Examining the impact of a city-wide Intensive Interaction staff training program for adults with profound and multiple learning disability: a mixed methods evaluation

Clegg, J., Black, R., Smith, A. & Brumfitt, S. (2018) Disability and Rehabilitation [on-line]

This study of day service staff focused on answering three questions, these being:

  1. What did staff think about using Intensive Interaction in their daily work with people with PMLD?
  2. What challenges did staff experience in implementing Intensive Interaction?
  3. What support do staff need to implement Intensive Interaction?

The city-wide training:

Seven staff were trained by an independent consultant to become ‘Intensive Interaction coordinators’. These coordinators then delivered Intensive Interaction training to 120 staff working across the city day centres. Staff with a particular interest in the approach were then invited for further training and mentoring by a coordinator who supported them to develop their practice, video their sessions and prepare them to have their work appraised by a panel of other coordinators – if the panel considered their understanding of the approach was sufficient, and they had an aptitude for delivering it, they were signed off as ‘Advanced Practitioners’ (AP). Such APs were then expected to support their colleagues to use Intensive Interaction, as well as use it themselves. 

The Method:

This study had 2 phases: Phase 1 was a survey looking at the outcomes of Intensive Interaction training on the work practices of 54 staff supporting people with PMLD from day services in a northern UK city.  This survey asked questions about the participant’s role, the length of their employment with people with PMLD, the level of their training, their use of Intensive Interaction, and any barriers they perceived in using the approach. Phase 2 had 29 participants who were interviewed to more fully investigate their experiences and perceptions of using Intensive Interaction.

The Results:

The city-wide Intensive Interaction training had a significant impact on the levels of staff knowledge of the approach, their work practices and on their perceptions of people with PMLD. 96% of the participants reported using Intensive Interaction, with 76% also wishing to use the approach with even more people. Using Intensive Interaction was seen to enable staff to build better relationships with their service users, giving them more confidence and greater job satisfaction. However, some challenges in the continued implementation of Intensive Interaction were identified.

The implementation of Intensive Interaction was reported to be about more than just having adequate and consistent staffing – there was an identified need for a consistent core team of highly skilled and enthusiastic staff (the APs) who are trained in and committed to Intensive Interaction; the ‘Advanced Practitioners’ role was viewed as vital in maintaining staff’s focus on Intensive Interaction across the day centres. Support from managers and dedicated time to reflect on the use of Intensive Interaction were also valued. The completion of Intensive Interaction session and attainment records was also seen as important, as was external support from speech and language therapy services.

Some implications for future service wide Intensive Interaction interventions:            

  • Training staff in Intensive Interaction promotes social inclusion for adults with PMLD.
    • With Intensive Interaction training staff can facilitate and then identify changes in the interactive and communicative behaviours of adults with PMLD. 
    • Care staff need continued support and training to sustain their use of Intensive Interaction with adults with PMLD.
    • Services need to reduce the barriers of staffing, management and organisational structures to enable care staff to sustain their use of Intensive Interaction for adults with PMLD.

In conclusion:

This study provided robust evidence that a city-wide Intensive Interaction intervention can be effective in increasing both the social inclusion and developmental progression of people with profound and multiple learning disabilities.

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