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!

'Yet more Twaddle from Graham Firth!'  

Enthusiasts, supporters and some quieter ones at the back!

On Tuesday I had the pleasure of co-hosting an Intensive Interaction training day with one of the originators of the approach, Dr Dave Hewett. We were in Birmingham, training the clinical staff from the cities three CLDTs. We were actually at the Birmingham City Football Club - in the City Room, so unfortunately not in the 'Jasper Carrot Suite', which I would have much preferred: was that his real name?

Anyway, the 30+ multidisciplinary staff (a good mixture of SLTs, OTs, psychologists, psychiatrists, LD Nurses, and Crisis Team staff) seemed to receive the day very well (although I should say at this point that I haven't as yet read the official evaluations which might tell a different story). 

Being in Birmingham reminded me of my last time presenting there, at our 2008 UK conference at the local Hippodrome theatre. Despite me thinking that the day had gone well, and the general evaluation feedback being overwhelmingly very positive (as it always is at our conferences), one comment has stuck with me to this very day. It simply said: 'Yet more Twaddle from Graham Firth!' - and it was the 'yet more...' bit that got me most - they must have seen me speak before! 

But that comment (which really does make me laugh now - honestly, I'm well over it !) has always made me think about how powerful the effects of negative feedback can be compared to positive feedback: and how much more positive stuff do all of us generally need to hear about ourselves to arm us against any negative comments. Especially so if those comments resonate with our sense of self (no honestly, I am well over it!) or seem to be at least partially true (okay then, yes, I do know that I can sometimes talk some twaddle - but certainly not about Intensive Interaction!). 

From many of our service users' points of view, imagine the long term effects of generally negative or no responses to their twaddle (or attempts at meaningful expressive communication) if they don't have Intensive Interaction used with them. Imagine how that effects someone's sense of self. Then imagine how many positive responses they may need to their attempts at meaningful expressive communication to counteract that, and over what length of time. That is the essence of our Intensive Interaction work.

Back to this week's training. As I have now got into the habit of doing at such events, I was looking out for those people who I could quickly see were potential or even current 'enthusiasts' and 'supporters' (see previous Blog 14/08/17). This was relatively easy, even as we were setting up and getting sorted for the day we had already started chatting with some of the trainees who got there early. Among this group were several people - like Jo who had been the organiser of the day - who would no doubt be the main instigators of change to more Intensive Interaction ways of working across adult learning disability services in Birmingham (and I'm sure they are already well along that journey now!). 

Then there was a group of people who got more and more engaged in aspects of the discussions as the day progressed - which is a good sign: these I feel will become the supporters. There were also some people who were a bit quieter: perhaps not as comfortable talking in front of others in such an open arena - but still the sense in the room (my sense ... proper evaluations as yet unknown) was that many of the trainees would go on to change their practices, and ultimately the practices of others - and especially so if they worked together, building a local Intensive Interaction 'Community of Practice' (more on this in another Blog) around the initial ground work of those evident enthusiasts and supporters. 

Anyway, I had a great day: and twaddler or not ... 'You Decide'! You can see me speak on Intensive Interaction issues via the wonders of YouTube at:

https://www.youtube.com/watch?v=I8A3AT9NeTE 

https://www.facebook.com/dave.hewett.71/videos/10154399638976123/  

p.s. I am away on holiday next week, so no blogging until the week after.

The First Follower: Leadership Lessons from Dancing Guy 

(with a commentary by Derek Sivers)

Just to follow up on my last couple of Blogs about the roles of individuals in supporting (or not) a particular change process, I thought I would use a video example of how a social movement can take shape in practice. 

The video link below for the 'dancing guy' (first shown to me by Dr Mark Barber in Australia - although that isn't him dancing on the hill) shows how the role of first 'supporters' is the vital phase of making ideas (hopefully good ideas like Intensive Interaction) initially have some traction, and then build increasingly widespread support, before then becoming 'the right thing to do' for the majority.

The link is: https://www.youtube.com/watch?v=fW8amMCVAJQ 

So the lesson is ... well if Intensive Interaction isn't as yet established then put plenty of effort into finding those who will be active supporters (the more passive acquiescers will come along later).

... and if it is to some degree established then you will still need to put some effort into cultivating the members of the Intensive Interaction 'Community of Practice' so that they all continue to positively and productively act together with the same purpose (i..e doing II rather than stupidly dancing on a hill).

cheers,

Graham Firth

(still) Intensive Interaction Project Leader - LYPFT NHS Trust
Director: Intensive Interaction Institute

We all have different attitudes to change: some we like, some we don't like quite as much.

As the title of this Blog suggests I am again thinking about change, and how we can all take different positions in relation to the different types of change we might encounter. Sometimes it might be us who suggests a certain type of change to moves things on, and sometimes we might take up the ideas of others and support them. Sometimes we aren't sure about something until we've seen it in action, and then, if the positives seem to outweigh the negatives, we might accept it and even adopt the change ourselves (perhaps reluctantly). 

However, there are other times, times when we don't really fancy the change: whatever this change is, it didn't come from us, or people like us, and it is going to ask more of us than we are really willing to give - putting us too far outside of our physical, emotional or intellectual comfort zones. Or perhaps we feel that the outcomes of the change won't fit with our desired outcomes or our current values. If so, then we might drag our heels with respect to the change ... we might not 'get on board' with the proposed change 'going forward'. Although often, especially if you are low down in an organisational hierarchy, then probably you will have to change, however reluctantly, and come to some sort of accommodation with the new way of doing things (or leave!).

