‘Exploring the Plateau’ Context and concepts to inform an analysis of the ‘developmental aspect’ of Intensive Interaction Graham Firth Intensive Interaction Project Leader Leeds Partnerships NHS Trust Photo-background - Nullarbor Plain, a ‘limestone plateau’, located across Western and South Australia ’Exploring the Plateau’

’Exploring the Plateau’ We need to understand the ‘plateau’ and we can usefully ask 4 kinds of questions to promote our understanding Where has something come from? i.e. what is its history? What does it look like? i.e. what are its observable features? What is it made up of? i.e. what are its constituent parts What can it afford us? i.e. of what use can it be? ’Exploring the Plateau’

The idea of ‘the plateau’: Where has the Intensive Interaction Plateau come from? i.e. what is its history? The history of Intensive Interaction as an approach The child/client’s personal history and interactive experiences The ‘communication partners’ personal history and interactive experiences The term ‘the plateau’ (N & H, AtC, 1994) oh dear! ’Exploring the Plateau’

the ‘dual aspect process model’ of intensive interaction Firth, G. (2008) in British Journal of Learning Disabilities (37, 43–49) ‘Social Inclusion Process Model’ evidenced in the initial rapid expansion in the client’s sociability and communicative practice as latent communicative skills are expressed in response to an Intensive Interaction intervention. ‘Developmental Process Model’ evidenced in the longer term acquisition of new communicative skills via extended experience of Intensive Interaction. Baseline of the client’s sociability and communicative practice prior to the use of Intensive Interaction Temporal axis of the application of Intensive Interaction techniques Level of sophistication of client’s communicative practice Initial adoption of Intensive Interaction The transition phase or ‘plateauing’ of expansion in the client’s sociability and communicative practice, (See Nind & Hewett, p.134, 2005). Transitional phase ’Exploring the Plateau’

’Exploring the Plateau’ the ‘dual aspect process model’ of intensive interaction Firth, G. (2009) in British Journal of Learning Disabilities (37, 43–49) The ‘Social Inclusion Process Model’ - This process model appears to be evidenced by practitioner accounts of an initial relatively rapid expansion of someone’s sociability and communicative practice, presumably as currently-available-but-latent communicative means are expressed in response to Intensive Interaction techniques. The ‘Developmental Process Model’ – This process model appears to be evidenced by practitioner accounts of an extended and incremental expansion of someone’s sociability and communicative practice, as communicative skill progression and acquisition is demonstrated. ’Exploring the Plateau’

Nind & Hewett: Access to Communication, 2nd Edition, 2005, p.134-5 ‘One of the main problems we have experienced is that work with an individual may enter a type of ‘plateau’ period, where, for ages, nothing more or new seems to happen … One of the effects of this is that you start to lose your sparkle and even lose some of your optimism, wondering whether the person has developed as far as they can go.’ ’Exploring the Plateau’

the ‘dual aspect process model’ of intensive interaction Perhaps this might be a more accurate 2D representation for someone with profound and multiple learning disabilities? ‘Social Inclusion Process’ ‘Developmental Process’ Baseline of the client’s sociability and communicative practice prior to the use of Intensive Interaction Temporal axis of the application of Intensive Interaction techniques i.e. time Level of sophistication of client’s communicative practice The ‘plateau’ - oh dear again! The transition phase or ‘plateauing’ (Nind & Hewett, p.134, 2005) ’Exploring the Plateau’

’Exploring the Plateau’ What does ‘the plateau’ look like? i.e. what are its observable features? All we have to share and shape our ideas is our cultural and language ‘toolkit’, but this can have hidden effects Language tends to be reductionist e.g. ‘making eye contact’ can become decontextualized measures and therefore planned for outcomes! Beware!… here ‘the plateau’ is used as a metaphor which leaves too much room for interpretation e.g. ‘plateau’ = flat, barren, featureless, a disappointing destination !! ’Exploring the Plateau’

