbers in many aspects of work and life and what they purport to represent (which to me seems to have all the hallmarks of fitting within some sort of unconscious cognitive bias). I suppose all I am saying is that I think that sometimes numbers can sneak in some unwarranted confidence in their own actuality and meaningfulness (when shared in certain decontextualised ways).

Not that I am against numbers in many fields – they are utterly invaluable when used and reported correctly (as with many robust quantitative research studies - although please remember here that some studies tend to be somewhat reductionist in nature when they end up representing complex issues as just numbers! - they can never tell the whole story).

So, we should always be wary that we might consciously or unconsciously fall prey to our internal bias and unconsciously and unquestioningly project too much confidence into a set of sometimes quite crude numbers - they can at times confuse a picture ... by at best being quite meaningless, but at worst they might actually be misleading (I hope!).

We all have something in common: we all share the aim of enabling positive and affirming human social contact for all the people who need it.

Last week I was lucky enough to be a part of two different Intensive Interaction events - firstly doing some teaching on organisational change on the Intensive Interaction Institute Coordinators course in Great Malvern, and then sharing a weekend in Malham with 22 other Intensive Interaction practitioners focusing on using Intensive Interaction with people with language.

I suppose what I took from these two very different events was how we … and across these two events 'we' were a mixture of teachers, teaching assistants, speech & language therapists, a speech and language technician, an occupational therapist, adult residential staff, adult sessional support staff, a parent, senior leaders, a researcher, a learning disability nurse, an II coordinator/practitioner, and me ... with varying levels of professional qualification and/or none … how we all share a common belief in and passion for creating positive and affirming human social contact for people (adults and children, and now also older adults with dementia) who had a communication or social impairment – whether that be when looking for educational, social or therapeutic outcomes.

But I also took something else; a realisation that Intensive Interaction has certain fundamental qualities about it that mean that, as a social communication approach, it is open for us all to do, at least to some degree, from the most novice practitioners to gnarled old timers like myself.

And I also started to think about some of the things that set Intensive Interaction apart from other approaches used within our respective fields, these being that:

• Intensive Interaction doesn't need a particular qualification for practitioners to start to do it – as can be seen by the range of people on these two events - we come to Intensive Interaction from many different working and/or care contexts; in fact the approach embodies some common humanistic values that we all seem to share - although obviously good quality training and/or supportive mentoring in the rationale and practices of Intensive Interaction is essential for positive practice development. 

• Intensive Interaction doesn't need complex and esoteric (and sometimes methodologically opaque) professional assessments of certain areas of skill (or deficit) or performance (or behaviour) to identify those who should be a recipient of our socially inclusive Intensive Interaction - although obviously the involvement of consulting professionals can always strengthen a case being made for the sustained provision of the approach. 

• Intensive Interaction doesn't need professional gate-keepers i.e. those who might assume authority to say who can and who can't at least try to do Intensive Interaction at some level, to the best of their ability, given that we are all on a journey of our own practice development - although obviously having champions for Intensive Interaction who work to identify and nurture fellow enthusiasts and supporters can be very useful. 

• Intensive Interaction doesn't need the person who receives it to have been given an official and/or professional diagnosis of any particular condition, disorder or syndrome - although having a diagnosis of certain developmental conditions or intellectual disabilities that affect communication and/or sociability will obviously make a case stronger for its provision.

But also I took from my interactions with all the people over this last week a renewed feel for the real power of peer support within an identifiable community of practice, of the positive benefits of inclusively sharing our Intensive Interaction experiences and viewpoints, and of the great value of receiving (and giving) encouraging and constructive feedback to support individual and collective reflection on our Intensive Interaction practices.

Phew - what a week!

So many thanks to Elizabeth, Lena, Gillian, Emily, Eleanor, Tom, Julie, Wendy (twice - that's just being greedy!), the three Jos, Stella, Jayne and Catherine, Anne and Nancy (apparently Victoria is waiting to hear all about it), Nick, Lynnette, Janet and Anne, Charlotte, Sharon (all the way from Cornwall!), Paula, Liz (don’t forget the research summary!) and Rachel, Neal and Frances (great curry!), Claire and Sam – all your contributions to our dynamic, open and expanding Intensive Interaction community of practice were all very welcome.