The ‘Differentiation and Integration Phase’ of Intensive Interaction: the ‘Pros and Cons’?

Following on from my last Blog – ‘Where does Intensive Interaction go now?’ – I will now try to set out my thinking about any potential ‘Pros and Cons’ of a ‘Differentiation and Integration Phase‘ of the Intensive Interaction journey.

So to recap briefly: my conclusion about the Intensive Interaction journey, from its initial development in the 1980s (by teachers Dave Hewett and Melaine Nind), was that from around 2010 (well, a bit before really) the application of Intensive Interaction had started to become more visibly differentiated by its use across some quite radically different service user groups (e.g. very different by age, presentation, diagnosis, etc), often targeting differently defined outcome domains (e.g. developmental, educational, social inclusion or psychological well-being), and being employed across an ever wider range of care, educational or therapeutic settings and contexts.

Also interestingly, during the same period, the research evidence also suggests that Intensive Interaction is now more often integrated into or used more holistically alongside other approaches or care frameworks e.g. as part of a ‘Total Communication’ curriculum, within or alongside sensory processing support, or as complimentary to some form of music therapy, or as a proactive strategy within a Positive Behaviour Support framework.

However, when presenting my views on such a putative ‘Differentiation and Integration Phase‘ of Intensive Interaction development (which I did at the recent Us in a Bus 30th Anniversary Conference) I did not go into much detail about my views on any potential positive or negative effects from such a development. Below I will set out some initial thoughts:

Firstly, some of the Pros (or positive potential outcomes):

1. Such a wide-ranging differentiated use of Intensive Interaction (i.e. differentiated by user group, outcome domain focus, or care/educational/therapeutic context) will get the approach used more often, in more ways, by more people, with more of the people we care for or support.
2. Therefore, more of those people who might benefit from Intensive Interaction will in fact ultimately benefit from Intensive Interaction (… I now think that this should have been point 1b really!).
3. The benefits of having Intensive Interaction used with someone will be added into (or onto) any of the benefits that might accrue from the other approaches within which it has been integrated (or used alongside) – such total positive outcomes hopefully being complimentary and mutually supportive in nature (i.e. ‘the whole being bigger than the sum of the parts‘ kind of thing).
4. This broadening of the differentiated or integrated application of Intensive Interaction should feed back into our general understanding of the practical application of the approach as a whole. It should therefore add more nuanced understandings of the use of the approach in different contexts, with different people, thus feeding back into discussions that inform future practice and service/policy development.
5. Equally, such a broadening of the differentiated or integrated application of Intensive Interaction should give us different analytic planes from which to analyse, discuss and further develop the theoretical models (e.g. of care or education or therapy) underpinning our approach; further detailed theoretical work supporting more powerful arguments for the adoption of Intensive Interaction across more (or broader) groups.

However, I think that there are some potential Cons (or negative potential outcomes) to this development, including:

1. Such a wide-ranging differentiated use of Intensive Interaction (i.e. differentiated by user group, outcome focus, or care/educational context) could potentially dilute the power of the approach if it isn’t conceptualised and practiced correctly. This may occur through practice drift away from the accepted core principles and practices of the more historic undifferentiated use of the approach if it is loaded in with other things.
2. If Intensive Interaction is seen and practiced as some integrated add-on to, or extra aspect of, some other approaches (and not conceptualised as an approach in and of itself), the supporting evidence base and literature may no longer fully support such a use. Such a position may weaken otherwise robust research and academic claims made for its utility and effectiveness.
3. Over time, a differentiated or integrated phase of Intensive Interaction development may fracture or divide the diffuse ‘Community of Practice’ developed over previous years amongst Intensive Interaction advocates and practitioners. Such a fracture would mean that the mutual support networks built up incrementally since the late 1980s may no longer function effectively to develop and widely disseminate further Intensive Interaction information or resources (both human and informational).
4. Also, if groups within the Intensive Interaction community move apart through increasing differentiation, new groups may take perceived (or even actual copyrighted) ownership of such differentiated or integrated use of the approach, potentially creating competition within, rather than collaboration across, the broader Intensive Interaction community.

So, to conclude this Blog about my views on the ‘Differentiation and Integration Phase‘ of Intensive Interaction development; well, my initial thoughts are that it is the current reality, whether we (or I) like it or not. As Cath Irvine (SLT and founding co-director of the Intensive Interaction Institute) said:

‘Intensive Interaction is a rare modern phenomenon in that it has been discovered from practice, researched and shared without the firm controls about who can use, teach and research the approach.’ Cath Irvine (RCSLT Bulletin, 2001).

And she’s right – that’s how the Intensive Interaction journey started, and it is how it will continue.

But we must remember that, as stated above, Intensive Interaction is now used across a wide range of people with social or communication difficulties, be they coming from an intellectual disability, or autism, or dementia, or Acquired Brain Injury, or challenging behaviour (due to communication or relational breakdown), and many others. The approach has vastly expanded out from its original classroom to other schools and colleges (special and mainstream), and on to families, to residential services and day services, to hospitals and speech therapy services, to occupational therapy, psychological services, etc. The approach is now taught on a wide range of professional qualifications, at both undergraduate and postgraduate levels. It is now explicitly recommended in Government and NGO guidelines (in the UK from the Dept of Health, the Dept of Ed & Science, the RCSLT, the RCP/BPS, etc). And in geographical terms, well, its use is now worldwide (to my knowledge in every continent apart from Antarctica!).

So not a bad journey so far (this being a deliberate understatement for rhetorical effect)… with much more still to come. But others’ thoughts (yes you, yours) on the potential pros and cons of this next phase of the Intensive Interaction journey would certainly be welcomed …