Education, Health and Care Plans & Intense Interaction

Recently Dave Hewett posted in the 'Intensive Interaction Users' Facebook page, and he shared a question he had been asked by a mother of a child with autism about whether anybody had experience of getting Intensive Interaction stipulated within an Education, Health and Care Plan (such an Education, Health and Care (EHC) plan being a UK statutory educational plan for children and young people (aged up to 25) who need more support than is available through generic special educational needs support). 

Such EHC plans identify a child's educational, health and social needs, and set out the additional support required to most effectively meet those stipulated needs. Anyway, Dave then asked members of our 'Intensive Interaction users' whether anybody could share any advice on successfully getting Intensive Interaction stipulated within an EHC plan. Below I try to bring these responses into a hopefully helpful single Blog piece:

KW: My team recommend II regularly in child and adult services and is contained in paperwork. EHCPs will also contain II where it has been recommended by the therapist ... with an additional comment of: JV: Yes, we had it agreed by our therapist.

MB: We have it recommended in our twins EHCPs ... we have sessions to be delivered by SLT to our children with their TAs ... and then for the TAs to use II with the boys both generally in their interactions and in some discreet sessions during the week.

KM: I have typed up a form that captures and rates the adult's competency using PAVE (taken from an idea from Phoebe Caldwell).

SC: No reason why it can't be included under the 'Communication and Interaction's part. Fits in perfectly ... with an additional comment of: EF: Also perfect for the ‘social, emotional and mental heath needs’ section.

BE: In ours we have it in the pen portrait, what is needed for them and in the provision and sometimes in the targets! It has never been queried.

JS: We attend the joint assessment meetings where possible to co-write the EHCP, if Intensive Interaction is needed we put it in ...

GPP: For us it would be in the provision and especially in the Pupil Passport which contains short term targets towards the long-term outcomes. We have a list of provision which is ticked if children access it and II is one of these You may find that the outcomes and provision on the actual plan are quite vague.

DT: Have referred to II in Leeds in care plans for young people and adults as a guide for communicational style and emotional engagement. Not putting in place pure II sessions as an educational strategy necessarily but still helpful because it gives a clear context for lots of things we might do or do less or leave undone.

AH: We always add Intensive Interaction either in the social skills or communication skills section. Normally set it within an outcome or within the how outcomes will be achieved section ... with an additional comment of: DL: We do the same as this at our college.

LM: I’ve stipulated it in a recent EHCP I have amended for a young lady I teach. I’ve written it in the communication part and where the detail of how to support her best is.

HP: Make sure I.I. is written into the 'Provision' as this is then legally binding.

JL: I'd say it's in the majority of plans in a range of sections through the plan. It's crucial it's in the provision section in how to achieve outcomes as some LA's will only fund what's named in the outcomes and provisions (section F).

KM:Yes in many plans I have contributed to. We make sure by including an outcome that is dependent on its use. The framework that describes levels from Encounter through to Student Initiates helps a lot ... with an additional comment of: EBC: Yes, in the provision part,section F.

PJR: We have EHCP targets like: ‘... will engage in intensive interaction activities for up to 10 minutes, at least 5 times a day.’ Obviously the length of time and regularity change depending on the needs of the child. But all the pre verbal children in my department have something similar to that.

So the answer seems to be a resounding 'Yes'. You can, and you should get Intensive Interaction into a EHCP, with the more specific advice being: 

• Be the person that is active in writing up the EHC plan with a mind to including Intensive Interaction. Also, try to get it recommended by a Speech & Language Therapist. 

• You can include Intensive Interaction under the 'Communication and Interaction', 'social, emotional and mental heath needs', 'social skills' or 'communication skills' sections of the EHCP. 

• You should also include Intensive Interaction as an outcome, or put it in the 'how outcomes will be achieved' section. 

• You should set Intensive Interaction specific targets like: Child A ... ‘will engage in Intensive Interaction activities for up to 10 minutes, at least 5 times a day’. 

• You should make sure that Intensive Interaction is written into the 'Provision' section of the EHCP, as this is then legally binding, and some Local authorities will only fund what's named in the outcomes and provisions (Section F). 

I hope this helps all those faced with a similar prospect; and it is always a good idea to exploit the key drivers of an organisational system to support the delivery of appropriate provision for individuals within that system - and sharing an understanding of how it has worked in the past can only be a real help for others seeking similar positive outcomes.

