Healing Relationships Within Adoptive Families in England Through Video Interaction Guidance (VIG). Caroline Feltham-King & Jane Leighton

Healing Relationships Within Adoptive Families in England Through Video Interaction Guidance (VIG)

Caroline Feltham-King and Jane Leighton

“All children need relationships to thrive; traumatized children need relationships to heal.” (Golding and Hughes, 2012).

Introduction

This article began as discussion between the authors preparing their workshop presented at the 2017 International AVIGuk Conference ‘Closing the gap’ in Glasgow. It describes two models of VIG service delivery within English local authority adoption support services and reflects on some particular issues that the authors believe need to be borne in mind when offering VIG to adoptive families. VIG is supported by research (for example, Fukkink et al, 2011) and is named as an effective intervention in NICE guidelines including Children’s attachment: attachment in children and young people who are adopted from care, in care or at high risk of going into care (2015).

The theoretical explanation of VIG’s effectiveness (Jarvis and Polderman 2011) is illustrated below by a portion of transcribed conversation between family members in Hampshire, who took part in VIG after experiencing child-to-parent violence:

Video – theories of change which use self-modeling and video feedback:

“With VIG, you’re interacting and it’s being recorded and then fed back on a normal situation. VIG comes out of what you’re doing and helps you learn to read each other. It helps to improve everyday situations.” (Adoptive Dad).

Interaction and Guidance – theories of intersubjectivity and mediated learning:

“VIG opens up communication and through your skill, we’ve been able to facilitate better conversation. We’ve learnt to listen better through VIG.” (Adoptive Mum).

Empowerment – theories of change which emphasise respect, building on strengths, empowerment and collaboration with families:

“VIG showed us that even though normal everyday situations aren’t always easy, there are ways we can all pull together to make it easier.” (Teenage Daughter).

Based on research by developmental psychologist Colwyn Trevarthen, a video feedback method using the ‘principles of attuned interactions and guidance’ (Kennedy, Landor & Todd 2011) was developed in the 1980’s by Harrie Biemans in the Netherlands. Since then, VIG’s therapeutic approach has been applied across the world in an increasing variety of contexts, including classrooms and care homes (Brooks, 2008). Instead of 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 with the person they wish to engage more effectively, in their usual setting (e.g. home). The guider shares carefully 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 filming and shared review is repeated, new narratives considered and progress towards the client’s goals celebrated. Insights and working points are recorded on a collaborative ‘traject’ plan that captures the systemic nature of the approach.

Service models

In Suffolk, VIG is offered to all prospective adoptive families. If accepted, a social care staff member in training as a VIG practitioner contacts the family to provide three cycles of VIG. To keep role boundaries clear this is usually a different person to the case-holding social worker. They are supervised by Jane Leighton, an Educational Psychologist (EP) seconded to the Permanence Team, which includes the county’s post adoption support service. This is part of a year-long project, funded by the government’s adoption support fund (ASF), which aims both to deliver and create capacity for therapeutic parenting early in adoptive placements.

In Hampshire, VIG is considered at any stage in the adoption journey, from introductions until after an adoption order has granted full parental responsibility to the adoptive parents. Social workers from the assessment, children’s or post-adoption teams may request the support and arrange funding through the ASF. Additionally, parents may be recommended it by other adopters, school staff or EPs following consultations or therapeutic parenting workshops. Coordinated by Caroline Feltham-King, EP, the work is undertaken by the county’s EPs who are also trained in VIG. Following three or four cycles of VIG, an additional shared review is facilitated by the EP, in which the parent(s) show their selection of previously-discussed clips to the social workers supporting them, to illustrate their learning through VIG and highlight any further support needs. Parent(s) then approve the notes made in their ‘traject’ plan before it is circulated as a record of involvement (Appendix A).

Research Projects

The Hampshire model was inspired by the Dutch provision of four video feedback sessions available to all adopters within the first two years of placement and developed following a pilot project funded by the Children’s Workforce Development Council in 2009-10 (Feltham-King and Warhurst, 2016). The Suffolk model was informed by the Hampshire project and encouraged by the strategic thinking of the permanence service manager who could see the benefits of embedding VIG within the adoption support service. It builds on doctoral research evaluating the provision of VIG to fourteen Suffolk adopters (Leighton, awaiting publication).

