Types of Intervention
Summarized from: McInnes, J.M., ed. (1999) A Guide to Planning and Support for Individuals who are Deafblind, Toronto: University of Toronto Press.
General Intervention
Main Focus: To support the individual with Deafblindness. Support is provided in such a way that the difficulties caused by deafblindness are reduced to the greatest possible degree.
General Intervention is the process by which a support person provides information to the person with deafblindness that allows them to gain much of the same understanding of the world as the sighted/hearing individual gains through their distance senses. It is always present but becomes more evident as the individual grows older and takes more responsibility for making plans and carrying them out.
The Role of the Intervenor within General Intervention:
• to foster and respond to all attempts at communication
• to provide information necessary for the individual to make informed decisions, act on those decisions, and understand the results of those decisions.
• to facilitate contact with and awareness of the environment.
• to increase the individual’s control over and sense of responsibility for his or her life.
• encouraging requests for appropriate assistance.
Instructional Intervention
Main Focus: To have the individual with deafblindness, regardless of age or level of functioning, reach the stage where he or she will decide appropriately when, with whom, for how long, and how well he or she will do the activity, to the best of that person’s ability.
Instructional Intervention involves the recognition and use of the following three sequences within every activity:
Presentation sequence - The Intervenor follows a specific sequence as he or she presents the material to be learned.
Interaction Sequence - There is a recognizable sequence of interaction between the Intervenor and the person with deafblindness.
Reaction Sequence - The deafblind individual follows a specific sequence as he or she reacts to the presentation by the Intervenor.
Social Intervention
Main Focus: To provide the information necessary to ensure the development of personal relationships and appropriate social responses.
• Takes place at all ages between the individual living with deafblindness and family members or between him or herself and friends or others within the community.
• The purposes of Social Intervention are to:
- form emotional bonds
- communicate the Intervenor’s personal response to the actions and responses of the deafblind individual
- communicate family, extended family, and societal expectations in a positive way.
• Social skills should be taught through interaction.
• During Social Intervention the Intervenor supplies any necessary information needed to understand the situation - who is present, what they are wearing, what they have said, any jokes, interesting events etc.
• Stresses leaving age appropriate decisions to the person living with deafblindness.
• The role of the Intervenor is to provide opportunities to learn social skills and social opportunities to practice them in a safe and supportive environment.
• The importance and the absolute necessity of Social Intervention can not be overemphasized in the lives of people
living with congenital and early adventitious deafblindness. Intervenors should note that time spent interacting is as, if not more, important than teaching skills or supporting participation in scheduled activities.
Social Intervention:
Expanding Social Awareness and Skills in Children Who are Deafblind
Written by: Gerald Harris, Consultant, BC Provincial Outreach Program for Students with Deafblindness (2006)
Social Intervention was recognized as an important aspect of Intervention for children with deafblindness by John M. McInnes, A Guide to Planning and Support for Individuals Who Are Deafblind (1999), University of Toronto Press, Toronto, pp. 96 – 98.
Terms:
Intervenor: The person who supports the child who is deafblind to make sense of his world and to actively participate in it.
Intervention: The practice of supporting a child who is deafblind make sense of his world and actively participate in it.
Social Intervention: The practice of supporting a child who is deafblind to develop and expand their social awareness and social skills.
MODULE I: A WORLD APART
Social development is one of the great challenges for a child with deafblindness. Her senses don’t give her good information about the social world. She doesn’t automatically learn even the very basic social concepts.
For example: A child who is deafblind may not automatically figure out:
- that she is a person in a world of people
- that people are big and small, young and old
- that we have names and individual identities
- that she has a name and an individual identity
Note how basic the social development issues may be for a child with deafblindness:
- What’s a me?
- What’s a you?
- What’s a person?
The deafblind child may be scarcely aware of the social world we all live in. Hers may be a world apart.
With sighted, hearing babies, a kind of pre-programming goes to work immediately between babies and moms to develop social awareness and social skills. Children and their families automatically enter into social games and routines. Children see and hear the people around them relating to each other. But in the case of the child with deafblindness, most of the automatic programming doesn’t work. She doesn’t see or hear the playful social cues coming from family members. She may give social cues, but then not pick up on how they affect other people. And she doesn’t see and hear how people exchange with each other. All that social information must be brought to the deafblind child, for her to use in her social development. That’s Social Intervention. The Intervenor must bring
social information to her:
- in modes that she can use
- and in situations that she can make sense of.
