Video Interaction Guidance in Cambridgeshire Children’s Social Care: Having Better Relationships in a Safeguarding Context. Holmes, D.

Video Interaction Guidance in Cambridgeshire Children’s Social Care: Having Better Relationships in a Safeguarding Context

Deb Holmes, Specialist Clinician, Cambridgeshire Children’s Social Care

‘When people start writing they think they’ve got to write something definitive… I think that is fatal. The mood to write in is “This is quite an interesting story I’ve got to tell. I hope someone will be interested. Anyway it’s the best I can do for the present”. If one adopts that line one gets over it and does it’.

John Bowlby, in Hunter (1991)

Those wise words from John Bowlby sum up the spirit in which this article is written. This is a personal perspective of the Video Interaction Guidance (VIG) story so far in Cambridgeshire Children’s Social Care (CCSC), including some brief reflections from colleagues and some case anecdotes. Although we are having on-going conversations about evaluation and are currently conducting a mini-audit of the use of VIG, for a number of reasons – the not least of which is far-reaching organisational change – we are not at the stage yet of a comprehensive and reliable study of outcomes. I hope you find this story interesting… it’s the best I can do today!

I am a Specialist Clinician working in CCSC. Five years ago in January 2012, Cambridgeshire County Council began to deliver services differently to children in need of safeguarding and their families, using a model based on systemic and social learning theories (see Goodman and Trower, 2012). The Specialist Clinician role was created to work closely with social workers to help apply these models – facilitating the safeguarding task in collaboration with families and in a way that is aimed to enable lasting change, rather than instructing families in what they must do or applying interventions that families found difficult to accept. The Specialist Clinician team includes family therapists (my own training), psychologists, educational psychologists, mental health nurses and occupational therapists. Many are in the role part-time and some also work part-time in roles outside CCSC.

VIG is a strengths-based, relational intervention with its theoretical basis in attachment theory. It was developed through observations of what was happening when interactions between parents and their children go well. Through intervening at the level of communication in the carer-child relationship, VIG helps to strengthen a child’s sense of security within key relationships and to promote emotional well-being, self-identity and developmental progress. Since arousal and stress levels for children are generally lowered, unwanted behaviours both within and outside the family home are often reduced, as children feel more contained. For more information about VIG, see Kennedy, Landor and Todd (2011).

How VIG is delivered is as important as what is delivered. VIG works in a respectful and collaborative way with clients, using edited video clips of ‘better than usual’ communication between parent/carer and child, as a basis for reflective dialogue about how to develop the relationship further. These reflections arise from one or more relationally-based goals known as “Helping Questions”[1] – what changes would the parent/carer (and in our context, the social worker[2]) like to see? The Helping Questions can be rated to show change over time.

VIG builds on the skills a parent/carer already has, helping them to do more of what they are already doing that is working well, however transient or isolated these moments appear to be. Seeing themselves on video communicating effectively with their child is empowering and motivating – parents/carers gain confidence and enjoy their relationships with their children more, becoming increasingly attuned and sensitive to their children’s emotional needs.

A handful of our Specialist Clinician team began training in VIG in January 2013, alongside Educational Psychologists whose Lead, Helen Phelan, initiated and organised the training. I for one am very grateful for her insight and creative thinking, and for our own Managers at that time recognising the potential for VIG in enabling ‘our’ families to change.

I had some knowledge of VIG from my previous role, as a family therapist in a voluntary sector organisation where I worked alongside VIG practitioners, one of whom was Marie Robertson. Unbeknown to me, Marie was one of the trainers at our ITC – we were both surprised and pleased to see each other. Marie became my supervisor and I valued her support and her modelling of the model throughout my training.

For me, an aspect of VIG I appreciate is that following the two-day Initial Training Course (ITC) participants are then able to deliver it right away, under supervision which constitutes on-going training. We were able to learn in a heuristic, experiential way which suited me, the close supervision providing a safe context for our families to whom we offered VIG interventions very early in our training process.

