Dave Hewett is appointed an OBE for 'services to people with special educational needs and disabilities'.

Dave Hewett is appointed an OBE for 'services to people with special educational needs and disabilities' in the UK New Year's Honours List (see BBC News website article below).

Dr Dave Hewett is one of the originators  of Intensive Interaction (alongside Professor Melanie Nind). He initially published on the approach as far back as 1988, and has spent most of his working life developing, defining and tirelessly disseminating this approach extensively across learning disability and special education services. 

Indeed Dave continues to this day, despite declining health, to be the main driving force behind the broadening influence of Intensive Interaction in helping people with learning disabilities and/or autism, irrespective of age, degree of impairment and learning or living environment, to have access to genuinely 'meaningful two-way communication' (Valuing People Now, DoH, 2009). He has more recently promoted its use for those suffering from later stage dementia.

Dr Hewett’s publications and presentations, including his many articles, chapters, books, training resources and DVDs (many collaboratively undertaken) have had a enormous impact on the development and implementation of Intensive Interaction. 

Intensive Interaction is now an approach that is used by an extensive range of individuals and professionals including families and carers, teachers, nurses, speech and language therapists, occupational therapists, clinical psychologists and many residential and other care establishments or services. Indeed it is an increasingly important feature of the graduate and post-graduate curricula for many of these professional groups.

Intensive Interaction is now seen to have a wide breath of utility and is used to improve social communication outcomes for adults and children with learning disabilities, autism, acquired brain injury, late stage dementia and, indeed, any individual whose diagnosis involves a social or communication impairment. However, it is important to bear in mind that the people who truly understand the power of Intensive Interaction are those many people who have had personal experience of it, such as families, carers and, of course, service users themselves.

In summation, without Dr Hewett’s tireless and continued endeavours to define, develop and continuously promote Intensive Interaction over the last 30 years, many people would not now have a chance to enjoy and benefit from the positive, affirming, nurturing and socially inclusive engagements that this single approach has made possible.

Directly and indirectly the work of Dr Hewett has had an extraordinarily positive effect on the quality of life of many thousands of individuals with social and communication impairments, and subsequently also their families and carers. I can think of no one more deserving of such an honour.

An NHS 'Observation' policy without mentioning how to interact? ... in 2019? Surely not!

I was recently sent a copy of a newly ratified (in July 2019) NHS policy on 'Procedures for Observation and Engagement' for staff of a NHS mental health and learning disability trust 'in all acute units, inpatient settings and residential areas where service users may be observed by staff'. This policy states that: 'Observation and engagement is a skilled clinical intervention' and that 'Effective observation is underpinned by continuous attempts to engage the service user therapeutically'.

All well and good I hear (imagine) you saying, but below I will list the number of mentions in this 'observation' (which gets 138 mentions!) and 'engagement' (which manages a paltry 19 mentions) policy of the possible 'Fundamentals of Communication' through which any 'engagement' could be developed for service users with communication or social impairments (e.g. because of a learning disability, autism or mental health condition):

So, for 'Interaction' = 0 mentions - so how about, in alphabetical order:

'Attunement' and/or 'tuning in' = 0 mentions 

'Enjoyment' and/or 'pleasure' = 0 mentions  

'Eye contact' = 0 mentions  (although having someone in 'eyesight' = 14 mentions!)

'Facial Expression' and/or 'Smiling' = 0 mentions 
'Joining in with' and/or 'mirroring' and/or 'echoing' = 0 mentions 

'Joint focus' = 0 mentions 

'Sequencing' (as in 'sequencing' communicative actions) = 0 mentions   

'Touch' or 'physical contact' = 0 mentions   

'Turn taking' = 0 mentions.  

Well then, how about 'rapport': well, that got 1 mention as 'therapeutic rapport', as opposed to normal, run-of-the-mill, sociable rapport. 

So how about 'sociable' and/or 'social' ... you're probably there before me = 0 for both!

