The use of Intensive Interaction within a Positive Behavioural Support framework

Following on from my previous Blog on The ‘Differentiation and Integration Phase’ of Intensive Interaction, I thought that I would share a summary of a research paper to illustrate my contention i.e. that Intensive Interaction is now increasingly being used within or alongside other educational, health or care approaches (in a hopefully mutually supportive and beneficial manner).

So below is a summary of the McKim and Samuel paper: The Use of Intensive Interaction within a Positive Behavioural Support framework (2020, BJLD). This article examines the use of Intensive Interaction techniques within each phase of the Positive Behavioural Support (PBS) framework used within an NHS Trust. In this study, case descriptions of individuals who displayed challenging behaviour and received Intensive Interaction are discussed. The data gathered included recorded comments from family and staff.

The Participants: three case descriptions were included in this article. Each person presented with behaviours that were identified as challenging. They were all referred to the NHS Trust’s Intensive Support Team (IST) and received Intensive Interaction as part of the intervention. All three people lacked the capacity to consent to any intervention or publication, so an agreement was sought from their network of support.

The Intensive Interaction Interventions

Jane: after four months with the IST, Jane was referred to the trust’s Intensive Interaction service. Members of the IST had previously used aspects of Intensive Interaction informally. Support for staff, modelling and training was given by the IST and the Intensive Interaction Coordinator in partnership. Group supervision was also conducted. Intensive Interaction was offered every 15 minutes, if Jane did not initiate, which included non-verbal turn-taking (dancing and rocking), and verbal echoing. During escalated behaviour, physical contact was initiated by Jane, and firm handholding was used to reduce the likelihood of an incident.

Graham: during Graham’s 20 months in hospital, the use of Intensive Interaction was formalised, with scheduled sessions and guidance given by a speech and language therapist. At discharge, the PBS plan included a touch protocol and Intensive Interaction guidelines. The staff team were trained in Intensive Interaction, and interactions were videoed and analysed individually and as a group. It was crucial for staff to remain available so that interactions could be led by Graham. In addition, staff needed to be tuned in to Graham to assess micro changes in his mood, give positive non-verbal responses, with the use of touch and vocal imitation.

Lynne: staff were trained in Intensive Interaction and autism. Intensive Interaction was used without the use of video or scheduling of the intervention. The intervention involved side-by-side positioning without eye contact, tuning in, and the sensitive use of imitation. Tuning in to Lynne’s emotional state was crucial to lower her levels of arousal. Availability was maintained by making no demands, waiting and positioning.

The Findings: according to this paper, the three case descriptions supported the use of Intensive Interaction within a Positive Behavioural Support framework. Whilst the data did not allow for conclusions to be drawn about the specific impact of the Intensive Interaction, comments from family stakeholders and staff suggested that Intensive Interaction had an ‘important place in building rapport, improving communication and reducing challenging behaviour’. Jane’s service manager also stated that ‘If it wasn’t for Intensive Interaction, I don’t think Jane would still be living in the community’, with Jane’s sister describing Intensive Interaction as a ‘saviour’. 

This paper was kindly summarised by psychology intern Mankaran Kaur whilst on placement at the Oxford Health NHS Trust.

Full Ref: McKim, J. & Samuel, J. (2020) ‘The use of Intensive Interaction within a positive behavioural support framework’. British Journal of Learning Disabilities, 49(2), 129–137.

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