Therefore many thanks should go to 'II Users' - Catherine, Jane, Michelle, Karen, Suzi, Eva, Becca, Jenny, Gaynor, David, Aileen, Jennie, Debra, Louise, Hayley, Ellen & Paula for your very helpful contributions.

More 'indirect' evidence in support of Intensive Interaction practices?

Continuing the theme from my recent blog (Using 'Perseverative Interests' ... 02/04/18) about 'indirect' evidence supporting aspects of Intensive Interaction practice, I was recently pointed to an interesting case study (by II Institute Associate Jules McKim) that described the use of 'silent mirroring' in the treatment of Ms M., a 75 year old woman with a diagnosis of chronic paranoid schizophrenia, dementia with agitation, and several medical problems. Below I set out some extracts about the case from the paper:

The Mirror of Silence: A Method of Treating a Preverbal Schizophrenic Patient

Susan R. Blumenson (1993) Modern Psychoanalysis, 18(3), 179-189.

‘During her 3 years in the nursing home Ms M. spent her time in bed or in a wheelchair ... she was minimally verbal and unresponsive ... When spoken to or questioned, Ms. M. would turn away without responding ... She was agitated much of the day – constantly shifting from side to side in the wheelchair crossing and uncrossing her legs, turning her head, placing her hand with outstretched fingers over her face covering her mouth, nose and eyes.’

The 3 months of treatment for Ms M. was described  by the clinician as 'basically silent mirroring of her bodily movements', by the end of which ... ‘Ms. M. had stopped being verbally disruptive and her physical agitation had diminished to a fraction of its original form. She had accepted the presence of the analyst as she sat with her, she had stopped screaming except for rare instances, and she had responded verbally several times to the analyst’.

At the end of the paper the author concluded that: ‘Whatever had happened in Ms. M.’s life had caused her to retreat behind a defense of not talking. Her screams were understood to be a form of communication, presumably of discomfort or displeasure, perhaps a plea for attention. Being minimally verbal seemed to be her attempt at withdrawing from a hostile environment while maintaining a slim thread of verbal contact, at her discretion. She rejected the world as it undoubtedly had rejected her’.

Now, as I said in my last but one post, 'silent mirroring' is not in itself Intensive Interaction, but it is (or was) a therapeutic approach that clearly utilises one of the main practices of Intensive Interaction (behavioural mirroring); it clearly resulted in reduced disruption and agitation, 'to a fraction of its original form', as well as an increase in Ms. M's verbal responsiveness. 

So again I ask,  does this case-study add to the evidence base for Intensive Interaction [which, as noted above incorporates forms of 'mirroring' as one of its central features] ... well, again I would say "yes"; again only indirectly, and again only for this one particular 'mirroring' strategy ... but I think it is still a 'yes'.

Interestingly, in her exploration of 'the literature' that informed her therapeutic intervention the author points us to other evidence that I think indirectly supports aspects of Intensive interaction practice: 

'Spotnitz (1985) … discusses “joining techniques” … especially those reflecting preverbal functioning. The therapist makes interventions which support and even reinforce continuation of the resistance until such time as the patient develops awareness and ego strength to replace it with more adaptive and controlled behaviour'.

'Tiegerman and Primavera (1981) conducted a study of object (toy) manipulation with autistic children. The behaviour characteristics of the children included: mutism or echolalia, looking at or through people, an indifference to physical contact, rocking and head-banging, among others. The experimenters discovered that imitation of the child’s performance by the experimenter was most effective in increasing the frequency and duration of object manipulation in the autistic subjects.  Their data support the premises that the imitation of the child by the adult may be a critical factor in the autistic child’s learning to establish and maintain interaction. Imitation of the child placed her/him in complete control of the environment, the adult and the adult’s performance’.

So, irrespective of age, diagnosis or presentation, there is something going on here that goes to the very heart of how we treat (clinically or generally) other people with communication and/or social impairments. It would appear from a wide range of evidential sources that, if we focus on our common humanity, and treat other people (clinically or generally) in a socially responsive and empathetic manner, we should expect to get better social and therapeutic outcomes! (no s**t Sherlock!)

Care Quality Commission identifies Intensive Interaction as an 'Outstanding' care practice!

