Gaining the power of initiation through Intensive Interaction

Calveley, J. (2017) Learning Disability Practice, 20(1), p.19-23.

Rosie was 15, living at home and cared for by her mother and a team of home carers. She had complex health needs, requiring regular nursing care and frequent hospital admissions. She was non-verbal, physically disabled and visually impaired. At the time the Intensive Interaction started Rosie spent all day in bed.

Making a connection: in this case study the author worked with Rosie, her mum and her carers to develop their use of Intensive Interaction, this involved modelling ‘how to do it’. Interactions were filmed so that the video could be used as a teaching tool, and also for progress outcomes to be recorded. As Rosie was visually impaired the author looked for alternative ways of signalling her social availability, and used touch, hearing and smell (e.g. always wearing the same perfume). The author would say “Rosie” and “hello” and then gently hold her hand and monitored her reactions, giving Rosie the chance to take the lead and do something to which the author could then respond.

Responsiveness: Early interactions involved contingently responding to the rhythm of Rosie’s breathing. This appeared to promote an awareness in Rosie that the author was there for her, as she turned her head towards her and her facial expression indicated that she was intently attending to her. When Rosie squeezed her hand, the author responded by gently squeezing back, or when she stretched her arms out the author commented with an “aah, big stretch”. Responses were made to all of Rosie’s attempts to vocalise in order to motivate her to find and use her voice more

Through frequent repetition of these simple interactions Rosie began to express a wider range of intentional sounds and movements, vocalising with more clarity and frequency. She became more physically active, moving her arms, hands and upper body, and became more facially expressive and smiled more. 

Rosie’s progress over 3 months:

  • More engaged in interactions, and focused on interaction for a longer time: turned towards the person interacting with her.
  • Developed greater sense of social connection and was more aware of other’s responses.
  • Vocalised more frequently, with more intent and expression. Made new sounds, e.g. ‘hi.’
  • Personality and sense of humour more evident in interactions: more smiles, more facially expressive, seemed happier.
  • Responded with pleasure when cheek stroked, and swallowed more often.
  • More movement within interactions and improved circulation following interactions.
  • More relaxed during and following interactions: muscles appeared less tense, and also able to pass urine following interactions.

Progress: Intensive Interaction was initially carried out as a ‘session’, but then also during the care tasks that took up a large part of Rosie’s day. Rosie’s mum and the care team also became more confident in using Intensive Interaction, and were there to provide the repetition needed to make progress.

Conclusion: Intensive Interaction enabled Rosie’s mum and carers to connect with her socially, emotionally and psychologically. This enabled Rosie to be an active participant during the interactions, and motivated her to want to communicate more.

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