MODULE II: ME + YOU = FUN
For a student who is deafblind and just entering school, the starting point of social development is in her relationship with the Intervenor. Most students with deafblindness enter school at early beginning stages of social awareness. They may still lack the very basics of interacting with other people. They may not yet be hooked on the value and pleasure of interaction. They may experience interaction as mainly confusing and unwelcome. They may still exist in that world apart. A deafblind student in the earliest stages of social awareness still needs to learn the mom and baby games of attending and responding and turn-taking play. But she needs those games in sensory modes she can understand, mainly movement and touch. The Intervenor is the person who translates the mom and baby social development
games into games of touching and moving together.The Intervenor joins the child in her world of touch and motion:
- physically following the child’s lead,
- turning the touch and motion into back and forth play.
The school week may include hours of rocking, swinging, hand games and massage. In back-and-forth play, the child is learning to respond and initiate, to lead and be led. She is learning conversation.
People think of conversation as something we do only with language (speech or sign), but it’s exactly the opposite. Conversation comes before language. We learn to love conversation in our earliest development, with our eyes and bodies and hands. Later, when we get language, we use it in conversational patterns with which we are already expert. For a child with deafblindness it’s the same. Conversation, the skill of back-and-forth interaction, develops with motion, touch, gaze and vocalizing. Later, as she gets language, she is able to apply the language in those known patterns. The social skill develops before the language skill.
A word about permission:
Intervenors often have difficulty justifying to themselves the hours they spend playing with a deafblind child, rocking, using playground equipment, doing massage routines, hand games and other pleasant stuff, while the classmates are doing “real” schoolwork. But Intervenors know that all those games of movement and touch are vital. They are the foundation of social awareness and skill. They develop the child’s concepts of self and other. They bring her out into a world of relationship that she begins to find more interesting, rewarding and fun than her inner world of sensation. So, Permission Granted. Go ahead and have way too much fun.
MODULE III: PLAYING BY RULES
The Intervenor brings responsible social behaviour into every part of the child’s school day. The deafblind child does not automatically know that every person lives a great portion of her life within socially established routines and according to socially established rules. So an important aspect of Social Intervention is gradually teaching the habits to the child.
A vital step in learning social conventions is taking responsibility in the common routines of daily life. Because the child is deafblind, and not primarily a visual or auditory learner, she learns by being shaped through her routines many, many times. The Intervenor moves the child through the routines, and very gradually passes responsibility to her.
Life in society has its responsibilities, but it also has choices. In Social Intervention, the Intervenor strives to build opportunity for choice into all the child’s routines. So the child is learning not just to follow convention but also to exercise choice within her routines. At all times with the Intervenor, the child is learning that life with other people has patterns to it, which begin to make sense and to become enjoyable. She is learning that life in society is largely about playing by rules, taking responsibility and making choices within daily life routines.
MODULE IV: JOINING THE CIRCLE
Social development starts with just a few key individuals. At school, it’s the Intervenor. But social awareness must expand for the child who is deafblind. He needs to join the larger circles around him, the communities of the classroom and of the school. Most often, the child who is deafblind starts school with very little awareness of classmates and teachers, and even less interest in them. Social Intervention fosters that awareness and interest. The Intervenor brings the deafblind child into social contact with the people around him. Those moments of social contact need to be meaningful and successful both for the child who is deafblind and for the other people. Creating opportunities for purposeful interactions in the school day may be the most challenging part of Social Intervention.
It takes flexibility, goodwill and creative thinking with the teacher and Intervenor working as a team.
For the Intervenor, bringing the student into contact in the wider circle requires three distinct kinds of work. One is teaching the deafblind student how to function in the social interactions, including giving him clear feedback about the results of his actions on other people. Another kind of work for the Intervenor is in giving classmates and teachers the awareness and skills they need to successfully interact with the deafblind student. The third kind of work for the Intervenor is the teamwork with the teacher, finding and creating those points in the school day when there is opportunity for interaction that works for everybody, deafblind child, classmates and teacher.
