Feltham-King, Caroline. What are the prospective adopters’ and social workers’ experiences of an adoption support package using Video Interaction Guidance? An exploratory study. “This paper describes the participants’ experiences of an adoption support package piloted for new adoptive placements, as evaluated by the prospective adoptive parents who received it and the social workers facilitating these placements of looked after children in Hampshire.”

Introduction

This paper describes the participants’ experiences of an adoption support package piloted for new adoptive placements, as evaluated by the prospective adoptive parents who received it and the social workers facilitating these placements of looked after children in Hampshire. The Video Interaction Guidance (VIG) package was designed and delivered as a pilot in collaboration with social workers by two educational psychologists (EPs) while training as VIG guiders – an example of creative, community psychology enhancing statutory work within children’s services (Osborne et al 2009).

 

Context

Although not a uniform group, looked-after children represent one of the most vulnerable sectors of our society with a diverse range of educational, social and mental health needs (Hare & Bullock, 2006, Cairns & Stanway, 2004). The profile of children requiring adoptive placements has changed over recent years – they are often older or part of a sibling group, with complex developmental needs and ways of relating that may not all be apparent at linking (Schofield & Beek, 2006). This can place significant demands on the parenting skills of prospective adopters in learning to connect with and care for the child/ren to whom they have been introduced (Wolfs, 2008).

The growing evidence of neurological damage to the infant brain caused by insensitive care reminds us that changes of family context and legal status are not sufficient for adopted children to overcome their experiences of neglect, abuse, trauma and loss, however early in life these changes occur (Bomber, 2007, Archer & Gordon, 2013). It is crucial therefore that adopters be given ‘tools for life’ – empathic ways of relating to troubled children that are applicable, however stressful the situation or whatever the age of the child (Elliott, 2013). In recognition of this, the Adoption Act (HMG, 2002) made it a legal requirement of adoption agencies in England and Wales to plan and provide support to adopters, with therapeutic interventions funded through the government’s Adoption Support Fund since 2015.

Video feedback interventions, of which VIG is a therapeutic coaching example, are effective in families with young children, helping parents to become more skilled in interacting with their child and more positive about parenting (Fukkink et al, 2011). Both these behavioural and attitudinal changes in parents correlate with improvements in their children’s behaviour and development (Fukkink, 2008). A Dutch experimental intervention study evaluating VIG with 130 adoptive families found a significant improvement in maternal sensitivity and child attachment security post-intervention, with some long-term improvements seen in the children’s social, emotional and behavioural development when followed up at age seven (Juffer et al, 2008).

Since its origins in the Netherlands in the 1980s, VIG has been applied internationally to an increasing variety of contexts, from classrooms to special care baby units (Brooks, 2008, Juffer et al, 2008). Rather than directing or demonstrating to a client how to improve their interpersonal skills, the guider negotiates goals for change and then videos a short sequence of the client sharing an activity or conversation with the person they wish to engage more effectively. The guider shares edited examples of attuned sensitivity shown by the participant in response to the other and invites them to identify the specific verbal and non-verbal skills that are proving positive within the relationship they seek to deepen. This ‘cycle’ of videoing and shared review is repeated and progress towards the client’s goals celebrated.

Adopted and fostered children benefit from parents and carers with refined communication skills. Actively receiving the child’s actions, thoughts and emotions, in verbal and non-verbal ways, ensures that the child feels fully understood and feels psychologically safe to trust his or her care-givers (Polderman 2009, 2011). This enables a child to acquire a healthy sense of self and develop a strong, secure attachment to them (Juffer et al, 2008; Wolfs, 2008).

Sensitive yet playful parenting enhances children’s confidence, capabilities, creativity and ability to cope with strong emotions (Sunderland, 2006), and is vital for building attachment security in children from care (Golding and Hughes, 2012). Following the initiatives of the child has neurological and psychological benefits: Child-led play is likely to activate those lovely opioids, which have the power to reduce levels of stress chemicals and have anti-aggressive properties. On a psychological level, child-led play gives vital messages that are key to a child’s self-esteem: ‘My ideas are valuable.’ (Sunderland, 2006, p.200).

