A qualitative study of the practice related decision making of Intensive Interaction Practitioners

'A qualitative study of the practice related decision making of Intensive Interaction Practitioners' 

by Graham Firth, Megan Glyde & Gemma Denby 
(with thanks also to Emily McGall and Cheryl Campbell)

The aim of this qualitative study was to investigate the sometimes conscious and sometimes ‘intuitive’ or unconscious decision making processes of Intensive Interaction practitioners. Through interviewing 13 experienced practitioners (all qualified Intensive Interaction Coordinators), this study set out to shed some useful light on how practitioners make judgements when developing 'a dynamic interactive repertoire' with an individual with severe or profound learning difficulties and/or autism.

The main conclusions drawn from this study (hugely paraphrased for brevity!):

The study found that practitioners co-constructed 'a mutually recognised interactive repertoire' with the people then engaged through Intensive Interaction, but also that 'their understanding and consequent enactment of their own practices' evolved through a cycle of:

1. Some pre-engagement considerations: focusing on aspects of the practitioners’ learning or care ‘agenda’ and expectations, possibly with some proactive environmental preparation (including any required changes to the social or physical environment).

2. Some ‘trial and error’ experiential learning: during each engagement (including at the initiation and disengagement phases), this often being based on the practitioner’s ‘in the moment’ decision making (often intuitively but at times consciously considered) that elects to follow or offer particular variations on any established interactive repertoire. Such ‘in the moment’ decisions being concurrently reflected on ‘in action’ by the practitioner in the light of the person’s perceived feedback responses to their interactive offer, either positively so, or otherwise.

3. Some post-engagement conscious reflection: conducted either individually or collaboratively, sometimes involving informal or more structured reflective processes, and focused on either individual practice or developing a greater understanding of broader and thus more general Intensive Interaction principles, or both.

To cut a quite long (but very interesting) story short for this blog, we go on to conclude that:

'Without a clear process to support reflection on our experiences, we are unlikely to develop our Intensive Interaction practices, both individually and collectively, to their full potential.

‘Anybody only gets that [improved Intensive Interaction practice] through reflection and looking at the videos and chatting about it with your staff; nobody’s an expert, we all need each other’s eyes to support each other’ (Practitioner verbatim text extract: #2, 243-245)

'Services that purport to use Intensive Interaction therefore need to create a supportive and nurturing developmental process within which novice practitioners can learn the skills, principles and knowledge required to practice good quality Intensive Interaction – and they need to do this to effectively and consistently provide the people they care for or support with genuine social inclusion and appropriate developmental opportunities to enhance their social communication and connectedness to maximum degree possible'.

(In some of my following Blogs I will lift various more focused aspects out of the main report to illustrate some more detailed areas of practitioner decision making as it relates to particular issues, or temporal aspects, when using Intensive Interaction).

For a copy of the full (and really very interesting) initial draft report, please email: 

graham.firth@nhs.net