'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.

 'One amongst many' = a 'Community of Practice'?

In my last blog I talked about how proud I felt to be 'one amongst so many' during our International Intensive Interaction Week 2017 i.e. being a part of our growing world wide community of Intensive Interaction practitioners*. Indeed this very Blog has now been accessed from 29 different countries, the latest being someone in Cape Verde, which if I'm being honest I had to locate via Google-Maps (its a small group of islands in the mid-Atlantic), so thank you for that! 

Anyway, in this statement I deliberately alluded to the concept of a 'Community of Practice' (sometimes 'CoP' for short), and did so because I think that such a 'CoP' is manifest across those of us who use or advocate for Intensive Interaction (albeit a defuse 'CoP' community i.e. spread widely by role, discipline and geography).

To put some theoretical flesh on this description, a ‘Community of Practice’ was an educational concept developed by academics Jean Lave and Etienne Wenger who defined a ‘Community of Practice’ as a self-defining, but open and supportive group of people ‘who share a concern, a set of problems, or a passion about a topic, and who deepen their understanding and knowledge of this area by interacting on an on-going basis’ (Wenger, 1998). 

Such a ‘Community of Practice’ should have three distinct and defining aspects: ‘mutual engagement’, ‘joint enterprise’ and ‘shared repertoire’ (Wenger, 1998: 72–3):

1. Mutual engagement: through participation in the ‘CoP’, individual members build relationships that bind the group together as a social entity.
2. Joint enterprise: through a process of continuous discussion and clarification, members of the ‘CoP’ build a shared understanding of the issue(s) that bind them together.
3. Shared repertoire: in the pursuit of their joint enterprise members of the ‘CoP’ collectively develop a set of shared practices or ways of working.

Lave & Wenger actually made the claim that such a 'CoP' grouping was 'an intrinsic condition for the existence of knowledge’ i.e. it was in such dynamic social learning groups that knowledge and understanding in particular disciplines is actually advanced. 

Within the Intensive Interaction 'CoP' we tend to feel that new or novice Intensive Interaction practitioners are best nurtured [or even actively mentored], and their skills and understanding of the approach developed, with the help and support of other more experienced Intensive Interaction practitioners (the 'old-timers'); and I think that this fits well with the general understanding of the theoretical 'CoP' concept. 

The way a ‘Community of Practice’ works is in marked contrast with more hierarchical ways that people (and organisations) have often chosen to share certain skills and knowledge (or not share them) in a top down and sometimes potentially non-inclusive manner.

Therefore to conclude: an Intensive Interaction ‘Community of Practice’ should deliberately set out to have certain defining features*, these being that:

• We are a group of people who share a common interest in the practices and theory of Intensive Interaction.
• We work together in a mutually encouraging and supportive manner in pursuit of our common interest e.g. the dissemination of good quality Intensive Interaction.
• We continuously look to collectively develop our shared skills and knowledge.
• We are collectively accessible to help ‘novice' practitioners develop their Intensive Interaction skills and understanding at whatever pace, and to whatever extent as individually appropriate. 

(*see the 'Intensive Interaction Users' Facebook group at https://www.facebook.com/groups/13657123715 for the evidence about how wide spread the Intensive Interaction community has now become). 

(**adapted from Firth, G. in 'The Intensive Interaction Handbook', Hewett et al, 2011, p.143)

   

What an 'II Week' its been so far ... after just one day!

I have waited until near the end of  the first official day of 'International II Week 2017' before doing my weekly blog - and I must say that I waited with a bit of baited breath (I think it was a bit baited) to see how well things were doing  ... and as usual I have been mightily impressed and delighted to see just how much stuff has already been posted on Facebook about what is going on around the world (e.g. in Greece, Russia, Finland (well done Dave!), Wolverhampton). Even just saying 'around the world' sends a shiver down my spine.

Anyway, there has been so much social media traffic so far on Intensive Interaction that I don't want to add anything that might deflect from from the combined efforts of our international and ever growing Intensive Interaction 'Community of Practice': indeed this blog has actually been viewed in 26 different countries, the latest being East Timor - so thanks for that!

There is just one thing that I would like to add - and that is just how proud it makes me to be 'one amongst so many' of our world wide community of Intensive Interaction practitioners and advocates. Our combined efforts and dedication are surely the most important resource we all have.