This adoption support package explicitly combined VIG with child-led play, to increase opportunities for intersubjectivity and build adopters’ mentalisation and problem-solving abilities so that they might more quickly attune to their new and needy children (Jarvis and Polderman, 2011). Reflecting on the special moments and current strengths of the emerging relationship as seen in play provided a springboard for discussion with the EP about effectively managing more potentially challenging times. A sense of mastery and the use of a problem-solving approach to managing the stresses of adoption have been found to be protective factors against the high levels of distress adopters may experience (Bird et al, 2002). VIG was selected as an intervention because its strengths-based therapeutic yet practical approach has been shown to increase parental sensitivity and confidence (Doria 2009).

The placement period is one of transition for all involved in forming an adoptive family, with prospective adopters and social workers needing to negotiate parental responsibility and agree when to apply to court for an adoption order. Schofield and Beek propose, ‘in this context, it can be hard to admit to the need for recognition and praise when things have gone well or to feelings of anger, bewilderment and despair at difficult times … in case the child is removed or they are considered to be bad parents’ (2006, p. 382). The pilot’s design promoted partnership-working between adopters and professionals, through its application process, workshops, home visits and planned evaluation.

A practitioner-led research grant from the Children’s Workforce Development Council (CWDC) awarded to one of the EPs funded this pilot and its evaluation in 2010. The evaluation focussed on any perceived benefits of the VIG support and any improvement suggestions, recognising the importance of asking service recipients about their experience of it to shape any future support offered, because ‘support can only be as good as it feels and the same package of support will feel different to every child and family. And if it feels good enough at one stage, it may not feel as good at another.’ (Argent, 2006 p.61).

 

Aims of the pilot

The VIG adoption support package pilot had four aims:

  • to assist prospective adoptive parents to identify, develop and apply their inter-personal communication skills and attachment-enhancing strengths;
  • to increase the learning confidence of children placed for adoption through shared play experiences with their new parents;
  • to introduce a model of partnership working, with new parents as equal partners with professionals in sharing success and addressing concerns;
  • to inform the county’s development of VIG as a therapeutic intervention.

 

Design of the adoption support using VIG

The pilot adoption support package consisted of:

  1. an introductory half-day workshop for parents with their family placement social worker and new child/ren’s social worker covering the principles and process of VIG, increasing a child’s confidence to learn and form secure attachments through child-led play with joint planning of developmentally-appropriate play opportunities;
  2. an optional, weekly play diary in which adopters could reflect on special shared experiences, and an invitation for social workers to ask on statutory visits about what the adopter was learning;
  3. two cycles of VIG for each family in their home, carried out in confidence by an EP, guiding the parent towards reflecting upon the effects of their skilful interactions on their child’s engagement and encouraging them to apply these more often;
  4. a concluding half-day workshop, to include EP-facilitated sharing of favourite video clips by adopters with their two supporting social workers.

Methodology

Approximately forty placements were being overseen by the county’s adoption service when the pilot was proposed. As details of these were confidential, the EPs wrote a briefing document for social workers and letter to be sent via the adoption service to all prospective adopters with whom children were already living, inviting them to discuss the pilot with their social workers and apply together. Eight families were to be selected and a control group identified in this original recruitment design. However, instead of sending letters to all, social work managers chose eight new placements, informing prospective adopters and social workers that they would participate. This unexpected methodology change altered the participants’ basis for engagement in the pilot, which ran with seven families (but eight adopters) without a control group. Children had been placed for between three days and three months by the time of the EP’s first home visit.

Prior approval was obtained from the county’s ethics committee. Consent and confidentiality required careful consideration and communication, due to shared parental responsibility and understandable anxieties around video recording. Consent was obtained from all participants at the workshop, along with pre-intervention individual questionnaires (contact the author for pre- and post- questionnaires, results and semi-structured interview schedule). Two focus groups (adopters and social workers) were planned for the final workshop, along with individual post-intervention questionnaires.

Unfortunately, severe weather caused the second workshop to be cancelled. Due to tight CWDC timescales, it could not be arranged so the support’s design and evaluation methodology was amended: instead of a facilitated session, each family was given a unique DVD of their video clips to share with their social workers if wished; individual telephone interviews, using a semi-structured schedule replaced the focus group questions; parents completed the post-intervention questionnaire over the telephone; and social workers were sent an electronic version. Interviews were transcribed, then analysed by the lead EP and a psychology research associate for their content relating to the main emergent themes.