Even the use of words like 'conversation' and/or 'talking' (i.e. for those who could use symbolic language to develop and sustain some sort of conversational exchange or engagement), for both (oh no, here we go again) = 0 mentions. 

However, 'Activity' does get 6 mentions in a half-page section called 'ENGAGEMENT' where 'Consideration should be given to the use of activity, discussion and distraction techniques ...'. Hardly much there in terms of any useful detail, I'm sure you'll agree.

Now obviously this is a necessary and important area of 'policy' if we want to create therapeutic 'engagement' (remember = 19 mentions) during periods of care requiring some level of service user 'observation' (=  138 mentions). However, to me this 31 page policy is woefully unbalanced in terms of not sufficiently pointing staff to proactive (= 0 mentions) social engagement, and lacking in any useful procedural guidance on how staff should use their 'fundamental communication' skills to enact some form of therapeutic engagement with service users with communication or social impairments. This made me think: 

a) it evidences a particular therapeutic (no, actually overly medicalised) NHS mindset that sees engagement as a specialised professional skill set not naturally available to all staff through the sensitive use of their 'Fundamentals of Communication' (either intuitively, or via some method of training or mentored support) 

b) it is such a missed opportunity to set out how to achieve more sociable 'engagement' and genuine 'rapport' with some of our service users who struggle to use language for sociable or therapeutic engagement (if the two can be truly separated) ... or due to the level of their impairments, have no access to the sociable use of language.

Now, I am in no way calling out any of the genuinely dedicated NHS staff who developed this policy (it is probably just a development of a previous one) ... but to me it evidences a de-personalising institutional perspective that can at times skew how we see (or 'observe' = 138 mentions!) and provided engagement for some of our most challenging service users. 

However, I am not utterly downcast by this. It is my experience generally (and more specifically in the adoption of Intensive Interaction by the brilliant staff on our learning disability inpatient units) that policy tends to follow positive develops in practice, and not the other way around (although often too slowly for my liking). Things are changing, and it is the staff who work directly on the units that are driving this change forward - and hopefully future iterations of this policy will acknowledge and then follow the successful adoption of the more proactive social engagement strategies of Intensive Interaction.

p.s. Wishing you a merry and interactive Xmas and New Year!

Intensive Interaction emotional development and emotional well-being: by Melanie Nind

For my blog this week I am again summarising a chapter from the book 'Intensive Interaction Theoretical Perspectives' (Ed: Hewett, D. 2011) that I have been rereading recently. This time it is the chapter by Professor Melanie Nind: 

Intensive Interaction, emotional development and emotional well-being 

In this chapter Melanie Nind (now Professor of Education and Director of the Centre for Research in Inclusion at Southampton University) sets out a perspective on Intensive Interaction being concurrently both educational and therapeutic in nature, addressing the important and interrelated issues of emotional well-being and development. 

Initially Melanie relates a little history, pointing to the fact that their students’ emotional well-being was not one of the issues they were thinking about when Intensive Interaction was first developed. However, she then goes on to point out the recent emergence of the concepts of ‘emotional intelligence’ and ‘emotional literacy’, and states that emotions are ‘a crucial and integral component of self development’, and are seen ‘to emerge in the interactions between children and their social surrounds’. She also states that ‘emotions are embedded in the interactive space’ and this explains ‘how intertwined the emotional, social and communicative essentially are’, and therefore Intensive Interaction ‘unconsciously yet actively fosters emotional development’.

Melanie points us to 'theories of emotional development in infancy', referencing Dr Suzanne Zeedyk who argues that ‘intense emotional engagement between mothers and infants is regarded as the best foundation for later development’. She then goes on to draw on studies in developmental psychology, including Dynamic Systems Theory, which doesn’t define emotions as ‘discrete states’ but sees them as dynamic ‘coherent emotion patterns that support infant’s meaningful relationships with others’.