Evaluation Methods

Both counties use Target Monitoring & Evaluation (TME) designed by Sandra Dunsmuir at UCL to record a baseline and progress towards client goals, framed as ‘helping questions’ (Appendix B). Clients are asked to record where they think they are in relation to one to three goals for change at the start, where they would like to get to and what they would settle for. Using a ten point scale enables change, as reported by the client, to be tracked between cycles.

Examples of ‘helping questions’ negotiated with parents include:

  • What helps G relax and be happy? (Child with a need to be in control).
  • How can I help K’s attachment with me be stronger?
  • How can I strengthen my relationship with JJ? (Hyper- vigilant and resistant to physical closeness).
  • How am I reading my child’s emotions and reflecting them back? (Quiet, eager-to-please child).
  • How are we helping our (previously neglected) son feel safe and secure with us?
  • What works well when responding to our new toddler’s behaviour?
  • How am I helping my impulsive teenager listen to parental advice?
  • How are we supporting the children to develop a relationship with each other? (Birth daughter and newly placed adoptive son).

Along with the TME, prospective adopters in Suffolk are asked to complete the Parenting Stress Index (short-form) and the Behaviour Rating Inventory of Executive Function. In previous project work, the Child Behaviour Checklist and parent version of the SDQ were used to measure impact. The latter proved to be a blunt instrument, but analysis indicated that a trend towards reduced child overall distress and increased kind and helpful behaviour was perceived by adoptive parents.

After the final shared review in Hampshire, semi-structured evaluation forms are given to both parents and social workers (Appendix C). On the few occasions that a teenager has been a client also, they are given an evaluation form adapted for them so that their perspective may be gained. Comments from these are shared with the service managers and the ASF, once personal data has been removed.

Evaluation Themes

Five themes were elicited from Suffolk adopters’ and practitioners’ responses to the evaluation question, “What stands out as being the most helpful part of VIG in this situation?” These were:

  1. Opportunity: The intervention gave valued time and space to explore the parent-child relationship. Watching video clips and discussions with guiders were particularly helpful in changing their self-perceptions.
  2. Skills: Respondents found it helpful to see and be reminded of the skills of attuned communication.
  3. Thinking: VIG provided space for reflection and problem-solving. For example: raising conscious awareness of interactions; realising the strength of their relationship with the child that they did not think was there; helping them to see pathways to strengthen their bond with their child.
  4. Changes in self-perception: VIG helped clients to be confident in themselves as parents and not to feel judged by others. It improved their self-efficacy giving them a ‘can do’ attitude.
  5. Changes in behaviour: Participants reported spending more time with their children having ‘fun’. VIG gave them more positive stories when talking about their children.

These are illustrated in the graphic below:

Issues to hold in mind

Fear of professionals

Having undergone a rigorous and lengthy assessment, parents can feel a failure for experiencing difficulties and may delay requesting professional help until the placement is in a state of crisis. The VIG guider models to parents how to collaborate with discerning yet non-judgemental professionals, a relationship which adopters perceive as helpful (Feltham-King and Warhurst, 2016). It is important for the guider to be transparent about confidentiality and name any perceived conflict that arises. VIG may be with prospective adopters, who therefore are still being assessed for their capacity to care for their child/ren, or with adopters, whose children are sometimes made subject to a child protection plan after a recent investigation. In both local authorities, it is made explicit to clients and social care that the clips belong to the adults in them and conversations around them happen in confidence, within child protection parameters.

Before videoing children from the care system, guiders check out with their social worker(s) or substitute parent(s) what their prior experience is of being filmed. Some may have been filmed by abusive parents, others as part of a police investigation. Occasionally, the sight of a badge-wearing professional in the home is very unsettling for adopted children, reminding them of previous moves. Poorly-attached children may see a new adult as another person to please or test, so it is important to strike a balance between reassuring the child (and gaining their consent to video if they are of an age to understand this) and remaining aloof so as not to undermine the parent as the primary attachment figure.

Loss

There is a history of loss for both adopter and adoptee, which may not be fully acknowledged. Many people consider adoption only after conceiving a birth child has proved impossible or inadvisable. Miscarriages and failed IVF attempts are traumatic and not always shared or supported experiences (Donovan, 2013). There is the loss of birth children parents may have hoped for and the goals they thought they would achieve through adoption (Donovan, 2013). For adoptees, they have experienced the loss of their birth parents and often also of siblings. Even if children are removed soon after birth, they have lost all that was familiar and in gaining a ‘forever family’, children leave behind other significant relationships from their foster families, nurseries or schools.

