Intensive Interaction: Bringing the laggards on board!

My Blog this week is based on notes taken at our recent Leeds Intensive Interaction Regional Support Group meeting which had the title of: 'Intensive Interaction: Bringing the laggards on board!'. Below is what we came up with:

In order to better understand why Intensive Interaction isn’t used with all potential beneficiaries, in all circumstances, by all staff or carers, at our meeting we discussed the kinds of arguments or issues that potentially might be felt or voiced by individual staff or carers, and which might then make them less likely to do Intensive Interaction.

Below are our collated thoughts on these potential Intensive Interaction restraining issues:

• Some staff or carers who might appear disinterested or unenthusiastic towards a change that includes more Intensive Interaction practice (labelled here as ‘Laggards’) are often focused on, or reacting to, or constrained by multiple other distracting systematic issues and pressures. 

• Some staff or carers may feel a need to look busy, and to fill any silences, driven either by their own need to be ‘doing something’, or wishing to be seen to be ‘doing something’ by others; making pausing, waiting, or ‘being with’ someone feel inappropriate or time inefficient. 

• Staff or carers may feel a sense of embarrassment, or may feel uncomfortable when out of their normal ‘comfort zone’. Some new members of staff might also be hesitant and/or worried about making a fool of themselves in front of other, more established staff (or managers). 

• Staff or carers may feel they don’t have enough time, and therefore Intensive Interaction may be seen as ‘another thing’ to do, on top of the other more observable tasks they have to carry out. 

• Staff or carers may not have enough training to be sufficiently confident in their own Intensive Interaction practices. Also many staff are not paid for any ‘outside working hours’ training, restricting access to training and suggesting a lack of importance in training some staff. 

• Without sufficient training (or mentoring) in Intensive Interaction, some staff or carers simply cannot pick up the ‘Fundamentals of Communication’ social cues coming from their person. 

• Some staff or carers intuitively view the caring role as essentially task-orientated, and such care is therefore not really social in nature; Intensive Interaction is therefore potentially judged on the basis of: tangible ‘jobs to be done’ vs. intangible ‘being with’ or even ‘messing around’. 

• Staff or carers may assume that the person they are working with is not capable of socially engaging through Intensive Interaction (i.e. having too low an expectation of the person): or conversely assuming that they should talk to the person they are with, even if that person doesn’t use symbolic language expressively (i.e. having too high an expectation of the person). 

• There being a wide range in the ‘level of need’ presented within a classroom or service location, subsequently Intensive Interaction never becoming a mainstream ‘norm’ for staff or carers to practice in their given care or working context. 

• For some staff or carers working with older children or adults it may personally feel uncomfortable (or even potentially disrespectful) to engage with their people in such a responsive, developmentally pertinent Intensive Interaction way. 

• There may be ‘mixed messages’ coming from an organisations own training or policy, or even service level values i.e. structured and SMART target teaching and routines vs. unstructured Intensive Interaction engagement, etc. e.g. if Intensive Interaction is timetabled within the organisation, it then stops when it is not within the timetabled times. 

• Staff or carers may not be easily conversant with the particular Intensive Interaction language used by others to explain the approach i.e. using words like ‘phatic’ rather than ‘being social’. 

• There being too much ‘defensive’ organisational emphasis placed on ‘Safeguarding’ (including issues of physical contact or potential sexualised behaviour), this then becoming a perceived barrier to engagement for some staff or carers i.e. the general management tone is defensively risk averse and therefore ‘service centred’ rather than ‘client-centred’. 

• Some staff or carers might not be able to recognise incremental ‘progress’ made by the person they support, and therefore may not see the vital need to continue with Intensive Interaction. 

• Staff or carers may be unaware of the positive overlaps between what they would class as ‘work’ and what they would class as ‘play’, and holding some non-Intensive Interaction supporting assumptions about the differences (and overlaps) between them. Indeed, some staff or carers may not actually know how to ‘play’ (in an unstructured way) with other people i.e. they themselves might lack the skills and knowledge of social play ‘rules’, this leading them to focus on some kind of structured, end-point defined ‘activity’. 

• Some staff or carers may have quite rigid professional or hierarchical boundaries as to what a job entails, and whose responsibility it is to carry it out e.g. Intensive Interaction.

After collating all the reasons listed above for staff or carers not wanting to do Intensive Interaction, we then discussed what support processes, or pieces of nurturing advice could be made to counter such individually held, non-Intensive Interaction friendly points of view?

• We should recognise that ‘laggards’ are usually not just lazy or uncaring people, but instead we should think that current circumstances may be conspiring to make it unlikely that they will enthusiastically embrace Intensive Interaction.

• We should adapt our language when introducing Intensive Interaction to a new audience, taking account of and using the staff or carers’ current working language (with English not always being a first or home language), whilst also reducing the level of Intensive Interaction ‘jargon’.

• Intensive Interaction training at various levels (from complete ‘novice’ training to that focused on more advanced practitioner’s reflective practice) needs to be prioritised in the service … and staff should be paid to attend if it is outside of their normal working hours.

• We should present Intensive Interaction as something that can be done opportunistically whilst doing other tasks i.e. it doesn’t need to be in a ‘session’, and you don’t need extra time to do it. Indeed, we could create video examples of ‘doing Intensive Interaction whilst doing other routine daily activities’ e.g. care tasks, to counteract a seemingly implied message in current Intensive Interaction DVDs that Intensive interaction is only properly done sessional, in 1:1, with experts.

• Senior staff and/or experienced practitioners should purposively model Intensive Interaction in visible areas, and therefore lead by example and legitimise its practice for all to see e.g. doing Intensive Interaction in the foyer, in the corridor, in the classroom, etc.

• We should look to nurture and build the confidence of reluctant or novice practitioners; on all possible occasions we should point out and celebrate positive Intensive Interaction moments with all staff and service users, but especially so the less confident ones! Also don’t scare them off; don’t add to their workload at the start (maybe introduce recording sheets and video later).

• We should explain the benefits of reduced challenging behaviour when Intensive Interaction is used proactively with some people - rather than staff relying on reactive strategies that are often overly (and sometimes inappropriately) used.

• We should not just assume a common or shared cultural understanding amongst everyone of the positive nature of all aspects of Intensive Interaction practices e.g. parents and/or carers may hold culturally divergent views on physical contact, gender roles, etc.

• We could initially ask some staff and carers to do a different job that better matches their (non-Intensive Interaction) skill set e.g. videoing sessions or updating the Intensive Interaction noticeboard, and for some staff and carers doing this in the long term (until they leave!).

• Finally, be proactively positive: tell them – “You can do it!”