According to Garvey & Fogel (2008) emotions emerge through communication and ‘help punctuate the dynamic flow of communication by opening (or closing) opportunities for individuals to experience themselves in relation to others’, hopefully in ‘a mutually enjoyable and satisfactory experience’ (i.e. via Intensive Interaction). Therefore, through being active agents in interactions, both parties can reciprocally foster ‘a sense of connection with and differentiation from others’, thus building an emotional repertoire. 

Melanie then points to a social-biofeedback model (Gergely & Watson, 1999) which sees infants becoming aware of their emotional dispositions through ‘social mirroring’ i.e. contingent reflections of their own emotions by caregivers ‘modulating the infants affective states before the infant develops mechanisms to do so’. Melanie points to Zeedyk again who, when considering the Intensive Interaction strategy of contingent imitative responding as a powerful means of creating emotional intimacy, states that ‘imitation provides the closest correspondence between self and others!’. She then goes on to discuss the role of touch, which Montagu (1986, 1995) identifies as ‘fundamental to health, well-being and cognitive development’; touch having ‘a deep emotional and psychological significance’ and is ‘a primary means for providing comfort and for communicating empathy’. 

Melanie also looks at 'Attachment Theory' (Bowlby, 1969), stating that the attachment experiences of an individual are 'hypothesised to impact on the individual’s later relationships’, as individuals build ‘internal working models’ of their primary relationships (and how to regulate their associated internal states), with good attachment states creating a ‘relational place of safety’. She then relates how Intensive Interaction has helped parents feel ‘newly connected to their children’, and also advises a ‘team approach’ to prevent potential attachments that, if broken, might cause ‘isolation and hurt’. 

Melanie sets out a holistic view of promoting emotional well-being, so that instead of looking at ‘individual problems’ it is better to look at ‘environments’ and ‘positive capacities’ rather than ‘problems and deficits’. The building of an Intensive Interaction ‘culture’ is seen as being particularly effective where a community can ‘foster productive, pleasant relationships, teamwork [and] mutual responsibility...’. Indeed, she identifies Intensive Interaction as helping create ‘emotionally healthy environments’.

Finally, Melanie argues that Intensive Interaction has a clear place among the other more traditionally identified 'therapeutic approaches' (and therefore it is not solely educational), and also argues (correctly in my view) against those who take a position in which teaching/learning and emotional well-being are seen as separate or discrete issues.

It is well worth a read!

Using Intensive Interaction with learners or service users who present with some level of ‘engagement and/or task avoidance’

My Blog this week is admittedly quite long - but please stick with it as I think it addresses a vitally important but little discussed issue. Here goes:

The 2019 Intensive Interaction Weekend Workshop discussed using Intensive Interaction with learners or service users who presented with some level of engagement or task avoidance*. We collectively as participants thought that we saw a range of children or adults who fitted somewhere along ‘a broad spectrum of engagement or task avoidance’ with such generalised ‘avoidance’ often differing in its form and severity 

(*We purposively did not base our discussions on considerations of the apparent or claimed symptomology or diagnostic processes (or even legitimacy) of the condition known as Pathological Demand Avoidance (PDA), as we felt this would channel and constrain our thinking away from considerations of some of our own learners or service users, who we all felt did fit somewhere along ‘a broad spectrum of engagement or task avoidance’).

We asked ourselves the following questions: 

1. How might any such ‘engagement and/or task avoidance’ be presented?

2. Why might any such ‘engagement and/or task avoidance’ occur?

3. What factors might perpetuate someone’s ‘engagement and/or task avoidance’?

4. How might Intensive Interaction help ameliorate the impact of ‘engagement and/or task avoidance’ for such learners or service users?

The results collated from all the participants in the workshop activity:

1. How might a person’s engagement or task avoidance be presented?

• Having a ‘Melt-down’ e.g. shouting, crying, throwing things, jumping on tables, causing environmental damage, etc.

