Staff experience of the implementation of Intensive Interaction within their places of work with people with learning disabilities and/or autism

Berridge, S. & Hutchinson, N. (2021) ‘Staff experience of the implementation of Intensive Interaction within their places of work with people with learning disabilities and/or autism’, Journal of Applied Research in Intellectual Disabilities – DOI: 10.1111/jar.12783

Method: A computerized search was conducted in Oct 2018 across several research databases (CINAHL, PsycInfo, ERC and MEDLINE) to identify and review the qualitative literature which explored staff experiences of the implementation of Intensive Interaction in their workplaces.

Several inclusion/exclusion criteria were used, and the UK NICE Checklist for Qualitative Studies (2016) was used to critically appraise the included ‘qualitative’ studies. Thematic synthesis was then used to develop a ‘meaningful synthesis of these data’ from the 9 included papers*. The ‘workplaces’ included schools, day services, an acute medical hospital and residential settings. Staff sample sizes ranged from 3 to 29, most of whom were previously unfamiliar with Intensive Interaction.

Results: the thematic synthesis of the 9 studies generated 3 higher-order themes: 1. Personal Doubt, Discordance & Discomfort, 2. A Turning Point and 3. Needing Implementation at All Levels.

1. Personal Doubt, Discordance & Discomfort:

Some staff identified Intensive Interaction as not fitting with their former working methods, at times feeling uncertain in their own abilities, or in the approach. Some staff were uncertain of how to “do” intensive interaction: “I don’t see the clear steps of what I should do…”. Intensive interaction was also seen to contrast with views on “age-appropriacy”, and some worried about getting “too close” or holding onto previous behavioural “boundaries”- or losing previous levels of “control”.

Interestingly, Intensive Interaction also appeared to make staff more aware of their own emotions and the emotions of those they worked with, changing the quality of their working relationships e.g., they started to feel more empathetic, or even “loving” towards clients. 

• A Turning Point:

‘A turning point’ was often identified during implementation when staff felt more positive about the approach, this generally being when they saw the benefits of the approach. Staff expressed feelings of “surprise” or were “amazed” when they saw the outcomes for their clients/pupils. Subsequently, staff appeared to think more about clients/pupils and “treat them as an individual[s]”.

Another turning point related to staff gaining more confidence and, therefore, more enjoyment from using the approach; this being directly related to the kinds of training and support they were given.

• Needing Implementation at All Levels: 

Staff described ‘practical barriers’ and ‘distractions’ within their workplaces e.g., the need to work with many others, often with inadequate staffing levels. The number of staff ‘duties’ could also be overwhelming: “I’ve got quite a heavy workload anyway … and (it’s) getting bigger … so sometimes you just think ‘no, no I can’t do anymore’”. Some staff described feeling “self-conscious” in front of those unfamiliar with Intensive Interaction, although one felt the training ‘gave them permission to work in the ways they wanted’: “Now … everyone is doing the same thing. I just felt relieved”.

For successful implementation, “really good teamwork” was important, as were ‘consistency’ and ‘collaborative communication’. Ideally, there should be “a core team of consistent, enthusiastic staff who are trained in and committed to Intensive Interaction”, if possible with some ‘advanced practitioners’ to support systematic implementation. ‘Top-down support’ from managers was also seen as important, as was ‘making the approach official’ e.g., “… as a part of the pupil’s IEP”. 

Discussion & Conclusions: In summary, the authors recommend that:

• Training should provide opportunities for experiential learning, adapted to specific workplaces.

• Staff be allowed time and a reflective space when implementing and using Intensive Interaction.

• An ongoing, whole-organizational approach should be taken during implementation.

• Future studies should include homogenous papers, present clear and consistent data, account for context bias and examine broader influences regarding the implementation of Intensive Interaction.

*Included papers = Clegg et al. (2018); Jones & Howley (2010); Sri-Amnuay (2012); Zeedyk, Davies, et al. (2009); Bodicoat (2013); Firth et al. (2008); Leaning (2006); Nagra et al. (2017); Rayner et al. (2016).