Whalley, Paul, Williams, Mike, and Cotmore, Richard. Can screen time actually help families talk to each other? An evaluation of Video Interaction Guidance where initial concerns over neglect have been noted. “The NSPCC has been testing more than 25 programmes for parents, children and young people in a systematic attempt to report on what works, and how, in the area of abuse and neglect. One approach is Video Interaction Guidance (VIG) …”

The NSPCC has been testing more than 25 programmes for parents, children and young people in a systematic attempt to report on what works, and how, in the area of abuse and neglect. [1]One approach is Video Interaction Guidance (VIG) which aims to improve relationships within families (Kennedy, Landor and Todd, 2011) by training practitioners or ‘guiders’ to work with families on relationships, focusing on positive interactions with their children and modelling these more widely. It does this by videoing the parent and child doing an activity together, editing in order to highlight something that the parent does well, and then reviewing the video with the parent. The process uses reflection to promote and reinforce behaviour that shows greater sensitivity to the child’s needs. Parents are helped to recognise behaviour that is better than usual, even if this is the exception, and to recognise times of attunement.

Early studies reported on behavioural improvements in children, and later studies have also reported on improvements in parents, including parental sensitivity (Dowrick 1999, Benoit et al 2001). A meta-analysis of 29 studies on the use of video feedback to parents (Fukkink 2008: page 912) concluded that:

“On completion of the program, parents are more skilled in interacting with their child and have a more positive perception of parenting…. parents improve their interaction skills, which in turn help in the development of their children.”

 

Methodology and aims

VIG has been used by the NSPCC where concerns have been expressed over possible parental neglect in cases where the focus child is aged 2–12, and where the child is not the subject of a child protection plan. It has been provided in the family home from seven service centres across Northern Ireland, Scotland and England.

The theory of change of the service, that is the way that activities are expected to achieve service goals,[2] is that the service provides activities that will:

  • increase parental understanding of what is expected of them
  • increase parental understanding of their child’s needs
  • increase parental commitment to their child
  • increase parental sensitivity to their child
  • increase parental capacity
  • reduce the emotional and behavioural difficulties of children, and
  • meet their developmental needs.

These primary outcomes are expected to lead to changes in parenting behaviour, reducing the risk of harm to the children in order to ensure that they are physically safe and that their emotional needs are met.

The evaluation measures the impact of VIG and explores the parents’ experience of the programme, reporting on any barriers and facilitators to success. The impact evaluation uses a before-and-after design, comparing three measures completed by parents at the start and end of the programme: the Strengths and Difficulties Questionnaire (SDQ); the Parenting Scale; and the Parent-Child Relationship Inventory.

The impact evaluation also uses a historic comparison group to compare children’s emotional and behavioural difficulties through SDQ scores. This comparison group had also received an NSPCC family support service between 2006 and 2009 to address concerns about neglect. Qualitative interviews were also carried out with a sample of parents who received VIG to understand the factors that helped them, or were a barrier to them, in achieving good outcomes. Interviews had not been carried out with the historic comparison group.

 

Key findings

SDQ results show that parents reported reduced emotional and behavioural difficulties of their children by the end of the VIG programme. The changes were statistically significant and related to:

challenging behaviour, such as temper tantrums, fighting with other children, disobedience, lying or stealing; emotional symptoms, such as headaches, worries, fears and nervousness; hyperactivity, such as fidgeting, lacking concentration, restlessness, not seeing things through; and pro-social strengths, such as being considerate, sharing, helpful and kind. [3]

There was also a statistically significant reduction in the number of children experiencing very high needs, from almost three-quarters (72 per cent) of children at the start of the programme, to just over half (56 per cent) by the end of the programme.[4]

The SDQ results for the comparison group showed similar amounts of overall change in children. But whereas the comparison group showed slightly greater reductions in emotional difficulties, hyperactivity, conduct problems and peer problems subscales, the VIG programme achieved slightly greater improvements in pro-social strengths. However these differences were not statistically significant.

The Parenting Scale shows that parenting problems reduced following Video Interaction Guidance: about half (49 per cent) of the parents reported severe difficulties in their parenting at the start of the programme but by the end of the programme this figure had fallen to 40 per cent. There were statistically statistical reductions in all three of the subscales as well as the total parenting score: 

  • laxness, ie parents not following through what they say to the child
  • over-reactivity, which measures overly harsh or punitive disciplinary strategies
  • verbosity, ie getting drawn in to long verbal exchanges that may confuse the child and become ineffective.

The proportion of parents who reported high need for these subscales also reduced over the time of the VIG programme: laxness from 43% to 29%; over-reactivity from 53% to 31%; and verbosity from 40% to 32%.