The authors believe that although the needs of children in and from the care system are similar and caring for them is both challenging and fulfilling, adoptive parenting is different to that of fostering. The former is a legal means to achieving family life, the latter, current employment within the family home. VIG guiders undertaking this work are mindful that for many adopters, this is not the life they imagined when they sought to become parents and they may feel broken by or resentful of their current situation. We find that VIG can bring parents to a greater acceptance of how life is for them now, having gently named this inner conflict of dashed dreams. It enables them to show greater acceptance of their children as the unique individuals they are and more patience with their ongoing needs for parental reassurance and emotional regulation. Activating questions in the shared reviews develop the parent’s capacity for reflective functioning, essential for sensitive attunement (Maskell-Graham, 2016). VIG ties in well with the more mindful, value-based approach to parenting, recommended for nurturing confidence and security in troubled children for example by Kim Golding & Dan Hughes (2012).

“I know that a lot of parenting [my adopted son] is very similar to parenting [my birth son] but the stakes seem higher as he had such a poor and scary start and it’s up to us to help him learn that the world is not a horrible scary place where you never know what happens next and be able to relax, grow and enjoy the world safely.” (Hampshire Mother).

Trauma

All adoptive children from the care system have some degree of developmental trauma. As Louise Bomber notes, “developmental trauma can come about as a result of having experienced or witnessed, amongst other things, physical abuse, severe neglect, sexual abuse, domestic violence, multiple placement moves, emotional abuse, deprivation …. all within a child’s close, early relationships” (Bomber, 2011, p. 5). Developmental trauma is implicated in attachment difficulties, emotional dysregulation, adaptive behaviours, cognitive and executive functioning complexities, and sensory difficulties. The effects may then be exacerbated by reward-punishment thinking rather than therapeutic parenting approaches by some carers, adopters, teachers and social workers, which produces more feelings of terror, loss and shame for the child (Elliott, 2013). It also presents a challenge to their new parents, as “adopted children’s signals can be distorted, subtle, or difficult to interpret, making it harder for their adoptive parents to react to their signals in a sensitive way.” (Juffer et al, 2008).

Preparation for adopters, to better understand the history of their child and the far-reaching impact of developmental trauma, is more thorough now than previously. Some adopters have been applying standard parenting approaches for years, to little or no effect, to address their children’s trauma-related behaviour (Elliott, 2013). They need to be encouraged that it is not a case of trying harder but of doing differently (Naish, 2016). The supported microanalysis of video in shared reviews helps adopters discover what is working well when parenting their particular child/ren with complex additional needs.

“…looking at your interaction with the child from almost a third party point of view is brilliant and I’ve learnt so much about the things I do. It’s been very confidence-boosting for me. In terms of understanding the behaviours that you’re seeing it’s all specific to your child rather than it being general like it might be on a course or in a book. I think that’s really priceless.” (Hampshire Mother).

Blocked trust and blocked care

Whether well-prepared or not, the reality of living with a child who finds it difficult to trust their adoptive parents due to their prior experience of family life needs to be acknowledged (Golding and Hughes, 2012). Baylin and Hughes (2016) propose that in order to protect oneself from further abuse or loss, a child will reject the care that their new parent offers: their capacity for trust becomes blocked. Experiencing this is deeply painful for an emotionally-invested adult seeking to develop a meaningful relationship with the child. In order to self-protect, neurobiological changes occur involving natural opioids blocking cortisol receptors in the brain stem. In numbing emotional pain, access to the limbic system (where emotions are processed and attachment experienced) and to the frontal lobes (involved in reasoning and problem-solving) is also reduced: parental capacity to care becomes blocked (Baylin and Hughes, 2016).

The authors suggest that VIG as a therapeutic approach offers a way to promote trust in the child and release care in the parent, releasing the potential for a trusting loving relationship to grow. Firstly, VIG videos parents undertaking a shared activity with their child, where previously they may have avoided providing these. Reviewing special moments arising during child-led play encourages parents to plan in more shared time with their child, who may be resistant or demanding of parental attention. The approach coaches parents to respond sensitively to their child, going at a pace with which the mistrustful child is comfortable.