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.

What's in a title? but at least I am still 'not a psychologist'

Today has been D-Day at my work: the start of a our new Community LD Service structure kicked in and 'went live' going forward: 

• I have got my new work's smartphone - so that I can be online at all times, even if working remotely.
• I have got a new office phone number, as well as new address, as well as my new smartphone number, as well as my old proper mobile number.
• I have had my working title changed to 'Intensive Interaction Highly Specialist Practitioner' and am no longer a 'Project Leader' anymore, presumably as we as a trust no longer see the Intensive Interaction work here in terms of a general project ... so after 14 years I will have to work hard to get my head around the idea of it and me being something else with a new putative identity.
• I have, for the fist time, used my 'Outlook' calendar to tell myself what I am supposed to be doing (today - retrospectively, collecting my new phone, and then filling in my Outlook calendar, and then properly moving in to my new office space, and then doing this Blog to increase my digital footprint). 
• I have properly moved in to my new office space - more or less: downsizing 14 years of accumulated stuff hasn't been easy, physically, cognitively or emotionally - but perhaps de-cluttering is a necessary, and maybe even useful thing to do at various times in our lives.
• I have used the new toilet near my new office - it didn't feel right somehow: its not just me is it, but this is a big psychological security issue!.
• My 'Outlook' calendar is now set up (at least for this week) so that all my managers can see what I am supposed to be doing.
• My new income generation targets have been activated ... Q1 & Q2 figures soon to be required, Q3 & Q4 then to be estimated and operationalized.
• I have used a new cup for my coffee/tea - again it didn't feel right somehow: but eventually this was yet another psychological security issue bravely confronted and overcome - I have now brought my 'I am not a psychologist' mug successfully into play (a recent-ish present from Secret Santa! What could he have meant by that?).
• I have manged to get through the day mainly with a smile on my face, and did so with the kind support of my most trusted and supportive colleagues.
• I have firmly resolved to come back to work tomorrow to do it all over again (well some other stuff actually), to try to help people with severe or profound communication or social impairments gain the clear psycho-social benefits from positive and affirming social interaction i.e. having access to Intensive Interaction (highly specialised or not).

I realise that this is not a particularly profound blog, so sorry for that, but sometimes the seemingly simple and mundane stuff is what really effects us the most: especially when the locus of control is somewhere external...

Cheers, Graham. 

‘The Myth of the Hero-Innovator ...'

Trying to be 'the' person who, by going on some training and then cascading some new knowledge across a team, can push radical change forward is difficult ... and in larger organisations it can be nigh on impossible. An interesting piece* on such organisational level change states:

‘This then is the myth of the hero-innovator: the idea that you can produce, by training, a knight in shining armour who, loins girded with new technology and beliefs, will assault his organisational fortress and institute changes both in himself and others at a stroke.  Such a view is ingenuous. The fact of the matter is that organisations such as schools and hospitals will, like dragons, eat hero-innovators for breakfast.’ (Georgiades & Phillimorep 1975, p.315)

This 'hero-innovator' idea is based on the false belief that because organisations are made up of individuals, we can change them just by changing those individual members. What we should also do is look at developing the positive (or at least productive) relationships, and the host or working culture that we share with our colleagues, and do so in a way that is supportive of the underlying social network that enables us all to collectively be at our most productive.

Georgiades & Phillimore offer 6 guidelines that can give change (lets say the successful and sustainable adoption of Intensive Interaction) its best chance. These 6 guidelines are:

1: ‘The manager of the change effort should work with the forces within the organisation which are supportive of change and improvement rather than working against those which are defensive and resistant to change’ [remember the 'laggards' and 'antagonists' - initially try to work around them, at least for a while!]. 

2: ‘Try to develop what has been called a ‘critical mass’ in each change project. The manager of change should aim to produce a self-sustaining team of workers which is self-motivated and powered from within’. 

3: ‘Whenever possible, the manager of change should work with the organisationally ‘healthy’ parts of the system which have the will and the resources to improve… [and] avoid being seduced or pressured into working with or for parts of the system which might be regarded as lost causes‘. 

4: ‘The manager of the change team should try to work with individuals and groups who have as much freedom and discretion in managing their own operations and resources as possible’. 