 

Participants

All eight parents were first-time adopters, but two had parented previously. One was single and one was male. Five placements were of single, pre-school children. One was a sibling pair and the other a sibling group of three, where, in each instance, the eldest child had recently started school. All of the children had been fostered in Hampshire prior to their adoptive placement.

Six prospective adopters attended the first workshop, supported by nine social workers out of a possible eleven (as some social workers held casework responsibility for more than one adult or child). One couple were briefed on their initial home visit instead and as they wished to share review sessions, also provided joint evaluations. Therefore, findings are reported for seven adopters.

 

Findings

Four main areas were explored, along with emergent themes within them:

  1. perceived benefits of the adoption support package;
  2. improvements to the support package;
  3. working relationships;
  4. future uses of VIG.

Due to unexpected methodology changes, the strength and specificity of the evaluation data is likely to have been reduced by interviewing individuals ‘cold’ rather than as part of focus groups.

 

  • 1. Perceived benefits of the adoption support package

Adopters’ views

Six of the seven parents felt that the pilot had been a good experience overall, with the following typifying most responses:

It was a very good experience and very reassuring. I can’t say more than that. It was excellent.

Most commented on the shared review as the most useful part of the process:

The feedback bit was lovely, [it was] good to see the positives and to discuss the concerns. Seeing things helped me to try things.

One parent found the adoption support to be of moderate usefulness, disliking the VIG process, appreciating instead asking questions of the EP on home visits.

I hated being filmed and hated seeing the clips of myself and hated having to pull it out of myself…[but] I think it is clear that there should be some psychology support post-placement.

Several parents valued the focus on child-led play.

It’s lovely. It teaches you to play with your children.

When asked what specific skills they felt they had gained or developed, the adopters’ answers focused on five areas:

  • improved parental confidence;
  • reassurance of interacting positively with their children;
  • improved awareness of their child’s verbal and non-verbal skills and signals;
  • greater focus on constructive playing;
  • developing their child’s use of language.

Because I’ve been focussed more on play, and getting them to play together, their language has improved… Naming was very useful as it has kept the children on task for longer.

Responses to the questionnaire’s scaled questions indicated that prospective adopters often found the support even more helpful than anticipated for themselves and as useful as they had first predicted for their family. Although they regarded the support for their child as helpful, this was slightly less so than they had predicted, because the child had not received any direct intervention from the EP.

The parents rated their child as a more confident learner by the end of the pilot. Linked to this, their level of concern about their child’s learning confidence decreased while their confidence to support their child had increased.

I’m trying to use certain techniques and [child] is increasing in confidence.

As some new parents pointed out, their confidence may have grown as they got to know their child more fully, rather than as a result of the VIG support received, given how early into placement the support was provided.

 

Social workers’ views

Nine of the eleven participating social workers completed post-intervention questionnaires, giving a collated rating of the package as very helpful for their families, even more so than expected. When asked generally about the pilot, their positive comments often mentioned the reassuring and confidence-building aspects of VIG.

I was surprised that the adopter enjoyed it as much as she did, as she was fairly experienced and confident to start with. 

Looking together at some things that they were doing well, rather than just focussing on what wasn’t going well, perhaps made it easier for them to think about the times things weren’t going so well without them feeling complete failures.

A child’s social worker who had not attended the workshop and expected placement feedback from the EP, expressed a negative view:

I can’t see how positive it has been for us and it goes against the grain of working together. The prospective adopter did say the video was good but I still don’t really see what the purpose was.

When asked what they thought had gone well and what they had found useful, social workers’ responses fell into three sets:

  • parents and social workers learning more about attachment and play
  • parents appreciating support from someone other than a social worker
  • the different knowledge and expertise educational psychologists have compared to social workers.

Social workers were more aware than parents of how child/ren benefit from parental gains in skills and confidence.

Indirectly they have gained quite a lot – their new adoptive parents feel comfortable caring for them, so they’re relaxed and so it’s an indirect benefit to the child, a positive spin-off.

