Supporting adoptive families through Video Interaction Guidance. Jane Leighton

Supporting adoptive families through Video Interaction Guidance.

Jane Leighton

Introduction

The purpose of this paper is to briefly report on the preliminary findings from a research project presented in the ‘Fostering and Adoption’ workshop at the international Video Interaction Guidance conference, Glasgow 2017. This forms part of a small-scale study, which explores the potential benefits of using Video Interaction Guidance (VIG) with adoptive families. This is within the context of a doctoral research thesis to be submitted later this year.

Video Interaction Guidance and the concerns of adoptive families

VIG is a therapeutic relational, strengths based intervention which incorporates the use of video-feedback to enhance the relationships of those involved. It is defined as an

“intervention to help clients move from discordant to attuned communication by supporting them to reflect through dialogue on the micro-analysis of video clips of their own successful interactions” (Kennedy, Landor and Todd, 2011, p. 294).

VIG is used in situations where there is a desire to improve relationships. It aims to strengthen these by focusing on the ‘attuned’ moments of interactions between individuals, in this instance, between parent and adoptive child. In VIG, attunement is defined by the ‘principles of attuned interaction and communication’, which are derived from theories of primary and secondary inter-subjectivity and mediated learning as provided by Colwyn Trevarthen (see Kennedy et al., 2011). The experience of ‘attunement’, the feeling of being “at one” with another being, with a responsive, sensitive parent is a prerequisite for a secure attachment (Ainsworth et al., 1978; Bowlby, 1973, 1982). This is a central concern for adoptive families where parent-child relationships are formed much later in the child’s development than in birth families (see Golding, 2008, for further discussion of attunement and its importance, as well as a good overview of attachment theory).

Adoptive families have been found to be at increased risk of difficulties due to the adverse early care experiences of adopted children and the associated subsequent additional pressures on parenting that this brings (e.g. Beihal, Ellison, Baker and Sinclair, 2010; Rushton, 2004; Rushton and Dance, 2006; Selwyn, Sturgess, Quinton and Baxter, 2006). It has also been argued that the adoptive parents themselves also bring risks to the forming of relationships and secure child-parent attachment – for example, difficulties with reading their child’s signals, their own unmet attachment needs and unresolved loss or trauma, as well as stress arising from adoption processes (Howe, 2007; Nickman, Rosenfeld, Fine et al., 2005; Juffer, van Ijzendoorn and Bakermans-Kranenburg, 2008; Golding, 2010).

Research has also identified that the parent-child relationship mediates a range of important outcomes for children, including modulating behaviour and emotions, school attainment and the ability to form and sustain healthy relationships with others (e.g. Kriebel and Wentzel, 2011; Masten, 2001, Simmel, Barth, and Brooks, 2007).

Consequently, VIG is an intervention which is particularly applicable to adoptive families, i.e. those where the child/ children have a history of local authority care and where the parent(s) have undergone extensive assessment prior to becoming adoptive parents. Family formation is arguably the first task of a new adoptive family, and the building and sustaining of secure bonds between parent and child is an ongoing active concern that significantly impacts on positive long-term outcomes.

Aims

This study adopts a mixed methods, quasi experimental design to explore the potential benefits of using VIG to support adoptive families. Specifically, it aims to assess the impact on parenting confidence and parenting sensitivity (attunement). As with similar studies (e.g. Colonnesi et al., 2012) it will also aim to establish if there is any impact on the involved children’s psychopathology and prosocial behaviour. It will also examine if there is a positive impact on the problems participants bring (problem questions) as other research suggests that interventions which actively address client’s problems have the greatest efficacy (Rushton and Monck, 2009). The aspects of VIG perceived to be most helpful by both client’s and practitioners will also be explored.

Method

Participants

Fourteen parent participants from eleven families eligible for support from Suffolk Adoption Service were recruited: two via a service newsletter to adopters, seven via social worker referrals and a further two via the local Educational Psychology Service. The participants comprised both mother and father from three families, and then seven mothers and one father from the remainder.

The adopted children and young people participating included four girls and seven boys. They ranged in age from 35 to 189 months with a median average age of 59 months.  Their age on placement with their adoptive family varied from 6 to 64 months with a median average of 20 months. The duration of the children in placement varied from 8 to 187 months with a median average of 40 months.