The Care Quality Commission (the quasi-governmental body charged with inspecting and regulating the quality of health and social care services here in England) has recently inspected our trust's Specialised Supported Living Service - an NHS managed and staffed residential service here in Leeds for people with severe or profound learning difficulties. In their report findings they stated that:

Is the service effective? Rating = 'Good'!
Since the last inspection, the registered manager had developed champions in areas such as PBS, Makaton, postural management and Intensive Interaction ... A member of staff told us about the training they had received around Intensive Interaction. They said, "I have not only seen our residents benefit from us knowing about this but it has enabled me to be more confident. I feel it has brought me out of my shell. I see that I am part of the communication process and that I need to communicate back to people. This was the best training I have ever done*."  

(*GF- my underlining, not theirs; and there's a box of chocolates waiting in my office for the, as yet unidentified staff member who said that!) 

Is the service caring? Rating = 'Outstanding'!
People and their relatives told us that staff delivered extremely person centred care and support ... Staff had exceptional knowledge about people's preferred communication ... A support manager told us, "To work with the people we work with, with such profound multiple needs, Intensive Interaction is required to build up positive working relationships." The provider had ensured staff had received training in specialised communication such as Intensive Interaction ... The benefits of staff having knowledge and using their skills meant people were able to express themselves, be involved and direct their own care and support.

So congratulations must go to:

a) Gill Galea (Operational manager) and her 'outstandingly' caring staff team for demonstrating 'outstanding' levels of care, evidenced to the CQC inspectors through their (best ever!) training in and use of Intensive Interaction; apparently this being identified on the first day of the inspection by one of the inspectors asking: "So, where will we see Intensive Interaction in action?"

b) The CQC and their team of inspectors for clearly identifying Intensive Interaction as one of the main means through which an effective and outstandingly caring service is enacted (and therefore evidenced) on a day by day basis - which it self-evidently is.

This also reminded me of the work of Debbie Whiting, an Intensive Interaction coordinator working for the Frances Taylor Foundation (and winner of our 2016 'Intensive Interaction Practitioner of the Year'), whose service also received an 'Outstanding' rating from CQC for its care, evidenced via the use of Intensive Interaction. CQC said of their St Joseph's service:

'Everyone we spoke with, without exception, commented on the caring nature of staff. One relative said, "They are an absolute joy." Another said, "They are just amazing." ... All staff had adopted an ethos of 'Intensive Interaction' which shaped the care delivered at the home ... Staff were passionate about this and we saw from our observations that it meant a lot to people. People were smiling and laughing and looked genuinely cheerful and happy. We saw examples of this interaction taking place, and could see what it meant to the people living at the home.'

So perhaps the secret is finally out (I know its not really a secret, I am only saying that for dramatic/literary effect) - if you want to be judged by CQC as  an 'outstanding' residential service for people with severe or profound learning difficulties ... them show them the Intensive Interaction!

Using 'Perseverative Interests' ... as joint focus activities in Intensive Interaction

Perseveration is defined as an uncontrolled, repetitive behavioural response to a set stimulation, despite the termination of the initial stimulation, the continuation of which appears contextually irrelevant to the current situation. The definition of 'perseverative interests' (PI) in the DSM (4th Ed), is: 'encompassing preoccupations with one or more stereotyped and restricted patterns of interest that are abnormal either in intensity or focus'.

Now the reason I am blogging about perseverative interests (or behaviours) is that during Intensive Interaction I will often join-in with such highly repetitive and 'contextually irrelevant' behaviours to try and create a person-centred and joint-focus, social engagement context ... and I recently came across a paper (Vismara & Lyons, 2007) that suggested that if an individual’s perseverative interests are integrated into the topic of a joint focus activity (in this case as part of an approached called Pivotal Response Treatment), then this was found to enhance that individual’s levels of social engagement (no s**t Sherlock!). So here are some interesting (well to me anyway) extracts from the paper:

'Perseverative Interests to Elicit Joint Attention Behaviours in Young Children with Autism' 

Vismara, L. & Lyons, G. (2007) Journal of Positive Behaviour Interventions, 9(4), 214-228. 

This study looked 'to examine whether joint attention initiations for social sharing would occur as a collateral effect of utilizing the motivational techniques of Pivotal Response Treatment (PRT) in conjunction with perseverative interest stimuli for three young nonverbal children with autism' ... using 'a large variety of highly preferred age-appropriate board games, activities, and toys'...  (and people sometimes say that I'm a bit 'too wordy'!) ... anyway: 

'[The] results indicated an immediate increase in joint attention initiations when perseverative, or highly preferred, interests were incorporated within the motivational techniques of PRT. Additional findings included collateral increases in joint attention initiations towards less preferred interests, as well as improvements in the quality of interaction between the children and caregivers' (my underlining not theirs).

