Researching Intensive Interaction: which ‘outcomes’ are the most important, and for who?

I recently attended a meeting to discuss a possible bid for research funding to look at the outcomes of Intensive Interaction. This meeting concerned a bid for the National Institute of Health Research (NIHR)/Health Technology Assessment (HTA) funding to study the question: What is the clinical and cost-effectiveness of Intensive Interaction for improving communication in children and young people with profound and multiple learning disabilities? 

The NIHR/HTA bid guidelines state that the outcomes they want to look at include: 

Important outcomes: Communication skills. Quality of life … and Other outcomes: Social and emotional engagement; education outcomes; carer outcomes; service user/carer acceptability; challenging behaviour; self-harm; treatment fidelity; adverse effects; social care outcomes; cost-effectiveness.

Now on reading this 2-part ‘outcomes’ list, for me, it immediately illustrated both the strength and potential weakness of Intensive Interaction when it comes up against attempts to simply define it, and simply define what it does … in simple and neatly classified terms! 

Intensive Interaction patently is, especially for those who have practised it, simply what it is – it is responsive, it is inclusive, it is being a good social communication partner … but what it does, well there it is perhaps a somewhat more complex story. 

Intensive Interaction can, and in many instances clearly does, deliver outcomes across many or even all of the indicated areas (many already having been evidenced to some degree in previous peer-reviewed research studies) … but that then makes me worry that sometimes Intensive Interaction can be seen, or can be presented as a bit of an ‘all things to all people’ type of thing; it being educational, therapeutic, caring, nurturing, a tool for universal social inclusion, ‘having a laugh’, etc. But also, by extension, I worry that it could also be perceived as a thing that seems ‘too good to be true’, a ‘Jack of all trades’ type approach … which can sometimes be off-putting or confusing due to a lack of singular focus.   

When I prepared for the above meeting, I did my own list of the potential outcomes that might be somehow measured and evaluated. It looked a bit like the NIHR/HTA list above – although for each element I split it into the outcome for the recipient of the Intensive Interaction, and the outcomes for those individuals or groups of people who would be delivering the interactions. That then leads me to ask (at first quietly to myself), in research terms, whose ‘quality of life’ is most important? Whose communication skills? Whose social and emotional engagement? Whose mental health and well-being are we to look to measure? … and anyway, aren’t these things far too tightly interrelated and socially constructed to be considered as separate, individualistic entities. 

And there is a further worry (I again thought to myself quietly) – if we look at just one side of the Intensive Interaction equation, could we then claim it as sufficient to define the approach’s effectiveness across that whole list of potential outcomes? But on the other hand, if we try to evidence too much and across too many areas (i.e., across both sides of the interactive partnership) all in one study, then perhaps we will lose some of that necessary research focus and variable control; and we may consequently fall short of properly nailing one outcome issue in a sufficiently robust fashion. 

Compared to many other medical or therapeutic intervention research (does it cure/alleviate Condition A – yes or no, or how much in % terms), these aren’t easy judgements to make. But with Intensive Interaction research we need to be careful when considering the options on what the outcomes potentially are, which ones are the most important, who exactly they manifest themselves for, and how we might then best quantify, and then somehow approximate/measure them (directly or indirectly) – and I’ve not even mentioned the issue of ‘cost-effectiveness’! but I’m not even going there!

Finally, all the above research stuff doesn’t even consider what is possibly the most important issue – the issue of human rights and societal ethics; the issue of including, or at least attempting to include everyone, no matter what their social or communicative impairment, in some form of enjoyable, meaningful, affirming human social interaction. We who already do Intensive Interaction do it because it is the right thing to do, individually and collectively – it is just the right way to be with and be around our fellow human beings – although I do also think that it will be proved to be socially, educationally and clinically effective as well! 

Intensive Interaction, and what it does, is both as simple and as complicated as we humans are – no more, no less … and again, that is its strength, and that is its weakness rolled into one … oh, and that thing about the cost; well, actually I will go there – with Intensive Interaction there is no need for expensive drugs, no need for complex equipment, and no need for teams of consulting professionals, the cost is just some of our precious time!

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