From the Inside Looking Out [FILO] – an Intensive Interaction group for people with profound and multiple learning disabilities

Leaning, B. & Watson T. (2006) British Journal of Learning Disabilities, 34, 103-109.

Method: This paper reported on a series of workshops conducted in an adult learning disability day centre. Intensive Interaction was used with 5 people (3 female and 2 male) with profound and multiple learning disabilities over 8 weeks. All the participants had very limited non-verbal communication, and all were said to avoid interaction. These sessions were videoed for 50 minutes prior to the sessions as a baseline measure with the video analysed to observe behaviours that were viewed as being important for either interaction or for avoidance of interaction, and 5 such behaviours were described: eye contact with others, object-orientated eye contact, self-stimulation (e.g. rocking, breath holding, face slapping), smiling and active avoidant behaviour (moving or turning away from others, covering the face to block the view of others).

After the assessment phase the group was run as 8 weekly 50-minute sessions with two facilitators (a Music Therapist and a Clinical Psychologist). A box was placed in the middle of the room that contained a variety of sensory items (e.g. balls, silk materials, musical chimes) which were used in interactions. In each session each facilitator would engage with clients who indicated their wish, or readiness, to do so, often building a game from an action, facial expression or sound made by the client.

Each session was videotaped and analysed for the 5 identified behaviours. One follow-up session was conducted one month after the end of the last group. In both the baseline and follow-up sessions the participants were engaged in the group sessions with staff from the day service. Four different types of groups were observed to measure the baseline and follow-up (music and movement, massage, communication, and news and views).

Results: Across the group there was an increase in eye contact, to others and to objects, signifying the participants developed a greater interest in interacting than during baseline or follow-up phase. An increased incidence in smiling during the group also indicated a higher level of pleasure during interaction than at baseline or follow-up.

A reduction in both self-stimulation and active avoidant behaviours suggested that the participants felt more comfortable interacting during the group sessions; it was thought the facilitators were able to build a better understanding of the participants. However, when the data was analysed from the follow-up session (one month later), the frequency of behaviours shown by the participants reverted back to a rate similar to that of the baseline. This appears to indicate that the mechanisms learnt in the group were not, at that time, generalised to other areas of the participant’s lives.

Discussion: from the findings this study suggests that there was an increase in the ability of all the participants to sociably engage with the facilitators. Therefore, the authors concluded that this study supports the idea of FILO and the use of Intensive Interaction principles in working with people with profound intellectual disabilities. The authors state a belief that Intensive Interaction can be taught to staff (over 3-4 session training course, with ongoing supervision), and that such training supports government policy ‘to ensure that social and health care staff working with people with learning disabilities are appropriately skilled, trained and qualified’ (DoH 2001, p.26).

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