• Engaging in self-injurious behaviour e.g. hand biting, head slapping, etc.

• Becoming violent e.g. punching, kicking, etc.

• Engaging in inappropriate social behaviour e.g. swearing, abusing others, laughing (at unfunny things), grounding, masturbation, stripping, etc.

• Verbally declining (“no thanks”) or refusing (“No!”) tasks that the person has the ability to do, or has even historically liked doing.

• Ignoring or not responding to requests or the presentation of an activity.

• Closing down a conversation e.g. “its okay luv”, “Not just now” or giving apologies before not doing something.

• Steering a conversation or creating a distraction away from, any given demand.

• Hiding offers of activities e.g. destroying letters, leaflets or invites etc.

• Physically pushing things or people away, out of their immediate space.

• Physical isolation e.g. staying in bed, staying in room, not going out, etc.

• Physical withdrawal e.g. leaving the room, turning their back, etc.

• Social withdrawal i.e. retreating to an ‘inner world’ e.g. shutting eyes, avoiding eye contact, self-soothing.

• Regulating aural and/or visual input e.g. looking away, putting fingers in ears, etc.

• Incongruent verbal and/or non-verbal behaviour i.e. saying something verbally but doing the opposite behaviourally.

• Switching sleep patterns to avoid engagement or contact with others e.g. sleeping during the day, being up at night.

• Using prolonged engagement with technology (or other rigidly focused object orientations or activities) as a shield from external demands.

• Using rigid routines to control the level of potential demand in any given situation.

• Responding negatively to everyday requests (not just potentially novel or potentially ‘challenging’ things); even failing to choose between some offered positive choices.

• Responding negatively to positive comments or praise from others.

2. Why might someone be (or become) engagement or task avoidant?

• Chronic anxiety, including social anxiety and/or prolonged exposure to stress.

• A fear of the unknown, and a wish to avoid uncertainty; a fear of failure, of getting something wrong; a fear of being judged by, or of disappointing others.

• Needing to control a situation (possibly in response to some change or as a means of protection from something) and/or being unwilling to be controlled by others.

• A lack of understanding about what is being asked, leading to anxiety about their ability to complete the given demand.

• Previous or continuing negative experiences leading to trauma.

• A historic lack of positive interactions or feedback in any previous engagements.

• Low confidence or self-esteem and/or a negative self-view or self-worth.

• A lack of the necessary social skills to engage with others.

• A ‘power’ issue, seeking power over those around who historically or currently hold power over the person.

• Due to the onset of puberty and the resultant changes in hormonal levels and/or the menstrual cycle.

• Being in pain or having other medical or health related issues e.g. musculoskeletal, of the bowels, etc.

• Being in a constant state of exhaustion through maintaining a physical posture.

• Being on psychoactive or other medication (e.g. tranquillisers, anti-epileptics), thus reducing cognitive functioning.

• The result of some form of sensory processing disorder or other sensory issue.

• Not being cognitively, emotionally or physiologically ‘ready’ in some way.

• As a means of gaining and holding prolonged attention (even if that is negative attention) from others.

• Boredom with or not being interested in the potential ‘demand’ i.e. not being genuinely demand avoidant.

• Neurodevelopmental issues (incl. P.D.A. diagnosis).

3. What other factors might perpetuate someone’s engagement and/or task avoidance?

• The demands being made are too often too complex or unfamiliar or unpleasant or uninteresting.

• A continued lack of trust in others e.g. due to previous ‘false promises’ e.g. “it’s gonna be okay”.

• A confusing lack of consistency experienced across previous engagements with others.

• Continued experiences of simply not being listened to by others.

• A physical or cognitive deterioration in the person.

• Too much language used, too little processing time.

• Both the person and their carers getting stuck in a negative cycle of perceived and expected failure.

• There being a hierarchical power issue i.e. a battle for control between the person and their carers/staff.

