Integrating Intensive Interaction

Developing Communication Practice in Services for Children and Adults with Severe Learning Difficulties, Profound and Multiple Learning Difficulties and Autism

Amandine Mourière, Jules McKim

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138106567
• eBook ISBN: 9781351589345
• Edition: 1
• Topic: Education
• Subtopic: Education General

This unique book features a collection of lively stories on the integration of Intensive Interaction practice into schools and adult service settings. It addresses communication development, both from a micro and macro level across a variety of service settings, with each chapter written by a different practitioner. These personal accounts cover individual practice and reflection with a single case-study person, as well as influencing organisational change.

The authors assert that within adult services and educational settings, Intensive Interaction can be used as a way to develop communication and confidence and to work with the principles of inclusion and person-centred acceptance and support. The book develops an understanding of issues that can be addressed within training and mentoring other staff, and uses case studies throughout as a powerful training tool.

Filled with practical advice and techniques to develop communication with people who find it hard to communicate, as well as guidance on ensuring the sustainable extension of the use of Intensive Interaction by embedding the approach within organisational ways of working, this book will be of value to anyone working within children and adult services for people with communication impairments.

Chapter 1

Introduction

Amandine Mourière and Jules McKim

This is a book about nine practitioners, who all went through an individual and professional journey in becoming Intensive Interaction Co-ordinators.

These journeys have been put together as a collection of stories to provide the reader with insight into people’s journeys in implementing what they believe in into their service settings. In each chapter, the author tracks their individual use of Intensive Interaction with a single person, their experiences in mentoring other staff, and the initial steps in establishing and embedding Intensive Interaction in their workplaces. With this book, our aim is to share with you a collection of good and lively stories of the development of Intensive Interaction both in school environments and adult residential services.

The approach

Intensive Interaction has been developed and disseminated for over 30 years. As a result, most people in the field of learning disabilities have heard of the approach. However, knowledge of the approach is very different from an understanding of the strategies to develop and establish quality provision of Intensive Interaction. A brief description of the approach is therefore needed for readers who may not be familiar with Intensive Interaction.

Intensive Interaction is an approach for people at early levels of communication development. First and foremost, Intensive Interaction is about spending time with another person, about being connected, and being part of their social world. When we work with people with communication difficulties, our very first goal is to connect with them, to find a way to relate, and eventually empower them to become successful communicators.

The essential point here is that ‘personal communication is essential for our well-being’ and it may be that communication is the ‘primary goal’ of human existence. (Adler & Rodman, 2006).

Intensive Interaction promotes social inclusion by teaching the pre-speech fundamentals of communication (Nind & Hewett, 2001). It is used with children and adults who have severe learning difficulties and/or autism and adults with dementia.

The fundamentals of communication

•enjoying being with another person

•developing the ability to attend to that person

•concentration and attention span

•learning to do sequences of activity with another person

•taking turns in exchanges of behaviour

•sharing personal space

•using and understanding eye contact

•using and understanding facial expressions

•using and understanding physical contacts

•using and understanding non-verbal communication

•using vocalisations with meaning

•learning to regulate and control arousal levels

The teaching of these fundamentals takes place in the most naturalistic and humanistic ways, through daily interactions. As the people supporting an individual become more confident as practitioners, Intensive Interaction becomes an integral and essential part of their social-communication fabric.

Intensive Interaction stems from the natural model of communication learning, and therefore borrows some key principles from the parent-infant model of interaction. Holding back, observing and waiting are key in empowering an individual to take the first turn, and to therefore become a fully active participant in the interaction. By tuning-in, the practitioner can then time their responses to effectively support the flow of the interaction. Being relaxed and unhurried is essential; it allows for the pace to be dictated by the person, and thus be just right for them. Through bursts of active periods, the person may need time to process what has just happened, or to rest. This time is called a ‘pause,’ and will be as long and as frequent as the person needs it to be. All the while, the practitioner remains tuned-in, with an available look and body language, responsive in stand-by. Responses can be as varied and unique as people are: imitating, modified reflecting, gentle dramatisations, marking what the person did using facial expressions and body language, delighted face/voice, bursts of speech or running commentary.

How is Intensive Interaction being disseminated?

