'Delivering Intensive Interaction Across Settings' - edited by Mark Barber & Graham Firth

Edited by Mark Barber and Graham Firth. 

Kindle Edition - £0.99 from Amazon (we tried to make it free, but the computer said "No"- this is the minimum fee allowed)

https://www.amazon.co.uk/dp/B07NRGFS3R/ref=sr_1_5?s=books&ie=UTF8&qid=1550225112&sr=1-5 

'Practitioners of Intensive Interaction, I.I.Coordinators, Heads of Service, Principals and Psychologists from Australia, UK, New Zealand and Denmark describe the practices, strategies and considerations they have used while organising and implementing Intensive Interaction across services'.

We hope that across its 14 insightful chapters this book will help as many Intensive Interaction practitioners as possible, across a range of care and educational settings, provide the best quality Intensive Interaction to all those who might benefit.

By reading about, and learning from, the experiences and reflections of our book's dedicated contributors, we hope that other services and organisations can more confidently apply Intensive Interaction in the most effective ways possible.


The Contents

Introduction and Forward: Mark Barber & Graham Firth

Chapter 1: Mark Barber - Bayside Special Developmental School: The proving ground for Intensive Interaction in Australia.

Chapter 2: Ditte Rose Andersen - Creating a clearing for live activity: exploration, decisions and steps in implementing Intensive Interaction in Denmark.

Chapter 3: Jules McKim and Judith Samuel -Twenty Years of Developing Intensive Interaction in a National Health Service Setting.

Chapter 4: Ric Day - Intensive Interaction in a Special School: The Leadership Challenge.

Chapter 5: Susi Stephenson -The Ongoing Adventures of an Intensive Interaction Coordinator working across a large county preschool specialist education team.

Chapter 6: Janee Williamson -Tensions and Triumphs: Supporting the Implementation of Intensive Interaction within and across schools.

Chapter 7: Kieron Hubrick - Intensive Interaction Implementation and Culture Building in a New Zealand Special School.

Chapter 8: Janet Gurney - “Your singing is crap: and why do you sing anyway?” ... or... “How can we understand each other?”

Chapter 9: Sue Lowry - Implementing Intensive Interaction and the Art of Plate Spinning: Establishing, Building and Maintaining a Robust Intensive Interaction Community of Practice in a Large Special School.

Chapter 10: Sara Moroza-James - At home with Tom: maximising my son’s potential with Intensive Interaction.

Chapter 11: Abigail Everiss - Integrating Intensive Interaction: A Specialist School’s Community and Practices.

Chapter 12: Deb Dowling - Intensive Interaction in a Special School Setting: Eleven years and still developing.

Chapter 13: Louise Golshevsky - Learning, communication, teamwork and respect! We love it at Glenallen!

Chapter 14: Graham Firth - A view on organisational and institutional issues: the theory of change management.

The Interactive Café in Leeds ... some history

This week will see the final regular session of our combined Leeds & York Partnership NHS Trust and Leeds Community Healthcare 'Interactive Cafe' at Bramley Fulfilling Lives Service. To mark this final session, I have copied out a description of our Interactive Cafe from The Intensive Interaction Handbook (2nd Ed, 2018). I would just like to thanks the literally hundreds of service users, staff, parents/family members and volunteers who have supported us, and made these sessions such a truly fantastic and enjoyable aspect of our work.

An ‘Interactive Cafe’ is a pre-planned and yet informal social occasion that is specifically set up to support the use of Intensive Interaction with identified service users or clients. The relaxed cafe atmosphere is created to make everyone feel welcome, no matter how difficult they generally find social interactivity or how profound their intellectual disability.

The basic idea behind the Interactive Cafe was to disseminate the general message of Intensive Interaction, and at the same time, to increase the opportunities for everyone who might benefit from the approach to engage in and enjoy Intensive Interactions.

During each ‘Interactive Cafe’ session experienced Intensive Interaction practitioners are present to facilitate the occasion. These practitioners are available to use Intensive Interaction directly with any visiting service users. These facilitators can also offer advice on implementing Intensive Interaction to any support staff or carers who attend, and answer any other questions concerning the use of the approach.

In this way, the support staff present can see directly what Intensive Interaction might look like with the person they support. This enables the support staff or carers to realise that the skills necessary to ‘do’ Intensive Interaction are not ‘out of the ordinary’ in any way, and that Intensive Interaction is almost certainly well within their current capabilities.

