‘Using Intensive Interaction – A case study’

Forster, S. & Taylor, M. (2006) Acquiring Knowledge in Speech, Language & Hearing, 8 (1), 12-15.

This study focused on Cameron, a young man with a profound intellectual disability, severe visual impairment and a physical disability, who attended a small day service. The study was conducted over 6 months with 9 service staff participating, two being interviewed regarding their reflections on the intervention.

Design: Multiple sources of data (reports, assessments, observation, reflections by participants, and interviews) were collated to compare to the pre-intervention data, including 50 interaction reflection forms completed by staff following Intensive Interaction sessions. Follow-up data included a re-administered communication assessment (Triple C), videoed observations, and 2 interviews with staff.

Results: In 2002 (before the Intensive Interaction intervention), Cameron’s communication was assessed as consistent with the pre-intentional reflexive communication stage, with some skills in the reactive stage. This indicated that Cameron was showing minimal reactions to people, activities and objects. Cameron also showed very few person engagements, a few engagements with objects (e.g. sucking objects) and was largely involved in self-engagement behaviours. 

In mid-2004, the service received a consultation on Intensive Interaction, and subsequently established daily Intensive Interaction sessions for Cameron.  These sessions varied from 15 minutes to 2 hours (occasionally occurring twice a day). A content analysis on 50 interaction reflection sheets was completed, with the following findings being of particular note:

  • There was a change in the interactions occurring separate from other clients, to interactions occurring in the same rooms as other clients, often on the periphery of established programs like art or music
  • New skills were recorded e.g. increased eye contact, searching for his interaction partner’s hand
  • There was a shift from negative ascription of behaviour to seeing the behaviour as communicating a need, and problem solving to address that need
  • Some staff reported using the same techniques continuously, whereas other staff reported trying out new techniques to extend the interactions.

The Triple C communication assessment was re-administered 6 months later and Cameron’s recorded skills had increased to being consistent with the pre-intentional reactive stage of communication. New behaviours observed in 2005 included smiling, reacting to the voices of particular staff and beginning to show anticipation.

The two staff members who were interviewed were also video recorded during 5 minutes of Intensive Interaction with Cameron. Observations of the video showed that the staff showed positive regard towards Cameron through their words to him and their physical positioning (e.g. sitting with their face close and body oriented towards Cameron). They also used techniques such as burst-pause, whereby they would rock or pat Cameron and then pause to see his response, and they imitated Cameron’s sounds to capture his interest. They also just sat with their hand on his chest or legs, making small movements to signal their presence. 

The staff also reported positively on the use of Intensive Interaction, though challenges of gaining resources for staff availability and ongoing training were acknowledged.

Conclusions: This study suggests improvements in both Cameron’s communication skills, and in the perceptions of staff following the intervention.  These results indicate the potential usefulness of Intensive Interaction for people with profound intellectual disabilities.

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