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Intensive Interaction: ‘a history’

Intensive Interaction: ‘a history’. Graham Firth Intensive Interaction Project Leader Leeds Partnerships NHS Foundation Trust. In the UK Before Intensive Interaction:. In the UK prior to 1970 children with severe and profound learning disabilities were deemed to be ‘ineducable’.

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Intensive Interaction: ‘a history’

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  1. Intensive Interaction:‘a history’ Graham Firth Intensive Interaction Project Leader Leeds Partnerships NHS Foundation Trust

  2. In the UK Before Intensive Interaction: • In the UK prior to 1970 children with severe and profound learning disabilities were deemed to be ‘ineducable’. • Then in 1970 came The Education (Handicapped Children) Act which gave all children a legal entitlement to an education. • At this time the main approach to teaching students with severe or profound and multiple learning difficulties was based on behavioural psychology, with widespread use of behaviour modification techniques.

  3. A number of schools found they were having a high staff turn over Many teachers developed a growing unease with behaviour modification techniques The 1980s – the start of Intensive Interaction The staff at Harperbury Hospital School, most notably Dave Hewett and Melanie Nindstarted to think about how they might help their students learn or further develop their‘fundamental communication’ abilities. Serious academic interest in ‘infant-caregiver’ interactions begins to increase Increased consideration is given to fostering natural forms of communication and relationship building

  4. Dr Geraint Ephraim, a clinical psychologist was having similar ideas to the Harperbury team - an approach he calls ‘augmented mothering’ Initially the idea of an Appropriate Communication Environment (ACE) emerged The 1980s – the start of Intensive Interaction By 1986 the Harperbury team felt their approach, now called Intensive Interactionwas well enough developed to be communicated to others The Harperbury staff start to film their work so that they can analyse what is really going on Some Harperbury staff meet with Dr Ephraim who encourages them to read up on infant-caregiver interactions

  5. The 1980s – the start of Intensive Interaction 1987 Nind and Hewett present: ‘Interactive Approaches to the Education of Children with Severe Learning Difficulties’, at a conference at Westhill College in Birmingham, UK. The first paper on Intensive Interaction is published by Nind & Hewett: ‘Interaction as Curriculum’ in the British Journal of Special Education (June 1988) Then the ‘bottom-up’ practitioner-led dissemination of Intensive Interaction began with Hewett and Nind being invited to speak at a number of conferences and to give talks and training sessions to staff teams across the UK.

  6. The 1980s – the start for me (Graham Firth) Volunteer, then worked as a ‘nursing assistant’ (Grade A, then made up to a Grade B!) at Meanwood Park Hospital for the Mentally Handicapped in Leeds (UK)

  7. The 1990s - Things move on: The 1990s saw the gradual dissemination of Intensive Interaction continue in services and schools across the UK. Increasing acceptance of ‘person-centred’ views of care, which identified people’s needs on an individual or personal basis. The first Intensive Interaction research papers begin to be published in the academic learning disability journals (initially - Watson & Knight, 1991). Intensive Interaction became increasingly recognised and practiced in special schools across the UK. It also started to become widespread in some adult services. International interest in the approach was just starting, initially with Dave Hewett visiting the Netherlands.

  8. The 1990s - Things move on: In 1994, Access to Communication, the first book on Intensive Interaction was published (Nind & Hewett, David Fulton) In 1996 Phoebe Caldwell published Getting in Touch (Pavilion Publishers) In this book she identified some of the parallels between her approach and Intensive interaction. this second I.I. book included chapters by parents and staff on their day-to-day work using Intensive Interaction. This book clarified the purpose and practical application of the approach, and gave the first multi-disciplinary view of Intensive Interaction In 1998 Interaction in Action: Reflections on the Use of Intensive Interaction (edited by Hewett and Nind)

  9. Nind, M. (1996) ‘Efficacy of Intensive Interaction: developing sociability and communication in people with severe and complex learning difficulties using an approach based on caregiver-infant interaction’ in the European Journal of Special Needs Education, volume 11 (1), pages 48-66. The 1990s - Things move on: Watson, J. & Knight, C. (1991) ‘An evaluation of Intensive Interaction teaching with pupils with severe learning difficulties’ in Child language, Teaching and Therapy, volume 7 (3), pages 10-25. Watson, J. & Fisher A. (1997) ‘Evaluating the effectiveness of Intensive Interactive teaching with pupils with profound and complex learning difficulties’ in the British Journal of Special Education, volume 24 (2), pages 80-87. Lovell, D., Jones, R. & Ephraim, G. (1998) ‘The effect of Intensive Interaction on the sociability of a man with severe intellectual disabilities’ in the International Journal of Practical Approaches to Disability, volume 22 (2/3), pages 3-9. Some important early research papers on the beneficial outcomes of Intensive Interaction

  10. The 1990s – things move on for me (Graham Firth) I move from teaching in primary schools (Key Stage 1) to F.E. for adults with severe or profound & multiple learning difficulties Start by employing the ‘Waldon Approach’ – an asocial, ‘radical constructivist’ approach to the teaching and/or learning process I become dissatisfied with this approach – big time!!

