The Percy Hedley Foundation Speaks Out

Conductive Education in context:
Can we learn more from colleagues?

Conductive Education (CE) faces many problems, and some have been around for a considerable time, for example a lack of understanding from other professionals, lack of recognition from governments, lack of research on effectiveness. But other parts of the disability field face similar problems and, in particular, the process of Intervention and the work of Intervenors with deafblind people have considerable similarities. As we try to solve some of the difficulties faced by Conductors I think it might be useful to think about how colleagues in other fields tackle the issues.

First let me say what an Intervenor is. He or she (there are both types!) is a trained professional who works with disabled people - in this case deafblind people. Their role is to intervene between the deafblind person and their surroundings; to help the deafblind person understand what is happening, and to help other people understand the deafblind person. They are more than a sign language interpreter as they provide information about what is happening around the deafblind person, and not just an interpretation of the words that are being spoken. They minimise the effect of the impairment, and they empower the deafblind person to have control over their life. Both of these are part of the Conductors work with people with physical disabilities. Their work is based on 'activity routines' - another similarity. They work in a situation where there is no cure for the condition, where fundamental human actions are impaired, and where there is a 'dislocation of development' because of the impairment. You may recognise these as fundamental principles of Conductive Education, although they apply equally to Intervention.

So the purpose and principles of their work are similar, even though the methods may be different. How else are the two groups of people - Intervenors and Conductors - similar?

They both face some severe problems - even crises; problems that may be getting worse rather than improving, although, today, these problems are of different importance in different countries. I suggest there may be 4 major problems.

  1. Their work is not fully understood by others. There is often confusion, for example, over whether they are instructional aides, or physiotherapists, or physical therapists, and in some schools they may be asked to carry out this work if someone is off ill. Intervenors are often confused with instructional aides - social pedagogues, or sign language interpreters.
  2. There is little recognition by local authorities or national governments of the role and importance -there are a few countries where deafblind people are entitled to an Intervenor service (e.g. Finland, parts of Canada) as there are a few places where Conductive Education is fully funded by the State.
  3. There are no accepted standards for a professional qualification, or one accepted description of a Conductor, or one charter of professional standards. This is emerging - for example, England is developing a document on this. For Intervenors, there are a very few countries that have developed an agreed description. Yet, at the very beginning of CE, Ester Cotton urged the field to 'codify with brevity and clarity' what Conductors do. Unfortunately, the more we examine it the more details we want to include for accuracy.

  4. There is sometimes tension between other professionals over the role, and arguments, for example, over how many children a person should work with and what instructions they can give to work colleagues.

The two processes have some weaknesses - and I feel more confident suggesting three common weaknesses.

  1. There is a lack of a firm theoretical basis for the work, and
  2. A lack of evidence of effectiveness.
  3. There is a lack of trainers and, therefore, inadequate training at all levels, basic, advanced and mastery level for experienced people, for example the trainers.

Both processes were originally thought up by a charismatic leader who was able to explain the process with 'beautiful simplicity' (Cotton). But in reality, CE is not based on modern neurological facts, and Intervention is not based on modern learning theory. So, although we know that both are successful, both are questioned by medical professionals. And we have not, truthfully, been able to provide research evidence that will satisfy those professionals - or social workers or administrators - that the process is a proven effective model of support.

So I have identified at least seven crises (although their importance will vary in different countries), that I think might be critical for a successful future for Conductors.

What has been done to deal with some of these problems?

Firstly, the confusion over what Intervenors and Conductors actually do. Both professionals say they are led by the child, and aim to support a child to make their own discoveries. But in CE there are clear methods, techniques, equipment that can be used; it is the Conductors doing an assessment that will determine how these are used with an individual. This is a strength, as Intervenors do not have such a clear set of resources - for example, there are many different communication methods (signs, signals, reference objects, symbols, haptic phonemes) and a lot of personal judgment on what a person needs to know about.

For Intervenors, some clarity over access to an Intervenor service was achieved through the assessment - a critical part of the process. In Canada, one of the first steps was to persuade government that people with visual and hearing impairments must have a functional assessment to evaluate if they are 'deafblind'. If the assessment results in them being classified as deafblind, then they will need some services, one of which is an Intervenor. This is essential, it is argued, as the support is fundamental to human development.

Now most countries have a clear functional description of deafblindness and this has been successful where it is clearly described (not defined) in simple rather than detailed terms., in many countries, deafblind people have a right to assessment, some countries include a right to services, but many do not have the professionals or the money to actually deliver the Intervenor service. A campaign to achieve more clarity and access must think about all these stages and this is something that seems missing from the CE field.

Now Job Description - do we need to agree within ourselves what a Conductor does, and have a professional code of standards?