'In summary, the findings suggest that using PI stimuli in conjunction with PRT appears to increase a child’s motivation to share his or her perseverative interest socially with another person and consequently to improve the quality of initiations and interactions. In addition, this study indicates that children in this type of intervention use their perseverative interest in a socially appropriate and controlled manner without the presence of negative side effects. The results are also promising in terms of providing an approach that utilises learning mechanisms that may be similar to those used in typical development'. 

Now 'Pivotal Response Treatment' (PRT) is not Intensive Interaction (it is a more behaviourally abstracted, controlled, and less naturalistic approach), but it clearly utilises one of the practices of Intensive Interaction ... and it resulted in increased sociability which also generalised out from the PI activity to improve 'the quality of initiations and interactions' via 'learning mechanisms that may be similar to those used in typical development'. 

So, does this add to the evidence base for Intensive Interaction [which is directly based on the learning mechanisms seen in typical development] ... well, actually I would say "yes": but only indirectly*, and only for this one particular 'joint attention' strategy ... but I think it is still a yes*.

(*my underlining again - and this time with a bit of added bold!).

Intensive Interaction fits within a ‘social model’ and not ‘a deficit model’ of impairment

In an eagerly anticipated*/dreaded* continuation of my last blog on Intensive Interaction being an approach that can ameliorate the level of a person’s apparent social impairment ‘in a socially mediated way’ (with the actual degree and form of social impairment itself also being co-created ‘in a socially mediated way’) ... I have been giving some further thought as to where Intensive Interaction sits philosophically within (or is parked alongside) our standard health service responses to people with learning difficulties and/or autism.

I have also spent some time wondering why Intensive Interaction still often isn’t even considered an appropriate ‘type’ of psycho-social intervention for many of the people we work with or support (despite psycho-social interventions being explicitly recommended by the UK National Institute for Health and Care Excellence  in their considered guidance for such service user groups).

One reason I think is that Intensive Interaction differs from most standard health/NHS interventions in that it isn’t seen to directly address a diagnosed or clearly defined problem (or deficit) that is identified as being of, or individualistically belonging to, the person themselves (which is most often the genesis of a referral into health or social care services).

Other interventions (many of them absolutely necessary and appropriate) do directly address some perceived problem (or deficit) in the individual person themselves e.g. psycho-pharmacological treatments, some behavioural interventions, some SLT interventions, physiotherapy treatments and sensory interventions (remember - many of them absolutely necessary and appropriate) do directly address some diagnosed or defined problem (or deficit) that is viewed as wholly residing in the individual ... and the individual is seen as just that, individualised and separate.

These types of treatments are, I believe, founded on a view of the 'person' as a bounded, individualised, cognitive, behavioural and/or sensory processing unit; with such a bounded, individualised cognitive, behavioural and/or sensory processing unit sitting between some kind of externally applied ‘stimulus in’ and some kind of processed and then expressed ‘response out’; i.e. physically, cognitively and psychologically separate, and thus physically, cognitively and psychologically separated from the rest of us.

This bounded view of a ‘person’, and their individualised problem (or deficit), is the one that dictates that each client or service user is required to follow an individualised treatment pathway or package. However this treatment pathway or package contrasts philosophically with a different view (and I think a view held by many of us Intensive Interactors) that human beings are not bounded and individualised, but are instead integrated and socially networked parts of a bigger social whole, and therefore the problem or deficit (and thus the socially mediated impairment) is diffusely situated within the social grouping, not simplistically located within the ‘individual' (i.e. as a personal characteristic of that individual).

However, many health, and I think many social care organisations can only see an individual as an individual … and perhaps this aspect of a systemic and reductionist health philosophy is actually a part of a bigger problem (or deficit) that needs addressing first!

p.s. Educational models of individualised 'learning' can also present with similar philosophical issues when contrasted with socially situated views of knowledge and skill acquisition and expression - perhaps I’ll try to touch on a bit of that in an up-coming blog ... 

Yes I know ... isn't it fascinating*/unfathomable*/too abstract by half!* 

(*delete as appropriate).

The social impairments due to Autism are co-constructed and socially mediated ... ?

At a recent training event for a Leeds schools autism support service, during an open period of discussion, I offered a rather poorly articulated view about the nature of the social impairment experienced by people with autism. The thought, again rather inelegantly expressed here, goes along the lines of:

'If an act of communication is defined as a coordinated and co-constructed activity (between two people, with a sender, a receiver, a means of sharing information and a shared topic), then surely any communication breakdown must in some way also be co-constructed (through communicative acts of either omission – things we don’t do; or commission – things we do do) i.e. the social impairment itself is to some degree socially mediated'.