The principles and techniques of Intensive Interaction are so natural, that some people can grasp enough after a one-day course to become practitioners.

The Intensive Interaction Institute offers however a range of courses available to practitioners and parents, from a 1-day introductory course, a 3-day good practice course to a 21-day course. The latter is the Co-ordinators’ Course, and is the most complete and in-depth course the Institute offers. It takes place over a period of 15 months, and is split into 7 blocks of 3 days. This format allows practitioners time to develop their practice. Practice is a key element in the completion of the course, but other aspects of becoming a co-ordinator are taken into consideration: understanding the rationale underpinning Intensive Interaction, the ability to mentor colleagues as well as to deliver workshops and training within their organisations, influencing organisational change and development. The course includes seminars on autism, parent-infant interactions, the use of physical contact, challenging behaviours, organisational issues, etc.

Co-ordinators are usually highly motivated individuals who are chosen by their organisations to be trained, and eventually disseminate and embed the approach themselves in their settings.

Why this book?

The idea of a collective book came in April 2015, on the final block of this particular Co-ordinators’ Course. The format of this course is very unique, and gives amazing opportunities to develop a professional network. The course takes place over a period of 16 months and requires each participant to select an individual they have regular access to, in order to record and assess the individual’s progress as well as providing opportunities for the practitioner to reflect on their own practice and develop accordingly. On the last block, each course member presents a summary of their project which showcases the journey and change that has taken place for each individual. On the last day of the last block, we were all sitting around the big table for lunch (about 12 of us). Whilst all very pleased with the thought of becoming fully-fledged co-ordinators, there was a heavy feeling of sadness in the air. We were all very aware that this was the end of a rather exceptional adventure together. What is more, it felt like a shame that these incredible journeys we all went through with our person, as well as with our organisation, would end like this. Someone, Michelle I think, jokingly suggested that we write a collective book. Soon, everyone started to warm up to the idea, and before we had time to process, both Jules and I were designated to be the editors.

Outline of chapters

In chapter 2, Pam relates her Intensive Interaction journey with five-year-old Hayden, a boy who was more interested in shiny beads than in people. With warmth and great passion, Pam tells us how she raised Intensive Interaction’s profile in her school, and enthused her colleagues to subsequently create an Intensive Interaction Club. She also writes about the inclusion of Intensive Interaction within Education, Health and Care Plans (EHCPs) and the importance of ensuring communication work is not reduced to SMART targets (Specific, Measurable, Attainable, Relevant and Time-framed).

In chapter 3, Jules gives us an account of his Intensive Interaction journey with Dennis, a middle-aged man with severe learning disabilities in a supported living setting. Jules also gives us a valuable insight into his already established Intensive Interaction co-ordinator role, and developing and expanding that role when his Trust was acquired by a much larger NHS Trust.

In chapter 4, Michelle relates her journey with John, who blossomed through the use of Intensive Interaction. Michelle talks with great enthusiasm about the simplicity of Intensive Interaction, and yet the crucial impact it has on communication and well-being. She also makes reference to attachment theory and Maslow’s hierarchy of needs in order to promote the role of social interactions within the provision of adult residential services.

chapter 5 focusses primarily on the importance of minimalism. Amandine explains how Sarah helped her rethink her understanding of Intensive Interaction techniques. By doing less, not only did she see Sarah’s communication develop greatly, but she also became a better mentor for her colleagues. Amandine also includes in-depth detail from the recording processes she followed that beautifully illustrates reflective practice in action.

In chapter 6, it is with great passion and conviction that Lucy tells us how her practice developed hand in hand with Vincent’s gradual abilities to connect with her. She talks with clarity about her journey to deepen her understanding of Intensive Interaction, and then to expand the knowledge and use of the approach within her school environment.

chapter 7 gives an invaluable understanding of the crucial importance of using video in mentoring. Kaisa describes in great detail how she mentored a support staff member to carry out Intensive Interaction with Laura. Informed by Video Interaction Guidance, Kaisa’s sensitive and empowering mentoring style is illustrated with transcripts of conversations she had with her mentees.