During the ‘Interactive Cafe’ sessions: 

• appropriate ‘easy to read’ Intensive Interaction literature and hand-outs are available 
• Intensive Interaction DVD footage might also be shown on any available television or laptop 
• Intensive Interaction training application forms can also be left out for anyone that might be interested 
• other items made available might include various sensory or resource items that might be useful in creating and supporting joint focus interactions with specific service users 
• drinks and biscuits are usually made available at some point as well. 

As people visit more regularly, everyone gets to know each other, and the cafe can provide a comfortable arena for staff to share their experiences, and possibly their concerns, about the approach with other staff and their service users.

p.s. the ‘Interactive Cafe’ was originally facilitated in Leeds by Graham Firth and sadly missed speech and language therapist Marion Crabbe – the first session being at Potternewton Fulfilling Lives Service in early 2006.

More research into the use of Intensive Interaction with people with late stage dementia

Following on from my last blog focusing on a 'discourse analysis' paper about changing the medicalised narrative that usually defines the process of caring for people with dementia, below I've summarised a 2014 paper about the actual use of Intensive Interaction with people with dementia.

Intensive Interaction: to build fulfilling relationships

Harris, C. & Wolverson, E. (2014) Journal of Dementia Care, 22 (6), 27-30.

In this paper the authors (CH & EW) share their experiences of using Intensive Interaction to support people with late stage of dementia. The authors point out that there is a growing recognition of the importance of reciprocity in dementia care, and that Intensive Interaction could be a means to this end as the approach focuses on social inclusion and emotional connectedness.

This paper reported on some research carried out by author CH with three people with dementia. For each of the participants in the research CH found a sense of relationship development over the week of the study, and also in the following weeks. Two of the participants in particular also showed signs of engagement and social interaction, such as ‘looking at carer’, ‘vocalising’, ‘initiating’, ‘smiling / laughing’, which were more prominent in the Intensive Interaction session than in the standard interaction.

For one participant Mr D (who was bed-bound) Intensive Interaction gave him an opportunity to initiate interactions e.g. moving his hand to his ear as CH sang. Mr D also started to change his vocalisations: outside of the Intensive Interaction sessions he vocalised loudly and constantly, but shortly into the first Intensive Interaction session he began to adapt his vocalisations so that they were gentler, and mirroring of CH’s sound): it felt like the give and take of a true conversation and led to a feeling of profound connection.

Mrs K flinched at touch and was isolated through her constant walking. She allowed CH to join her on her stroll.  During sessions there were shared moments of laughter and game playing as Mrs K showed CH her favoured routes and routines. As the Intensive Interaction sessions progressed Mrs K allowed CH to gently touch her arm, and this eventually developed, much to the shock of observing staff, into twirling each other’s hair. Perhaps most important of all was Mrs K’s husband’s comment that, for the first time in months, she had made eye contact with him.

As the authors themselves acknowledge, this study was small and exploratory, but the results suggest that there is great potential for the use of Intensive Interaction with people with dementia, and indicative of the impact it can have on their relationships and well-being.

This paper also goes to explore some other, Intensive Interaction related issues e.g.:

• As Intensive Interaction can be emotionally and physically demanding, ongoing supervision and support is essential. 

• A culture change in services is need to move away from models of reactive communication towards proactively seeking out ongoing dialogues and building trust.

• 'Personalisation' is key, which means communicating in a way that has meaning for the person.

• Concerns about the use of touch are a common barrier to Intensive Interaction, therefore services need to develop 'person-specific touch guidelines'. 

• Intensive Interaction has the potential to be renewing and transformative for staff.

The authors also note that family caregivers showed a keen interest in Intensive Interaction, with many family caregivers automatically communicating in an Intensive Interaction manner having spent a lifetime tuned-in to their family member or partner, particularly valuing the use of touch.

In conclusion: The authors state that Intensive Interaction can be an approach to improving well-being in dementia. Intensive Interaction is an approach that respects personhood, adds quality to the working lives of staff, and reintroduces the possibility of interactions based on 'fun' and 'understanding'.

Intensive Interaction and discourses of personhood: A focus group study with dementia caregivers:

I was recently alerted to a new 'discourse analysis' research paper about the potential use of Intensive Interaction with people with dementia. The paper looks at the way people think and talk about caring for people with dementia; and how this care falls prey to medicalised ways of thinking, talking and responding. Below I set out a brief overview of the paper. 

Intensive Interaction and discourses of personhood: A focus group study with dementia caregivers:  Heap C. J. & Wolverson, E. (2018) Dementia, online.

