How do we engage with people who have profound and multiple disabilities: people who also often have sensory processing issues and may have an additional impairment of hearing or sight loss?

One of the most effective ways, that we at Us in a Bus have been using for 30 years, is Intensive Interaction. The approach is based on observing a person’s movements, facial expressions and vocalisations and mirroring or echoing them back to the person to communicate that we have noticed or heard them. The aim is to entice them into an inclusive and meaningful conversation conducted in their language. To help enable this connection we adjust our positioning to give people the maximum opportunity to focus on us. We often use appropriate touch, equipment aids and our facial expressions to help us engage with the person.

A pandemic arrives and suddenly our weekly visits are temporarily stopped. Clients we have been building relationships with, often for many years, are undoubtedly confused as to our disappearance from their lives. For a great many, 7 months on, we have not been able to recommence visits. For a few we have, and we are grateful for this but, things are not the same. 

Our sessions have changed dramatically in line with the new Covid restrictions. We wear face masks, visors and gloves to keep everyone safe. We stay at least 2 metres apart from the clients, and facilitate the sessions outside whenever we can, in all weathers. This brings a totally new set of challenges to both the practitioners and the people we visit. 

• Masks mean the people we are with are restricted from seeing most of our faces, making clues to our communication from our facial expressions almost impossible for them to read. 
• Our voices are muffled and unclear. 
• The visors often steam up, causing another physical barrier to our facial expressions. 
• Gloves, which may have negative connotations to our clients (medical or personal care) make us look less welcoming and may give mixed, confusing messages as to our purpose. 
• The required separation distance of 2 metres and the fact that we are unable to use touch in our sessions to reaffirm our engagement creates a barrier we are not used to. 
• We now cannot always hear the sometimes almost inaudible vocalisations people often share with us. 
• It may be difficult to see us from the required distance and we are unable to adjust our position to make focused eye contact. 
• We also have to contend with multiple distracting sounds outside as well as the unpredictable weather.

But… We are determined to continue to offer sessions that are meaningful and engaging to those who ask for so little but deserve so much. So, we find ways to embrace the challenges we face and find new ways of engaging. We raise our voices a little louder, exaggerate our facial expressions, use our voices to explain what may be obscured from view, use our body movements to emphasise actions we observe, sing louder and celebrate the weather, nature, the sounds of the garden, and incorporate them all into our sessions. We have become differently creative, imaginative, and very determined to continue to deliver sessions that are engaging, purposeful and enhance the quality of life of those we love to visit.