But there might be occasions when we really can't contemplate the change, or its intended outcomes. Indeed, perhaps we are so against this change that we will actively work against it, and against those who propose this change ... we might even try to challenge or sabotage the change in some way, either overly or behind the scenes, to stop it from happening at all.

But all of this is perfectly normal: indeed, during my time trying to get people and services to adopt Intensive Interaction, I have encountered all the above attitudes towards the adoption of our approach - from unbridled enthusiasm to outright opposition (luckily more the former than the latter - and thankfully the latter is now less and less frequent as we have now put Intensive Interaction into the mainstream).

But when I do encounter people at training events or at our Interactive Cafe sessions (and we had a brilliant session last Thursday!) I now tend to compartmentalise people into a number of categories that were set out in a book on curriculum design and development (Pratt, D. (1980) Curriculum Design and Development. New York: HBJ). In this book the author said that people, when encountering proposed changes to the way they work, tend to fall into 5 categories depending on their responses to it. These categories being:

1. Enthusiasts – those people being the initiators of change.
2. Supporters – those people being easily persuaded by the arguments put forward for the need to change.
3. Acquiescers – those people who follow the line of least resistance, eventually adopting the change in response to a 'critical mass' of supporters.
4. Laggards –  the sceptics, those people who passively resist the proposed change until it becomes unstoppable.
5. Antagonists – those people who actively resist all change attempts.   

It should be remembered that these categories are not general descriptions of people's individual character, but an attempt to be analytic in looking at people's responses to particular types of change (we are not intending to criticise anyone here). Indeed I am a proud Laggard (or Luddite!) in terms of many technology related changes that I think often promise much, and then fail to deliver. I am also a somewhat weak and feeble acquiescer in terms of some of the structural changes now going on in our trust, and more broadly across the NHS.

But, when I am doing work that will change how people view or use Intensive Interactive, I usually try to identify those people most likely to be Intensive Interactive 'enthusiasts' and 'supporters' - as these are the people who will adopt Intensive Interaction most readily and will therefore be vital in starting the process of embedding Intensive Interaction into their workplace or service - I always try to look for the low hanging fruit first!. I think that this is a better way of securing the change we want, rather than initially investing too much of our efforts into trying to get the 'laggards' and 'antagonists' on board - trying to do that too early in a change process will most likely waste both time and energy for very little positive change. 

In my next blog I plan to look at these bottom two groups in a bit more detail in terms of how they might (sometimes legitimately) think about change, and also what we might do when encountering such people.

cheers,
Graham Firth
(still) Intensive Interaction Project Leader - LYPFT NHS Trust

Director: Intensive Interaction Institute

Being 'mainstream' but not yet 'established'

(as you can see I have now decided to add a pithy title to each blog - neat eh!)

On Thursday myself and Julia (one of my long-term SLT colleagues) started our most recent run of our 'Interactive Cafe' sessions at a local learning disability service.

These open access Interactive Cafe sessions (and I think that I have now probably done getting on for 200 over the years - i.e. since our first at the very same service 12 years ago) are probably the most rewarding, and also at the same time the most anxiety causing way of doing Intensive Interaction. Everything depends on who turns up - the various service users and staff, and how they respond to the Intensive Interaction being offered. The general idea for these sessions is that me and Julia (and a number of other experienced Intensive Interaction practitioners who regularly come along to help) practically promote the approach by demonstrating its effectiveness 'in the moment' with service users, some of whom we have never met before (although many of our attendees are repeat attenders!).

In these sessions we want not only the recipients of the II, but also their accompanying staff, to enjoy the open, equitable and nurturing social environment. We also want the accompanying staff, some of whom haven't encountered II before, to see the potential benefits of the approach - so no pressure there then! Actually we ultimately want them to adopt II and thus change (and I would obviously say improve) their social practices with the service users they support. We are therefore trying to capture the interest of those staff who haven't as yet properly encountered II via examples of hopefully good II practice, and do so in a way that will make them see the clear reasons to change their current practices: and we hope this happens because they can hopefully see the bl***ing obvious (to us) i.e. that II is evidently the right way to socially 'be with' people who have a social or communication impairment.

But making change happen across individuals, and ultimately whole organisations, from the bottom up isn't always easy or straight forward! For a start, not everyone can see the  bl***ing obvious in the same way that we do. Perhaps they don't always have the same aims that we do in creating or being a part of 'an open and equitable social environment' with people with severe or profound learning disabilities and/or autism. Perhaps they lack confidence, or perhaps they see behavioural control as being more important than genuine social interactivity.

But anyway, some staff (the natural & often intuitive II supporters) do share our equitable and nurturing 'interactive' aims, and some, to varying degrees don't (well not always straight away). This makes me think that, even though II is now an accepted approach, one that might even be said to be the mainstream approach for developing positive and affirming social engagement with people who have a social or communication impairment, it still isn't established as the default approach: but I do think that day will come! Until then we still have plenty of basic II dissemination work to do to continue to capture the interest, and then help define the social practices, of those new and hopefully supportive staff and carers coming into our services.

As Albert Schweitzer (who?) famously one said: "example isn't the main thing in influencing people: it is the only thing" - Actually Albert Schweitzer was a famous humanitarian and philosopher and, according to Wikipedia, an organist! Oh, and he won a Noble Prize as well!

cheers,
Graham Firth
(still) Intensive Interaction Project Leader - LYPFT NHS Trust
Director: Intensive Interaction Institute