• The use of over-enthusiastic and/or non-genuine initiations or invitations to join in with an engagement.

• Some response from third party reinforcing the behaviour.

• Not addressing a need to alter a current sensory environment.

4. Strategies used within an Intensive Interaction intervention to ameliorate the impact of a person’s engagement or task avoidant avoidance:

• Pausing a lot, and for longer; allowing the person extra processing time.

• Being indirect with requests or invitations e.g. “Bet I can get my coat on before you” will be better than “put your coat on” … or “I’m going now”.

• Being careful when using language e.g. at times more, at times less; using comments and/or statements instead of questions or requests e.g. “you can join me if you want” or “I don’t know where this goes”.

• Sometimes providing reassurance e.g. “we’re all ok”.

• Consider reducing the volume of vocalisations: try whispering!

• Providing ‘failure free’ (i.e. unstructured) tasks or activities, led by the person.

• By staff initiating an activity and allowing the person to just observe, before they then choose to join in (if they want to).

• Reducing the availability of eye contact, if this adds to a perceived level of demand.

• Creating some kind of ‘joint activity’ out of less obvious ‘joint activity’ situations when led by the person.

• Do things alongside or in parallel, but actually not with the person (and sometimes at a distance).

• Presenting the person with ‘Unconditional Positive Regard’ (UPR) irrespective of any level of engagement.

• Being taskless; just seeking ways of equitably ‘being with’ the person.

• Making any necessary adjustments to the sensory or social environment (possibly to tone it down?).

• Being thoughtful about too much, or too little proximity i.e. not being too far away/too close in.

• Being open-minded and genuine, whilst persevering and demonstrating empathy.

• Looking to match the mood and presentation of the person in the current situation… let the person lead.

• Knowing when to stop (i.e. when they’ve had enough), whilst also trying to wind down when things are still going well i.e. ending on a positive.

• When stuck seeking help and/or peer support e.g. by using video analysis for constructive feedback and new ideas.

• Re-labelling ‘avoidance’ to something like ‘engagement and/or task avoidance’ (as in this document) so that we do not get confused with the approaches used with those whose avoidance is diagnosed as ‘Pathological’.

Finally, some potential outcomes of the use of Intensive Interaction with people with engagement and/or task avoidance:

• Improved social engagement with staff or carers.

• Improved relationship development.

• Improved psychological well-being e.g. in mood and self-esteem.

• Improved staff rapport and morale.

• Improved emotional well-being.

• Improved access to educationally enabling activities and engagements, increasing the potential for all future educational and social outcomes.

• Greater independence for the individual.

• A generally improved quality of life!

Intensive Interaction: Bringing the laggards on board!

My Blog this week is based on notes taken at our recent Leeds Intensive Interaction Regional Support Group meeting which had the title of: 'Intensive Interaction: Bringing the laggards on board!'. Below is what we came up with:

In order to better understand why Intensive Interaction isn’t used with all potential beneficiaries, in all circumstances, by all staff or carers, at our meeting we discussed the kinds of arguments or issues that potentially might be felt or voiced by individual staff or carers, and which might then make them less likely to do Intensive Interaction.

Below are our collated thoughts on these potential Intensive Interaction restraining issues:

• Some staff or carers who might appear disinterested or unenthusiastic towards a change that includes more Intensive Interaction practice (labelled here as ‘Laggards’) are often focused on, or reacting to, or constrained by multiple other distracting systematic issues and pressures. 

• Some staff or carers may feel a need to look busy, and to fill any silences, driven either by their own need to be ‘doing something’, or wishing to be seen to be ‘doing something’ by others; making pausing, waiting, or ‘being with’ someone feel inappropriate or time inefficient. 

• Staff or carers may feel a sense of embarrassment, or may feel uncomfortable when out of their normal ‘comfort zone’. Some new members of staff might also be hesitant and/or worried about making a fool of themselves in front of other, more established staff (or managers). 