Procedure

All participants received the VIG intervention from AVIGuk-accredited guiders or trainees who received regular supervision from AVIGuk-accredited supervisors. This included an initial meeting with participants to discuss participant helping questions well as their outcome hopes. Following this, the guider undertook at least three cycles of VIG (one cycle equates to one video and shared review) and up to five cycles depending of the needs of the client. A final meeting was then undertaken to complete the Target Monitoring and Evaluation form. Pre-and post-questionnaires were also completed by participants and returned to the researcher.

Measures

Questionnaires

A range of measures were used. These included measures of generalised performance as well as measures which are tightly aligned to VIG. These included the Parenting Confidence Rating Scale (PCRS, Rait, 2012), the Strengths & Difficulties Questionnaire (SDQ, Goodman, 1997) and VIG Target Monitoring & Evaluation form (TME) used by guiders to measure impact (see appendix I).

Video Analysis – Parenting sensitivity

Scores for parenting sensitivity were gained through video analysis (see appendix II for scoring sheet). This was adapted from the scoring methods used by Kennedy and colleagues in their initial study investigating the effectiveness of VIG (Simpson, Forsyth and Kennedy, 1995). Minutes 2 to 6 from the first videoed parent-child interaction and then from the final video taken were analysed. This counted adult verbal initiatives and child verbal initiatives. Following a child initiative, adult reception (response) was marked as being attuned, discordant or missed in accordance with the ‘principles of attuned interaction and communication’ (AVIGuk). If the adult reception was deemed attuned, the number of conversational turns resulting from child verbal initiative and attuned adult reception were counted (one turn equated to one person saying something and the other responding). Three accredited VIG supervisors were involved in the video analysis which were scored blind.

Qualitative analysis

A thematic analysis of the client and practitioner responses to the TME open question, “What stands out as the most helpful part of VIG in this situation?” was undertaken following the framework given by Braun and Clarke (2006). Each stage was conducted by the researcher and two assistant psychologists. Guiders involved in the project were asked for their views on established codes and categories. VIG practitioners within Suffolk Psychology and Therapies Service were asked to comment on the established themes. At each stage, all were in agreement with the analytic outcomes.

Results  

Parenting confidence

A Wilcoxon Signed-Ranks Test showed that the total PCRS score following VIG was statistically significantly higher than the total PCRS score obtained before VIG z = -3.062, p < 0.01. Significant main effects (p < 0.05) were found on all items of the PCRS with the exception of Q4 where significance was not achieved z = -1.876, p > .05:

Note: Q1 managing behaviour at home; Q2 managing behaviour in most situations; Q3 supporting play; Q4 praise and descriptive language; Q5 praise for helpful behaviour; Q7 helping play and learning.

Impact on child psychopathology and prosocial behaviour

A Wilcoxon Signed-Ranks Test showed that the differences obtained across these measures were not significant:

Impact on parenting sensitivity

A Wilcoxon Sign-Rank test showed that the percentage of child initiatives made in participant’s final video (following VIG) was statistically significantly higher than those observed in their first video (before VIG) z = -2.830, p < 0.01. This test also found that the number of attuned adult responses to child initiatives in participant’s final video was statistically significantly higher than those seen in their first video     z = -2.857, p < 0.01. The difference in average median verbal turns resulting from attuned adult responses before and after VIG as seen in the same videos was also found to be statistically significant z = -2.125, p < 0.05.

Impact on client intervention goals

A Wilcoxon Signed-Ranks Test showed that the scores for the TME targets 1, 2, and 3 after VIG were statistically higher than those set before intervention, z = -3.321, p < 0.01; z = -2.552, p < 0.05 respectively.

What did client’s and practitioners find most helpful about VIG?

Five themes were elicited from client and practitioner responses to the TME form question, “What stands out as being the most helpful part of VIG in this situation?” These were:

  1. Opportunity: Respondents reported that the intervention gave them valued time and space to explore their relationship with their child. They found watching video clips particularly helpful in changing their self-perceptions as well as the shared discussions with guiders in review sessions.

