To improve young people’s health and wellbeing by developing their resilience through the use of targeted evidence based interventions, professional development opportunities and teacher coaching and mentoring (i.e. Video Enhanced Reflective Practice). Published in Educational Psychology in Scotland Vol.18 No.1 Winter 2017. Cruikshank, Findlay and Quinn

Research Questions:

  1. Does the Resilience Planning Toolkit combined with professional development opportunities in the area of resilience enable school staff to better identify barriers and supports for children with emotional and mental health needs?
  2. Does Video Enhanced Reflective Practice (VERP) help staff to implement resilience theory in practice?

Resilience

Getting it Right for Every Child (GIRFEC) is the national approach in Scotland to improving outcomes and supporting the wellbeing of our children and young people by offering a variety of supports via partnership working. The Resilience Planning Toolkit (RPT) is a planning tool, developed within North Lanarkshire to help staff, in conjunction with children and young people, to assess, plan for and support a wide range of additional support needs using a single framework based on resilience. The Resilience Toolkit has been created to help professionals make sense of the assessment information gathered through GIRFEC processes. It takes well known resilience factors identified from research and maps these onto the GIRFEC wellbeing indicators in order to link evidence based interventions, strategies and resources to GIRFEC assessment processes.

Resilience is a key feature of GIRFEC and underpins health and wellbeing. The cornerstone of addressing the emotional wellbeing and resilience of children would seem to be effective models of training and support and development for staff within establishments to allow them to plan for and support children’s mental wellbeing. The concept of resilience and how to integrate this into assessment has been highlighted as difficult for practitioners (Scottish Government, 2012).

VERP

Video Enhanced Reflective Practice (VERP) supports practitioners to reflect on and develop their communication skills within their typical daily work. The process of VERP aims to allow practitioners to discover how important they are in any interaction and their impact on the other person in their interaction (Kennedy and Landor, 2015). An aim of VERP is to develop more effective interaction and communication through which a practitioner can establish a greater sense of safety and security for pupils and build strong, nurturing relationships. There is a rapidly growing evidence base to support the benefits of video interventions in many different contexts to support children with a range of needs: social, emotional, behavioural and cognitive (Fukkink, 2008). Evidence also supports the professional benefits of an approach such as VERP for practitioners in many different roles and capacities. Video Interaction Guidance (VIG) and VERP in schools has been shown to lead to cognitive and emotional gains for pupils (Gavine and Forsyth, 2011).

What did we do?

We selected nine primary schools (5 experimental and 4 controls) that were identified to have high percentages of pupils within SIMD decile 1-3. The experimental schools were provided with two sessions of whole staff training on theories of resilience and use of the Resilience Planning Toolkit.

In addition, two teachers from each of the experimental schools were offered training in VERP; consisting of one full day of training and four follow up workshops. All teachers (control and experimental) were asked to identify one pupil in their class in SIMD decile 1 or 2 who required support in relation to their health and wellbeing needs. This pupil would be the focus of planning, intervention and VERP (if applicable).

Evaluation was carried out and consisted of:

  • Staff Questionnaire (investigating understanding of pupils’ needs and confidence in planning for them) across all schools, pre (39 returned from experimental schools and 35 from control schools) and post intervention (26 returned from experimental schools, 28 from control schools).
  • Resilience Planning Toolkit (RPT) evaluation for those participants within the experimental schools. VERP evaluation questionnaire (for those participating in the VERP training) Video analysis of raw footage from 1stand last VERP sessions.
  • Finally, existing planning documentation for identified children across all schools was requested, as was any further documents developed following the training and over the course of the session August 2016 – June 2017.

What have we found so far?

Research Question 1:

There was a significant increase in teachers’ confidence in their knowledge of the Resilience Toolkit post intervention. At pre-test no teachers rated themselves above 6, whereas 75% of teachers rated themselves between 7 and 10 at post-test, suggesting the training was effective.

The Staff questionnaire was completed by all teachers (in experimental and control schools) at both time points (pre- and post- intervention). Staff confidence in assessing children’s difficulties and implementing appropriate strategies across the areas of learning and health and wellbeing was recorded using a seven point rating scale ranging from 1 (not confident at all) to 7 (very confident). Staff in the experimental schools demonstrated statistically increased confidence in their ability to both assess difficulties and implement appropriate intervention strategies for children with learning difficulties. This was also the case for children with health and wellbeing difficulties. Furthermore, a statistically significant increase in staff knowledge and understanding of resilience was found following training in the use of the Resilience Planning Toolkit.

In the control schools, staff confidence in their ability to assess and implement appropriate strategies for children with learning difficulties decreased. No statistically significant difference was found in staff confidence in assessing and implementing appropriate strategies for children with health and wellbeing difficulties or in their knowledge and understanding of resilience.

Analysis of planning revealed that out of the 37 children in the experimental schools, only one had any type of pre-existing planning prior to the project. Following the intervention, 35 of the pupils had planning in place:

  • 25 pupils had a joint summary plan and/or resilience assessment developed directly from the RPT. Such plans were based on assessment of the child’s resiliency factors, and highlighted target areas with a range of evidence based interventions to support the child.
  • 9 pupils had a formal Additional Support Plan in place which included health and wellbeing targets that were assessed and identified through the RPT and included evidence-based interventions to support the pupil.