• Staff or carers may feel they don’t have enough time, and therefore Intensive Interaction may be seen as ‘another thing’ to do, on top of the other more observable tasks they have to carry out. 

• Staff or carers may not have enough training to be sufficiently confident in their own Intensive Interaction practices. Also many staff are not paid for any ‘outside working hours’ training, restricting access to training and suggesting a lack of importance in training some staff. 

• Without sufficient training (or mentoring) in Intensive Interaction, some staff or carers simply cannot pick up the ‘Fundamentals of Communication’ social cues coming from their person. 

• Some staff or carers intuitively view the caring role as essentially task-orientated, and such care is therefore not really social in nature; Intensive Interaction is therefore potentially judged on the basis of: tangible ‘jobs to be done’ vs. intangible ‘being with’ or even ‘messing around’. 

• Staff or carers may assume that the person they are working with is not capable of socially engaging through Intensive Interaction (i.e. having too low an expectation of the person): or conversely assuming that they should talk to the person they are with, even if that person doesn’t use symbolic language expressively (i.e. having too high an expectation of the person). 

• There being a wide range in the ‘level of need’ presented within a classroom or service location, subsequently Intensive Interaction never becoming a mainstream ‘norm’ for staff or carers to practice in their given care or working context. 

• For some staff or carers working with older children or adults it may personally feel uncomfortable (or even potentially disrespectful) to engage with their people in such a responsive, developmentally pertinent Intensive Interaction way. 

• There may be ‘mixed messages’ coming from an organisations own training or policy, or even service level values i.e. structured and SMART target teaching and routines vs. unstructured Intensive Interaction engagement, etc. e.g. if Intensive Interaction is timetabled within the organisation, it then stops when it is not within the timetabled times. 

• Staff or carers may not be easily conversant with the particular Intensive Interaction language used by others to explain the approach i.e. using words like ‘phatic’ rather than ‘being social’. 

• There being too much ‘defensive’ organisational emphasis placed on ‘Safeguarding’ (including issues of physical contact or potential sexualised behaviour), this then becoming a perceived barrier to engagement for some staff or carers i.e. the general management tone is defensively risk averse and therefore ‘service centred’ rather than ‘client-centred’. 

• Some staff or carers might not be able to recognise incremental ‘progress’ made by the person they support, and therefore may not see the vital need to continue with Intensive Interaction. 

• Staff or carers may be unaware of the positive overlaps between what they would class as ‘work’ and what they would class as ‘play’, and holding some non-Intensive Interaction supporting assumptions about the differences (and overlaps) between them. Indeed, some staff or carers may not actually know how to ‘play’ (in an unstructured way) with other people i.e. they themselves might lack the skills and knowledge of social play ‘rules’, this leading them to focus on some kind of structured, end-point defined ‘activity’. 

• Some staff or carers may have quite rigid professional or hierarchical boundaries as to what a job entails, and whose responsibility it is to carry it out e.g. Intensive Interaction.

After collating all the reasons listed above for staff or carers not wanting to do Intensive Interaction, we then discussed what support processes, or pieces of nurturing advice could be made to counter such individually held, non-Intensive Interaction friendly points of view?

• We should recognise that ‘laggards’ are usually not just lazy or uncaring people, but instead we should think that current circumstances may be conspiring to make it unlikely that they will enthusiastically embrace Intensive Interaction.

• We should adapt our language when introducing Intensive Interaction to a new audience, taking account of and using the staff or carers’ current working language (with English not always being a first or home language), whilst also reducing the level of Intensive Interaction ‘jargon’.

• Intensive Interaction training at various levels (from complete ‘novice’ training to that focused on more advanced practitioner’s reflective practice) needs to be prioritised in the service … and staff should be paid to attend if it is outside of their normal working hours.

