More details on current UK government guidance on Covid-19.

For my nice and short Blog this week I am just going to point out the links I have been given for the most current UK government guidance on Covid-19 (as of 29.04.20).

1. Government guidance for Home/Domiciliary Care (24 April 2020)

The new home care guidance can be found at COVID-19: how to work safely in domiciliary care which includes the latest PPE guidance.

2. Government  guidance for care staff supporting adults with learning disabilities and autistic adults (updated as of 24 April 2020)

Apparently an updated version  of this guidance (it is now all in one place) came out on Friday, and can be accessed at: Coronavirus (COVID-19): guidance for care staff supporting adults with learning disabilities and autistic adults. 

3. Testing (updated as of 29 April 2020)

Social Care staff can now be tested either by self-referral, or employer referrals – you can check the guidance at: https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested

Please keep well, please keep going, but please keep safe.

p.s. My 'weekly' blogs are now likely to become a bit less frequent (i.e. less than weekly) as I have been redeployed, and am now going back to work as a Healthcare Support Worker in one of our NHS Specialised Supported Living Service homes (after a career break of more than 30 years) - Fingers crossed that I can be more of a help than a burden!

This week's Blog is a sad one.

Unfortunately, my blog this week is a sad one, but it was one that I have been expecting to write for some time now (although that doesn't make it any easier).

Last week one of my long term, Intensive Interaction partners died from Covid-19. Anthony was a man I have known for well over 20 years. He was a man that helped me learn so much about how to positively and genuinely connect with someone who has profound levels of intellectual and physical disability. He was someone who, at the very start of my professional Intensive Interaction journey, helped me develop my deeper understanding of the rationale and practices of the approach – he made it all so easy for me! I owe him a lot; I hope I have repaid that in some way by helping many other people like Anthony experience the positive social inclusion afforded by our approach.

But Anthony wasn't someone whose character was limited by his profound levels of impairment, quite the opposite; his sense of open and inviting sociability filled a room. He was always a genuine pleasure to be with; his enticing smile and raucous laughter both highly infectious (perhaps that's not the most PC of terms to use at the moment, but it’s no less true now than it was before). He will be greatly missed by all those that knew him and cared for him.

I was so very sad to hear of his passing. I was equally sad for all the members of his care team – some of whom I have also known for many years, and for whom I have the greatest respect and affection.

It is hard for us on the outside to truly imagine what it is like to work under such physically and emotionally draining conditions. When I left some flowers at the house I could only wave at them through the window (they were fully gloved, gowned and masked up as they continued to care for the other residents in the bungalow); it seemed like an impenetrable barrier to our sharing our collective anguish. My heart goes out to them, and to their own families who will be currently struggling through the effects of pandemic.  

When we are clapping on a Thursday night, let’s make sure you give an extra round for all our residential carers – I know I will.

Some simple Dos & Don’ts for Intensive Interaction during the Covid-19 pandemic

These continue to be the most difficult of times; for some, they are truly tragic. But, whilst following all social distancing and infection control guidelines, we also need to continue to practice Intensive Interaction (as best we can). So, to take account of the current crisis, we have adapted some of our pre-crisis Intensive Interaction ‘Simple Dos and Don’ts’. So, please remember that:

•      Intensive Interaction is still a person-centred approach: we are still trying to interact with our person by, in some way, sensitively joining in with (or reflecting back) some aspect(s) of their current activity or behaviour.

We still want to do Intensive Interaction ‘with’ our person, not to them!

•      Go at the pace of the person: there is absolutely no rush; use all the time you need to find the best, and safest, means of socially interacting.

•      Good observation is as important as ever in deciding how best to safely interact with our person. Sometimes just sitting back (at a safe social distance) and patiently waiting for the person to do something potentially small, but potentially interactive, can give us the best starting point.

•       Be sure to share your ‘adapted’ interactive successes with everyone else who should know. If you have found something important (e.g. about how best to adapt your Intensive Interaction practices) then let everyone know!

•      Don’t be put off if things don’t always go well; especially when adapting your Intensive Interaction practices to fit with safe ‘social distancing’ and infection control practices (e.g. with full PPE). But remember, that is the very nature of Intensive Interaction; sometimes things go well, sometimes they don’t … but we adapt, try again, and thus continue to move forward.