Secondly, showing parents video clips when they have done this and then experienced a powerful moment of connection with their child affirms their skills, encouraging them to seek more occasions to apply them. As their confidence builds, they develop a desire to seek connection, rather than avoid situations that risk rejection. Finally, savouring these golden moments in the shared review with a reflective and empathic guider amplifies the positive emotion the parent felt at the time and increases the potency of its effectiveness (Jarvis and Polderman, 2011).

VIG “forced me to be more interactive” with my child.” VIG has “cemented the fact that we have fun together.” (Suffolk Adopters).

Rage

Their child’s extremes of emotion can be frightening for many adopters, who understandably feel unable to safely contain the raw rage that their children might display with very little provocation (Elliott, 2013, Donovan, 2015). A small number of parents have shared how this has reminded them of a previous relationship that was abusive, perhaps with an alcoholic parent or violent partner. This has made it difficult for them at times of heightened stress to differentiate between the child and their own past, or between the child and the rage.

Using language that separates the child from the strong emotion or challenging behaviour is essential for the guider to model – for example: “Fear will bully your child in to poor behaviour” (Purvis et al, 2007). Closely watching positive clips seeks to support parents to better read their child’s non-verbal signals, identify principles to use as potential de-escalatory strategies and hypothesise about the behaviour’s communicative function, so that they might plan how to better meet the child’s underlying need. Receiving then referring discussion back to the video helps the guider redress the balance in the parent’s mind of the rage being all about them/all of the time.

“It has helped me to say we do have our fun moments and it’s not always negative experiences that we share.” (Suffolk Adopter).

Invitations and Patterns

Parents sometimes find themselves surprised by the strength of negative emotion their child’s behaviour evokes in them, inadvertently becoming as controlling and insensitive as authoritarian birth parents or as rejecting and disinterested as neglectful birth parents, out of defensiveness (Elliott, 2013). Elliott helpfully describes this replication of the birth family parenting style as ‘accepting the invitation’ to confirm the child’s previously learned patterns of relating. VIG’s focus on attuned moments highlights the effectiveness of positive cycles of relating (‘yes cycles’) and encourages parents to create more of these. The ‘traject’ plan helps parents to embed the principles of attuned interactions into their daily routines and family life.

“I have reflected on how S’s anxiety has impacted on me and I have made some changes as a result. The whole family dynamic has moved forward.” (Suffolk adopter).

Supervision for the VIG practitioner is essential to give space to reflect on these patterns between parent and child and to discern how they may be influencing relationships and being mirrored at higher systemic levels, for example, between the parent and social workers, child and school staff, or guider and parent (as illustrated by Jenny Jarvis using nesting Russian dolls at her supervision workshop in Glasgow, May 2017).

Concluding comments

Some might argue that we should not attempt to differentiate ‘these families’ from any others. We agree that a reflective VIG practitioner takes each client at face value and comes alongside them with curious acceptance of their story, then encourages them to consider new narratives and hopeful futures for their relationships, while guiding them towards naming the skills that underpin effective communication. However, we believe that the combination and complexity of challenges faced by adoptive families is unique and have found it helpful to hold these themes in mind while negotiating goals, editing video and deepening discussions with adoptive parents and their children.

“If relationships are where things developmental can go wrong, then relationships are where they are most likely to be put right.” (Howe, 2005).

caroline.feltham-king@hants.gov.uk

References

Baylin, J. & Hughes, D.A (2016) The Neurobiology of Attachment-Focused Therapy: Enhancing Connection and Trust in the Treatment of Children and Adolescents. New York: W. W. Norton & Company.

Bomber, L. (2011) What About Me? Inclusive Strategies to Support Pupils with Attachment Difficulties Make It Through the School Day. London: Worth Publishing.

Brooks, J. (2008) ‘Video Interactive Guidance: A practitioner’s perspective’, Community Practitioner, 81, 9, p.p. 21-24.

Donovan, S. (2013) No Matter What: An Adoptive Family’s Story of Hope, Love and Healing. London: Jessica Kingsley.

Donovan, S. (2015) The Unofficial Guide to Adoptive Parenting: The Small Stuff, The Big Stuff and The Stuff In Between. London: Jessica Kingsley.

Elliott, A. (2013) Why Can’t My Child Behave? Empathic Parenting Strategies that Work for Adoptive and Foster Families. London: Jessica Kingsley.

Feltham-King, C. & Warhurst, A. (2016) What are the perceived benefits of an adoption support package using Video Interaction Guidance with prospective adopters? An exploratory study. Attuned Interactions Issue 1.