 

  • 2. Improvements to the support package

The majority of parents felt that the package was complete and needed no additions or alterations. Some improvements were suggested to the introductory workshop, its timing and paperwork. For example, one parent suggested a personal introductory home visit instead of a long group session. One social worker recommended including a session on child-led play and the VIG ‘principles of attuned interactions and guidance’ (Kennedy, Landor & Todd 2011) in the mandatory adoption preparation course.

The timing of support was explored in the parental interviews and although two thought it was ‘fine’, a couple were undecided as they could see advantages and disadvantages to receiving VIG at the start of the placement, and the rest thought it would have been better to wait a while.

Overload! It has been very useful, but very intense so early on – but maybe good to have it early on as it was useful.

Social work opinion about the timing of support was very varied, suggesting the need for a flexible approach to take account of the needs of the child, adopters and family.

The sooner the better. They get into their own ways if you leave it too long.

It would be helpful to consider VIG after about eight weeks into placement, where there are behavioural difficulties and the adopters are demanding quite a lot of support.

Four to six months into placement, unless adopters are struggling beforehand. Children need a few months to bed in; you are not getting their true behaviour before then.

Four parents had found two cycles of VIG sufficient for them, but three would have preferred more. Some suggested more time be allowed between cycles.

Two was not enough, really great but not enough – I would prefer more time between cycles and three cycles. The benefits would have been better with more time between each as you’ve done different things and will have more questions.

Most social workers did not have firm views about the number of cycles of VIG, probably because they were not closely involved in the process, although one suggested offering more if appropriate.

Four social workers were happy about their level of involvement, but most would have liked more direct involvement or feedback from the EPs, in order to inform their work.

It was a tool for them to develop bonding – it gave them the power to do that – we didn’t need to know more than that. 

It’s like collating evidence and putting it in a box. I’ve had some concerns about the placement myself. I want pointers to making the placement better.

When asked how information could be shared in a transparent way, many social workers would have liked to view the video clips as had been planned and several wanted to know more about the issues parents discussed with the EP through joint home visits. Only one adopter trialled the play diary and although she found it helpful to capture particularly positive experiences to share, no parents or social workers regarded this as an essential part of the support package.

 

  • 3. Working relationships

When asked to describe the working relationship with their EP, all parents were very positive. Typical responses included:

Very good – easy to get on with. 

I was put at ease straightaway.

Although two prospective adopters felt that there was no difference between this working relationship and others during their adoption journey, many felt that this was more positive. Some ascribed this to the different role and non-judgemental stance that EPs hold in the adoption process.

Different because she was unknown, an outsider coming in, so [EP] had no preconceived ideas about us as a couple or the child. 

It’s helpful to have someone external to offer support and help. I feel, perhaps irrationally, that if I mention concerns or ask for support that the social workers may say, ‘Oh [child] isn’t doing well here, let’s move [child].’ So it was great to have an outside person to support me, who wasn’t judging me.

Several social workers showed awareness of the placement as a transitional time with the potential for tension, seeing the involvement of a separate professional as a key asset.

Adopters tend to feel in a goldfish bowl, with all the visits they get, all the things they have to do like telling us if the child has a fall – they must feel we’re constantly monitoring their parenting skills, which we are – but this [VIG] is separate, someone different to talk to, with different ideas.

Most adopters had been asked at least briefly about VIG by social workers visiting them. One family valued sharing what they had learnt with social workers at a statutory review. Two social workers appreciated asking about the pilot on statutory visits, as a starting point for deeper discussion:

It provided a focus for conversation above seeing the child’s bedroom and asking, ‘Have you got a health visitor yet?

All parents thought it would have been good to share video clips with their social workers, especially as it would have emphasised what they were doing well.

That’s a really good idea. The child’s social worker is quite concerned about the relationship, as [child] gets quite anxious when the social worker is there, so the social worker only sees a difficult time. It would have been really nice to show her some more positive times.

It’s a good idea for them to see us as a family unit. Sometimes it’s nice to have a little pat on the back – see we do some things right!