•      Don’t be afraid to ask for help and support if you need it (from whoever else is available); this is surely never more true than at the moment. We all need help to stay strong and well for each other during this current crisis. Let’s get, and let’s give as much support as we all collectively need.

•      Finally, please also remember that Intensive Interaction should still be mutually pleasurable, so to try to enjoy interacting with your person; this may be difficult at the moment, but it still remains our ultimate purpose.

(Adapted from the work of Firth, G., Menzies, L. & Guthrie, N. - 2012)

Also, to support the continued fidelity of our Intensive Interaction practices, it might be useful to check any adaptations we make against Melanie Nind’s ‘5 central features of Intensive Interaction’ (‘Efficacy of Intensive Interaction’, 1996), these being (slightly adapted for the current Covid-19 crisis):

1.   The central purpose of Intensive Interaction is still the creation of ‘mutual pleasure’ i.e. Intensive Interaction is still all about sociably ‘being with’ someone, with the purpose of mutually enjoying each other’s company.

2.   Intensive Interaction practitioners adjust their interactive behaviours (e.g. their use of eye contact and facial expressions, the use of their voice, the use of movements and posture) so that they can be more visibly and/or audibly meaningful, and therefore more socially engaging, to their person.

3.   Intensive Interaction engagements will develop a mutually agreeable tempo and sense of ‘flow’; such a flow being enabled by the judicious use of pauses (e.g. to allow for participant processing), and the repetition of aspects of a mutually negotiated interactive repertoire.

4.   Intensive Interaction practitioners will accredit social ‘intentionality’ to the actions of their person, responding to all of a person’s behaviours as if they potentially have intentional communicative significance.

5.   Intensive Interaction practitioners contingently responding to the social initiations and subsequent actions of their person; following the person’s lead and sharing control of any interactivity.

The now required Covid-19 infection control practices (i.e. social distancing, and the wearing of PPE) will inevitably limit some of the strategies we might use in our usual Intensive Interaction practices. But it will still be useful to have these ‘5 central features of Intensive Interaction’ in mind to ensure that our adapted Intensive Interaction routines still fit within the true spirit of our socially responsive Intensive Interaction approach.

Please stay well, and practice Intensive Interaction effectively but safely!

Some guidance on the use of Intensive Interaction during the Covid-19 pandemic

These are certainly the most challenging of times.

During the current Covid-19 pandemic we are personally and professionally required to keep social contacts to a minimum, and strictly adhere to all social distancing and infection control practice guidance. Inevitably this crisis is therefore creating many complications in terms of how we continue to care for our most vulnerable people, including how best to continue to use Intensive Interaction.

Many of those we care for or support will not be able to understand the need for social distancing or increased infection control measures, but they will still expect and need some form of responsive and reassuring Intensive Interaction engagement.

Indeed, many of those we care for may currently be feeling highly anxious due to changes in their familiar care and support routines. Such increased anxiety will make the need for social engagement even more important for the mental health and well-being of those we support; all at a time when it is potentially more difficult to enact.

As we follow all the necessary steps to minimise the risk of a potentially fatal Covid-19 transmission, the use of gloves, face masks, and in some instances full Personal Protective Equipment (PPE) will become necessary (and is already in some services). Such mandated infection control practices will unfortunately limit some of our available means for social exchange e.g. physical contacts, close proximity, or if face masks are being used, even verbal/vocal exchanges and/or exchanges of positive facial expressions.

However, fortunately the varied means and flexible structure of Intensive Interaction allows us to explore some other potential means of social interactivity with those we care for and support. It may well be necessary to adapt our strategies for social engagement, avoiding when and where we can, or at least minimising physical contacts or close physical proximity (although for many this will still be required to meet their functional care needs).