Also, in trying to clarify this view I think I said something like: 

'It has become my view that the social impairments due to the developmental impacts of Autism are to some degree socially constructed, and are therefore socially mediated in their form and degree i.e. a person’s social impairment is either made more severe, or less severe, depending on the social expectations and behaviours (responsive or otherwise) of the other people they socially encounter.'

To expand on this a bit: when attempting to socially engage with some people the social impairment of one individual with autism may be almost absolute (i.e. allowing for no social interactivity to take place), but with some other, more sensitively responsive people, the social impairment experienced by the same person may be much less evident, even at times seemingly negligible. So surely we must ask: ‘where does this social impairment lie?’ From this example, not entirely as an intrinsic and individual characteristic of the person with autism.

This is not an area I feel at all expert in, but this view has developed over many years using Intensive Interaction with people with autism (in my case generally also with a learning disability) i.e. that the social impairment caused by autism is something that sits between us, and that it is therefore at least partially socially co-constructed or mediated in from and degree (and is therefore not an absolute condition in and of itself – even when it is used as an individual condition defining, diagnostic criteria).

Indeed social environments, or more accurately the people in those social environments, can make that social environment potentially more attuned and therefore potentially more socially accessible to the individual with a social impairment (e.g. by the use of Intensive Interaction) or less attuned and less socially accessible, depending on the way the person reacts or responds to the person with a diagnosed social impairment.

To recap my initial contention: although autism is clearly a defined and diagnosable characteristic of an individual, the social impairment associated with autism is not a characteristic solely of the individual with autism; it is co-constructed, in the same way that any successful interaction between two (or more) people with, or without autism, is by its very nature co-constructed.

Again I must state that I have little real legitimacy to air this view from a personal perspective, but in my professional Intensive Interaction role, having seen the manifest social impairment suffered by many individuals with autism be significantly reduced through the use of Intensive interaction, this idea of the co-construction or mediation of either successful engagement or continued socially impairment and isolation, seems to me to have useful analytic (and potentially clinical) value.

It is not the responsibility therefore of the individual with autism to change (or be changed) in some manner, or for others to demand or effect change solely in that person (to overcome a diagnosed social impairment), but instead the responsibility lies with those potential social partners around the person to adapt their pro-social behaviour to be socially inclusive of the person with autism. 

If a social impairment lies in the space between people, then so does the responsibility to reduce the potentially socially isolating impact of this impairment. If there is something we can do to make a social environment generally more ‘person-centred’ in ways that allow social access to a person with autism, (i.e. via the use of Intensive Interaction) then we have a responsibility to act in ways that do just that.

Anyway, I can't decide if this general idea is something I should develop further and submit for publication in either the 'British Journal for Stating the Bl**ding Obvious' or the 'International Journal of things that are already widely known and accepted, apparently by everyone but you!'

Although just possibly it might be right at some time to submit it for publication in the 'Journal of potentially interesting ideas that are as yet only partially developed'  ...  Hhhmm, well I suppose that all depends on what other, more informed people, make of it!

Intensive Interaction: a growing body of published evidence

Intensive Interaction is clearly built upon genuinely socially inclusive and universal humanistic values; it is highly plausible in its developed practices and principles (they are based on the most successful communication development model that there is - the infant-caregiver model), and therefore it is clearly theoretically coherent. Oh, and it is also a pleasure to do! But also rightfully, in these days of 'evidence based practice', I think it useful for us all to know that the hard 'evidence' for the claimed outcomes of Intensive Interaction approach exists.

So, lets have a quick look at some of the most epistemologically (what a word that is!) 'robust' evidence: well, across the general body of research into Intensive Interaction (summaries of 36 research and academic papers are are included in our  Intensive Interaction: published research summaries 2018 document available on the 'Intensive Interaction Users' Facebook page) there are a number of common findings of increased or novel interactive responses found across the studies - this evidence coming from a reassuringly broad range of British, European and international academic and research journals that publish peer-reviewed papers on special education, learning disabilities, disability studies, autism, language therapy, nursing, dementia and psychology. 

Listed below are some of these ‘external’, observable and therefore measurable interactive outcomes associated with Intensive Interaction interventions when compared to initial baseline measures. 