’Exploring the Plateau’ the plateau’s observable features Across the research studies into Intensive Interaction are external observations of increased or novel interactive responses compared to baseline conditions, such as: increased social initiation and/or engagement (Nind, 1996; Watson & Fisher, 1997; Kellett, 2000; Cameron & Bell, 2001; Kellett, 2003; Kellett, 2004; Barber, 2008) increased levels of contingent smiling (Nind, 1996; Lovell et al, 1998; Leaning & Watson, 2006 ; Barber, 2008) 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; Kellett, 2004; Kellett, 2005; Leaning & Watson, 2006 ; Barber, 2008) increased levels of socially significant physical contact (Lovell et al, 1998; Kellett, 2000; Elgie & Maguire, 2001; Kellett, 2003; Kellett, 2004; Firth et al, 2008 ; Barber, 2008) increased toleration of, or responsiveness to physical proximity (Nind, 1996; Firth et al, 2008) improved levels of joint attention (Nind, 1996; Lovell et al, 1998; Kellett, 2000; Kellett, 2003; Kellett, 2004; Kellett, 2005; Leaning & Watson, 2006) increased use of vocalisation (Watson & Knight, 1991; Lovell et al, 1998; Kellett, 2000; Elgie & Maguire, 2001; Cameron & Bell, 2001) ’Exploring the Plateau’

’Exploring the Plateau’ How else might the ‘the plateau’ be viewed? Interactions described by varying levels of engagement? Encounter*: when someone is present during an interactive episode without any obvious awareness of its progression Awareness*: when someone appears to notice, or fleetingly focus on an object, event or person involved in the interactive episode Attention and Response*: when someone begins to respond (although not consistently) to what is happening in an interactive episode Engagement*: when someone shows consistent attention to the interactive episode presented to them Participation*: when someone shows anticipation of, and engages in, taking turns in a sequence of events during an interactive episode Involvement*: when someone makes active efforts to reach out and consistently join in, or even comment in some way on the interactive episode *From ‘A Framework for Recognising Attainment in Intensive Interaction’ based on the work of S. Aitken and M. Buultjens (1992), E. Brown (1996) and J. M. McInness and J. A. Treffry (1982). For further information see http://www.qcda.gov.uk/resources/assets/P_scales_Guidelines.pdf accessed 07/10]. ’Exploring the Plateau’

Beverley’s Story (2006) UK Supported Living Service ‘report’ document “My life changed for the better three years ago. It started by being given the chance to be a citizen in my own right, not just an in-patient. This meant I could apply for my own benefits to be able to have control over my own money. I can go for my clothes when I need them, not just once a year with a limited budget. To go on holiday when and where I choose. Probably the most important change to me, I was made a tenant in my own right. I now feel I have a place I can call my own, a place I can chill out with my own kind of music whenever I wish to.” “I know I have to rely on my supporters, but they are doing a great job. They treat me as an individual, taking the time to get to know me, to find out my likes and dislikes. Last year I went on holiday to Kielder Waters in Northumbria, they supported me to zip wire, something I thought I could never do. They are also supporting me to access the local community, going for walks to the hairdressers and shops, which can only help getting me accepted in the community.” “I know all my hopes and dreams are not going to be realised over night, but I am getter there. My life has changed from being a frustrated person into a more happy and contented person.” ’Exploring the Plateau’

’Exploring the Plateau’ Beverley’s Plateau? (2000) ’Exploring the Plateau’

’Exploring the Plateau’ What is it made up of? Some ‘constituent’ issues populating ‘the plateau’ 2 people: with their own personalities and communicative strengths, and their own past experiences and expectations for the future… 2 people: with their individual… feelings of anxiety, or ‘fear of failure’ feelings of responsibility and uncertainty feelings of hopelessness ‘it won’t make any difference…’, ‘it’s too hard because…’, ‘you must be joking…’, Bigby et al, 2009** ’Exploring the Plateau’