 

  • 4. Future uses of VIG

All parents involved agreed that they would recommend the use of VIG as adoption support to other prospective adopters, especially first time adopters and some thought that the approach would benefit birth parents too. Other families that they thought would benefit were adopters of children with behavioural problems, attachment problems or who had experienced trauma. All social workers, apart from the one who was not directly involved, would recommend VIG:

Definitely, I would highly recommend it. I’ve had positive feedback from adopters. It’s another tool we can use as a service in promoting positive attachments and comes from a strengths-based perspective.

I would like to see it offered to all families, even where things are going right, as it affirms that and increases the confidence of the adopters.

Social workers highlighted the additional needs of children being placed from care in recommending VIG, to help prospective adopters ‘tune in’ to their particular child’s needs. They thought that established adoptive placements under strain could be supported by EPs using VIG and that VIG would benefit families not quite meeting the threshold for social care’s intervention, or foster carers with whom children requiring sensitive parenting are living.

 

Development of VIG as a therapeutic intervention

The pilot’s generally positive evaluation indicated that VIG would be beneficial for other families. All the suggestions for its future use were discussed with social care managers, who prioritised commissioning the EP service to provide VIG to new adoptive placements and to some families experiencing distress and challenging behaviour post-adoption within Hampshire. Very recently, parents of children in and on the edge of care have received VIG also, to assist them in adjusting their parenting approach.

The participants’ views and improvement suggestions have shaped the subsequent development of a highly-valued adoption support service using VIG, delivered by VIG-trained EPs. Now, three cycles are offered to parents with the option of one more or less to respond to family-specific requirements, whilst taking account of the research evidence base (Doria, 2009). This complements the county’s VIG and VERP work with schools and early years’ practitioners.

The group sessions have been exchanged for joint visits with social workers at the start and end of EP involvement, allowing families a flexible start date whilst maintaining a collaborative approach. On the initial home visit, a focus for the work is negotiated and phrased as one or more ‘helping questions’, which are rated by the client using Target Monitoring Evaluation (TME) scales (Dunsmuir et al 2009). Ratings are revisited at each shared review to quantify progress towards the parental priorities for change. Videoing of shared play activities is done in or outdoors according to parental choice. On the concluding joint visit, the EP supports the adopter to share their new insights or enhanced skills with social worker(s) using their favourite clips as a basis of the shared review. Instead of a play diary kept by the parents, a family ‘traject’ plan (Kennedy, Landor & Todd 2011) is compiled by the EP in discussion with the parent, of principles observed and insights gained through VIG, which is shared with social workers. Therefore, social workers receive sufficient information to assess or assist the family, but without hearing details of discussions held in confidence, with parents empowered as equal partners in the process.

 

Recommendations for future research

This study allowed exploration of people’s experiences of VIG within adoption support, but the small sample sizes limited statistical analysis of reported change. Fruitful research into the effectiveness of VIG using a child-focused perspective would be to assess changes in the dyadic interaction through micro-analysis of a portion of the first and last videos of shared play. One would wish to see increasingly skilful parental sensitivity when receiving the child’s initiatives, alongside an increase in both the quality and quantity of children’s initiatives. An objective coding schedule could be developed from Polderman’s Basic Trust method (2009) derived from VIG’s principles of attuned interactions and guidance. This would complement any qualitative data including that of observed change reported by parents and social workers.

 

Conclusion

Overall, the prospective adopters and social workers involved in the VIG pilot reported a number of benefits of the adoption support package. These included the reassurance adopters received from the strengths-based approach of VIG, which raised their parenting confidence. Parents and professionals appreciated the focus on building security and learning confidence through play. Merit was seen in the placement support being provided by an EP, offering specialised advice from outside of the adoption assessment process.

As a result of the pilot’s positive evaluation, VIG has become an established part of the county’s therapeutic support for children in and from the care system. Evaluation data from social workers and parents continue to shape this support, which promotes collaborative working relationships whilst respecting different professional roles / responsibilities and takes account of adoptive families’ individual and often complex needs.

 

Caroline Feltham-King (Hampshire Educational Psychology, AVIGuk advanced supervisor and trainer), Amy Warhurst (University of Winchester) and Emma Gibbs (Hampshire Educational Psychology, AVIGuk supervisor)

Enquiries for further information to: caroline.feltham-king@hants.gov.uk

References

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Wolfs, R. (2008) Adoption conversations: What, when and how to tell. London: BAAF.

 

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