Instead it may be necessary to use Intensive Interaction strategies that can be enacted with more and therefore safer social distance e.g.:

• Using more demonstrative body language e.g. using bigger hand gesturing or using more dramatised body posture, or shoulder movements, to communicate our social responsiveness.
• Finding more ways to exchange eye contacts and mirror facial signalling (from a safe social distance) e.g. using more dynamic, or even very dramatised eye-brow expressions and head movements from further away.
• Using more, or more kinds of behavioural mirroring (at a safe social distance), including amplified hand, arm or body movements to make our socially interactive responses clearer for the person to see or sense.
• Developing increased turn-taking in various forms (from a safe social distance) e.g. via sequenced hand, arm or body movements; clapping hands or stamping feet in sequence or together; tapping or banging items of furniture in sequence or together; using a range of sequenced voice or mouth sounds.
• Using standard vocal echoing or exchanges of vocal/verbal sequences (at a safe social distance): remember, responding to a person’s vocalisations does not have to be via a direct echoing; some physical movement can also act as an appropriate response, so long as the shape of the movement somehow matches the pattern of the person’s vocalisation.
• Using verbal “commentaries” on a person's actions, or the actions of others in a shared environment; possibly at increased volume from a safe distance.
• Using more forms of ‘joint-focus’ activity that can be enacted with greater social distancing e.g. jointly listening to music or watching mutually interesting TV or films together, and regularly signalling the mutual enjoyment of the joint activity with the person e.g. via frequent eye contact and shared smiles.

Also, while Intensive Interaction is a mainly responsive approach, due to social distancing then more proactive social initiation by a practitioner choosing the safest, socially distant means, seems entirely prudent and correct i.e. proactively using the safest interactive means available (taken from any previously developed interactive repertoire with a person) will often be the most advisable. Trialling different ‘safer’ interactive means will at times be necessary; some adaptations will work well, others may not – that is just the nature of Intensive Interaction anyway!

Remember, it will be up to every practitioner and manager to discuss, agree and then trial any ‘safer’ adaptations to their normal and individualised Intensive Interaction practices; this may not always be easy, but in many cases it will be absolutely necessary to support the well-being of those we support and care for.

P.s. If you wish to share your experiences of making adaptions to your Intensive Interaction practices (if required), then please feel free to add your comments below.

Please stay well, and practice Intensive Interaction effectively but safely!

Coronavirus Resources web-page from Leeds 'STARS' team

Last week I was contacted by a friend from the Leeds 'STARS' team pointing me to their 'Corona-virus Resources' web-page (STARS standing for 'Specialist Training in Autism and Raising Standards', which is part of the Leeds City Council Children's' Services).

On this page there are a number of drop-down menus providing links to various types of resources, including: 'Social Stories', 'Symbols', 'Talking Mats', 'Addressing Worries', 'Quick Guides and Ideas for Parents and Professionals', and 'Hospital Passports'. Within each section are a number of downloadable electronic resources and advice that may be of use during the current difficult circumstances. 

There are also a number of links to other, external 'Useful websites and organisations', including the official Intensive Interaction website at 'www.intensiveinteraction.org'. Again, a number of them may well be worth a look.

To access these resources go to: http://www.starsteam.org.uk/coronavirus-resources

World Autism Awareness Week (30 March-5 April) - some Covid-19 resources

As World Autism Awareness Week (30 March-5 April) has fallen within these difficult times, the National Autism Society has provided some information and resources to support autistic people and their families during the current phase of the Covid-19 crisis.

From the NAS website: 'This unprecedented period of change and disruption is very difficult for many autistic people and families. We have created some tips that we hope will help you. Remember it’s not forever and there are lots of things you can do that may make things easier. We have created some handy tips to help you during this time of uncertainty'.

You can follow this link (https://www.autism.org.uk/services/helplines/coronavirus/resources/tips.aspx) to a couple of accessible and downloadable 'Tips for autistic people and families'. 

Other useful information is also available on the other pages of the NAS website, including a link to 'The Community' page (at: https://community.autism.org.uk/) which is a 'discussion forum for autistic people, their families and other wider network. It allows you to meet online and share your thoughts and experiences. It’s free to join and a great way to share support'.

Finally, there is information on how to contact the NAS 'Autism Helpline' and their 'Supporter Care team' at: https://www.autism.org.uk/services/helplines/main.aspx (however, in order to 'support the health and well-being' of their staff and volunteers, both these services are currently only responding to enquiries using email and webforms).

Please keep well, and please keep yourself and others safe! 

'The psychological impact of quarantine and how to reduce it' - The Lancet paper.

Following my last Blog 'Keep Calm ... Do Intensive Interaction ... but minimise the risks of Covid-19 transmission', this week I am summarising a very recent Lancet paper (Feb 26th) that was sent to me by one of my colleagues. This paper is: 

The psychological impact of quarantine and how to reduce it: rapid review of the evidence

By Brooks, S., Webster, R., Smith, E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. of the Dept of Psychological, Medicine, King’s College, London. The Lancet (2020) 395, 912–20 (at -https://doi.org/10.1016/S0140-6736(20)30460-8).

