Intensive Interaction and Positive Behaviour Support

At a recent Intensive Interaction Forum meeting we held here in Leeds, we addressed some questions relating to the use of Intensive Interaction within or as part of the Positive Behaviour Support (PBS) formulation and planning process. 

Below are some of the notes that I took as we discussed the three questions I posed: 

Q1: What are the theoretical overlaps in the PBS and Intensive Interaction approaches?

• Both PBS and Intensive Interaction fit within a positive psychology theoretical framework, identifying positive aspects (or communicative strategies) of the service user's presentation as the basis of the proactive interventions, seeing these as the foundations on which to build improved engagement and developing an upward spiral in the development of positive and adaptive behaviours.

• PBS and Intensive Interaction are both about ‘getting it right from the start’, with PBS at times including Intensive Interaction (or the ‘adapted’ form of Intensive Interaction, and other communication and/or health/well-being approaches) to be used in a proactive manner to meet an individual’s identified psychological or psycho-social needs – rather than focusing on any resultant (and at times potentially challenging) behaviours i.e. they both address needs and issues ‘at the level of the antecedent’.

• PBS is a process (as is Intensive Interaction) which brings together an assessment and a formulation, and then incorporates both proactive and reactive strategies to address identified behaviours (more formally and predeterminedly structured in PBS, less formally and more reflectively and ‘in the moment’ with Intensive Interaction).

• PBS is seen as being a proactive and/or preventative approach (or process) that aims to support processes that are specifically designed to create the conditions for developing a good quality of life … (as does Intensive Interaction).

• PBS and Intensive Interaction are both processes that look to reduce, or somehow mediate, the impact of any demand avoidance on the part of the service user as they are structured in proactive ways to take account of any such issues.

 Q2: How does a combined PBS and Intensive Interaction process work in practice?

• After the Winterbourne scandal, PBS has been officially recognised as a more structured (and behaviourally informed) means of successfully embedding preventative and proactive strategies across services for people who present with challenging behaviour.

• PBS gives a more robust and evidenced analysis of behaviour (i.e. via the assessment and formulation aspects) of the underlying functions of certain behaviours (including the social engagement function).

• When recommendations (including Intensive Interaction) are included in a multi-disciplinary PBS plan, then it is more likely that this will be accepted as accurate and useful, and subsequently followed (to some level) by a service or staff team.

• PBS works by creating the potential for a positive spiral of more positive behaviours, and creating learning opportunities for service users to develop a broader positive behavioural repertoire (again, as does Intensive Interaction).

• However, the more structured process of PBS works well for some staff (and some staff teams) but less well for others; this being related to, and therefore dependant on, both the quality of management support, and the confidence levels of individual staff members.

 Q3: How does PBS help define with whom, when & where Intensive Interaction is used?

• The PBS assessment and formulation processed can help in identifying a person's social engagement needs through the use of specific social engagement trigger questions e.g. when contained in the behavioural assessment.

• PBS assessments can (although in practice often don’t) identify the social engagement needs for more cognitively able people who present with social impairments or demand avoidance issues.

• The PBS assessment should identify (although in practice sometimes doesn’t) those service users whose needs include the building of positive rapport, the development of trusting and supportive relationships (with support staff) i.e. prioritising ‘being with’ type practices before ‘doing with’, ‘doing for’ or ‘doing to ‘ type activities (see Blog of 18/12/17 for more details of these states).

• The PBS approach is focused on changing the support staffs’ or carers’ behaviour; this being the first order catalyst of change in the service user's behaviour i.e. creating a better and more responsive social ecology around the service user, not looking to change the behaviour of the service user directly 

i.e. “You have to lay the foundations [of the staff]… before you lay the foundations [for the service user]” Nick Guthrie (Intensive Interaction Coordinator).

I hope this helps other professionals using either Intensive Interaction or Positive Behaviour Support approaches (or both), and I would certainly be interested to hear any other points others might consider important.