5: ‘The manager should try to obtain appropriate and realistic levels of involvement by key personnel in the hospital or school system’ [i.e. upwardly delegating some work to senior staff] . 

6: ‘Arrangements should be made for most of the team to work in small groups or pairs for mutual learning and support. People should not be expected to work alone ... until they are quite experienced’. 

So if you are the person that is being given the role of the Intensive Interaction hero/change agent i.e. the person responsible for changing the care or educational practices of a team, a class, a service or even the whole organisation, perhaps these guidelines can be of some help in building a positive and supportive 'critical mass' of like-minded colleagues ... they certainly have been a help to me. 

*Georgiades, N. & Phillimore, L. (1975) ‘The Myth of the Hero-Innovator and Alternative Strategies for Organisational Change’, in Kiernan & Woodford (Eds.) Behaviour Modification with the Severely Retarded, Associate Scientific Publishers, Amsterdam.

Change: getting on ... and getting on together

Change: getting on together... and getting on together

Not wanting to overly ring dry the issue of change, and how it effects us all in different ways, but having been present in a couple of recent change related meetings that seemed generally fraught and at times openly antagonistic, I thought it might be useful to look a bit more at the effects change (sometimes unwanted, at least initially) has on us all.

It left me thinking about two issues:

Firstly, I thought about how people who face the prospects of what might for them be unwanted change will often feel insecure and anxious about it's prospect. 

I then went on to think about the well established, although admittedly simplistic model of the 'Hierarchy of Psychological Needs' by Abraham Maslow, who has been labelled as the grandfather of positive psychology (I have a copy of the original 1943 paper, and although it is now often rightly criticised in more academic psychology circles, to me it still seems pertinent and keenly insightful - I often see these psychology states at play in myself!). 

This tiered model of psychological need places the creation of psychological security just one step above the fulfilment of basic physiologic need (i.e. feeling safe is what we as humans will prioritise after gaining access to air, water, food, etc). This means, according to this model, that we can't generally move on to developing positive relationships with others (the next stage up) if we currently feel threatened or highly anxious i.e. when we are more likely to be in the 'fight or flight' state of mind. In these situations we tend to become defensive, both of ourselves as individuals, and often of our current roles or ways of being. 

The second issue I thought about was how stress (a cumulative, unconscious process) and anxiety/worry (a conscious, issue focused process) reduces our cognitive processing performance and efficiency. According to a theoretical model outlined in a paper on 'Anxiety and Cognitive Performance' by Eysenck et al (2007) ... 'Worry has two effects. One effect involves cognitive interference by pre-empting the processing and temporary storage capacity of working memory.' 

The second effect of this negative emotional state is on executive function i.e. it impairs our decision making processes. To me this seems highly plausible: why, because I think that it clearly describes the effects I tend to feel myself when stressed - I can't think as quickly or as clearly as usual, my access to my working memory seems to be impaired, and I struggle to effectively decide what to do! 

So what of these observations: well I suppose they lead me to think that during my now not inconsiderable working life, my best work has always been done when I have felt part of a collaborative effort i.e. working as part of, or from within, a supportive and socially cohesive team. Doing what can be at times stressful and emotionally demanding work is made easier, and over the longer term more emotionally manageable, when I have felt that I have had the general support of the other team members - or a least a feeling that they understood me, and appreciated what I was trying to achieve (even if the didn't always agree with what I did, or the way I did it). 

So in my experience spending time on developing effective working relationships has paid dividends in increased individual and collective productive capacity - so we need to 'get on' (socially) to 'get on' (productively), although there is admittedly something of a 'virtuous circle' effect in these two things.

But finally, the cognitive/emotional issues I have noted above i.e. that stress and anxiety/worry can seriously inhibit cognitive performance, memory access and executive function (well it does for me) - I think that these same issues are very often at play when working to support people with a communication and/or social impairment. I often think about how people's cognitive impairment is likely to be significantly exacerbated by conditions of high stress/anxiety, a state not unusual in many of the people I work with who have severe or profound intellectual disabilities and/or autism. 

So how then do we help them? One way would be to be positively socially responsive to them in non-anxiety causing ways ... and how might we do that I hear you ask ... well, most probably through a sensitive process of socially validating, and positive rapport building, Intensive Interaction!