  11. the Waldon Approach Accessed at http://www.waldonassociation.org.uk/ on 03.12.10 Dr Geoffrey Waldon (a neurologist)… developed his ideas … through extensive observation of human behaviour and learning… he sought to identify the essential processes and mechanisms that shape understanding before culture comes to play its part. At the heart of Waldon theory is the premise that all human understanding arises directly from the organising of patterns of movement in time and space; that meaning comes from movement. ‘The fact that vertebrates are bilaterally and independently symmetric provides the mechanism for a stereopraxic understanding echoed in the stereoscopy of binocular vision. Such a mechanism means that the final basic stage of the primary organismic development is a fusion between the understanding of the two lateral halves of the body, and the need for a relative bias in favour of one side in the fused condition’ Wow! You don’t say!

  12. The 1990s – things are still moving on for me I study to find some other ways of teaching (an OU Av Dip in Sp Ed) that aren’t Waldon! I worked more interactively and tried to be more ‘equitable’ in terms of the power relationships with the learners I started to differentiate the teaching and learning processes I found Intensive Interaction in a chapter in a book I discovered ‘being with’ the students i.e. forming positive and affirming relationships with them and then I had to have some serious chats with my Waldonite boss – oh dear!

  13. Back to Intensive Interaction2000-2010 - A new millennium: Intensive Interaction becomes much more widespread in special schools and adult services across the UK (although not all). Interest in Intensive Interaction continues to develop in a number of countries worldwide. Practitioners from various disciplines published research studies and important position papers that significantly move Intensive Interaction forward.

  14. 2000-2010 – some other significant stuff: • In 2002 the first I.I. training video, ‘Learning the Language’ is published featuring the work of renowned practitioner Phoebe Caldwell. • 2002 Dave Hewett and Cath Irvine (a feisty specialist Speech & Language Therapist) organised the firstUK Intensive Interaction Conference, attended by well over 200 delegates (and me) held over 2 days at Birmingham University. • In 2003 ‘Implementing Intensive Interaction in Schools: Guidance for Practitioners, Managers, and Coordinators’ by Mary Kellett & Melanie Nind (David Fulton Publishers) is published. • By 2003 the dissemination of the approach is starting to become more organised and far reaching, and in this year www.IntensiveInteraction.co.uk, the official Intensive Interaction website, is launched.

  15. 2000-2010 - A new millennium: for me (GF) I develop a curriculum based on Intensive Interaction and collect evidence of progression from with the classroom and report it back to carers and parents (via written, photo, and new fangled video reports) In 2003 I get the newly created Intensive Interaction Project Leader post (in the LMHT psychology dept.) and the UK Intensive Interaction Newsletter is created. I carry out research looking at the practice change process within social care, and find the results of carer interviews/observations very informative I come to see Intensive Interaction as a means of genuine social inclusion rather than ‘normalisation’ philosophy providing the route to this (although I still think this is important) I develop ‘Community of Practice’ ideas related to Intensive Interaction

  16. 2000-2010 - A new millennium still continues… In 2006 The Intensive Interaction DVD was produced by Dave Hewett. With footage of Intensive Interaction being conducted in a number of contexts, including with children in special schools, and with adults in residential and day services. In 2006 Dave Hewett, Cath Irvine and Graham Firth first worked together on setting out on a pathway that would eventually lead to the establishment of the Intensive Interaction Institute (almost nearly!) In 2008 the inaugural Australasian Intensive Interaction Conference was held in Brisbane, (this being mainly through the inspiring work of Dr Mark Barber and Janee Williamson). A year later Intensive Interaction Australia produce a DVD - Exploring the Envelope of Intensive Interaction (produced by and featuring Mark Barber & Karryn Bowen). This DVD contained some inspirational Intensive Interaction footage from Australian special schools. In the UK Cath Irvine started nurturing the emergent Intensive Interaction Regional Support Groups across the UK

  17. 2000-2010 - A new millennium:a really big thing happens in the UK This document also gave the whole next page over to an exposition of Intensive Interaction, and such explicit advocacy positioned Intensive Interaction as a mainstream approach that should be made available to everyone who might benefit with an complex or profound learning disability. In 2009 the new UK government policy document Valuing People Now (VPN): A new three-year strategy for people with learning disabilities was published. This document explicitly stated that people with complex needs should have ‘very individualised support packages, including systems for facilitating meaningful two-way communication’ (on page 37, paragraph 1.6).