“seeing the relationship with her that I didn’t think I had” (adoptive parent)

“seeing self and interactions, what’s working” (adoptive parent)

“you have really enjoyed watching K on film” (VIG guider)

“clips are stuck in my head, (the) initial clip in particular which parents will remember and have a photo of” (VIG guider)

  1. Skills: Respondents found it helpful to see and be reminded of the skills of attuned communication.

“(helpful to be) reminded of basic communication” (adoptive parent) 

“seeing it visually, giving her (the child) time and space, (I) could see her thinking, so learnt that I did need to give her time to absorb and not ask” (adoptive parent)

“use of VIG helped the client to become more aware and mindful of non-verbal communication already there” (VIG guider)

  1. Thinking: VIG provided the space for ‘thinking’ and reflecting – for example, raising conscientious awareness of interactions; helping clients to realise the strength of their relationship with their child that they did not think was there; helping them to see pathways to strengthen their bond with their child.

“things are not as bad as I first thought” (adoptive parent)

“I remembered how easy it was to tune in and be allowed to give physical affection” (adoptive parent)

“The cover has been peeled off. Now we see a little girl that struggles to understand. It is our job to guide her and help her understand. We need to go slow and repeat things four times- she needs it!” (adoptive parents)

“VIG helped the client to become more aware of the attunement already there in the relationship with her son” (VIG guider)

“becoming more aware of the amazing PACE parenting in daily interactions” (VIG guider) 

  1. 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.

“it’s given me the confidence not to worry about what others think” (adoptive parent)

“it’s stopped me feeling self-conscious” (adoptive parent) 

  1. Changes in behaviour: Participants reported spending more time with their children having ‘fun’. They reported VIG gave them more positive stories and narratives when talking about their children.

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

“We can stand up more when others are judgmental” (adoptive parents)

“It’s cemented the fact that we have fun together” (adoptive parent) 

“(now he is) happy for me to lead and take some control” (adoptive parent)

“helping mum be more active in play” (VIG guider)

 These are further illustrated in the graphic below:

Discussion

This study aimed to explore the potential benefits of using VIG with adoptive families. A preliminary analysis of the results indicates that there is a positive impact on parenting confidence, parenting sensitivity (attunement) as well as client set goals (helping questions). No significant impact on child psychopathology and prosocial behaviour was found. All but one child’s score for Overall Distress remained in the “High” or “Very High” range. Scores for pro-social behaviour for three of the children did move into the ‘average’ range post intervention where none were found prior to VIG.

Five themes were derived from client and practitioner’s responses to the TME post intervention evaluation question, “What stands out as being the most helpful part of VIG in this situation?” The opportunity to make time for, watch and discuss positive interactions; a focus on the skills of attuned interaction; time to think and reflect; changes in self-perceptions and changes in actual behaviour.

This study represents an initial exploration of the potential benefits of the VIG intervention for adoptive families in the context of practices in the UK. This complements the findings of the only other UK study known to the author, conducted by Feltham-King and Warhurst (2016). Whilst small scale and therefore lacking in power for generalisation, together these studies suggest that VIG is a very promising intervention for supporting adoptive families. In particular, it appears to strengthen the bond between parent and child and re-energise clients in their endeavours to be effective adoptive parents. This seems important in addressing the particular concerns of adoptive parents (e.g. Rushton, 2004; Rushton and Dance, 2006; Selwyn et al., 2006) and consequently warrants further research.

These preliminary findings sit well with those from The Care Inquiry (2013) which aimed to discover the critical factors which mediate positive outcomes for children with a history of Local Authority care.   This concluded:

“the weight of evidence, from all quarters convinces us that the relationships with people who care for and about children are the golden thread in children’s lives and the quality of a child’s relationships is the lens through which we should view what we plan to do” (The Care Inquiry, 2013, p.2).

It is proposed that VIG is an intervention which should be seriously considered for enhancing adoptive family relationships and thus supporting positive long-term outcomes for adoptive children.

Jane.Leighton@schoolschoice.org

 

 

 

References

Ainsworth, M. D. S., Blehar, M. C., Waters, E. and Wall, S. (1978). Patterns of Attachment: A Psychological Study of the Strange Situation. Hillsdale: Erlbaum.

Beihal, N., Ellison, S., Baker, C., Sinclair, I., (2010). Belonging and permanence: outcomes in long-term foster care and adoption. London: BAAF.