• We should present Intensive Interaction as something that can be done opportunistically whilst doing other tasks i.e. it doesn’t need to be in a ‘session’, and you don’t need extra time to do it. Indeed, we could create video examples of ‘doing Intensive Interaction whilst doing other routine daily activities’ e.g. care tasks, to counteract a seemingly implied message in current Intensive Interaction DVDs that Intensive interaction is only properly done sessional, in 1:1, with experts.

• Senior staff and/or experienced practitioners should purposively model Intensive Interaction in visible areas, and therefore lead by example and legitimise its practice for all to see e.g. doing Intensive Interaction in the foyer, in the corridor, in the classroom, etc.

• We should look to nurture and build the confidence of reluctant or novice practitioners; on all possible occasions we should point out and celebrate positive Intensive Interaction moments with all staff and service users, but especially so the less confident ones! Also don’t scare them off; don’t add to their workload at the start (maybe introduce recording sheets and video later).

• We should explain the benefits of reduced challenging behaviour when Intensive Interaction is used proactively with some people - rather than staff relying on reactive strategies that are often overly (and sometimes inappropriately) used.

• We should not just assume a common or shared cultural understanding amongst everyone of the positive nature of all aspects of Intensive Interaction practices e.g. parents and/or carers may hold culturally divergent views on physical contact, gender roles, etc.

• We could initially ask some staff and carers to do a different job that better matches their (non-Intensive Interaction) skill set e.g. videoing sessions or updating the Intensive Interaction noticeboard, and for some staff and carers doing this in the long term (until they leave!).

• Finally, be proactively positive: tell them – “You can do it!”

'Interactive approaches to teaching and learning' by Dr Penny Lacy

 Interactive approaches to teaching and learning 

For my blog this week (which are becoming much more infrequent I know, sorry about that) I am summarising a chapter by the late and sadly missed Dr Penny Lacy from the book:

'Intensive Interaction Theoretical Perspectives' (2011) edited by Dave Hewett, Sage Publications, London. 

There is some belting stuff in it!

According to Penny ‘Interactive approaches to teaching and learning ... developed in the UK in response to the prevailing dominance of behavioural approaches in the 1980’s’. She notes the concern prevalent at the time that skills were being taught that did not lead to an understanding of ‘when, where and how to use those skills’, and the skills could only be reproduced ‘in that one [classroom] context’. 

She then goes on to cover some of the history of the development of ‘interactive approaches’ and how difficulties arose due to the adoption of the National Curriculum and the prevailing ‘target driven agenda’. Lacey identifies interactive approaches as influenced by ‘the processes of education rather than by the products’, and such approaches encouraged teachers to consider the importance of ‘intrinsic rather than extrinsic rewards’.

Penny states that: ‘Interactive approaches have their routes in cognitive psychology and a desire to understand the development of such processes as thinking, perceiving, reasoning, judging, problem-solving as well as the development of communication and language’. Within interactive approaches children are viewed ‘as being active in their own learning’ and this active engagement ‘lifts learners from ‘learned responses’ to ‘intelligent behaviours’’.

Interactive approaches also support learners in ‘taking control of their own learning’ allowing learners to ‘gradually understand that their actions are the causes of the effects they can see, hear and feel’. She also points out that in the early stages, ‘3 components of learning appear to be important ... exploration, imitation and repetition’ and these are ‘all part of active learning and enable young children to become increasingly autonomous’.

Penny then looks at some theoretical views of learning and language acquisition, initially pointing the reader to Piaget’s theories of the child ‘developing ideas and concepts through trial and error’. She also points to the work of Vygotsky (he of the Zone of Proximal Development or ZPD) who viewed ‘learning and development to be mutually dependent and interactive’, and that ‘learning needs to be organised and structured by teachers to provide an environment within which children can derive the most benefit’ ... ‘children need an environment ... that is interactive, where people around them talk to them, listen to them and generally encourage all attempts at communication’.