The evidence suggests that the RPT and opportunities for professional development in the area of resilience do enable school staff to better identify barriers and supports for children with emotional and mental health needs.

Research Question 2:

A total of 9 out of 10 participants from experimental schools completed the RPT plus VERP training programme. Due to technical issues, raw footage from first and last VERP sessions was gathered from three participants for analysis. Two minutes of each video was coded following the Principles of Attuned Interactions and Guidance (teacher behaviour) and taking initiative (pupil behaviour). Video analysis highlights the positive impact of VERP plus RPT training. Specifically, improvements were identified in teacher behaviour in all but one of the Principles of Attuned Interactions and Guidance. Although these findings were not statistically significant, the greatest increase was observed in the teacher’s ability to develop attuned interactions. In terms of pupil behaviour, despite results not being statistically significant, there was an increase in overall number of initiatives taken by the child during the analysed interactions.

VERP evaluations showed that 86% of staff members reported they had made changes to their practice as a result of VERP and all staff members involved reported that the training had an impact on the children with which they work.

It can therefore be argued that VERP plus RPT training has brought about positive changes for the individual child and teacher.

What do we plan to do next?

The RPT and the associated training will now be provided as a universal offer to schools in North Lanarkshire by the educational psychological service. Future improvements may include:

  • Ensuring a greater time period between pre- and post-test evaluations to increase validity of findings.
  • Commencing pre-testing at a later date as staff members did not feel that they knew the children very well at pre-test stage.
  • Ensuring all VERP videos are recorded using allocated iPads to enable a greater number of videos to be returned for analysis.

References

Fukkink, R. (2008). Video Feedback in the widescreen: A meta-analysis of family programs, Clinical Psychology Review 28 (6), 904 – 916.

Gavine, D. and Forsyth, P. (2011). “Use of VIG In schools” in H. Kennedy, M. Landor and L. Todd (Eds.) Video Interaction Guidance: A relationship based intervention to promote attunement, empathy and wellbeing (pp.134 – 143). London: Jessica Kingsley Publisher

Jarvis J. and Lyon, S. (2015). “What makes video enhanced reflective practice (VERP) successful for systemic change” in H. Kennedy, M. Landor and L. Todd (Eds.) Video Enhanced reflective practice: Professional development through attuned interaction (pp 35-46). London: Jessica Kingsley Publisher.

Joyce, B. and Showers, B. (2002). Student Achievement through Staff Development, 3rd Ed. Longman: London.

Kennedy, H. and Landor, M. (2011). “Introduction” in H. Kennedy, M. Landor and L. Todd (Eds.) Video Interaction Guidance: A relationship based intervention to promote attunement, empathy and wellbeing (pp.18-34). London: Jessica Kingsley Publisher

Scottish Government, (2012) Preparing Scotland: Scottish Guidance on Resilience. Edinburgh: Scottish Government.

Further information and materials

North Lanarkshire Council – Research and Development

Email: CruickshankC@northlan.gcsx.gov.uk Telephone: 01698 262840

 

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VIG as a Way to Improve Well-Being and Relationships in a Home for Elderly People. Oliva

Francesca Oliva, October 2017 oliva@activechange.it

Video Interaction Guidance (VIG) is a video feedback intervention that enhances communication and facilitates change in important relationships, at home, school, hospital, care setting, helping professions.  It does this by using video clips of ‘better than usual’ interactions in day-to-day situations to actively engage clients in change.  Clients are supported by a VIG guider in a shared review  to reflect on the better than usual moments in the video clips,  in the light of their own hopes and reflecting about what has been done effectively, in order to consciously do more of it (Kennedy, Landor & Todd 2011). The following article will explain how VIG was used in a home for elderly people as an approach to improve wellbeing and relationshipsamong workers and between workers and guests.

In Italy we say that becoming old means becoming a child again ….

During my VIG training, as a VIG trainee, I asked myself if it would be useful and worthwhile to offer VIG to the care givers in the home for elderly where I was working once a month as team supervisor.

I monthly supervise the care givers team of the home, with the aim of promoting effective relationships between each other and with guests and to help deal with conflicts or emotional problems which might arise.  At that time I was dissatisfied with the participation and results of the supervision meetingsof my supervision’s meetings. I felt that I needed to give them something more and a new perspective … why not try with VIG?

The home‘s mission is to give a “home” to elderly people who can’t stay in their homes anymore, due to their family situation and/or their physical and mental situation. The home is owned and run by a township and it is very ‘locally based’ (most of the guests come from the town). It hosts up to 34 people who can live independently and partially independently, with 5 places for people who require intensive support.

There are 10 professional care givers, all women, working to provide 24 hour care. They mostly satisfy basic needs: assist with bathing, dressing and grooming; distribute meals; medication reminders; make beds and change linen; assist with walking, monitoring changes in client’s health.  Occasionally they also engage in stimulating activities, escort on appointments or little walks, and give relational support.

Precisely because workers have to satisfy basic needs, their job is fundamental and very important, because they are the people who are most in relationships with the guests, and the wellbeing and health of the guest depend a lot on them.

Their work is actually hard, both physically and psychologically: there are many activities to be completed during a shift, many guests to pay attention to and some of them very demanding, and many unexpected events to deal with. The attitude you use to deal with this situation makes a great difference of course: workers instead tended to complain, because of the shortage of time and resources, of the lack of acknowledgment from the board and guest’s families, of the abundance of rules and procedures…

There were conflicts and misunderstandings among each other, and a significant rate of absenteeism and illness among the workers. I saw that their work was even harder because often they didn’t see the true meaning of it; they found it difficult to see the value of themselves, of each other, of what they did for the guests.