What else is ‘the plateau’ made up of? This is not an exhaustive list! Intensive Interaction strategies & methodology (see N&H, H&N, N&H for details) A socially inclusive, participatory and person-centred ‘philosophy’ Individual intuition(?) and creativity (Nind & Thomas, 2005) Structured recording, reflection and discussion (GQII?) Active/social supported learning (rather than teaching!) (Vygotsky – ‘social constructivist’; Bruner, Rogoff and Lave & Wenger ‘socioculturalist’ stuff here) Active exploration of a person’s potential? – we will come back to this! ’Exploring the Plateau’

’Exploring the Plateau’ But: What can it afford us? Well it depends on who we are and how we see our role! Enjoyment and fun - Yes, but is that all!! Need Fulfilment see Maslow’s Hierarchy of Needs (1943) Identity, Esteem and Agency Relationship building Attachment ’Exploring the Plateau’

What else can ‘the plateau’ afford us? A firm foundation upon which to build genuine social inclusion and personal affirmation A firm foundation to build an Intensive Interaction ‘Community of Practice’ A firm foundation upon which to develop that as yet unrealised ‘potential’ ’Exploring the Plateau’

Beverley’s Plateau (2010) ‘the plateau’ from Beverley’s perspective is a real and a good place to be It is simply the right way to be with people! it is less anxiety causing, more interesting, more pleasurable, more predicable, more dynamic, more engaging, emotionally warmer and more available, and more genuinely inclusive (than being a tenant, or clothes shopping, or…). The plateau = the only place to realise and develop her and our emotional and cognitive ‘POTENTIAL’ ’Exploring the Plateau’

Reconceptualising ‘the plateau(x)’? Intensive Interaction works like this ‘spiralling’ ‘many learning outcomes gradually emerge over time as a result of the rolling, cumulative, generative process’ Hewett, D. (2006) ‘The most important and complicated learning: that’s what play is for!’ ICAN, Talking Point, March. www.talkingpoint.org.uk repetition activities spiraling repetition repetition frequent, daily sessions repetition repetition of early engagements first access - small beginnings repetition ‘… these activities lift off and spiral upwards with success breeding on success day-by-day’ (Stern, et al,1977) ’Exploring the Plateau’ 18

Reconceptualising the ‘dual aspect process model’ of intensive interaction? perhaps this might be a more accurate representation of the ‘plateaux’ for someone with profound and multiple learning disabilities? Level of sophistication of client’s communicative practice The ‘plateaux’ ? Baseline of a person’s sociability and communicative practice prior to the use of Intensive Interaction Temporal axis of the application of Intensive Interaction techniques i.e. time ’Exploring the Plateau’

And finally…. Some final thoughts: Intensive Interaction isn’t a magic wand Intensive Interaction isn’t a ‘cure’ for anything Intensive Interaction ‘plateaux’ aren’t created and sustained without perseverance and effort Potential remains hidden, until it is realised! ‘…a result of the rolling, cumulative, generative process’* activities spiraling ’Exploring the Plateau’