Bowlby, J. (1973). Attachment and Loss, Vol. II Separation, Anxiety and Anger. New York : Basic Books.

Bowlby, J. (1982). Attachment and Loss, Vol. I Attachment. New York: Basic Books.

Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3:2, 77-101.

Colonessi, C., Wissink, I.B., Noom, M.J., Asscher,J.J., Hoeve, M., Geert, J. et al., (2012). Basic Trust: An attachment oriented intervention based on Mind-Mindedness in adoptive families, Research on Social World Practice, 23:2, 179-188.

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, 1.

Golding, K. S. (2008). Nurturing Attachments: Supporting Children who are Fostered or Adopted. London: Jessica Kingsley.

Golding, K. S. (2010). Multi-agency and specialist working to meet the mental health needs of children in care and adopted. Clinical Child Psychology and Psychiatry, 15:2, 573-587.

Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A Research Note. The Journal of Child Psychology and Psychiatry, 38:5, 581-586.

Howe, D. (2007). Adopters unresolved loss, and baby adoption outcomes. ACAMH Occasional Papers No.26, Fostering, Adoption and Alternative Care, 19-24.

Juffer, F., van Ijzendoorn, M. H. and Bakermans-Krenenburg, 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.

Kriebel, D.K., Wentzel, K. (2011). Parenting as a Moderator of Cumulative Risk for Behavioural Competence in Adopted Children. Adoption Quarterly, 14:1, 37-60.

Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56:3, 227-238.

Nickman, S.L., Rosenfeld, A.A., Fine, P., Macintyre, J.C., Pilowsky, D.J. & Howe, R.A. (2005). Children in adoptive families: overview and update. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 987-995.

Rait, S. (2012). The Holding Hands Project: Effectiveness in promoting positive parent-child interactions. Educational Psychology in Practice, 28:4, 353-372.

Rushton, A (2004). A Scoping and Scanning Review of the Research on the Adoption of Children Placed in Care, Clinical Child Psychology and Psychiatry, 9: 89-106.

Rushton, A., and Dance, C. (2006). The adoption of children from public care: a prospective study of outcome in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 877-883.

Rushton, A, and Monck, E., (2009). Enhancing Adoptive Parenting: A test of effectiveness. London: BAAF.

Selwyn, J., Sturgess, W., Quinton, D. and Baxter, C. (2006). Cost and outcomes of non-infant adoptions. London: British Association for Adoption and Fostering.

Simmel, C., Barth, R., and Brooks, D. (2007). Adopted foster youth’s psychosocial functioning: A longitudinal perspective. Child and Family Social Work, 12, 336-348.

Simpson, R., Forsyth, P. and Kennedy, H. (1995) An evaluation of video interaction analysis in family and teaching situations Professional Development Initiatives SED/Regional Psychological Services.

The Care Inquiry (2013). Building Futures for our most Vulnerable Children. The Care Inquiry Final Report.

Appendix I

TARGET MONITORING AND EVALUATION FORM

INITIAL TARGET MONITORING SHEET( to be filled in before and after if possible)

Target IA – initial:

Describe target

 

Rating Circle and name, B(aseline), H(oped-for), A(chieved at end):

 

Not Present 1 2 3 4 5 6 7 8 9 10 Always present
Descriptor of baseline level:
Descriptor of level achieved:

 

Target IB – initial:

Describe target

 

Rating Circle and name, B(aseline), H(oped-for), A(chieved at end):

 

Not Present 1 2 3 4 5 6 7 8 9 10 Always present
Descriptor of baseline level:
Descriptor of level achieved:

 

Target IC – initial:

Describe target

 

Rating Circle and name, B(aseline), H(oped-for), A(chieved at end):

 

 

Not Present 1 2 3 4 5 6 7 8 9 10 Always present
Descriptor of baseline level:
Descriptor of level achieved:

 

EVALUATION. TO BE FILLED IN AT THE END ONLY

What stands out to you as the most helpful part of the VIG support in this situation?          

VIG GUIDER:  

 

 

CLIENT:  

 

 

 

Appendix II

Video analysis scoring sheet

Video coding table

Scorer__________________ Participant_________________________

Pre__________ Post___________

Contact time Adult initiative Child initiative Attuned Discordant Missed

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s