They felt forced to follow procedures and to accomplish tasks, and felt that the relational side of their work was underestimated, if not barely considered.

The aim of our meetings had become to go beyond the sense of hopelessness and despair and to help them to see what was working, what made a difference for the guests, the importance of their role and their job.

I thought that VIG could be a good approach to better spot the resources available, in terms of skills that everybody brings in and of significant relationships built up through everyday activities.

The first challenge has been to convince the Home’s Coordinator to use VIG, and to convince caregivers to participate.

I explained to the caregivers during our monthly group meeting the advantagesin using VIG, presenting it as an opportunityto be more aware of their own strengths, characteristics and approaches, and to improve relationships with both guests and colleagues. Participation was voluntary. 5 to 10 applied plus one civil service volunteer.

PROCESS

I met each care giver individually, found with her a helping question and identified a guest/situation to be video recorded.

I went to the Home at every time of the day, depending on the situation they had chosen: from breakfast time to sleeping time! It has been a fun and interesting activity for me, I don’t usually do it and I saw and learned a lot of things about the Home’s everyday life, about the worker’s job in practice and about the guests.

I did the usual VIG cycles, 2 or 3 per person depending on what they decided at the end of each cycle.

I measured the outcomes rating the accomplishment of VIG goals for each cycle, and asking each care giver ‘what did you learn from this activity?’

After 6 months from delivering VIG, I organized a 3 hours workshop with all the participants and their colleagues who didn’t participate. I agreed with participants to use their clips with colleagues, and we worked on Attunement Principles. They showed their clips and we used clips to find Principles in action.

KEY OUTCOMES

  1. A space for self-reflection

These kind of workers don’t allow themselves to reflect on their own behaviour and the implications of what they do. There are tasks to be completed, and each shift has a determined amount of duties to be accomplished. It seems that there is no time during the day to think about emotions, relationships, and the possibility to do it is considered a luxury, something you need to ‘steal’ from everyday activities.

VIG was therefore an opportunity to reflect on what happens in the relationships with guests, observing themselves  in everyday activities.

It has been possible to see the effect of small gestures during the day(a smile, a handshake, a light touch, an eye contact, a voice pause, a moment of stillness…) which can make a difference for the guests.And having the myth of ‘it takes time that we don’t have to deal with social interactions and feelings’ challenged helps us to discover how to make the time.

It’s something I know I do, but seeing it is different’.

  1. Helping questions and the choice of a situation to be video-recorded

To choose a helping question is always a crucial step in my VIG practice, and once again this was the case.

I helped participants to choose by asking them to think about something they wanted to improve or do differently, or about a relationship with a guest they wanted to explore, or challenge.

The difficulty in finding the helping question is that most of the time we are used to think about weaknesses, what we miss, the mistakes we do in our work: it’s difficult to state a ‘positive’ intention, and my effort is often to help workers to reframe and restate their intention, to find a ‘generative way’ to express themselves and pose the helping question.

Some of the participants chose to work on a relationship with a specific guest, considering a challenging situation, or the specific condition of the guest. Some chose instead a particular moment of their shift and the relationship with the group of guests in a specific activity they were carrying on.

The choice of the situation to be video-recorded has been meaningful to the people: workers who chosen to do VIG with a single guest identified  a specific moment, and in fact they dedicated a special moment to the single elder, and the elders appreciated the possibility of having a dedicated space, even if very short. Workers appreciated the possibility of dedicating themselves to a single person for a moment, giving them special attention without being distracted by other activities.

It seems trivial seen from the outside, but for them it has been important to see that is possible to be fully present for a guest even for a short time, without neglecting tasks and duties.

“I’ll try to find 10 minutes every night to stay with her and listen to her stories, I like it”

These are the helping questions chosen by the participants:

Participant Helping Questions Situation
Am I want to be sure when I am with Mrs A that what I am doing is really what she wants and she needs, and not just what I feel she needs Tea time at A’s bed, feeding her
Ant 1.     Is it possible for me to have dialogue and communication with the elders even during the breakfast and the distribution of medicines?

2.     What can I do to give attention to each guest when they are together?

Breakfast time at morning, in the dining room
B How to improve my communication with guests who are unable to use traditional communication channels? Helping B. to get out of the bed and to have afternoon snack
D 1.     I am able to keep balance between to urge, to solicit and to make a step back in the cognitive stimulation activities?

2.     How can I be close to M when she has difficulties during our stimulation activities?

Group activities in the living room
L What does help Mrs N to communicate with me, to have a quiet conversation with me? Having a conversation with N just before night sleep

 

  1. Reading the elder’s mind

We know from Elizabeth Meins (Bernier & Meins 2008) that parent’s ability to ‘tune in’ to the baby’s thoughts and feelings is crucial for a secure attachment. She also said that “Being Mind-minded is about validating other people’s perspectives and can be helpful for everyone including peers, partners, and work colleagues. If you can think about another person’s perspective, then that has the potential to improve how sensitive and sympathetic you are towards people throughout life”.

Could a mind-mindedness ability be helpful with adults as well? What about those guests with few communication skills remaining, or whose communication ability is influenced by dementia, confusion, loss of memory?

Workers in their day-by-day-activities often take for granted the consequences of their behaviour and their actions with the elders, most of the time underestimating it. VIG shared review has been an opportunity for some of the workers to think about, explore and understand what the guest could eventually think or feel related to a specific action and behaviour of the worker.

Simple typical VIG questions like “What do you think he is thinking now?”, “How do you think he is feeling now, after you did that?”  helped workers  to put themselves in the other’s perspective, and try to give voice and substance to thought and feelings in a non-stereotyped way.

Mind-mindedness in this environment helps workers to better understand both elders’ desire and needs, and that different ways of responding and behaving of the workers can make a great difference in the elder wellbeing and health.

“I see she’s appreciating it, she is smiling. It is a good moment for her. I like to see her smiling”.  “I think he feels recognized, and that this simple gesture is very important for him”

What they said:

  • I saw that even small things like a smile or a gesture are important in our job
  • It’s possible to be effective and to make a difference, we don’t need too much time to do it
  1. Side effects?

After the use of VIG some things have changed in our usual meetings. I don’t have a ‘measure’ that the changes are related to VIG.

I believe that during our meetings, people tend to listen more, and to be more able to understand each other’s point of view and positions while discussing problem solutions.

It is possible to express disagreements and different opinions more openly and quietly, with fewer fights and confrontations.

It is possible to look for a common solution and problem solving: it is less important to “win” as a single worker, it is more important to find a shared solution and proposal.

The Home’s coordinator and nurse and Township manager asked me to do VIG with them, to improve their communication skills in difficult situations. I did one VIG cycle with each last spring, and I consider this request a further change.

References

Bernier, A., & Meins, E. (2008). A threshold approach to understanding the origins of attachment disorganization. Developmental Psychology, 44, 969-982.

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

 

Video Enhanced Reflective Practice (VERP) for a Trainee Educational Psychologist (TEP) Seeking to Improve their Work with Parents. Pitt and Soni

Video Enhanced Reflective Practice (VERP) for a Trainee Educational Psychologist (TEP) Seeking to Improve their Work with Parents

Sophie Pitt and Anita Soni (Sophie.Pitt@coventry.gov.uk, A.Soni@bham.ac.uk)

Abstract

 

Video Enhanced Reflective Practice (VERP) is a method of professional development that aims to improve practitioners’ attuned interactions with their clients, through a specificway of using video reflection (Kennedy, Landor and Todd, 2015). Existing literature on VERP is scant, but suggests VERP’s utility in: improving practitioners’ attuned interactions with their clients, providing a reflective space for practitioners and improving outcomes for practitioners’ clients. In the current professional practice report, as a Trainee Educational Psychologist (TEP), I used VERP to improve my collaboration with parents during consultation meetings. My initial goals for VERP were to encourage parents’ full participation in consultation meetings and to empower them to generate actions and ideas about the provision their child needs in school. After two cycles of VERP with my university supervisor/VERP guider, I rated my goals as largely met and reflected that my attuned interactions had improved. My mindfulness had increased and I was encouraging initiatives from parents more. The report discusses the logistics of using VERP and potential limitations of the research.

Introduction

This project developed out of dissatisfaction in my work with parents during consultation meetings. Consultation is one of the core functions of educational psychology service delivery (Scottish Executive, 2002). Wagner (2000) defined one of the key principles of consultation being working with others as equals.She noted that by working collaboratively with parents and teachers, ideas for how to make a difference to children and young people (CYP)’s situation develops.

In the Educational Psychology Service (EPS) where I was on placement as a TEP, a consultation model was a large part of EP practice. The standard pathway in this service was:

  • A request for involvement from the EPS is made for a CYP, usually by adults from their educational setting;
  • The link Educational Psychologist (EP) or TEP to the setting completes an assessment of the CYP, based on the referral information;
  • A consultation meeting is held with the CYP’s parents, teacher and the Special Educational Needs Co-ordinator (SENCo) from the setting, as well as any other professionals that may be involved. Depending on the circumstance, the CYP may or may not attend the meeting;
  • During the consultation, each person’s respective views on the CYP is shared and at the end of the meeting an action plan is agreed to meet the needs of the CYP in their setting; and
  • The action plan is implemented by the educational setting and a consultation review meeting is held 6-12 weeks later. In this meeting, the actions set in the initial consultation meeting are reviewed, and updated views about the CYP are shared.

In my practice, I was aware of my existing skills with parents during consultation meetings, including my abilities to build rapport, show empathy and demonstrate active listening. I received positive evaluations of my co-operation with parents from SENCosand through observations from my supervisor. Despite this, when reviewing the ideas, solutions and actions set during consultation meetings, I noted that very little emanated from parents and I felt as though parents’ voices werenot apparent. As a parent myself, I am acutely aware of the breadth and depth of knowledge that a parent has about their child. Yet, in consultation meetings, I felt that I was not supporting parents to share their knowledge in a purposeful way.

Reflecting on my practice using models such as Self-Organised Learning (Thomas and Harri-Augstein, 2013) and ordinary supervision were not enabling me to identify specific areas that I could target to enhance my work with parents during consultations. Thus, I was motivated to try other ways to reflect on my practice in this area and chose to use VERP with my university supervisor for two consultation meetings with parents.

Literature Review

What is Video Enhanced Reflective Practice (VERP)?

Video Enhanced Reflective Practice (VERP) is a method of supporting individuals or groups to improve their effective communication skills in their work practice. It involves practitioners reflecting on video clips of successful communications and identifying working points to strengthen future practice (Strathie, Strathie and Kennedy, 2011).  VERP was developed from Video Interaction Guidance (VIG) and is based on the VIG Principles of attuned interaction and guidance (Kennedy, Landor & Todd, 2011). The purpose of both VIG and VERP is to move from a discordant cycle, where individuals are missing each other’s initiatives, to an attuned cycle, where the individuals are attuned, receiving and encouraging each other’s initiatives and therefore engage in a deeper discussion.

How does VERP work?

The process of VERP is similar to the process of VIG, with both methods involving video recorded interactions and shared reviews of recordings with qualified VIG guiders. The VERP process is outlined in Figure 1. The requirement for VERP, similarly to VIG, is that the guider needs to be trained in the principles of VIG and accredited by the Association for VIG UK.

 

Figure 1– Model to illustrate the process of VERP used

The key difference between the VIG and VERP process is that in VIG, the VIG guider chooses the clipsto share in the review, whereas in VERP, the practitioner selects the clips. Nevertheless, in both models, the clips, of between a few seconds to a minute, shared in the review are moments of successful, positive interactions and thus both approaches are strength-based and solution-focused in nature.

What is the evidence base of VERP?

 

When attempting to search the literature for articles on ‘Video Enhanced Reflective Practice’, standard databases returned no results, although there were some for VIG. Searching the open-access e-journal named ‘Attuned Interactions’, which specifically reports research on VIG and VERP, I found two papers on VERP; Craddock and Branigan (2017) exploring the use of VERP in a children’s centre and Lomas (2016) investigated VERP in a specialist secondary school. In addition, several studies of VERP have been reported in the text ‘Video Enhanced Reflective Practice: Professional Development through Attuned Interactions’edited by Kennedy, Landor and Todd (2015). The studies within this book that are particularly relevant were:

  • Quinn (2015) – VERP used to enhance teachers’ mind-mindedness in six nurture groups;
  • Hewitt, Satariano and Todd (2015) – VERP implemented with teaching assistants to improve their interactions with four children;
  • Hewitt, Satariano and Todd (2015) – VERP used to support children with Autism Spectrum Disorder (ASD); and
  • Birbeck et al. (2015) – VERP applied in early years settings.

The four studies above will be discussed in addition to the work from Murray (2016), Craddock and Branigan (2017) and Lomas (2016). Parallels can be drawn across the research in terms of their discussion on VERP’s capacity to:

  • Improve attuned interactions with clients;
  • Enhance practitioners’ reflection skills; and
  • Achieve positive outcomes for clients.

Improvement of Practitioners’ Attuned Interactions with Clients

 

All seven studies reported that practitioners had developed better attuned interactions with their clients following their participation in VERP, suggesting that the primary aim of the intervention had been met. The five family support workers in Craddock and Branigan (2017) research aimed to enhance their communication with parents. The children’s centre workers wanted to be able to listen to parents and receive their initiatives to agree common goals and develop confidence in maintaining positive relationships with parents while having sensitive and difficult discussions. Following VERP, large effect sizes were reported in relation to the practitioners’ ratings of their goals and their attuned interactions with parents.

Similar findings were reported by Lomas (2016) who worked with eight teachers and one teaching assistant (TA). After participating in VERP, the teachers felt an increased sense of attunement with the young people that they worked with which in turn led to more positive interactions with the young people.

Quinn (2015) applied VERP to increase teachers’ mind-mindedness in six nurture groups (working with children aged between four and seven years) with three in the intervention and three as a control group. Quinn (2015) defined mindmindedness as adults being attuned to children’s possible thoughts and feelings and talking about these during interactions.

To measure the outcomes, two videos were taken in the six nurture groups during a breakfast session at the beginning and end of the study. The researchers transcribed and coded the adults’ speech for references to what the children may be thinking, experiencing or feeling (Quinn, 2015). In the nurture groups that received VERP, comments coded as attuned and displaying mind-mindedness increased from 4.75% to 16.86% compared to 4.44% to 7.14% in the control groups. In the post-intervention footage, the adults that received VERP used an average of 33 emotion-focussed comments in 72 minutes, whereas for the control groups, the average was seven comments in the same time. Consequently, the findings indicate that VERP may have led to an increase in teacher’s attuned interactions with the children.

The second VERP project by Hewitt, Satariano and Todd (2015) worked with two TAs who wanted to improve their interactions with two children with ASD. After three cycles of VERP, microanalysis of the video clips highlighted an increase in the frequency and intensity of attuned interactions between the TAs and the children. Similarly, the early years practitioners in Birbeck et al. (2015) noted that they had developed specific skills to increase their attuned interactions with children, such as repeating the child’s sounds and words and naming what the child is doing or feeling.

Taken together, the findings of these studies show the potential for VERP improving the attuned interactions between practitioners and their clients.

Enhancement of Practitioners’ Reflection Skills

 

In each of the seven articles there was discussion of practitioners valuing VERP as a way to improve their reflection skills and increase their self-awareness.  Birbeck et al. (2015) used VERP with early years practitioners to improve their ways of working with young children with Special Educational Needs and/or Disabilities (SEND) and to support the children’s language and communication skills. They participated in three cycles of VERP and reported positive outcomes of the project. Practitioners reported that it gave them space to think and that it inspired them to be reflective despite busy working environments.