The deafblind student who started school with little awareness of the other children, and even less interest, does become more social the more he interacts with the people in that wider circle. The social interaction then becomes a motivator for the child in working on other educational goals.
MODULE V: KEEPING THE “INTER” IN INTERACTION
Anybody’s development depends a lot on the sort of environment in which we develop. Some environments encourage us to become expressive individuals who are social initiators. Other environments might make us socially passive or withdrawn. People with deafblindness are more at risk than most for learning social passivity and withdrawal. So a challenge for Intervenors is to maintain a social relationship with a deafblind child that will bring the child out as an expressive person and social initiator.
Here are some ideas that can help.
Directing versus Commenting:
In our normal social interactions, we do a lot of commenting. Whole conversations consist mainly of commenting – about the weather, the food, the hairdo. Whatever topic may provide a point of mutual interest between two people, they comment back and forth about it. It’s THE mainstay of conversation.
Commenting is also a major way mothers teach language to infants. For example, the infant points to the picture in the book, and the mother says, “Doggie. The doggie is chasing the ball.” Humans are programmed to follow the interest of little children and to comment about it. And the children are programmed to learn that language. Commenting is powerful.
And then there’s directing. In everyday life, we usually keep directing to a minimum, if we want to keep our friends. But in school, with children with disabilities, directing is mostly what we do. So what the children learn mostly is how to be directed. It’s one-way communication. I say. You do. I ask. You answer. Directing certainly has its place at school. But for a child who is deafblind, we had better not make it the only model of social interaction. A great teacher, Barbara Miles, has challenged us to think about our interactions with children who are deafblind. We need to ask ourselves: “What proportion of my interaction with the child is directing him, and what proportion is commenting about things he’s interested in? How can I bring directing and commenting
more into balance in our interactions?” For children with deafblindness, language and social development both move forward best in a school day that has a goodly proportion of commenting mixed in with all the directing.
Portable, Accessible Communication Systems:
The task, remember, is to help the student be expressive, a social initiator. But for anybody to be expressive, he needs to have his communication system available at all times. For example, where would we talkers be without our mouths and tongues always ready? It’s the same with children who are deafblind. If we want them to be social initiators, then we had better keep their communication systems always available. Portable, accessible communication systems: that’s another key to keeping the “inter” in interaction. It’s a constant challenge and a constantly moving target. How do we make sure the communication system is there and available whenever the student needs it.
The most portable and accessible communication modes are the ones that use the voice or the hands. Speech and vocalizations, sign and gestures are always with you: no equipment; no setup.
Objects, symbols, printed word, voice output, …any of these media are important to some deafblind students in social interaction. For the student to be a social initiator, an expressive person, any communication mode must be quick and easy to use, reliable, and always available. Making his communication modes accessible to the student is a continual problem. The solutions are unique to each student, and keep changing as the student develops.
A comment on vocabulary: If you want the student to be an initiator, a socially expressive person, give him vocabulary that reflects his interests, that he cares about, that he wants to use. Giving a student vocabulary for what interests him is another way of following his lead in social development.
The final point in this section about “Keeping the Inter in Interaction,” is always to give conversation a high priority and to allow time for it. Do half as many activities, and give the extra time to conversation and social development.
MODULE VI: TAKING IT TO TOWN
Beyond the classroom are larger communities, the school, the neighborhood, and the town or city. Social Intervention develops the student’s awareness and ability to function in an ever-widening and ever more complex social environment. With his style of learning through physical experience and routine, the child with deafblindness needs to start in the early grades to develop social competence in the wider communities. And social education beyond the classroom becomes an increasingly large part of the school week as he approaches graduation.
Whatever the social environment - shopping, recreation, work, public transportation - the deafblind child develops skills and learns social conventions by physically and frequently being there, doing the activities and interacting with the people.
In the wider communities, it’s still the Intervenor who is bringing information to the student, information such as:
-What are these different places?
-What’s the point of them?
-What do people do there?
-What are the social rules and responsibilities?
-What are the choices?