  18. Leaning, B. and Watson T. (2006)‘From the inside looking out – an Intensive Interaction group for people with profound and multiple learning disabilities’ in the British Journal of Learning Disabilities, volume 34, pages 103-109. 2000-2010 - A new millennium: Some important papers published after 2000 (not all papers can be included) Kellett, M. (2000)‘Sam’s story: evaluating Intensive interaction in terms of its effect on the social and communicative ability of a young child with severe learning difficulties’ in Support for Learning, volume 15 (4), pages 165-71 Samuel, J., Nind, M., Volans, A. & Scriven, I. (2008) ‘An evaluation of Intensive Interaction in community living settings for adults with profound intellectual disabilities’ in the Journal of Intellectual Disabilities, volume12 (2), pages111-126 Zeedyk, S., Caldwell, P. & Davies, C. (2009) ‘How rapidly does Intensive Interaction promote social engagement for adults with profound learning disabilities and communicative impairments?’ in the European Journal of Special Needs Education, volume24 (2), pages 119–137. Firth, G., Elford, H., Leeming, C., & Crabbe, M. (2008) ‘Intensive Interaction as a Novel Approach in Social Care: Care Staff’s Views on the Practice Change Process’in the Journal of Applied Research in Intellectual Disabilities, volume 21, pages 58-69.

