An evaluation of Intensive Interaction in community living settings for adults with profound intellectual disabilities

Samuel, J., Nind, M., Volans, A. and Scriven, I. (2008) Journal of Intellectual Disabilities (2008), 12 (2), 111-126.

This research took place in 4 residential service for adults with profound intellectual disabilities. The study looked at 2 hypotheses:

1. That support staff could learn the principles of Intensive Interaction.

2. That Intensive Interaction would have a positive impact on, (a) the communication and social abilities of people with profound learning disabilities and, (b) the quality of relationship between them.

Four participants took part in this ‘time-series multiple-baseline’ research, Alice (32), Betty (56), Clare (46) and Diana (23). The participants had no previous exposure to Intensive Interaction. The staff comprised 3 ‘practitioners’ and 3 observers per participant. The staff training comprised a ½ day workshop, service guidelines, reflection recording forms and a support group. The Intervention involved 5 sessions of Intensive Interaction per week, of between 3 – 60 minutes (100 sessions in all).

The Results: During the study fewer than 100 sessions of Intensive Interaction were actually recorded (although this reported as due to participant ill-health).

Hypothesis 1: Video data showed that the staff practitioners learned to use mirroring of movements and vocalisation and contingent responding more. It was however noted that the frequency and extent of reflection records completion declined over time, and that the analysis showed evidence of the use of the principles of Intensive Interaction, but not of any progression. Only ½ the staff practitioners attended a support group, and that they were reluctant to watch their own videos.

Hypothesis 2(a): Each of the participants developed differently, but there was early evidence of the impact of the intervention on ‘looking behaviours’, although for Alice this began before the study. The ability to become ‘socially engaged’ and to do ‘joint-focus’ activity became apparent later on. Also the development of initiation of ‘social/physical contact’ was noted as patchy.

For ‘positive interaction’ all of the participants showed improvements by the end of the intervention, whilst for Alice & Diana, ‘vocal imitation’ was also improved, and Clare showed improvements in ‘attention seeking’, ‘simple negation’ and ‘understanding non-vocal communication’. The staff questionnaires indicated an increased expectation amongst staff that Intensive Interaction would enhance skills of participants and would gradually lead to success and maintained progress.

Hypothesis 2(b): The code applied to most practitioner data in the staff questionnaires was ‘team cohesion’, whereas ‘benefits for staff (in general)’ was applied most to observer data. Practitioners also made some comments that were coded as ‘reciprocal relationship building’, although the observers made none.  At the end of the study one practitioner commented that ‘we have learned to read each other’, and it was also noted that Betty twice sought interaction with a practitioner, when previously she would never seek out the company of others. Overall, Intensive Interaction was generally rated as ‘positive’ for both participants and practitioners. 

Discussion & Conclusions: The findings of this study add to the Intensive Interaction evidence base, but also raising some issues. Service demands which compete with Intensive Interaction may need to be addressed, and more specificity in recording formats may help practitioners to use the Intensive Interaction principles they overlook.  The findings of this study complement the existing evidence about the development of communication and sociability for people with profound intellectual disabilities through Intensive Interaction. Use of Intensive Interaction in Supported Living by novice practitioners appears to offer some potential, both for staff to learn some of the principles of the approach and for the impact this might have on the communication and social abilities of the clients and their relationship with them.

%d bloggers like this: