Abbie Montell (Psychology Research Assistant)
& Zoe Stephens (Educational Psychologist & VIG Supervisor) firstname.lastname@example.org
It is important to work with vulnerable families by promoting positive interaction and communication, in order to support better family dynamics and improve child development and wellbeing. Strained family relationships and poor attachment are acknowledged as having an adverse effect on child development and wellbeing (Doria, Kennedy, Strathie & Strathie 2014). Negative effects may be evidenced through low levels of resilience, internalising behaviours, or low self-esteem (Sheeber, Hops and Davis, 2001). These vulnerabilities can lead to parents being less able to prioritise their children’s needs and requiring statutory service involvement at the level of a child protection (CP) plan in some instances. This can trigger referral for interventions such as Video Interaction Guidance (VIG).
Through embodiment of the Principles of Attuned Interactions and Guidance (PAIG), VIG is a therapeutic intervention which promotes, and seeks to develop attunement through positive interaction and communication (Kennedy and Underdown, 2017). The PAIG inform the core values and beliefs of VIG, emphasising a ‘compassionate approach in which hope is maintained and trust is formed through building respectful relationships’ (Kennedy, Ball and Barlow, 2017: 3). VIG involves sessions of videoing created to capture the best possible moments between parent/carer and child. Each videoing session lasts for approximately 10 minutes. On first meeting, the VIG Guider and parent/carer will have a conversation regarding the goals the parent/carer wishes to aim for. The VIG Guider then edits the footage, selecting video clips including micro-moments and sometimes still pictures that best evidence attuned interaction between the parent/carer and child and which relate to the goals. The VIG Guider returns to the family home with the edited video for a shared review, wherein the VIG Guider and parent/carer carefully study the video clips, working together to understand what the parent/carer is doing to help build an attuned relationship with their child. This process of videoing and sharing is called a ‘cycle’ and there are typically 3 cycles in a VIG intervention. In some situations, 1 cycle is all that is needed for people to change their perceptions, start to progress towards their goals and then they can continue to work on them independently.
The use of VIG
Doria et al. (2014) conducted a study exploring what makes VIG successful. Their qualitative research sought the views of families, guiders, and supervisors. All of the families were considered vulnerable at the time of VIG commencement. One of the factors mentioned by both families and guiders as contributing to VIG’s success was the study of micro-moments of video. This process can ignite recognition of the emotions in the interaction, which subsequently increases empathy and positive attitude change towards the child. Additionally, a significant impact on the lives of the families was described, including increased feelings of happiness, self-esteem, self-efficacy, and behavioural and attitude change. Overall, it was deemed that the video playback and exploration of the video, which challenges preconceived negative self-perceptions, may be the ‘underlying mechanism’ (Doria et al. 2014: 85) to VIG’s success with families.
In 2015, The National Society for the Prevention of Cruelty to Children (NSPCC) published a report evaluating the findings of a VIG intervention offered to families where there were concerns about child neglect (Whalley and Williams, 2015). The impact of VIG was measured using the parent scale from the Strengths and Difficulties Questionnaire (SDQ) and Parent Child Relationship Inventory (PCRI) and they explored the barriers and means to success. Their results were positive overall. The SDQ scores showed significant improvements in the children’s emotional, hyperactivity and conduct problems. Parents expressed experiencing positive outcomes, including increased 1:1 time with their child, improvements in the way in which disputes were resolved and the way in which they disciplined their child, as well as greater encouragement for the child to make choices.
Referrals for VIG for families subject to CP plans are made for a variety of reasons. For some this can be done in an effort to help a family get out of a negative pattern of going onto, coming off and then going on to a CP plan repeatedly over years, by focusing more on the child’s perspective. It can be requested to help parents gain confidence after previous children have been removed and where the family are in a better place to parent their next child. For others it can be an effort to prove that all has been tried when a request for removing a child is being made through the legal system or at the request of the Children’s Guardian during court proceedings.
The primary aim of this current research project was to investigate whether VIG has a positive impact for families where at least 1 Child was subject to a CP plan at the point of referral. This work was carried out to ensure that VIG is appropriate and effective for this client group: to make good use of resources and to consider when it may not be beneficial to refer for VIG.
Historical data was obtained from all CP cases referred to the VIG Service in a Local Authority (LA) for the years January 2016 to July 2019. Cases were included if they had been subject to a CP plan at the time of VIG referral.
A total of 27 VIG CP cases were identified. 17 of those cases completed a VIG intervention, 2 cases had begun VIG but did not complete it (i.e. completed 1 cycle of VIG before the child was removed) and 8 cases were referred but did not proceed. The 27 cases were categorised as such (table 1.) and were subject to quantitative evaluation.
|VIG complete||VIG incomplete before removal||Referred but VIG did not proceed||Total cases|
|Number of cases||17||2||8||27|
Table 1: Breakdown of VIG Service CP cases January 2016-July 2019
The five VIG Guiders who worked with the families were asked to consider the cases which had experienced positive change. Positive change was classed as a step down to either a Child in Need (CIN) plan or no LA service involvement. They were emailed with the single interview question, ‘What do you think went well for this/these particular case/s?’ and four of those guiders replied. Responses were then collated and were subject to thematic analysis, where common themes were identified.
Cases where VIG did not proceed were also analysed. Data collected from VIG relevant case notes and VIG referral forms were identified and a light, thematic analysis was performed.
Cases where VIG was incomplete were excluded from the analysis.
This mixed methods analysis aimed to investigate whether VIG has a positive impact for families subject to a CP plan and, if this is the case, what situations and circumstances at the time of referral make this more or less likely. Results from the quantitative analysis will be discussed first, followed by two thematic analyses: the first, the retrospective views of VIG Guiders about the families who had positive outcomes; the second, a light, thematic analysis exploring the possible reasons for VIG referral and no intervention.
In regards to the Children in Care (CIC), 2 were placed into care during the VIG intervention, suggesting that court proceedings were already underway at the time of referral to the VIG Service. 1 child was placed into care 2 years and 7 months after the VIG intervention.
The mean number of cycles for all groups was 3 and the average length of VIG intervention for all groups was 6 months.
As shown previously in table 1, a total of 17 families completed a VIG intervention. Of those, 13 (76%) of the children currently live in the family home and 4 (24%) of children live away from their birth family. This proposes that VIG may help contribute towards keeping families together. A deeper analysis was conducted on the data for the children living in the family home, in order to gain a greater understanding about the impact VIG may have on CP cases.
|Children on a CP plan||Children on a CIN plan||No current LA service involvement||Other||Total|
|Status immediately after VIG||9||2||1||1||13|
Table 2: Local Authority Service involvement status of the children living in the family home immediately after VIG intervention and again in July 2019
After VIG completion, 9 (69%) of the children currently living in the family home were subject to a CP plan, and 1 child (8%) had stepped down to having no current LA service involvement. As of July 2019, children with no LA service involvement have increased significantly to 46%, and children currently subject to a CP plan have decreased to 46% compared to the immediately after VIG data. This suggests that, where families are kept together, improvements may be sustained and increased over time. It is worth remembering that each case varies in the length of time between VIG completion and July 2019, from three years and 6 months and for a few cases this date will be the same. These results indicate a positive trend and for those who have recently ended VIG, their improvements may also be sustained and continue.
Thematic analysis of the retrospective views of VIG Guiders provides a greater insight into how VIG may contribute to a positive outcome for these families.
Thematic analysis 1: The retrospective views of VIG Guiders
Five VIG Guiders were identified as those who worked with the families who are no longer subject of a CP plan, and where children are currently living in the family home. They were approached with the simple question: What do you think went well for this/these particular case/s? Four guiders replied and a thematic analysis of their retrospective views identified three common themes; focus on the child, parental awareness and self-efficacy, and proactive positive engagement. Each will be discussed in turn.
Theme 1: Focus on the child
All four of the VIG Guiders reflected on improvements in parents’ focus on their child.
‘…worked on waiting more and allowing her child to lead’ VIG guider 2
‘…it helped her to focus on the experience of this child amongst the chaos and she prioritised him but also learnt to contain his feelings…’ VIG Guider 3
‘…helping him to feel held and have space’. VIG Guider 3
‘The parent changed her view of her child and was understanding him better.’ VIG Guider 4
The views of the VIG Guiders suggest that VIG improved the relationships between parent and child, and in different ways. Parents were seen to be prioritising their child more and viewing things from their child’s perspective. Some parents also developed the confidence to give their child space and to let them take the lead. Additionally, taking part in VIG improved a parent’s perception of their child, enabling the parent to better understand them.
Theme 2: Parental reflection and self-efficacy
Parents were described, by three VIG Guiders, as gaining self-efficacy through self-awareness and self-reflection.
‘…[she] could recognise the positive times that she thought were missing’. VIG Guider 1
‘…she noticed her strengths…’ VIG Guider 2
‘…became more aware of his [parent’s] communication style and how he was perceived by others.’ VIG Guider 3
‘He was able to talk about his own learning and ADHD and past school experiences and explore and then repackage some of that in a more positive light.’ VIG Guider 3
These views suggest that watching back their videos during the shared review prompted parents to self-reflect, and gain greater self-awareness. This not only improved their relationship with their child, but also their relationship with themselves i.e. VIG impacting positively on parental self-esteem. The theory of video-confrontation in VIG proposes that parents who lack confidence in their abilities are ‘confronted’ through play-back of their video, challenging their negative self-efficacy (Cross and Kennedy, 2011). There is clearly some evidence of this, with one Guider stating that a parent noticed their strengths, to another stating that a parent was able to reflect on, and explore, some of their life experience so far, to ‘repackage some of that in a more positive light’. VIG may therefore improve parent self-efficacy, through self-awareness and self-reflection, gained through the shared review.
Theme 3: Proactive, positive engagement
Lastly, three VIG Guiders shared how parents had been committed to VIG and engaged proactively in the process. For one Guider, their own engagement and relationship with the parent was significant, in order to provide the parent with the reassurance and trust to talk about his strengths.
‘…although mum was very hesitant to undertake VIG – she reported that she was very pleased that she had decided to take the offer…’ VIG Guider 1
‘…she […] received positive peer observations well and contributed positively to [a] group shared review.’ VIG Guider 2
‘Mum really signed up and wanted to do it. […] She didn’t have to do VIG as part of the CP plan, but it linked well to the reason for concern.’ VIG Guider 3
‘Providing a positive professional relationship through VIG meant he could become a participant and he was able to talk about his strengths’. VIG Guider 3
Despite there being initial apprehension for some, overall, parents engaged proactively and positively in VIG. For one parent, who was a member of a young mothers group, this involved taking part in peer observations and group shared reviews. For another parent, they had been really enthusiastic about taking part in VIG after seeing the outcome of a video intervention with their child in their pre-school setting. One VIG Guider’s own positive engagement with a parent encouraged the parent to ‘explore’ and learn during VIG. Empowerment and collaboration with families has been proposed as being a factor to VIG’s positive impact on families. One VIG Guider identified the contrast between the professional relationship between them and the parent, compared to his relationships with other involved professionals, as significant to his engagement in the CP process. This may be due to the Guiders’ wishes to solely share the improvements and outcomes their families made, rather than mention their own input. It is therefore unclear whether proactive engagement was encouraged as a result of the relationships the families had built with their Guider, or whether it was another form of motivation. Individual differences, such as personality, temperament, values, and self-esteem, are also likely to influence a family’s engagement in VIG.
Thematic analysis 2: Exploration of the reasons for no VIG intervention
As was identified in Table 1, 8 families were referred for VIG yet intervention did not begin. A light, thematic analysis identified two themes: complex family circumstances, and parent/carer not ready for VIG.
Theme 1: Parent/carer was not ready to engage in VIG
The most common theme identified four cases in which the parent/carer was not ready, or available, to engage in VIG. This was for various reasons, including soon moving out of county, anxiety, not feeling ready, and simply not wishing to take part. It is unclear from the case notes and VIG referral forms precisely why some of the parents/carers did not feel ready. However, it could be suggested that there may have been a lack of understanding and/or communication between the parents/carers and the professional who made the referral.
Theme 2: Complex family circumstances
The second common theme identified was that of complex family circumstances, including the child being placed into care. This was the case for 3 of the 8 families before the initial VIG visit could take place; 1 child was placed into care, 1 was adopted, and 1 was already subject to a Child Arrangement Order. This suggests that the referral for VIG was inappropriate, for both the families and the VIG Guider, due to the timeline of court proceedings i.e. court proceedings had begun at the time of VIG referral.
Of the 27 cases referred for VIG, 10 did not proceed. More than a third of all of the CP cases were allocated to a VIG worker, yet intervention did not commence. This is a significant resource issue. This would imply that more careful consideration needs to be made about which cases are referred. Some families did not have a chance to start the work as plans to remove their child were already well underway at the time of referral. Other families had not engaged: did not want it or did not understand VIG. Where time would have allowed it, perhaps more work prior to the VIG referral in order to help the family understand and explore the possible goals and outcomes of VIG and discuss their anxieties about taking part, could have addressed this and given more families the opportunity to benefit. The time available for this to happen could therefore be an indicator of whether or not VIG is appropriate for CP cases. Although VIG can be a relatively brief therapeutic intervention, it should perhaps be initially considered that, if decisions about placement may be anticipated to be made in less than 3 to 6 months from the point of referral, then a VIG referral is not appropriate at this time. Where there is a high chance that a child will be removed from the family imminently (i.e., soon after/before VIG has started), ethical dilemmas such as giving a family false hope, or encouraging closeness and bonding at a time when it is not expected that they will be able to stay together, needs to be seriously considered against how much impact can be realistically expected from a short term intervention. There should be very clear reasoning and agreed timescales for work to take place for any case referred for VIG which is already within the CP court procedures.
Despite the concerns regarding inappropriate VIG referrals, the quantitative analysis of the data collected on VIG CP cases, within the last three years, drew some positive results. In summary, the number of children with no current LA service involvement (July 2019) has significantly increased, in comparison to those currently subject to a CP plan. Of those who participated in a VIG intervention, 76% remained living in their family home. This suggests that VIG may help families to remain intact if referral for VIG is placed in a timely manner.
Thematic analysis of the comments from VIG Guiders, for cases currently living in the family home (with no current LA service involvement), identified the themes: focus on the child, parental reflection, proactive positive engagement and, as in Doria et al’s (2014) study, self-efficacy. Within these themes, it was recognised that parents demonstrated improvements in prioritising their child more, viewing situations from their child’s perspective, self-efficacy (through video-confrontation), and positive engagement during the VIG sessions. Partnership work is a core value and belief for VIG and, through positive engagement, authentic exploration may develop. Additionally, the light thematic analysis on the data of the families who were referred, but did not receive VIG intervention, revealed that over half of those referred were either not ready, or unable, to engage in VIG. Complex family circumstances, such as strained familial relationships and child in care placements, were also common. As such, it is important to be mindful of a family’s circumstances, relationships, and willingness before referring for VIG.
Future analysis of VIG CP cases may explore a longitudinal study involving a small group of families. This could provide a detailed insight into whether improvements after VIG are sustained over time for families who were subject to a CP plan on VIG commencement. Additionally, it may be beneficial to specifically identify families who are considered to be stuck in a repeating pattern of an on/off CP plan cycle, and investigate whether there is a break in this cycle after VIG intervention. It would also be advantageous to understand which of the themes were most influential in helping the cycle to change. Further study would also benefit from specifically investigating cases where previous children have been removed and how VIG helps a family in this situation to move forward positively with a new child. Finally, a study including a control group (e.g., of families in CP contexts who have turned down the offer of VIG), may provide the opportunity for comparisons to be made.
In summary some key points to conclude;
- For those who had time to engage fully in VIG a high proportion have stayed together and over time further LA service involvement has continued to reduce and the cases have been stepped down
- More work prior to referral or at the early engagement stage between accepting the referral and before attempting to start VIG, may increase participation for these particular families
- From this current study data, where formal CP proceedings are already active i.e. where the social worker intends to pursue removal of a child, VIG does not appear to be appropriate and could be seen as unethical. This gives good reason for careful consideration and rejection of some referrals where court proceedings are already underway
- VIG could be considered as part of a CP plan for cases already in the court arena, where the intended outcomes of VIG are clear, linked to the plan and where there is a considerable window of time in which the work can be meaningfully delivered. A case study from the VIG service of where this has happened and been seen to be helpful, could be available for future analysis
Cross, J., and Kennedy, H. (2011). How and why does VIG work? In H. Kennedy (Ed.), Video Interaction Guidance: A Relationship Based Intervention (58-81). London: Jessica Kingsley.
Doria, M., Kennedy, H., Strathie, C., and Strathie, S. (2014). Explanations for the success of Video Interaction Guidance (VIG): An emerging method in family psychotherapy. The Family Journal: Counseling and Therapy for Couples and Families. 22, 78-87
Kennedy, H., Ball, K., and Barlow, J. (2017). How does video interaction guidance contribute to infant and parental mental health and well-being? Clinical Child Psychology and Psychiatry. 1-18. DOI: 10.1177/1359104517704026
Kennedy, H., and Underdown, A. (2017). Video Interaction Guidance: Promoting secure attachment and optimal development for children, parents and professionals. In P. Leach (Ed.), Innovative Research in Infant Wellbeing (224-237). London: Routledge.
Sheeber, L., Hops, H., and Davis, B. (2001). Family processes in adolescent depression. Clinical Child and Family Psychology Review. 4, 19-35
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. NSPCC.