  19. Finlay W, Antaki C,Walton C, Stribling P (2008) The Dilemma For Staff In Playing A Game With A Person With Profound Intellectual Disabilities: Empowerment, Inclusion And Competence In Interactional Practice Cameron, L. & Bell, D. (2001) ‘Enhanced Interaction Training: A method of multi-disciplinary staff training in Intensive Interaction to reduce challenging behaviour in adults who have learning disabilities and who also have a severe communication disorder’, in Working with People who have a Learning Disability, Vol 18, (3) p.8-15. Kellett, M. (2003) ‘Jacob’s Journey: developing sociability and communication in a young boy with severe and complex learning difficulties using the Intensive interaction teaching approach’, in Journal of Research in Special Educational Needs, March. Zeedyk, M. S., Davies, C. E., Parry, S., & Caldwell, P. (2009) ‘Fostering social engagement in Romanian children with communicative impairments: The experiences of newly trained practitioners of Intensive Interaction’, in British Journal of Learning Disabilities, 37 (3), p.186-196 Nind, M. & Powell, S. (2000) ‘Intensive Interaction and autism: some theoretical concerns’, inChildren and Society, 14 (2), p.98-109. Barber M. (2008) Short report - using intensive interaction to add to the palette of interactive possibilities in teacher - pupil communicationEuropean Journal Of Special Needs Education vol23 no4 p.393-402 Elgie, S. & Maguire, N. (2001) ‘Intensive Interaction with a woman with multiple and profound disabilities: a case study’, in Tizard Learning Disability Review, Vol 6, No. 3, p.18 Kennedy, A. (2001) ‘Intensive Interaction’, in Learning Disability Practice, Vol 4, No. 3, p.14-15. Barber, M (2005) Intensive Interaction; What Is It? 2000-2010 - A new millennium: busy busy busy Kellett M. (2004) ‘Intensive Interaction in the inclusive classroom: using interactive pedagogy to connect with students who are hardest to reach’, in Westminster Stud Educ, 27: p.175–88. Kellett, M. (2005) ‘Catherine’s Legacy: social communication development for individuals with profound learning difficulties and fragile life expectancies’, in British Journal of Special Education (2005) 32 (3), p.116-121. Nind, M. (2000) ‘Teachers’ understanding of interactive approaches in special education’, inInternational Journal of Disability, Development and Education, Vol. 47, No. 2, p.184-199. Nind, M. and Cochrane, S. (2002) ‘Inclusive curricula? Pupils on the margins of special schools’, in International Journal of Inclusive Education, 6(2), p.185-198. Barber M. (2007) ‘Imitation, interaction and dialogue using Intensive Interaction: tea party rules’, inSupport Learning, 22: p.124–30. Hewett, D. & Nind, M. (2003) ‘Severe Learning Difficulties: Intensive Interaction’, in Five to Eleven, Vol 2, No. 10 p.30-32. Samuel, J. (2001) ‘Intensive Interaction in context’, in Tizard Learning Disability Review, 6 (3), p.25-30. Hewett, D. (2007) ‘Do touch: physical contact and people who have severe, profound and multiple learning difficulties’, in Support for Learning, 22, (3), p.116. Nind, M. & Kellett, M. (2002) ‘Response' to James Hogg, Juliet Goldbart and John Harris re 'Responding to individuals with severe learning difficulties and stereotyped behaviour: challenges for an inclusive era’, in European Journal of Special Needs Education, 17(3), p.299-300. Culham, A. (2004) ‘Getting in Touch with our Feminine Sides? Men's Difficulties and Concerns with Doing Intensive Interaction’, in British Journal of Special Education, 31 (2), p.81- 88. Kellett, M. (2001) Implementing Intensive Interaction: an evaluation of the efficacy of Intensive Interaction in promoting sociability and communication in young children who have severe learning difficulties and of factors affecting its implementation in community schools. Ph.D Thesis, Oxford Brookes University. Crabbe, M. (2007) ‘the Intensive Interaction research project… and beyond’, in Royal College of Speech and Language Therapy Bulletin, August 2007, p.12-13. Nind, M. & Kellett, M. (2002) ‘Responding to learners with severe learning difficulties and stereotyped behaviour: challenges for an inclusive era’, in European Journal of Special Needs Education, 17 (3), p.265-82. Nind, M. (2000) ‘Intensive Interaction and children with autism,’ in Powell, S. (ed) Helping Children with Autism to Learn. London: David Fulton. Firth, G. (2006) ‘Intensive Interaction – a Research Review’, in Mental Health and Learning Disabilities Research and Practice Volume 3 Number 1, p.53-58. Samuel, J. (2001) ‘Intensive Interaction’, in Clinical Psychology Forum, 148, p.22-5. Nind, M., Kellett, M. & Hopkins, V. (2001) ‘Teachers’ talk styles: communication with learners with severe learning difficulties’, in Child Language, Teaching and Therapy, 17(2), p.143-159. Nind, M. (2003) ‘Enhancing the communication learning environment of an early years unit through action research’, in Educational Action Research, 11, 3, p.347-63. Irvine, C. (2002) ‘Preliminary findings of an informal longitudinal study into the research/practice interface: noting the influence of extra trees in the wood rather than throwing the baby out with the bathwater’, in Speech and Language Therapy in Practice Samuel, J. (2003) An Evaluation of Intensive Interaction in Community Living Settings for Adults with Profound Learning Disability, DclinPsychol thesis, Open University/BPS. Irvine, C. (2001) ‘On the floor and playing…’ in Royal College of Speech and Language Therapy Bulletin, November, 9-11. Firth, G. (2008) ‘A Dual Aspect Process Model of Intensive Interaction’, in British Journal of Learning Disabilities (37, p.43–49) Hewett, D. (2006) ‘The most important and complicated learning: that’s what play is for!’ICAN Talking Point, March. www.talkingpoint.org.uk Caldwell, Phoebe (2006) Speaking The Other's Language:Imitation As A Gateway To Relationship

  20. Intensive Interaction now and into the future …some personal thoughts Phases of Intensive Interaction progress: Development Phase (early 1980s onwards) Dissemination Phase (late 1980s onwards) Policy Inclusion Phase (2000s onwards) Service Development, and Management Phase - STAFFING ISSUES, RECORDING ISSUES, MANAGEMENT ISSUES, ENVIRONMENTAL ISSUES I.I.-Service Development Schedule, I.I. Practice Assessment Schedule, (GQII)???, other stuff

  21. Intensive Interaction into the future …some personal thoughts We need to work collaboratively (developing supportive CoPs) We need to remain within the ‘robust’ academic tradition (as best we can!), and to remain analytic of what we do (but not self-critical) WE NEED TO ENJOY WHAT WE DO! And: The most important thing in the further progression of Intensive Interaction will be the resourcefulness, energy and drive of the people who use the approach. Any questions?

  22. Thank You for Listen Graham Firth Intensive Interaction Project Leader Leeds Partnerships NHS TrustLearning Disability Psychology Services, St. Mary’s Hospital, Green Hill Road Leeds LS12 3QE Tel: UK 0113 3055160 e-mail: graham.firth@leedspft.nhs.ukgraham.firth@nhs.net

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