Increasingly, the wider social world makes sense to the deafblind student, and he enjoys playing his roles there. Each new environment has its unique social routines and appropriate behaviour. In the wider communities, just as in the classroom, the Intervenor gives the deafblind student feedback about the results of his actions, and lets him correct his own mistakes. Here, just as in the classroom, the Intervenor pays close attention to what the student is interested in, and follows his lead by giving him the language and skills he needs to pursue his interest. Social Intervention in the wider communities, just as in the classroom, requires that the Intervenor take the time for conversation with the student, for hanging out, and for having way too much fun.
Conclusion:
In concluding this set of modules on Social Intervention, we hope we’ve made it evident that Social Intervention is absolutely necessary in the life of any child growing up with deafblindness. Intervenors need to know that time spent interacting, facilitating interactions, and helping the child learn to function successfully in the great web of social convention that holds convention that holds community together, is fully as vital as any other aspect of the child’s education. Whenever you encounter a deafblind child who is growing up socially aware and socially able, look around. Somewhere very nearby is an Intervenor at work.
The Impact of Deafblindness on Social Interaction
By Linda Mamer, Ed. D
How Deafblindness Affects the Individual’s Ability to Develop Social Interactions, Social Relationships, and Friendships
Introduction:
Social Interactions, social relationships and ultimately, friendships, are the riches that give meaning to life and reason to want to be part of the world. Parents want their child to have friends. Due to the nature of deafblindness, relationships can often take a long time to develop, since the individual cannot see or hear (clearly or at all) the interactions that occur several hundred times a day among people who are sighted / hearing. With children who are deafblind, the development of friendships may take longer, but is a very necessary goal and all involved should be committed to using every opportunity to develop relationships.
Types of Social Interactions that an Individual with Deafblindness may have:
There are many different types of social interactions and all are building blocks. There are different levels, types and intensities of relationships. Examples include child to parent, child to extended family member, siblings, intervenors, teacher, principal and other staff members of the school, peers in the classroom, a clerk in the corner store, therapists, regular medical and dental personnel, government social service provider, bus driver, church member / clergyman, neighbour, volunteer job such as in a hospital, job such as a paper route, employee-employer, with pets, on a sports team, at Brownies, Scouts, as a member of the local community centre, with day care providers.
What is Friendship?
A Friend is:
One who is personally well known by oneself and for whom one has warm regard or affection. One with whom one is united in some purpose or cause (from Funk and Wagnall’s, 1980).
Friendship is:
The state of being friends, mutual liking and self-esteem (from Funk and Wagnall’s, 1980).
Friendship is a coming together of people with shared or potentially shared interests.
An acquaintance is:
Someone who has “knowledge of any one person, having personal knowledge” , “one’s feelings for an acquaintance are less warm that for a friend and may have more courtesy that of affection" (from Funk and Wagnall’s, 1980).
An acquaintance may be a chum, pal, a sports buddy.
Practical Strategies to Facilitate Social Situations
What concepts need to be in place for each stage of the Social Interaction process for the individual who is deafblind?
The Individual who is deafblind NEEDS:
• Awareness of self.
• Awareness (at a beginning level) of name / label / concrete cue.
• Awareness of at least one family member.
• Awareness of that person’s name / label / concrete cue.
• Awareness of other family members.
• Awareness of those persons’ labels.
• Interaction with one or more family members.
These activities / interactions can be predictable regular routines around life skills such as dressing, eating, bathing.
These activities / interactions can be predictable regular routines around games, rough housing, tickling games, sharing. These activities may be specific to the family member involved.
• Some level of Communication – Receptive communication as a minimum – e.g. touch / concrete cues, simple gestures, simple signs.
• Awareness of people in school, community (Teacher, Intervenor).
• Interaction with one or more (of these) familiar / regular people in the community. These could include regular greetings from the teacher at the beginning and at the end of the day, predictable routines with the Intervenor.
• Interaction with one or more people in the community.
These activities could include regular greetings from the principal of the school, regular name signs from a few members of the class, regular gestures from the bus driver, regular concrete cues from the lunch time assistant.
• Some level of Communication -- both Receptive and Expressive – e.g. concrete cues, simple gestures, simple signs.