In the early days there were four full-time Clinicians and three in the role part-time (who were also part-time Educational Psychologists) who began the VIG training. In October 2015, a further three Clinicians began the training, one being full-time and two part-time. However, due to Clinicians leaving the team or taking extended leave (such as maternity and sabbatical), we currently have six Clinicians offering VIG, four of whom work full-time and two part-time. VIG is only one aspect of our role; availability to our families has fluctuated as other demands on our time have been made.

Historically, being from a variety of backgrounds, trainings, experiences and knowledges, different Clinicians have offered different interventions, depending on their own areas of expertise – which is far from ideal. The VIG offer has been no exception and whether families receive VIG has depended on access to a VIG-trained Clinician. However, despite the proportionately low number of Clinician VIG practitioners and the lack of a comprehensive, county-wide service, we have been able to work with a number of families and VIG remains an actively-used intervention. Our service is currently evolving, major restructuring providing an opportunity to review how the Clinician team can offer a more consistent and comprehensive service to families with greater opportunities for joint working. I am confident that VIG will be part of this.

Some experiences of VIG practitioners and trainee practitioners follow:

“I have found parents and children enjoy VIG, it is strengths-based and visual which is both acceptable and accessible to our group of families who often feel discouraged about their competencies and less comfortable with purely talking-based approaches.”

“I would say VIG can be quite refreshing for parents in social care. Because it is a strengths based model and is very much led by the parents. I think parents can enjoy being placed in the driver’s seat and encouraged to look at the good skills that they are putting into place. I think it is a nice shared piece of work where the pressure is not too intense on the parent and the videos give a nice focal point. I like the way VIG is centred on the child as its main emphasis but nicely brings along the parent.”

“I see VIG as part of my work, rather than as a discrete intervention. VIG is part of working in an eclectic way; it is part of relational working but it is not the entirety. It doesn’t take place in a bubble. VIG can’t fix everything! The contexts that are maintaining the problems for families open to social care are strong and creating a situation where VIG can happen can be 80% of the work. However I don’t think I have had an experience where, once the work starts, it isn’t great and has not been a positive experience. People love it!”

And from a Family Worker (not VIG trained):

“VIG work has been observed to be a powerful tool that helps promote awareness and curiosity. It has been useful visual representation to promote awareness of positive interaction, mentalization and emotional warmth between family members. It also helps the family to have an understanding in making helpful changes to one and other.”

VIG interventions, sometimes even just one cycle[3], can lead to substantial improvements in parents’ or carers’ self-esteem and communication with their child or children. As parents think differently about their children, safeguarding issues may subsequently diminish and with little further intervention the family’s case can be closed to social care. For other families, although parents may have enjoyed and benefitted from VIG work, overriding safeguarding issues such as inconsistency in providing for a child’s needs or choosing unhealthy adult relationships which impact upon a child, have unfortunately led to legal proceedings – including the removal of children from the parents’ care.

I have seen, both first and second hand, how helpful VIG has been in a number of situations: for example, improving family relationships in the context of inappropriate physical chastisement; and in blended families where a parent may struggle with not having the same feelings towards a step-child compared with a birth child. I have seen VIG help parents to better understand their children’s behaviour, which in turn has changed the parent’s behaviour towards the child.

VIG practitioners often co-construct a Traject Plan[4] with families– a tool that helps to contextualise the work, map changes made and articulate further changes desired, using headings such as Basic Communication, Daily Life, Development of the Child, Development of the Parent, Neighbourhood/Community. These headings can be adapted to make sense for the family. I have noticed how Traject plans have helped parents to see a wider picture, to identify changes made and to introduce new ideas and desires for the future.

VIG work with foster carers, often as part of a wider Clinician intervention, can enable carers to address relational issues, which may be different with each child, and to enjoy spending time with their foster children. It is lovely to see this work lead to outcomes such as permanent matching of children and carers for a long-term placement!