Murray’s (2016) research also recognised VERP’s capacity to support with reflection skills. In the study, Murray (2016) assumed the role of a VERP guider and worked with three TEPS during three cycles of VERP, where each TEP recorded footage of themselves in consultation meetings with parents and school staff. VERP was noted to enable reflective space and made interactions more explicit, whereas otherwise interactions are largely unconscious processes.

Quinn (2015) noted that the teachers commented onincreased self-awareness regarding their own interactive behaviours with the children. Similarly, Craddock and Branigan (2017) noted that the children centre workers commentedin the questionnaires that they felt more aware, conscious and reflective about their practice with parents.

The findings within these seven studies suggest that VERP has the capacity to improve practitioners’ reflection skills. In addition, it providesa means for recording the live reflection and for detailing the outcome of reflection (e.g. through monitoring the practitioner’s self-set goals during shared reviews).

Schon (1991) defined two types of reflection as part of ‘single loop learning’; these were:

  • Reflection-on-action – where past events are reflected on with a focus on what might be done better next time, and
  • Reflection-in-action – where present events are reflected on ‘in the moment’ in order to act right away.

Argyris and Schon (1978) also coined the term ‘double loop learning’, which refers to a deeper level of reflection that considers the underlying values and assumptions of the actions that are being reflected on. As highlighted by Birbeck et al(2015), Murray (2016), Quinn (2015) and Craddock and Branigan (2017) identify, the process of videoing interactions within VERP allows for this more thorough, double loop learning through exploration of the principles of attuned interactions and how they are being enacted in the videos that are reflected on within the shared reviews(Landor, 2015).

Positive Outcomes for Clients

 

Whilst most of the research on VERP focuses on outcomes for practitioners, the studies in the present review discuss the further effects of improved practitioner skills on the clients they work with. Table 1 outlines the VERP guider(s), practitioners and clients for each of the seven studies.

Table 1 – Outline of Guiders, Practitioners and Clients

Study VERP Guider(s) Practitioners Clients
Birbeck et al. (2015)  1 EP, 1 Inclusion Team Leader EYs workers EYs children
Hewitt, Satariano and Todd (2015) (Project 1) 1 EP 4 teaching assistants 4 children with SEND in mainstream primary schools
Hewitt, Satariano and Todd (2015)

(Project 2)

1 EP 2 teaching assistants 2 children with ASD
Quinn (2015) 1 EP 6 teachers and 6 teaching assistants Children within 6 nurture groups
Lomas (2016) 1 EP 8 teachers and 1 teaching assistant Young people from a specialist secondary school
Murray (2016) 1 TEP 3 TEPs Parents and teachers
Craddock and Branigan (2017) Not stated 5 children’s centres workers Parents

 

Lomas (2016) explored VERP’s utility in supporting teachers of a secondary specialist provision in supporting young people displaying challenging behaviour through reflection on their interaction.The needs of the young people included diagnoses of ASD, Attention Deficit Hyperactivity Disorder (ADHD) and learning difficulties. Following VERP, the eight teachers and one TA described the young people (their clients) as more ‘compliant’ in their traject plan,because interactions had improved. They stated that the young people’s self-confidence has increased in relation to their knowledge and ability in the classroom. Thus, this study suggests that VERP had a positive effect on the young people, through having a positive effect on the staff.

In the first project by Hewitt, Satariano and Todd (2015), VERP was used with four TAs from mainstream primary schools. Each TA recorded their interactions with one child with SEND during activities outside the classroom. Following five cycles of VERP, data suggested improved skills for the children – such as independence, academic skills and emotional development. The authors reported that there appeared to be a parallel between the development of the TAs and the children; the more the TAs developed, the more the children developed. A follow-up film made four months after the end of VERP suggested that improvements in the children’s skills were maintained or further improved.

The children from the nurture groups in Quinn’s (2015) study were presenting with fewer behavioural difficulties and less intense emotions following VERP, as measured by the Emotion Regulation Checklist.  InHewitt, Satariano and Todd’s (2015) second study, the two boys with ASD demonstrated increased task completion and engagement with academic tasks, improved attendance and improved social skills. These studies add further support to the notion that there is a measurable, positive impact on clients as well as practitioners following VERP.

In summary, the seven studies all suggest that VERP is a useful intervention for improving attuned interactions between practitioners and clients, improving practitioners’ reflection skills and for supporting the clients that practitioners work with.

Method

Procedure

 

The VERP process in the current paper followed the steps outlined in Figure 1Model to illustrate the process of VERP used. As a TEP I worked with a university supervisor who was trained in VIG and could thus facilitate VERP. We had an introductory session where we discussed the Principles of attuned interactions and guidance (Kennedy, Landor & Todd 2011) and I shared my learning goals. My overarching learning goal was:

  1. To improve my interactions with parents so that I am encouraging their full participation and collaboration in consultation meetings about their child.

Within that goal, there was a specific area that I wanted to improve within consultation meetings with parents, which was:

  1. To improve my ability to empower parents to generate actions and ideas about the provision their child needs in school.

Following our initial meeting, I video recorded a consultation meeting with a parent and school staff. I then proceeded to select three clips that I thought showcased positive, attuned interactions which worked towards my learning goals. These clips were shared in a review with my supervisor. During the shared review session, additional goals were added based on the reflections of the video. I then recorded a second consultation meeting and had a shared review in the same month.

Ethics

 

The study was conducted according to the ethical conventions outlined by the BPS Code of Conduct and Ethics (2009). A project information sheet and consent form was read and signed by every person who was video recorded (contact author for details). Prior to their signing, I had spoken to each person over the telephone or in person at least one week before the intended meeting to introduce the idea of the session being recorded and to allow them time to consider whether they were comfortable with the idea.

Reflection and Discussion

Improvements Relating to the Principles of Attuned Interaction

 

First VERP Cycle

Within a few days of recording the first consultation meeting I analysed the footage to find three clips to share during the review. Initially, I found watching the recording quite difficult, which connects with the experiences of the TEPs noted byMurray (2016) and practitioners noted by Birbeck et al. (2015). I instantly noticed negative aspects of myself – including my voice, facial expressions and hand movements. However, when watching it a second time, these negative feelings subsided and I was able to look in more detail at the interaction between myself and the parent. I chose three clips where I felt I was adhering to some of the principles of attuned interactions. For example, in one clip I received the parent’s initiatives by repeating their words and phrases and in another I maintained a good balance between receiving and responding to the parent’s initiatives.

In the shared review, I felt no anxieties around sharing the clips with my university tutor/VERP guider. Our working relationship is positive and non-judgemental, which allowed me to feel comfortable in the sharing of the recordings. This related to one theme in Murray’s (2016) dissertation, which discussed the importance of the VERP guider-practitioner relationship. The trainees commented that having a positive relationship with the guider enabled the shared reviews to be comfortable and effective. From my experience, the VERP guider was able to help me to notice more of what was working well in my interaction with the parent through looking at the parent positive responses, and then shifting the focus when watching the video again to my own behaviour, words and actions, alongside reference to the principles of attuned interaction. For example, in one interaction, the parent was empowered to have a longer turn during the discussion which was supported by me being attentive and encouraging initiatives. I had not noticed how the parent felt more comfortable to speak in that part of the meeting than any other, despite watching the recording two or three times before the shared review.

By looking closely at my facial expressions during the shared review, I noticed that at times I did not appear totally ‘present’ or engaged in my interaction with the parent. I reflected that these were the moments where I was trying to think through possible strategies, actions and ideas that I could share at the end of the meeting. We discussed that the purpose of me trying to think ahead was so that I could be useful, helpful and competent – which perhaps alluded to some anxieties that I had around being a ‘good’ TEP. The VERP guider asked me to estimate the percentage of time I was fully present in the meeting and the percentage of time where my mind was wandering to action planning. I surmised that I was present for 60% of the consultation and absent-minded for the remainder.

Towards the end of the shared review the VIG guider facilitated a discussion around goal setting and scaling using a scale of 1-10, where I was asked to think about how my interactions could be even better. We agreed that I could work on:

  • Being at least 10% more ‘present’ and mindful during the consultation meeting;
  • Waiting longer for a parent’s response before interjecting; and
  • Increasing the amount of commenting as opposed to questioning – as this may be less threatening for parents.

When rating these small-step goals, I set my scores as between three and five out of 10.

 

Second VERP Cycle

After the first VERP cycle I worked hard in all of my parent consultations to increase my mindfulness, waiting for parents’ initiatives and commenting instead of questioning. One consultation was successfully recorded and I selected three clips where I felt my interactions were attuned and better than usual. Watching the recording in the second cycle was not at all uncomfortable, as it was in the first cycle. I chose three clips where I felt I was:

  • Being attentive i.e. looking interested and maintaining a friendly, open posture towards the parent;
  • Encouraging initiatives i.e. waiting and pausing to allow time for parent’s responses;
  • Guiding i.e. building on the parent’s comments and extending their turn; and
  • Deepening discussion i.e. supporting the parent’s role in goal setting and ensuring their views were incorporated into the support plan.

 

Similar to the first cycle, the VIG guider was able to facilitate a greater depth of reflection about the interactions than I could achieve by viewing the recording alone through encouraging me to review the video focusing on the parent’s responses, and what I was doing to evoke these responses. For example, the parent became very animated when talking – their body language changed and they would often raise their hands in the air and smile widely. I had not observed these behaviours and how they formed a pattern. This enabled me to see exactly what I was doing to encourage those initiatives and to empower the parent, for example, returning smiles, facing the parent and nodding. This deeper level of reflection and self-awareness connects to existing literature on VERP (e.g. Birbeck et al., 2015; Murray, 2016).

When we returned to the rating scales, my self-reflective scores increased from between three and five out of 10 to between seven and eight out of 10, as indicated in Table 3. Considering the percentage of time estimated to be present and mindful, this increased from 60% in the first shared review to 90% in the second – suggesting that I felt more able to attune to the parent rather than planning strategies and actions in my mind. This indicates an improvement in my confidence about my practice and hopefully reflects a genuine improvement to my attuned interactions with parents during consultation meetings.

