Intensive Interaction as a Novel Approach in Social Care: Care staff’s views on the practice change process

Firth, G., Elford, H., Leeming, C. & Crabbe, M. (2008) Journal of Applied Research in Intellectual Disabilities, 21, 58–69

This study reported on a 6-month Intensive Interaction intervention in 4 NHS staffed group homes in the north of England. 29 staff members were trained in Intensive Interaction and subsequently supported to implement the approach with their clients. Data was collected via researcher field-notes and semi-structured interviews, these being analysed using a grounded theory approach; the data being categorised into 7 major thematic categories that appeared to influence staff’s adoption of the approach.

1. Levels of client responses: Client responses to Intensive Interaction ranged from the clearly beneficial and novel, to there being little or no response. The novel responses ranged from improved awareness of the social environment, to non-task associated physical contact. It also emerged that client responses were crucial, with staff using such positive ’feedback’ to decide whether or not to continue; this leading to some staff interact more with some specific clients.

2. Staff’s conceptualisation of Intensive Interaction: a range of conceptualisations of the approach emerged, with some staff seeing Intensive Interaction as: a form of communication; relationship building; client led activity. The most common view was that Intensive Interaction was a means of communicating with clients through their own communicative means and at their level.

3. Staff’s view of client’s personal attributes, and level of understanding: Staff’s views of their clients’ personal attributes also influenced the Intensive Interaction used. This was at times a barrier as some staff were deterministic about their client’s behaviour, or thought that clients might not like it.

4. Issues related to staff – client relationships: it was noted by some staff that staff-client relationships varied which potentially affected the levels of social interaction. Intensive Interaction was seen as a potential tool to build relationships with clients.

5. Philosophical issues influencing the care environment: some staff voiced concerns about Intensive Interaction being based on ‘infant-caregiver’ activity and felt that ‘age-appropriate’ methods should be favoured. Some staff also had concerns about how using Intensive Interaction ‘in public’ might look to outside observers.

6. Practical and personal issues affecting the use of Intensive Interaction: there were some aspects of Intensive Interaction that staff used more often, and others less so.Also time related issues emerged; one being that Intensive Interaction was competing with other tasks for finite staff time.

7. Issues related to the momentum of approach adoption: the data indicated that, over time, there was an apparent decline in the level of interest and involvement in Intensive Interaction compared to more functional care tasks.

Discussion: The study found that some clients evidenced greater initiation of social contact, improved sociability, and increased client led interactions and involvement. The research also found staff seeing Intensive Interaction as useful in improving relationships with clients, even when they had previously worked together. 

Although there were clear benefits to the intervention, there were still a number of issues that affected the levels of acceptance by staff of Intensive Interaction. Some staff felt they were already doing Intensive Interaction, but this research suggests that some of these claims could potentially be exaggerated. Also the issue of ‘age appropriateness’ was still identified as an obstacle to using Intensive Interaction with some staff feeling it could potentially damage their clients’ image in public. Another issue identified was an apparent ‘initiative decay’ over the 6 month period in the use the approach. It was suggested that future Intensive Interaction interventions should actively plan for more sustainable methods of Intensive Interaction adoption.

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