Accepting VIG may be more difficult for our families if parents do not want, or see any need, to change anything at all (i.e. they do not have a Helping Question) and for whom VIG is not their idea, but that of someone else in authority – such as a social worker or other professional, or the Child Protection (CP) conference or court. Even so, VIG interventions have been shown to have some success with some families in this position, both in our own service and elsewhere (e.g. the Family Drug and Alcohol Court). CP conferences and courts can in themselves provide motivation, and Helping Questions can emerge.

Although VIG is very much appreciated as a refreshing, strengths-focussed intervention, in CCSC we are learning that making good choices about appropriate families and situations for VIG is key. In general terms, indications for VIG are not unique to our context: difficulties in communication, interaction or attachment; lack of parental sensitivity and/or reflective capacity. More specifically to our context, the CCSC Clinician team aim to target interventions at obstacles to children being safe enough to no longer need a Child Protection (CP) or Child In Need (CIN) plan, and to address issues, often linked to attachment difficulties, for children in our local authority care; these if left unaddressed could compromise the happiness and well-being of the children and eventually lead to placement breakdowns. Any intervention, including VIG, needs to be embedded within the context of our safeguarding work, within a systemic formulation that includes attention to chronology – is this intervention likely to produce enough change within acceptable timescales, or are we doing more of the same? Good VIG practice in social care is strengths-based but by no means dismissive or ignorant of the reality, significance and impact of issues faced by our families.

Finally, here are some words from our Psychology Lead, Pam Parker, which highlight the importance of the contextual relationship between the VIG-trained Clinician and the family:

“My experience has been that VIG interventions can contribute significantly to developing resilience with families open to social care, offering them a different experience of a “helping” relationship and an accessible way of understanding what changes in relationships might be possible. In Cambridgeshire the VIG work is undertaken by highly skilled clinicians who understand the complex context of the work and have particular expertise in building relationships with families under stress. My impression is that practitioners navigate the balance between attending to child protection concerns and taking a strengths based approach in a highly sophisticated manner. It seems to be that this additional level of skill and knowledge is what makes the use of VIG possible and helpful in our service.”

On a personal level, for me as a VIG-trained Clinician, these are most encouraging words. They led me to notice how, as a Family Therapist working in social care, training in VIG has allowed me to experience its power for families through how it is delivered – both its visual nature and the relationship between the family and the VIG-trained clinician. I have noticed the space that can be created through VIG’s strengths-based approach, without needing to dilute or ignore safeguarding worries in any way. As well as the pre-existing skills and knowledge I bring to my VIG work, my VIG work has brought in new knowledges and helped me to hone my skills.

So this is my story, so far, which no doubt will change over time; and others will have different stories. There is always another story to be told… thank you for reading mine.

deb.holmes@cambridgeshire.gov.uk

References:

Goodman, S. and Trower, I. (2012) Social Work Reclaimed London: Jessica Kingsley Publishers

Hunter, V. (1991) John Bowlby: an interview Psychoanalytic Review 78: 159-65

Kennedy, H., Landor, M. & Todd, L. (2011) Video Interaction Guidance: a relationship-based intervention to promote attunement, empathy and wellbeing. London: Jessica Kingsley Publishers

[1] From Kennedy, H., Landor, M. & Todd, L. (2011) p291: Helping Question – A statement of what the client hopes VIG will help them achieve

[2] In our context the VIG guider, as a Specialist Clinician, is part of the Social Care team and families are made aware that information about the work will be shared with social workers. The social worker and VIG guider work collaboratively with the family, in particular regarding referral. Although social workers do not see the VIG clips themselves without permission from the family, in practice families may ask for the clips to be shared with social workers and other professionals, such as a child protection conference or child in need meeting.

[3] Cycle – A recording followed by a meeting between the VIG practitioner and the family, when edited video clips are viewed and discussed

[4] Traject plan – originally “treatment plan” – a plan used to consider the structural/systemic aspects of the VIG intervention. See Kennedy, H., Landor, M. & Todd, L. (2011) p293

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