The start of the Contact programme coincided with improved quality of interaction between professional caregivers and clients with visual and intellectual disabilities in group homes. Further research is necessary regarding the generalisability, long-term effects and effects on quality of life.

From the perspective of attachment theory, this paper discusses individual differences in the quality of caregiving by direct-care staff for persons with intellectual disabilities. Theoretical arguments and findings from related literature are cited to support the probable role of professionals' own attachment experiences and their mental representations thereof. Case examples are drawn from a study on video-based interaction guidance for direct-care staff in group homes for persons with multiple, serious disabilities. These examples illustrate how interventions may avoid attachment-related defences against changing the quality and affective mutuality of personal contact with clients. However, the possibility is discussed that in parallel processes, quality management systems and institutional culture may selectively reinforce care patterns associated with insecure, dismissing attachment, while failing to reward the positive contribution that sensitive, affectively attuned caregiving makes to wellbeing of persons with disabilities.

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Sensory disabilities may limit a person's development of intersubjectivity, that is, the awareness of self and other, which develops in conjunction with interpersonal communication. This study used intersubjectivity theory to test a new intervention called the High-Quality Communication (HQC) intervention for its effects on a young adult with congenital deafblindness and a developmental age of between 1.5 and 4 years. Three of his social partners were trained to support attunement and meaning making with him through education and video feedback. This study measured seven observation categories at three layers of intersubjective development during a baseline and two intervention phases: dyadic interaction, shared emotion, referential communication, meaning negotiation, shared meaning, declarative communication, and shared past experience. The participant's use of conventional communication was included as an additional category. Effects were observed in all observation categories from the baseline to the intervention phases. Further study of the effectiveness of the HQC intervention is recommended to test whether effects generalize across people and settings.

The High Quality Communication intervention aims to stimulate interpersonal communication between individuals with congenital deaf-blindness (CDB) and their social partners. Found effective in multiple-case experiments, the intervention is based on Trevarthen's theory of inter-subjective development (Bråten & Trevarthen, 2007), which describes children's innate and developing ability to share subjective states in interpersonal communication and social partners' mediating role in this development. One implication of this theory is that social partners can support the emergence of higher-complexity communication behaviors in individuals who are still developing these behaviors. To test this proposition, communication patterns between individuals with CDB and their parents, teachers, and professional caregivers were analyzed. Analysis of two-event sequences of communicative behaviors showed a highly significant correspondence between the behavior of the social partner and the subsequent behavior of the individual with CDB, confirming that social partners can scaffold higher-complexity communication within interpersonal communication.

Typically developing children are exposed to multiparty communication on a daily basis from birth. This facilitates both group belonging and observational learning. However, involvement in multiparty conversations is not self-evident for people with congenital deafblindness due to their dual sensory impairment. This study explored the added value of multiparty conversations for people with congenital deafblindness by analyzing communication partners' narrations of their experiences. Three focus group sessions were conducted with professionals and relatives (n = 24) of people with congenital deafblindness. These sessions were audiotaped, transcribed, and coded using thematic analysis. Participants described the following defining characteristics of multiparty conversations in relation to congenital deafblindness: a minimum of three people involved, with at least one who has congenital deafblindness; awareness of the presence of the other communication partners; attention for the communicative setting; and the use of communication means that are familiar to all communication partners. In their experience, multiparty conversations supported social, emotional, and communication development. Furthermore, focus group participants indicated that spontaneous multiparty conversations with people with congenital deafblindness were scarce and, therefore, needed to be encouraged by communication partners. The participants considered positive beliefs, preparation of the multiparty conversation, repetitions, and a low communication speed as important partner competencies to support the involvement of individuals with congenital deafblindness in multiparty conversations. Accordingly, we recommend the development of an intervention protocol for communication partners to initiate and foster multiparty conversations with people with congenital deafblindness. Another recommendation is to test the effects of MPC on the observational learning of people with congenital deafblindness.

The parents, teachers, and professional caregivers of individuals with disabilities may benefit from interventions to enhance their educational skills. In previous studies, positive effects were observed of a video-feedback intervention for caregivers (i.e. parents, teachers, and professional caregivers) on their communication with an individual with congenital deafblindness. The intervention they received, was the High-Quality Communication (HQC) intervention. The aim of the current study was to gain insight into the perceived relevance, feasibility, and effectiveness (i.e., social validity) of the HQC-intervention according to these caregivers, and the correspondence between the social validity ratings and the observational effects of the HQC-intervention. Responses on the Social Validity Scale from 25 caregivers who participated in the High-Quality Communication (HQC) intervention revealed that they considered the HQC intervention to be a relevant, feasible, and effective intervention. Comparing the caregiver ratings with observational effects of the HQC intervention at the individual case level, we found no association between the observed effectiveness of this intervention and caregivers’ opinions about its relevance, feasibility and effectiveness. There was however, an association between the rated feasibility and effectiveness, which suggests that the perceived success of the intervention was influenced by caregivers’ experienced competency in supporting the communication of individuals with CDB. The combination of observational and social validity data enabled a critical analysis of the clinical value of the HQC intervention. We recommend that future studies use multiple data source for social validity assessment.