Intervenors felt strongly - led by their pioneer founder - that the role needed a clear description. They included some principles - perhaps we would call them values and, from the very beginning were based on human rights; respect, individualisation, right of access to information, entitlements to services, empowerment. They then agreed some of the working elements, such as direct support for a deafblind person, no supervision of other staff, responsibility to devise educational approaches, links with families, right of attendance at professional meetings, a resource for other staff, not a replacement for other staff. Many of these phrases are now included in national descriptions, and the code of ethics that Intervenors sign up to when they join an international network. That network is not yet firmly established. It exists but has no leaders or road map for the future. But that was proposed at an Intervention meeting in 2007 and there has been some progress since then.

There are some moves to reach agreement on a charter for Conductors or description of core competencies, but also there seem to be extensive discussion over language, aims and concepts so, to me, it feels as if there is not so much agreement on this as there is in the field of Intervention.

One of the consequences of the Intervenor network and discussions on these values, was the realisation that the nature of the work can lead to burn-out, - compassion fatigue, overdeveloping an emotional bond with a child. Whatever the name, it is now a real concern. Not that the standards are too high, or the expectations Intervenors have of themselves are unrealistic, but that the systems of work must recognise the intensive interactions, and ensure the person experiences changes in children, or role, or training, so individuals can break away from the intensity of their commitment, and involvement.

A difference between the two systems is that, in theory, CE should fade over time as skills are developed. The need for Intervention does not fade over time, as the impairment will always prevent direct access to information. Perhaps, therefore, burn-out will be more of a problem for Intervenors? One measure is the performance of the professional - they must suspend their own perceptions, interpret reality as the child perceives it. They must be led by the child; 'do with, not do for' is a fundamental principle, and if you know the child too well, it is very difficult to avoid anticipating what they will do and then have expectations that limit the child, perhaps increase dependency. That is a danger sign- a warning that burn-out might happen - that can apply to both fields equally. Perhaps this still needs to be fully recognised in CE?

Theoretical basis and evidence

Both systems have the same difficulty in isolating variables to create valid research findings. The effectiveness of Intervenors was researched by state and national government in North America who wanted to find out if they should give money to pay Intervenors. Fortunately, that research found the use of Intervenors made a significant difference. They found that children who received Intervenor services made greater progress overall during their total treatment time than before treatment - in all developmental domains. They also scored higher at post test than would be expected due to maturation alone. Also parents had more positive perceptions of their child's progress, felt they could understand and meet their child's needs better than a control group.

This was a Level ll study (non-randomised quasi-experimental design) but in 1993. Since then there has been a mass of evidence and case studies (Level lll) but the field has failed to produce anything that explains why the system works (using a Level I rigorous research design). The current focus is on practice-based evidence, and this must move to evidence-based practice. This seems, to me as a researcher, a fundamental problem for both fields and the implication is that Conductors must develop their system for evidence collection through daily recordings.

Training is essential to become an Intervenor as it is to become a Conductor. In fact 'qualified' Conductors are essential if the field is to exist, or there can be no professional standards. For Intervenors, there are a wide range of basic qualifying courses. Some last just two weeks although others are a full university year.

What I think is particularly important is the lack of professional trainers and there really are very few spare people who have become full-time trainers. As a result there has been much sharing of resources. Many video examples of Intervenors at work, for example, that can be used for analysis in staff development. A group in Ontario has produced a DVD illustrating all the aspects of an Intervenor's work, and another one of Intervenors explaining what they do, and the excitement they get from their work.

But the most significant development is of distance learning. This is ideal if there is a shortage of trainers, or if students are geographically spread. Distance learning can mean different things, for example Intervenors can be trained through students sitting in different centres and learning through a TV link, or through having written and video materials sent to them so they can study in their own time, or a web and e-mail based learning package. Training is nearly always linked to supervised practice - students must be working in a centre where they can try out the ideas under supervision. But it results in very many students being trained in a short time; it ensures the learning materials are up-to-date and written by the very best people in the field; it makes for a modular course with elements that can be selected to make the best course content for any particular group of students.

Access to training is, I believe, a difficulty for Conductors. Perhaps this is a particularly useful development in Intervention that could be adopted by CE.

Finally, then, we have two fields that seem similar, but each seem to have their own natural development. Both fields grew through the enthusiasm of families who insisted that the system was of help to them. Intervenors used to often be siblings, and families - parents, grandparents and siblings - are still an integral part of Intervention. At the Canadian conference in 2006 over 30% of the participants were from families. In the field of Conductors, most people attending our conferences are professionally trained Conductors and, perhaps, families have a marginal role in supporting the professionals.

Both started out with the 'beautiful simplicity' of an idea by their founder. Intervenors developed that to become a system meeting a basic human need and entitlement. Conductors have become highly technical and specialist as a professional field of work. What might bring both groups together though, is a quote from one of the founders of Intervention who said 'all people smile in the same language'. That is the difference we all want to see, that we all want to make. Perhaps spending more time looking to colleagues facing similar challenges is one way we can move towards achieving that goal.

This is a revised version of a paper originally presented at the 2009 European Conference on Conductive Education, held in Helsinki.

Tony Best
Chief Executive Officer
Percy Hedley Foundation
January 2010

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