These activities could include receiving and giving concrete cues with members of the class, tactually and / or visually exchanging name signs with members of the class.
Social Interactions need to occur before social relationships can develop, These interactions are ones that happen with the same people on a regular basis. The individual needs to have predictable and consistent occurrences of social interactions. For example, regular greetings from the same person will build up the concept in the individual that the person is a constant in their life. Using consistent tactile cues and name signs on the part of the person will help the individual anticipate the appearance and interaction of that person.
Social Relationships occur because of a coming together to share interests – e.g. hobbies, sports, lessons. Realistically, they may be for brief amounts of time. The individual will need the Intervenor directly until the other person learns enough of the specific communication to be able to communicate directly with the individual. The Intervenor can back off at this time – but needs to be near by to assist if new communications opportunities or needs arise.
Social Relationships may be specifically based. The individual may learn to relate to specific persons in specific activities or specific events or specific times. This may, in fact, be the most realistic, at least initially – due to the difficulty that some individuals with deafblindness may have in transferring knowledge or experiences or concepts.
The Roles of the Intervenor, Parents, Teacher and Support Staff in Developing Social Relationships
for the Individual with Deafblindness
What can the child do?
1. Look first at what the child with deafblindness can do for him / herself.
2. Communication. Can they communicate? Do they attempt to communicate with others?
3. Can the child assist in any formal mode of educating classmates regarding their deafblindness?
4. Does the child have some control if they DO NOT want to interact?
What can the Parents / family members do to increase opportunities for Social Interaction?
• Chances for socialization don’t occur only in the classroom – students meeting other students in school is often a vehicle to get to know them.
• Parents may need to be fairly direct and determined and assertive in their strategies to encourage relationships.
• Parents need to work to maintain friendships that occur during the school during the after school hours and weekends and summer.
• Parents and family members need to be social themselves. They need to use name signs, concrete objects and communication with the child.
• Parents need to provide information to other people in the child’s social world, such as extended family members, neighbours.
• Parents need to model appropriate interactions with their child for those in the community.
• Family / Intervenors need to try to discover likes, dislikes of the child.
• Invite classmates home for activities, make it a fun place for children to get together.
• Inviting at least two children at one time keeps things moving.
• Parents need to take the lead in organizing outings for several of the classmates, such as picnics, bowling, swimming, pizza party, going to the park, going to a restaurant, going to a movie.
• Call other parents from the school or the program to introduce your family to their families.
• Parents could visit and/or volunteer at your child’s school to get to know the other children who are interested in your child.
• Throw a birthday party for your child and invite the other children.
• Watch to see what the other children wear (for clothing), note what is in style and what is age appropriate.
• Try to get involved with community programs, such as Scouts, Cubs, Beavers, swimming.
• Parents could call the families of their child’s friends to let them know that/when their child would have an Intervenor with them – if they wanted to invite the child with Deafblindness to their home. If the other family does not think the child would have anyone with them, they may be nervous about inviting the child to their home.
• Realize the amount of time that developing relationships take for all of us and be patient.
What can the Intervenor do?
• Depends on the individual, situations, interests
• Intervenor (and family) need to try to discover likes, dislikes of child.
• Try to discover what the classmates are interested in and expose the individual to those activities to see if you can spark an interest.
• Need a common interest or topic or piece of equipment with which to bring the individual and the other student together (initially, it may be the Intervenor that attracts the other students).
• Initially invite the other children to play with them (the Intervenor), then with the child with deafblindness – as a triangle arrangement.
• If another child seems interested in the individual but is not sure what to do, the Intervenor can create the activity if s/he knows what the other child likes.
• Work on having the individual learn appropriate body language – e.g. head nodding, head shaking, smiling, turning head toward the person, shaking hands, handing stuff to someone.
• Individual needs to learn to label items – that things have names.
• Individual needs to learn turn taking.
• Can use toys that require assistance to work – lids removed, on/off switches, wind-up toys.
• Individual needs to learn now to share. Teach the individual to “give………..” to the person.
• Teach concepts before the situations arise (where possible).
• Intervenor needs to develop the student’s array and knowledge – not just a single topic such as baseball.
How can the Intervenor structure the environment?