In interviews, parents reported that changes in their relationship with their child had been prompted especially by the following:

  • the level of practical and emotional support they had received as parents, for instance in relieving financial strain or being able to call on others to help with parenting duties
  • their propensity to show an interest in their child’s activities, reflected in the amount of time they spend with a child or how much they know about them
  • their awareness of how well they communicate with their child in a variety of settings, including simple conversation
  • the effectiveness and nature of their disciplinary techniques, including setting limits that the child knows and understands when they are exceeded.

Parents also described factors related to the programme that helped effect change, including the practitioner being flexible and non-judgemental in their approach, helping the parent to focus on positive aspects of their relationship with their child, and having practical suggestions to try. Providing the intervention in the parental home was also seen as helpful for promoting change.

Positive aspects of the VIG programme itself that were identified as enabling positive change were: the visual aspect of the programme, which made it possible for parents to see things they had not seen previously; the requirement of the programme to spend one-to one time with their children; and parents leading the analysis of the video clips.

Barriers for some parents included feeling that they had needed help for some time before the programme was made available to them. Some had also been fearful that the VIG programme might be a way for professional services to monitor families and ultimately remove their children, reinforced by an association of the NSPCC with child abuse and removal of children from their families. Initial fears about being videoed were overcome by support from practitioners.

 

Implications

These evaluation findings demonstrate the potential of VIG in achieving positive change for families where there are concerns of potential neglect. The key changes were that there was an improvement in the parent-child relationship and in the strategies used to parent effectively. There were improvements in the areas of parental support, involvement, communication and limit setting, and reductions in children’s emotional and behavioural difficulties reported by parents.

However, the findings also highlight the high level of need reported by these families even though they were not in the child protection process at the start of the VIG work, and that high levels of need were still present at the end of VIG. This suggests the potential importance of longer-term follow-up with these families in supporting them to continue to improve in their relationship with their children and to maintain that improvement.

The structure of VIG was viewed positively by those parents interviewed, in spite of some initial concerns about being videoed in their interactions with their children.

The importance of the relationship with the NSPCC practitioner was seen by parents as a key factor in helping them to achieve change.

The importance of establishing a good rapport from the start of the programme was emphasised, knowing that the worker would be supportive, non-judgemental and clear in their dealings with the parent.

The historical comparison group was helpful in creating a more complex and nuanced picture of outcomes for children. However, a stronger evaluation design would be required in order to be able to make claims of effectiveness for the VIG service in the context of neglect.

 

Limitations

The comparison data has been limited to one of the three measures; comparison across other measures would also be helpful. A more robust evaluation of VIG would require a ‘waiting list group’ who provide data and then subsequently receive the VIG intervention, or a ‘business-as-usual’ sample of parents who have been assessed with similar needs. In addition, interviewing more parents who have not progressed so well would be helpful in identifying further barriers to using VIG in this context.

 

Authors:

Paul Whalley – Senior Evaluation Officer, NSPCC; Mike Williams – Senior Evaluation Officer, NSPCC; Richard Cotmore – Head of Evaluation Department, NSPCC

Any correspondence please to:

Paul Whalley – Senior Evaluation Officer, NSPCC, Strategy, Policy and Evidence directorate. Address: NSPCC National Training Centre, 3 Gilmour Close, Beaumont Leys, Leicester LE4 1EZ. Email: pwhalley@nspcc.org.uk.

 

References

Benoit, D., Madigan, S., Lecce, S., Shea, B., & Goldberg, S. (2001). A typical maternal behavior toward feeding-disordered infants before and after intervention. Infant Mental Health Journal, 22(6), 611−626.

Dowrick, P. W. (1999). A review of self-modelling and related interventions. Applied & Prevention Psychology, 8, 23−39.

Fukkink, R.G. (2008) Video feedback in widescreen: A meta-analysis of family programs, Clinical Psychology Review 28, 904–916.

Kail, A. and Lumley, T. (2012) Theory of change: the beginning of making a difference. New Philanthropy Capital. Available at http://www.thinknpc.org/publications/theory-of-change/

Kennedy, H., Landor, M. and Todd, L., eds (2011) Video Interaction Guidance: A Relationship-Based Intervention to Promote Attunement, Empathy and Wellbeing. London: Jessica Kingsley.

 

For the full report on the evaluation of VIG by the NSPCC see Whalley, P. and Williams, M. (2015) Child neglect and Video Interaction Guidance: an evaluation of an NSPCC service offered to parents where initial concerns of neglect have been noted. London: NSPCC.

Available at https://www.nspcc.org.uk/services-and-resources/research-and-resources/2015/video-interaction-guidance-vig-evaluation-report/

 

 

[1] See https://www.nspcc.org.uk/services-and-resources/impact-evidence-evaluation-child-protection/

[2] For more on theory of change see Kail and Lumley (2012) .

[3] Using Wilcoxon Signed Ranks test

[4] Using McNemar’s Test

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