The Covid-19 outbreak has seen many people being asked (or told) to isolate themselves at home or in some specific 'quarantine facility'. This review covered 24 studies of the effects of quarantine on people with SARS/MERS, Ebola, and H1N1/equine flu. The review defined quarantine as: 'the separation and restriction of movement of people who have potentially been exposed to a contagious disease to ascertain if they become unwell, so reducing the risk of them infecting others'. 

Why is this Review needed? Quarantine is often an 'unpleasant experience for those who undergo it. Separation from loved ones, the loss of freedom, uncertainty over disease status, and boredom can, on occasion, create dramatic effects'. Therefore, using quarantine 'as a public health measure' will requires us to recognise, and then reduce, any negative effects associated with it. 

The psychological impact of quarantine: 

• All the quantitative studies covered by this review reported the psychological impacts of quarantine being generally identified as: 'emotional disturbance, depression, stress, low mood, irritability, insomnia, post-­traumatic stress symptoms, anger, and emotional exhaustion'. A number of qualitative studies also identified a range of other psychological responses to quarantine e.g. 'confusion, fear, anger, grief, numbness and anxiety ­induced insomnia'.

• One study of staff working with SARS patients found that, after 9 days of quarantine they were significantly more likely to report: 'exhaustion, detachment from others, anxiety when dealing with febrile patients, irritability, insomnia, poor concentration and indecisiveness, deteriorating work performance, and reluctance to work or consideration of resignation'. 

• A study comparing parents and children quarantined with those not quarantined found that 'the mean post-traumatic stress scores were four times higher in children who had been quarantined than in those who were not quarantined'.

Also, the review noted that there was 'mixed evidence' as to whether any individual characteristics or group 'demographics' were predictors of the effects of quarantine. However they did state that 'having a history of psychiatric illness' was associated with 'anxiety and anger 4–6 months' after quarantine.

What can be done to mitigate the consequences of quarantine? 

• Keep it as short as possible: not surprisingly the review stated that - 'Restricting the length of quarantine to what is scientifically reasonable' and not adopting 'an overly precautionary approach', would minimise the effect on people.

• Give people as much information as possible: also the review stated that - 'Ensuring that those under quarantine have a good understanding of the disease in question, and the reasons for quarantine, should be a priority'.

• Reduce the boredom and improve the communication: 'Boredom and isolation will cause distress; people who are quarantined should be advised about what they can do to stave off boredom and provided with practical advice on coping and stress management techniques. The ability to communicate with one’s family and friends is also essential'.

• The review also suggested that 'support groups specifically for people who were quarantined' could be helpful. One study found that 'having such a group and feeling connected to others who had been through the same situation could be a validating, empowering experience', and that such groups could provide people with the support they might not get from other people.

Health-care workers deserve special attention: the review also had a special section on the effects of quarantine on healthcare workers. The review pointed out that such staff 'might be concerned about causing their workplaces to be understaffed and causing extra work for their colleagues' and also that 'their colleagues’ perceptions could be particularly important'. Therefore, they state that 'it is essential that they feel supported by their immediate colleagues' (and also their managers). They state that 'organisational support has been found to be protective of mental health for healthcare staff in general and managers should take steps to ensure their staff members are supportive of their colleagues who are quarantined'.

Conclusion: Overall, this review suggests that 'the psychological impact of quarantine is wide­ranging, substantial, and can be long lasting'. If quarantine is necessary then 'officials should take every measure to ensure that this experience is as tolerable as possible for people'. 

According to the authors of this review, we should be: 

• telling people in quarantine what is happening and why, and how long it will last
• providing meaningful activities for them to do and clear communication while in quarantine 
• ensuring basic supplies (e.g. food, water, and medical supplies) are available, and 
• reinforcing the sense of altruism that people should, rightly, be feeling.

I was glad the author's identified that final point: that powerful 'sense of altruism' is and will be (and in fact always has been) the societal glue that gets us through our most difficult times. It is something that can't be quantified (there aren't any 'units' of human goodwill) but we know it when we see it, and we know just how vital it is to all our general well-being. Keep well and keep safe!