• Limit the physical size of the area where the individual is – to the range of their residual vision and hearing and tactile reach (so the other person and equipment/toy is close by).
• Try to teach the actual play skills at times other than at play time. Then the individual can more naturally interact with the classmate, because they will need less assistance from the Intervenor.
• Teach specific and deliberate social skills (where able) in a role playing situation separate from the other children. This needs to be quite directive. Tell the individual (and practice) the actual phrase (e.g. “Can I play with you?”). Then slowly introduce one, two children into the “scene” as the individual becomes more comfortable and gains in understanding.
• Forcing the pairing often does not work.
• Often there will be one or two others who appear interested – they may seem like the “mother hen” type. It may be that especially in the earlier grades it is usually girls who appear interested.
• It is Okay to realize that the actual interaction may not appear how we would define “equal”.
• Okay to see that the interaction may initially (and for quite awhile) appear to be of the helper-helpee set-up.
• We have to be realistic, especially in the early stages. It often takes a long time for the natural interactions to happen – don’t be discouraged – this is often true of children with other disabilities. The interaction cannot be forced.
• Need to be sensitive – not all students (who are non-disable) want to embrace the student with deafblindness.
• One or two social relationships would be great. They may be activity specific.
• Be warm and friendly and approachable.
• Use appropriate toys and materials with the child.
• Try to use functional activities and objects that make sense to the individual – this will reinforce concepts that they need to learn.
• Teach sign language classes (or equivalent) or teach the other children the communication system that the child uses – do not be afraid to explain the why behind the communication device (e.g. who concrete cues are used and how the individual uses them).
• Encourage others to use name signs of the Individual and of the other children.
• Encourage others to communicate with the child, by directing the others how to actually and physically do it.
• Help the individual learn about body language and assist them in reading body language – their own body language – what is correct placement, and the body language of the teacher / adult, their classmates.
• Be sensitive to possible health and comfort levels – some days, none of us feel that “social”.
• Have healthy expectations – assume that the Individual will understand the input at some level from the other child and that eventually the individual will be part of the back and forthness of the communicative intent.
• Realize the amount of time that developing relationships take for all of us and be patient.
What can the teacher / school support staff do to help the classmates socialize with the Individual?
• Create an atmosphere where everyone is accepted.
• Encourage simulations / awareness activities – on a regular, yearly basis:
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- Don’t assume that if the other students have questions, they will feel free to ask. - Don’t assume that just because the class has been together for a long time, that the other students know all that is needed to know about the student. - Encourage a feeling of openness if the other students have questions about the
individual. - Often the other students are curious about different things at different times in their lives. |
• Share day plan / week plan with the Intervenor to consider curricular activities and modifications to allow for more opportunities for social interaction (e.g. table top activities that have different goals for the rest of the students and the Individual).
• Set a good example by speaking / communicating directly with the child.
• Find something that the student can share with the class in a leadership manner e.g. a new piece of equipment, have them teach some words in sign,
• Look beyond the age range of the individual to different students throughout the school who may also be interested in interacting.
• Devote time to helping the Individual learn about emotions – both their emotions and people around them.
• Have expectations for the individual.
• Work to develop a relationship with the individual as you would with the other students.
• Have a bulletin board that highlights (e.g.) the sign of the week.
• Discuss the needs of the child i.e. tactile, visual, auditory in a straight forward manner and that students learn in different ways.
• Figure out a comfortable model of peer – assistance i.e. one student per day and watch for burn-out. Some teachers find assigning one per day works. Some teachers let the students sign up (may work, may not – may get lots or none). Some teachers may rotate the duties.
• Teach cooperative learning techniques with the class.
• Set up small group activities where the Intervenor can have a few students together with the student with deafblindness.
• Be aware of recess / noon hour activities that the individual can do and provide opportunities for these activities.
• Promote social awareness of all types of needs, likes, dislikes.
• When the teacher has expectations of groupings – they can occur without thinking.
• Ask the other students how to include the individual in activities in the class – often they will come up with more creative ideas.
• Help the students see the value in all of the classmates – Help the others be part of the successes of the individual.
(Thanks to Carolyn Monaco for her input on this topic.)
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