In chapter 8, Cath gives a precious account of how to successfully embed Intensive Interaction into a service’s ethics. Cath movingly recalls her journey with John, an adult with severe learning disabilities and behaviours that services found challenging and how Intensive Interaction changed his life. As CEO of her provider organisation she explains how Intensive Interaction has become the core of her services’ DNA.

In chapter 9, Lucy relates her sensitive journey with Logan, and how he learnt to express his emotions to ultimately find comfort in others. The development of Intensive Interaction in her school began as an almost ‘underground movement’ but with great strength and persistence, Lucy has made it mainstream.

In chapter 10, Ben discloses with humble honesty how Intensive Interaction made him re-evaluate and change his practice from one focussing on behavioural modification to now focussing on relationships and emotional well-being. His biggest learning opportunity was presented to him under the name of Mick, and Ben recalls how he had to learn to do less, in order to let Mick do more.

It is hoped that these stories will affect people differently in a very positive and uplifting way. For those who are new to Intensive Interaction, or perhaps know a little of the approach already, we hope to inspire you to find out more, and try it for yourself. For those of you who are already practitioners and great believers of the approach’s benefits, these stories will hopefully encourage you to keep faith, to stay strong and remind you that if you have passion, it only takes one person to start a movement in the right direction.

References

Adler, R. B. and Rodman, G. R. (2006) Understanding Human Communication. 9th edn. New York, NY: Oxford University Press.

Nind, M. and Hewett, D. (2001) A Practical Guide to Intensive Interaction. Kidderminster, UK: British Institute of Learning Disabilities.

Chapter 2

Becoming the beads

An Intensive Interaction journey with Hayden

Pam Smith

Pam relates her Intensive Interaction journey with five-year-old Hayden, a boy who was more interested in shiny beads than in people. With warmth and passion, Pam tells us how she raised Intensive Interaction’s profile in her school, and enthused her colleagues to subsequently create an Intensive Interaction (II) Club. She also writes about the inclusion of Intensive Interaction within EHCPs and the importance of ensuring communication work is not reduced to an objectives driven exercise.

Introducing Hayden

In the centre of the classroom, Hayden sits on the floor absorbed in twiddling a string of shiny beads. He watches them intently as they twirl back and forth apparently oblivious to his surroundings. Around him, Hayden’s classmates are busy playing or moving around the classroom. Occasionally, Hayden glances up but is quickly re-captivated by the sparkly hypnotic motion. For him, everything else fades into the background. Left alone he is happy in his ‘bubble’ – Hayden and his precious beads.

Hayden attends a special school for children with severe learning difficulties, complex needs and autism. He started at the primary school two years ago and is now five years old. Hayden has a diagnosis of tuberous sclerosis and severe learning difficulties. His medical condition impacts upon his ability to learn, he has social communication difficulties and severe epilepsy. Hayden’s seizures have a significant and detrimental effect on his health and well-being. Unfortunately, when Hayden is especially lively it can be a precursor to a seizure. So if he has a day when he is particularly ‘switched on,’ happy and motivated, this is often followed a few hours later by a large seizure. Hayden is always left drained and exhausted following this, and needs a considerable amount of time (sometimes several days) to get back to his usual cheery self. At these times, he tends to retreat to a cosy corner in his classroom where he curls up and rests, emerging for snacks, play and to participate in short bursts of activities with adult encouragement and support.

Why choose Hayden?

At the start of the project Hayden was quite self-contained, self-absorbed and often seemed isolated. He did not spontaneously...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• Figures
• List of contributors
• Foreword
• 1 Introduction
• 2 Becoming the beads: An Intensive Interaction journey with Hayden
• 3 Sustaining and developing practice in a large NHS Trust
• 4 Learning together through human connection: Individualised care at its best
• 5 Less is more: Working with a person with PMLD
• 6 Building an emotional connection through Intensive Interaction
• 7 Intensive Interaction mentoring process and the use of video
• 8 Managing a service that specialises in Intensive Interaction provision
• 9 Opening the box: Accessing our ability to enjoy and understand interaction
• 10 Intensive Interaction: From Einstein to Lady GaGa
• Appendix 1: The fundamentals of communication
• Appendix 2: The fundamentals of communication 2: Emotional learning
• Appendix 3: Style / technique list
• Appendix 4: Progress track
• Index