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Using a Child Centred Approach to Working with Children Preparing to Leave Institutional Care

Intensive Interaction is a practical approach to interacting with people with learning disabilities who do not find it easy communicating. Intensive Interaction ‘borrows’ the style of the caregiver of an infant in the first 6 months of life and uses this style to open up a communication channel that helps children to feel listened to and valued. It is an approach used by a wide range of professionals, care staff, and also families and friends. In particular, intensive interaction works well with people who are functioning at an age equivalent of under a year.

With UNICEF’s support, intensive interaction has been introduced in Montenegro in 2009. Cath Irvine, Specialist Speech and Language Therapist (SLT), visited Montenegro and worked with children with disabilities and staff in one of the institutions in order to teach them intensive interaction.

“The style is basic common sense: - being in a physical position for the child to see you, having an ‘I like being with you’ look on your face, scanning the child carefully for their signals, responding to everything the child does, maintaining good eye contact, using exaggerated facial expressions.” says Cath Irvine.

Children, even those with a disability or health problems are born expecting to be held, have people look at them and talk to them. Research into the early days of a child’s life shows us that children flourish and develop if they have this positive human interaction.Children with disabilities like others need access to the most flexible, interesting and educational piece of equipment possible – another human being who could be responsive. They need focused time to learn that other people can be good to be with.

“Improving the children’s living accommodation and providing toys - this approach has been used all over the world with many charities focusing on providing small houses, individual clothes and daily activities for the children. There are children, including in some EU countries, who have drastically improved living circumstances but still sit in corners rocking, self-stimulating and often displaying self-injurious behaviours and it is this quality of life that needs to be addressed.” explains Cath Irivine (SLT).

Cath introduced intensive interaction in one residential institution in Montenegro with excellent initial results that can be well illustrated through a story on her work with one boy with disabilities. This child had lung problems from birth and he arrived at the institute at the age of 7, weighing only 7 kilos and having the size of an eight month old baby.

"When I first met him – he looked around 2 years of age, spent most of his time gazing at his fingers. He spent most of his day in a cot and was immobile despite having no physical disability. His attitude to people was wary. He tolerated being lifted but looked at people from the sides of his eyes. He was a very silent child." bcontinues: “We began by just sitting on the floor with him – looking at him kindly with an expectant look on our faces. We mirrored what he was doing with his fingers. We also mirrored looking at him from the sides of our eyes – with a playful look on our faces. He became fascinated with our hands and would look from his hands to our hands. Once he realized that we were doing the same as him, he started to do more intricate movements and carefully checked to make sure we were doing the same. He showed his pleasure by making increased and direct eye contact and making little sounds. When we mirrored his sounds too he began to experiment with new sounds as well. In a few short sessions he began to enjoy human company, he made good eye contact and was making 7 different sounds, he was attending well to the person with him and beginning to show an interest in the objects around him.”

Cath Irvine will return to Montenegro in May 2009 and in the meantime, the sessions with children will be continued by the staff Cath trained earlier in the year. Her first visit to Montenegro was part of the overall UNICEF’s project to support alternatives to placing children in institutions and helping children to develop to their full potential.

50 years of research indicate that children in institutions do not have the same chances to develop as children in a family environment. Child placement, in any kind of institution, should therefore be a last resort and should also be for the shortest time possible.

UNICEF’s approach is twofold: on the one hand to assist the Government with the ongoing child care reform process, by transforming the institutions which are in the most critical state. On the other hand, UNICEF focuses at the development of alternatives to institutional care, including the small family like homes for these children, where they can live and develop to their full potential.





Intensive Interaction

Intensive interaction is a fun-process - it means playing, laughing and learning with children with disabilities.

Through the kind of interactive play that babies and parents do children with disabilities learn fundamental communication and social abilities.

Intensive interaction involves eye-contact, facial expression, physical contact and body language, expanding sequence of behaviours with the child.

Research shows that children and adults with severe learning disabilities can start making progress if we use these spontaneous and natural teaching methods with them.

Did you know that...

• About 430 children are placed in 6 institutions in Montenegro

• Proportional to its population, Montenegro’s number of children in institutions is one of the highest figures in the World Health Organization regions of Europe and Central Asia.

• 50 years of research indicate that infants who are placed in institutional care will suffer delays in physical and psychological growth

• Children learn 50% of all they will ever learn in their first year

• They learn another 25% in their second year

• 20% of children in the orphanage in Bijela are under three years old

• Only about 15 children in Bijela do not have a living parent

Alternatives to Placing Children in Institutions

No child under three years should be placed in residential care without a parent.

When high quality institutions are used as an emergency measure, research has suggested that the length of stay should be no more than 3 months. 

That is why the development of alternatives to institutionalized forms of protection is a top priority.


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