Penny also goes on to look at learning through play (for young children) and how adults need to ‘enhance’ the learning of children without ‘taking over’ i.e. they need to ‘take the lead from the child, rather than being didactic’. However, she acknowledges this kind of active exploration and learning can be very difficult for children with profound and multiple learning difficulties (PMLD), who may also have multi-sensory impairments (MSI), and severe physical and motor impairments, and thus, in such circumstances adults, ‘may need to take a much more leading role’.

She also points out that for children with PMLD ‘progress is likely to be extremely slow’ and they need ‘... a huge amount of repetition’ for learning to accrue. She then advocates the use of the ‘Routes for Learning’ assessment tool (Welsh Assembly Government, 2006) which provides 43 different behaviours (for communication and cognition development) that can be assessed and suggests strategies for moving children on to each behaviour. 

Finally, Penny points us to Alexander (2006) who defines ‘what makes universal good teaching’, i.e. that teaching is:  well organised and planned; reflective; is based on sound subject knowledge; depends on effective classroom management; requires an understanding of children’s developmental needs; uses exciting and varied approaches; inspires; encourages children to become autonomous learners; facilitates children’s learning; stimulates children’s creativity and imagination.

A qualitative study of the practice related decision making of Intensive Interaction Practitioners

'A qualitative study of the practice related decision making of Intensive Interaction Practitioners' 

by Graham Firth, Megan Glyde & Gemma Denby 
(with thanks also to Emily McGall and Cheryl Campbell)

The aim of this qualitative study was to investigate the sometimes conscious and sometimes ‘intuitive’ or unconscious decision making processes of Intensive Interaction practitioners. Through interviewing 13 experienced practitioners (all qualified Intensive Interaction Coordinators), this study set out to shed some useful light on how practitioners make judgements when developing 'a dynamic interactive repertoire' with an individual with severe or profound learning difficulties and/or autism.

The main conclusions drawn from this study (hugely paraphrased for brevity!):

The study found that practitioners co-constructed 'a mutually recognised interactive repertoire' with the people then engaged through Intensive Interaction, but also that 'their understanding and consequent enactment of their own practices' evolved through a cycle of:

1. Some pre-engagement considerations: focusing on aspects of the practitioners’ learning or care ‘agenda’ and expectations, possibly with some proactive environmental preparation (including any required changes to the social or physical environment).

2. Some ‘trial and error’ experiential learning: during each engagement (including at the initiation and disengagement phases), this often being based on the practitioner’s ‘in the moment’ decision making (often intuitively but at times consciously considered) that elects to follow or offer particular variations on any established interactive repertoire. Such ‘in the moment’ decisions being concurrently reflected on ‘in action’ by the practitioner in the light of the person’s perceived feedback responses to their interactive offer, either positively so, or otherwise.

3. Some post-engagement conscious reflection: conducted either individually or collaboratively, sometimes involving informal or more structured reflective processes, and focused on either individual practice or developing a greater understanding of broader and thus more general Intensive Interaction principles, or both.

To cut a quite long (but very interesting) story short for this blog, we go on to conclude that:

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

‘Anybody only gets that [improved Intensive Interaction practice] through reflection and looking at the videos and chatting about it with your staff; nobody’s an expert, we all need each other’s eyes to support each other’ (Practitioner verbatim text extract: #2, 243-245)

'Services that purport to use Intensive Interaction therefore need to create a supportive and nurturing developmental process within which novice practitioners can learn the skills, principles and knowledge required to practice good quality Intensive Interaction – and they need to do this to effectively and consistently provide the people they care for or support with genuine social inclusion and appropriate developmental opportunities to enhance their social communication and connectedness to maximum degree possible'.

(In some of my following Blogs I will lift various more focused aspects out of the main report to illustrate some more detailed areas of practitioner decision making as it relates to particular issues, or temporal aspects, when using Intensive Interaction).

For a copy of the full (and really very interesting) initial draft report, please email: 

graham.firth@nhs.net