According to the authors of this paper, due to ‘the medicalisation of dementia … dehumanising social practices and attitudes are enabled, and reinforced by medical discourses of dementia which have become societal discourse … Within the medical societal discourse, people with dementia are excessively medicated.’ Also, ‘Intensive Interaction assumes that all interaction partners can be meaningfully engaged [and] … can offer an alternative to medicalised discourses (and by proxy, the dehumanising practices enabled by such discourses).’

The Method: Paid staff from 2 residential care homes attended an Intensive Interaction training day, with these caregivers taking part in 2 focus groups, before and after the training. Transcripts of the focus groups were analysed using the method of 'Critical Discourse Analysis', an approach which ‘relates discourse to social power’. The focus group discussion were based on 5 themes identified as missing in medical/societal discourse: ‘personhood’, ‘communication’, ‘embodiment’, ‘reciprocity’ and ‘empathy’.

The Results: Before the Intensive Interaction training carers engaged in ‘medical discourses of loss, non-communication and lack of personhood’. Carers also talked about a lack of resources (time and staff), with job role and hierarchy being important in allowing time (and permission) to interact with residents. “Being with” people with dementia was framed as ‘inactivity’ (‘sitting’, not 'working’) or ‘a luxury, and therefore separate to paid work within ‘an industrial model’.

After training, caregivers engaged in ‘discourses of communication and personhood’. Intensive Interaction reframed “being with” people as a part of ‘doing work’. Staff viewpoints significantly shifted with carers talking about going ‘into the world’ of the person with dementia, and they also thought that ‘Intensive Interaction would improve relationships’. Intensive Interaction was also seen to ‘legitimise and explain existing relational and creative practices’. (For more on 'Being with' - see my Blog of 18/12/17) 

Some Conclusions: According to the authors medical discourses of dementia reinforce ‘a status quo whereby interpersonal interactions are devalued in dementia care, and professional ‘knowledge’ (thereby professional power) is privileged over relationships’. The medical model also frames a person’s problems as being of the ‘individual’. Therefore ‘if distress, loneliness and lack of occupation are framed as an illness, rather than a legitimate response to one’s circumstances, society does not have to change'. 

However, Intensive Interaction may enable caregivers to ‘access person-centred discourses’ (including ‘hopefulness’) and develop practices aimed at improving a person’s quality of life. But without wider systemic change in dementia discourse, Intensive Interaction training will be limited in its effectiveness. The adoption of Intensive Interaction requires ‘support from management, organisational structures, and wider society’.

'Exploring the Envelope of Intensive Interaction' ... yet another free II training resource on YouTube!

'Exploring the Envelope of Intensive Interaction' by Dr Mark Barber & Karryn Bowen (of Intensive Interaction Australia), previously only available on DVD, has now been made freely available via YouTube on the link below.

With a commentary from Mark, this hour long training video contains scenes of Intensive Interaction with a range of learners in Australian special schools. 

'Exploring the Envelope of Intensive Interaction' is divided into a number of chapters which address different Intensive Interaction techniques and issues e.g. echoing, pausing, extending, responses to learner initiated touch, changes of conversational topic, and ‘mutual adjustments’

To watch the video go to: https://www.youtube.com/watch?v=RvxlyiCErMg

Defining an ‘Advanced Intensive Interaction Practitioner’?

According to a recent research paper about the use of Intensive Interaction across day services for adults with profound and multiple learning disabilities in Sheffield by Prof. Judy Clegg et al  'Examining the impact of a city-wide intensive interaction staff training program for adults with profound and multiple learning disability ...*':

‘Structures supporting the use of Intensive Interaction centred on training and the role of the advanced practitioner … [this] role was viewed as vital … The advanced practitioner role was an important factor in maintaining a focus on Intensive Interaction’

This made me think about some previous attempts (mine and others) at defining the essential nature of any such advanced Intensive Interaction practices or practitioners. I then remembered Melanie Nind & Mary Kellet's three defined levels of ‘Interactive style and practice of Intensive Interaction’ as set out in their book Implementing Intensive Interaction in Schools**. From their work I have had a go at using and or adapting/simplifying these levels, and came up with the three levels below:

Emerging Intensive Interaction Practice: when the Intensive Interaction practice is increasingly well-rehearsed, but might often be described as constrained or formulaic.

Established Intensive Interaction Practice: when the Intensive Interaction practice is enacted with increasing confidence, is clearly based on Intensive Interaction principles, and as such is clearly responsive and sensitive in nature.

and then there was ....

Advanced Intensive Interaction Practice: when the Intensive Interaction practice is fluid and highly sensitive, and is informed by reflective thinking within and around a broad range of Intensive Interaction engagements.