’Exploring the Plateau’ References: Barber, M. (2008) ‘Using Intensive Interaction to add to the palette of interactive possibilities in teacher-pupil communication’, European Journal of Special Needs Education, 23 (4), 393-402 Bigby, C., Clement, T., Mansell, J. & Beadle-Brown, J. (2009) ‘Its pretty hard with our ones, they can’t talk, the more able bodied can participate’: staff attitudes about the applicability of disability policies to people with severe and profound intellectual disabilities’ in Journal of Intellectual Disability Research, Vol. 53 Part 4 p.363-376 Bruner, J. (1996) The Culture of Education, Cambridge, Ma., Harvard University Press. Csíkszentmihályi , M. (1991) FLOW: The psychology of optimal experience, Harper, NY DoH, (2009) Valuing People Now, HMSO, London Dykens, E. M. (2006) ‘Toward a Positive Psychology of Mental Retardation’ American Journal of Orthopsychiatry, Vol 76 No 2 185-193 Eisner, E.W. 1994 (2nd Edition) Cognition and Curriculum Reconsidered, PCT Elgie, S. & Maguire, N. (2001) ‘Intensive Interaction with a woman with multiple and profound disabilities: a case study’,Tizard Learning Disability Review, (6) 3, p.18-24. 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’ Journal of Applied Research in Intellectual Disabilities, 21, p.58-69. Firth, G. (2008) A ‘Dual Aspect Process Model’ of Intensive Interaction’ in British Journal of Learning Disabilities (37, 43–49) Firth, G., Berry, R. & Irvine C. (2010) Understanding Intensive Interaction Context and Concepts for Professionals and Families London, JKP. Hewett, D. (2006) ‘The most important and complicated learning: that’s what play is for!’ ICAN, Talking Point, March. www.talkingpoint.org.uk Leaning, B. and Watson, T. (2006) ‘From the inside looking out – an Intensive Interaction group for people with profound and multiple learning disabilities.’ British Journal of Learning Disabilities 34, 103–109. Lovell, D.M., Jones, R.S.P. and Ephraim, G. (1998) ‘The effect of Intensive Interaction on the sociability of a man with severe intellectual disabilities’, International Journal of Practical Approaches to Disability. Vol. 22 (2/3), 3-9. 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’, Support for Learning, 15 (4), 165-71. 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’, Journal of Research in Special Educational Needs, March. Kellett M. (2004) ‘Intensive Interaction in the inclusive classroom: using interactive pedagogy to connect with students who are hardest to reach’, International Journal of Research & Method in Education, 27 (2), 175–88. Kellet, M. (2005) ‘Catherine’s Legacy: social communication development for individuals with profound learning difficulties and fragile life expectancies’, British Journal of Special Education, 32 (3) p.116-121 Kennedy, A. (2001) ‘Intensive Interaction’, Learning Disability Practice, Vol 4, No. 3, 14-15. Macdonald, J. (2004) Communicating Partners – Guide for Professionals and Parents, US Maslow, A.H. (1943) ‘A theory of human motivation.’ Psychological Review 50, 4, 370–396. 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’, European Journal of Special Educational Needs, 11 (1), 48-66 Nind, M. & Hewett, D. (2005) Access to Communication: Developing the Basics of Communication for People with Severe Learning Difficulties, London, David Fulton. Nind, M. & Thomas, G. (2005) ‘Reinstating the value of teachers’ tacit knowledge for the benefit of learners: using Intensive Interaction’ Journal of Research in Special Educational Needs, 5 (3) p.97 – 100 Rogoff, B. (1990) Apprenticeship in Thinking- Cognitive Development in Social Context,’ OUP, Oxford. Rogoff, B. (1994) ‘Developing understanding of the idea of communities of learners’, in Mind, Culture, and Activity, vol1. (4). Stern, D.N., Beebe, B., Jaffe, J. & Bennett, S.L. (1977) 'The infants stimulus world during social interaction: a study of caregiver behaviours with particular reference to repetition and timing', in Schaffer, H.R. (ed) Studies in Mother- Infant Interaction (London: Academic Press). Watson, J. & Knight, C. (1991) ‘An evaluation of intensive interaction teaching with pupils with severe learning difficulties’, Child language, Teaching and Therapy, 7 (3), 10-25. Watson, J. and Fisher A. (1997) ‘Evaluating the effectiveness of Intensive Interactive teaching with pupils with profound and complex learning difficulties’, British Journal of Special Education, Vol. 24, (2), 80-87. Wenger, E. (1998). Communities of Practice: Learning, Meaning, and Identity. Cambridge: Cambridge University Press. Vygotsky, L.S. (1978) ‘Mind in society: The development of higher psychological processes.’ Harvard University Press, Mass. ’Exploring the Plateau’

Thank you for listening… Graham Firth Intensive Interaction Project Leader Leeds Partnership NHS Trust St. Mary’s Hospital, Green Hill Road Leeds LS12 3QE e-mail: graham.firth@leedspft.nhs.uk and graham.firth@nhs.net ’Exploring the Plateau’