Fukkink, R. G., Kennedy, H. and Todd, L. (2011) ‘What is the Evidence that VIG is Effective?’ In H. Kennedy, M. Landor and L. Todd (eds) Video Interaction Guidance. A Relationship-Based Intervention to Promote Attunement, Empathy and Wellbeing (pp.82-104). London: Jessica Kingsley.

Golding, K. and Hughes, D. A. (2012) Creating Loving Attachments: Parenting with PACE to Nurture Confidence and Security in the Troubled Child. London: Jessica Kingsley.

Howe, D. (2005) Child Abuse and Neglect: Attachment, Development and Intervention. Basingstoke: Palgrave MacMillan.

Jarvis, J. and Polderman, N. (2011) ‘VIG and Attachment: Theory, Practice and Research.’ In H. Kennedy, M. Landor and L. Todd (eds) Video Interaction Guidance. A Relationship-Based Intervention to Promote Attunement, Empathy and Wellbeing (pp.213-227). London: Jessica Kingsley.

Juffer, F., van IJzendoorn, M.H. and Bakermans-Kranenburg, M.J. (2008) ‘Supporting adoptive families with video-feedback intervention’, in F. Juffer, M.J. Bakermans-Kranenburg and M.H. van IJzendoorn (eds), Promoting Positive Parenting: An attachment-based intervention (Monographs in Parenting). New York: Psychology Press.

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.

Maskell-Graham, D., (2016) Reflective Functioning and Play: Strengthening attachment security in families from pregnancy to adolescence. Nottingham: big toes, little toes

Naish, S. (2016) Therapeutic Parenting in a Nutshell: Positives and Pitfalls. Amazon: Inspire Training Group

Purvis, K., Cross, D. & Lyons Sunshine, W. (2007) The Connected Child. New York: McGraw-Hill.

Appendices

Appendix A: Traject Plan for Adoptive Families

Appendix B: Target Monitoring Evaluation Tracking Form

Appendix C: Parent Evaluation Form 

Video Interaction Guidance Traject Plan / Summary for adoptive families

Child development

 

 

 

 

 

 

 

Adult communication skills and

personal development needs

Family development

Daily living

 

 

 

 

 

 

 

Wider support and inclusion

Name(s):

 

Date:

Helping question(s):

Appendix A: Traject Plan/Summary for adoptive families CFK

 

 

 

 

Hampshire and Isle of Wight Educational Psychology Service

Appendix B: Target Monitoring and Evaluation (TME) Form for VIG

Child: Home based targets
Client: Date of initial consultation:
Educational Psychologist Date of final shared review:

 

Helping Question 1:

 

Helping Question 2:

 

Helping Question 3:

 

 

 

 

Hampshire and Isle of Wight Educational Psychology Service

Family Support using Video Interaction Guidance (VIG)

Appendix C: Parent/Carer Questionnaire at End of EP Involvement

 

Name:  ______________________________________________________                  Date: __________

 

Name of child(ren):_______________________________________________________________________

Relationship to child(ren) (please tick):

Birth parent □                     Prospective adoptive parent □                    Adoptive Parent □

Foster parent □                  Special Guardian □                                               Other □

Start and end dates of EP involvement (mm/yy):                                         No. of VIG cycles:            

  1. Please rate how helpful the family support using VIG has been (please circle):

 

   1    2    3    4    5    6    7
Not at all helpful                                                                                               Very helpful
  1. What was the most helpful part of the family support using VIG?

 

 

  1. What was the least helpful part of the family support using VIG?

 

 

  1. What else, if anything, might have helped?

 

 

  1. To what extent has your confidence as a parent/carer grown since having the family support using VIG?
   1    2    3    4    5    6    7
Not at all                                                                                                                     Greatly
 
 
  1. What were you helped to recognise that you were doing well?

 

 

  1. What skills and understanding did VIG help you to develop:

i. For yourself?

 

ii. For your child?

 

iii. For your family life?

 

 

  1. What changes have you noticed since the family support started:

i. In yourself?

 

ii. In your child?

 

iii. In your family life?

 

 

  1. Would you recommend VIG to other families? (please circle)

 

Yes, definitely                                    Maybe/not sure                               No

 

Please say why you have chosen your answer:

 

 

  1. Please add any other comments:

 

 

 

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