So in Leeds we are thinking about how, in more detail, we could say with some certainty that a practitioner had attained the correct level to be such an ‘Advanced Intensive Interaction Practitioner’, and it is my view that the following aspects of ‘Advanced Intensive Interaction practice' should be observable in their practices:

1. Their use of observation is skilful, sensitive and reflective in nature.

2. Their interactive practice is fluid and sensitive, and is informed by the active use of observation and associated reflective thinking within and between interactions.

3. Their physical positioning during practice is adapted as and when necessary based on current or previous reflective observations.

4. The tempo of their interactive practice is well-paced, and is skilfully employed to maximise the participation of the student or service user.

5. The practitioner uses selective imitation and provides appropriate presentations for the student or service user to join in with or reflect back. 

6. The practitioner uses a broad range of vocal intonation and/or articulation (when appropriate) to facilitate the engagement of the student or service user.

7. The practitioner’s interactive routines are varied in content and intensity.

8. The practitioner is able to engage and sustain interactions with the most challenging and socially isolated students or service users.

9. A student or service user’s communications of complex and/or negative, as well as positive, emotions are handled and responded to confidently by the practitioner.

10. The practitioner is reflectively aware of their own interactive practices, their insights being gained through regular non-judgemental self-appraisal and shared feedback, and they can articulate their reflective thinking to others.

Do these 10 criteria sound about right? 

... and if so, I think that we should also ask ourselves how we could set about robustly evidencing (and even certificating) an Intensive Interaction practitioner's attainment of such an 'advanced practice' level; especially as having such 'Advanced Practitioners' across a service is evidenced in peer-reviewed research (by Clegg at al) as being vital in sustaining the provision of good quality Intensive Interaction for the people we care for and support.

*Clegg, J. , Black, R., Smith, A. & Brumfitt, S. (2018) 'Examining the impact of a city-wide intensive interaction staff training program for adults with profound and multiple learning disability: a mixed methods evaluation', Disability and Rehabilitation. pp. 1-10. ISSN 0963-8288.

**Nind, M. & Kellet, M. (2003) Implementing Intensive Interaction in Schools. David Fulton: London.

‘REACHING OUT TO OTHERS’ with Intensive Interaction in 2019.

It occurred to me recently that, over the last 15 years there has clearly developed a strong (albeit geographically diffuse) community of practice around Intensive Interaction, as well as there now being many different (although sometimes overlapping) local and service based communities of Intensive Interaction practitioners. These local, national and increasingly international communities of practice collectively have many members; some members still novice or peripheral (i.e. those at the start of their Intensive Interaction journeys), some others being longstanding and core members of their groups. It has been a real joy to see these self-supporting communities develop over the years.

But in line with the theme we had for our 2018 Intensive Interaction Week i.e. 'Reaching Out to Others’, my mind has started to move ahead into 2019 (not before time!) … and I think we, as a genuinely strong and stable (where have I heard that before!) community need to look with more vigour outside what could be seen as a potentially comfortable and self-referencing ‘echo-chamber’. I think that we need to more actively 'Reach Out' and embrace others, be they individuals, groups, services or even entire disciplines, and get our Intensive Interaction message more and more ‘out there’.

But how should we go about doing this (I hear you ask) ... well I think we need to actively set out to make links with those who might metaphorically and/or literally open the door for us. So rather than us just speaking to each other (which we will still continue to do), we should also be looking to get ourselves invited into other people’s meetings, their various networking events, get-togethers, away-days, conferences, on-line groups, webinars, etc. 

In our Intensive Interaction community we have parents, siblings and other family members, foster carers, teachers, teaching assistants, residential care staff, respite care staff, day service staff, support staff, speech & language therapists, nurses, doctors, occupational therapists, physiotherapists, other therapists (e.g. music and drama), counsellors, clinical and educational psychologists, psychiatrists, social workers, service managers, personal assistants, care managers, directors and trustees, and many more besides. So I think that we should all be making resolutions that 2019 will be the Intensive Interaction year of 'Reaching Out to Others’. Lets get our Intensive Interaction story to be the socially interactive 'cuckoo in the nest’ of all these other groups and professional disciplines who desperately need to hear what we have to say (even if they don't realise that just yet).

So perhaps these might be some useful questions to ask ourselves: 

1. Outside of Intensive Interaction, which other groups am I a member of, or work with? 

2. What kind of training, information or networking events or media do they use? 

3. Who organises these, and how might I contact them? 

4. Can I draft a short presentation proposal about Intensive Interaction? (Yes you can!) 

5. What is stopping me doing this? (Nothing!) 

So, let’s get Intensive Interaction out there ... Let’s all 'Reach Out to Others' in 2019!