So from a number of Intensive Interaction research papers we get epistemologically (there it is again!) robust evidence of:

• increased social anticipation, initiation and/or engagement (Nind, 1996; Watson & Fisher, 1997; Kellett, 2000; Cameron & Bell, 2001; Kellett, 2003, 2004; Forster & Taylor, 2006; Anderson, 2006; Barber, 2008; Samuel et al, 2008; Zeedyk et al, 2009a; Zeedyk et al, 2009b; Jones & Howley, 2010; Fraser, 2011; Argyropoulou & Papoudi, 2012; Harris & Wolverson, 2014; Rayner et al, 2016; Calveley, 2017).

• increased toleration of, or responsiveness to physical proximity (Nind, 1996; Firth et al, 2008; Zeedyk et al, 2009a; Zeedyk et al, 2009b; Fraser, 2011; Harris & Wolverson, 2014; Calveley, 2017).

• increased levels of contingent smiling (Nind, 1996; Lovell et al, 1998; Leaning & Watson, 2006; Barber, 2008; Zeedyk et al, 2009a; Argyropoulou & Papoudi, 2012; Calveley, 2017).

• increased levels of eye contact or looking at another person’s face (Watson & Knight, 1991; Nind, 1996; Lovell et al, 1998; Kellett, 2000; Cameron & Bell, 2001; Kellett, 2003, 2004, 2005; Leaning & Watson, 2006; Forster & Taylor, 2006; Barber, 2008; Samuel et al, 2008; Zeedyk et al, 2009a; Zeedyk et al, 2009b; Fraser, 2011; Argyropoulou & Papoudi, 2012; Harris & Wolverson, 2014).

• increased use of vocalisation (Watson & Knight, 1991; Lovell et al, 1998; Kellett, 2000; Elgie & Maguire, 2001; Cameron & Bell, 2001; Argyropoulou & Papoudi, 2012; Harris & Wolverson, 2014; Calveley, 2017).

• increased levels of socially significant physical contact (Lovell et al, 1998; Elgie & Maguire, 2001; Kellett, 2000, 2003, 2004; Forster & Taylor, 2006; Firth et al, 2008; Barber, 2008;  Samuel et al, 2008; Argyropoulou & Papoudi, 2012; Harris & Wolverson, 2014; Calveley, 2017).

• improved levels of joint attention (Nind, 1996; Lovell et al, 1998; Kellett, 2000, 2003, 2004, 2005; Leaning & Watson, 2006; Samuel et al, 2008).

Within the overall body of Intensive Interaction research there also appears to be two different time related aspects to the social communication progress being made i.e.:

1. Evidence of relatively rapid change in social interactivity associated with Intensive Interaction 

Instances of rapid change in social interactivity are often anecdotally related by practitioners using Intensive Interaction techniques with people for the first time, particularly when employing the techniques of behavioural mirroring or vocal echoing. Also empirical support for such claims of rapid ‘social inclusion’ (Firth, 2008) comes from short-term research evidence e.g. Lovell et al, 1998; Zeedyk et al, 2009a; Zeedyk et al, 2009b; Argyropoulou, & Papoudi, 2012; Harris & Wolverson, 2014.

Indeed, in the study using ‘micro-analytic analysis’ of Intensive Interaction by Zeedyk, Caldwell & Davies (2009b), it was shown that for all the participants Intensive Interaction was: ‘… effective in promoting social engagement ... well before the end of the first full intervention session’, with some changes being seen to ‘occur within minutes’.

2. Evidence of gradual developmental progress in aspects of social communication associated with the extended use of Intensive Interaction 

In addition to the potential for rapid increases in sociable communication over short timescales, the use of Intensive Interaction over longer periods has been evidenced to support ‘developmental progression' (Firth, 2008) as an outcome of systematic and sustained approach adoption.

Such extended use of Intensive Interaction has been shown to facilitate gradual and sustained development in certain aspects of the social communication practices of people with severe or profound intellectual disabilities and/or autism e.g. Watson & Knight, 1991; Watson & Fisher, 1997; Nind, 1996; Kellett, 2000; Kellett, 2004; Jones & Howley, 2010; Fraser, 2011; Calveley, 2017. 

Have a look for yourself in our Intensive Interaction: published research summaries 2018 document available on the 'Intensive Interaction Users' Facebook page (https://www.facebook.com/groups/13657123715/)  - but you will need a bit of time as there is plenty of it!

Evidence based practice is where we all need to go ... and we have an extensive and increasing body of Intensive Interaction evidence!