The use of Intensive Interaction with people with severe-profound intellectual disability

Weedle, S. (2016) Learning Disability Practice, 19(9), 27-34.

This paper reviewed the academic and research literature focusing on studies of Intensive Interaction with people with a severe-profound intellectual disability. The literature search produced 18 relevant peer-reviewed papers (6 quantitative, 6 mixed methods and 4 qualitative) 16 from the UK, 1 from Australia and 1 from a study in Romania. All the studies had small sample sizes, the largest being 18.

A thematic analysis of the papers was carried out, and four main themes emerged: social engagement; the effect of Intensive Interaction on people with intellectual disability; the effect of Intensive Interaction on practitioners; barriers to implementation.

Social engagement: this theme focused on an individual’s social engagement with the person implementing the intervention. The literature suggested that Intensive Interaction is most suitable for people who are in some way socially isolated or withdrawn, this being because Intensive Interaction is effective in enhancing social engagement. It was found across a number of papers that there was a clear increase in sociability compared with measurements at ‘baseline’. The studies used behavioural indicators to demonstrate increased social engagement; with these indicators including eye contact, engagement in mutual activity, body orientation, and proximity to partner, etc.

Four studies measured progress in communication development. These studies found that participants initiated communications more effectively. There was also an increase in vocalisations during sessions, which could be viewed as increased attempts at communication. Following Intensive Interaction there was also a reduction in self-stimulation and active avoidant behaviours, and also behaviours such as hand biting, rocking and head banging, which were considered to be barriers to social interaction.

Effects on people with intellectual disability: taking part in Intensive Interaction was seen as enjoyable and satisfying for clients, and as a more proactive and empowering approach. The effects reported for people with intellectual disability included increased client-initiated social activity, increased smiling, emotional valence, and a greater sense of well-being. There was also evidence of a decrease in distress i.e. reduced levels distress and self-harm among children. Similarly, it was seen that the person with an intellectual disability developed a greater ‘sense of self’ by learning that through Intensive Interaction they could affect their own environment.

Effects on practitioners: the importance of recognising that Intensive Interaction involves both the client and practitioner in a mutually communicative relationship was noted. Staff experienced increased job satisfaction due to an enhanced connection with the person they were supporting. Also the staff team felt an increased sense of team cohesion and empowerment, with staff feeling more capable of demonstrating that they cared, noting they felt Intensive Interaction gave them more ‘permission’ to touch or spend time with their client.

It was also noted that there was a greater sense of connection between staff and clients, with 32.5% finding relationship development a significant benefit of Intensive Interaction. This relationship development was evidenced in increased reciprocal interactions with clients, which also increased the motivation of staff.

There were however some practitioners’ concerns, particularly male practitioners being worried about issues of touch with female service users, including concerns about sexual assault allegations. This left some staff members unwilling to work physically close to clients, noting that it made them feel uncomfortable.

Barriers to implementing: there were reports of some environmental constraints which made the use of Intensive Interaction more challenging i.e. time constraints, staff shortages, and pressurised environments. Some practitioners were reported as having initial doubts about Intensive Interaction because they did not anticipate the positive outcomes: however, after they witnessed positive effects the resistance was overcome.

Conclusion: this review provides an improved understanding of the benefits and limitations of using Intensive Interaction. Overall Intensive Interaction was seen to increase a clients’ social engagement, strengthen their relationships and positively affect their overall well-being. However there are still some barriers, particularly concerning initial resistance from staff teams.

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