Intensive Interaction Training for Paid Carers: ‘Looking, Looking and Find Out When They Want to Relate to You’

Nagra, M., White, R., Appiah, A. & Rayner, K. (2016) Journal of Applied Research in Intellectual Disabilities, On-line (DOI: 10.1111/jar.12259)

Introduction: the authors of this paper identifiedIntensive Interaction (II) as a communication approach that is useful when working with people with severe or profound intellectual disabilities who have difficulty with the use and understanding of pre-verbal social communication behaviours. Health and social care providers were identified as offering II training with the goal of improving social communication for clients, with such training resulting in ‘increased use of mirroring movements, vocalisation and contingency responding’.

The Method: 8 carers were recruited to the study 2 to 3 years after completing Intensive Interaction training. Data was collected via semi-structured interview asking broad questions about the training, the purpose and current use of Intensive Interaction; these transcripts subjected to Interpretive Phenomenological Analysis. 

Results: the analysis revealed as significant ‘theme of endurance’, a theme that encompassed both emotional endurance and practical endurance. The analysis also indicated that the emotional component of the approach incorporates two interrelated themes of empowerment and better understanding. with the practical endurance incorporating the theme of perceived barriers to implementation.

Empowerment: as a result of the training the carers commonly expressed a sense of increased confidence when working with their clients. This increased confidence led to ‘an improvement in their relationships, possibly due to carers feeling greater control in tackling challenging situations’. The carers also placed an emphasis on the understanding that clients should be able to ‘let go and do what they would like in a safe environment’. Clients were also thought to socially initiate more often as they were ‘more comfortable in their own homes and around [their] carers’: and perhaps the most crucially, the bond between the carer and the client was believed to be ‘further strengthened as a result of the two-way interaction’.

Realization: the endurance of Intensive Interaction seen in the ‘empowerment of the carers, clients and the relationship between them’, and also in the realization carers had about how care was provided prior to the II training. The carers had though that they were communicating effectively with their clients before the Intensive Interaction programme, but ‘it was only after training that they realised quite what meaningful interaction was’. The carers also clearly expressed how before the training ‘they knew little about their clients, despite having worked with them for as long as three years in one case’.

The further benefits of II were commonly identified as: ‘better communication, happier clients and an overall positive experience’, with these outcomes being seen as reaffirming the endurance of the approach. Not only was better communication developed, but this ‘two-way process’ was seen to benefit ‘both carers and clients’.

Barriers to implementation: the carers highlighted some difficulties in implementing Intensive Interaction, with barriers at a management level (i.e. a lack of consistent support), and amongst the carers themselves: e.g. not being able to recall the training (this signifying a decay in the learning involved); fear of implementing Intensive Interaction ‘inappropriately’; and potential negative reactions from ‘third parties’. There was also a perceived need for improved training, refresher or ‘top-up’ courses, on-going support and mentorship from the training facilitators. The training of all carers was also suggested ‘to provide consistency for clients’. 

Discussion: in an extended discussion section the authors state that ‘the overarching impression that emerged from the analysis was the enduring power of II and the importance of two-way interaction’. The paper goes on to discuss related matters that include: ‘Developing relationships’, ‘staying connected’, ‘limitations’, ‘systemic factors’ and ‘ongoing support’ – covering these issues with broad reference to a range literature sources.

Conclusions: in a final short conclusion the authors state that ‘II training supports the practice of a much needed skill … as a way to meet [the] social interaction needs’ of clients with severe or profound learning disabilities. They also call for more research on ‘the effects of organisational characteristics on staff training and practice’ to facilitate the use and uptake of Intensive Interaction.