Table 2 – Goals and Ratings

Goal Rating in 1stShared Review Rating in 2ndShared Review
Being at least 10% more ‘present’ and mindful during the consultation meeting 60% mindful 90% mindful
Waiting longer for a parent’s response before interjecting 3/10 7/10
Increasing the amount of commenting as opposed to questioning – as this may be less threatening for parents. 5/10 8/10

 

Initial VERP Goals

The initial goals that I hoped to achieve through VERP were:

  • To improve my interactions with parents so that I am encouraging their full participation and collaboration in consultation meetings about their child; and
  • To improve my ability to empower parents to generate actions and ideas about the provision their child needs in school.

On reflection of these goals, I felt that my attuned interactions with parents had improved and as a result, their participation in the meetings (specifically with generating and sharing ideas for provision) had also improved. These findings are in line with previous research that demonstrates VERP’s ability to enhance attuned interactions with parents (Craddock and Branigan, 2017). From video-analysis, the parents in the second consultation meeting appeared to have more opportunities to generate ideas and solutions for their child’s action plan. If this was the case, it would extend the findings that VERP has an indirect, positive impact on the practitioners’ clients (Hewitt, Satariano and Todd, 2015; Lomas, 2016). However, this was not measured in a systematic way like in other research – for example, Quinn (2015) used a frequency count of comments that displayed mind-mindedness.

Logistics of Using VERP in Educational Psychology Consultations

 

Overall, I found the logistics of recording consultation sessions to be feasible within my practice as a TEP. My reflections on conditions that helped with the successful recordings and shared reviews were:

  • The host EPS having invested in an easily manageable and bookable video camera.
  • School SENCoswith good knowledge of which parents may be comfortable with the consultation meeting being video recorded. Before approaching parents to discuss VERP, I sought advice from the school SENCo. On most occasions, their advice was to make contact with the parent, however, in one or two incidents they advised me to choose a different parent. This was typically where the SENCo perceived the parent to be anxious or where parents had a history of not attending school meetings;
  • Making contact with the parent a week or more before the interview to introduce the idea of VERP and gauge their initial reactions; and
  • The VIG guider being available for a shared review within two or three weeks of the recording being made.

In between the first and second recorded consultation meetings, there were two unsuccessful attempts. In the first, the parent consented to the recording, but after 1-2 minutes asked for the camera to be switched off because she felt uncomfortable and was not sure of the purpose of the recording. In this instance, there was a language barrier with English being the parent’s second language. Thus, I found it difficult to explain VERP; words like “supervision” and “reflection” may not have been fully understood by the parent and I reflected that I needed to find ways to adapt my language so that the video recording is perceived as non-threatening for parents. In the second unsuccessful attempt, the video recorder lost its battery power during the meeting and was thus a minor, easily-avoidable technical error.

Limitations of the Current Research

 

Considering the limitations of this research, the current study implemented VERP over two cycles; this is relatively short when compared with the seven reviewed studies which varied using from three to five cycles of VERP. By limiting VERP to two cycles, it is more difficult to evaluate impact over time. Another limitation is the lack of research methods used to explore the impact of VERP; in other VERP research semi-structured interviews (Hewitt, Satariano and Todd, 2015; Murray, 2016), questionnaires (Craddock and Branigan, 2017) and video analysis using checklists (Hewitt, Satariano and Todd, 2015) have been used. The current research could have adopted some of these methods to explore the impact of VERP in greater detail and also reduced the subjective nature of the perceived impact.

 

Conclusion

 

In summary, the current professional practice report details my experiences of using VERP for two cycles with a VERP guider, who was my university supervisor. The aim of the project was to support my collaboration with parents during consultation meetings, and specifically to support them in contributing to the action plan for their child’s provision in school. From my own ratings and reflections, these goals were met and I improved my attuned interactions with parents, such as waiting for longer to encourage their initiatives. I experienced VERP to be a worthwhile intervention and feel that I gained knowledge and skills. The current research connects with existing literature on VERP, which suggest its utility for improving attuned interactions, promoting reflective space and improving outcomes for the clients that practitioners work with. Future research could strengthen the evidence-base for VERP so that it can be applied in a wider variety of settings. Future work with TEPs and parents could utilise more robust research methods like questionnaires, interviews and checklists to explore the impact of VERP.

 

References

Argyris, C. and Schon, D. (1978) Organisational learning: A theory of action perspective Reading, Mass: Addison Wesley

Birbeck, J., Williams, K., Celebi, M., and Wetzels, A. ‘Connect, Reflect and Grow’ IN ‘Video Enhanced Reflective Practice: Professional Development through Attuned Interactions’London, UK: Jessica Kingsley.

British Psychological Society (2009) Code of Ethics and Conduct: Guidance published by the Ethics Committee of the British Psychological Society. Leicester: The British Psychological Society.

BPS (2014) ‘Standards for the accreditation of educational psychology training in England, Northern Ireland & Wales’. Available at: http://www.bps.org.uk/system/files/Public%20files/PaCT/educational_accreditation_eng_ni_wales_2014_web.pdf(Accessed 1st September 2017)

Craddock, M. and Branigan, K. (2017) ‘The Fields Children’s Centre VERP Project, Cambridgeshire’. Attuned Interactions. Available at: https://attunedinteractions.wordpress.com/2017/08/18/the-fields-childrens-centre-verp-project-cambridgeshire-miriam-craddock-and-kirsten-branigan/(Accessed 21st September 2017)

DFE (2015) ‘Special Educational Needs and Disability Code of Practice: 0 to 25’. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/398815/SEND_Code_of_Practice_January_2015.pdf(Accessed 1st September 2017)

Greene, A., Cartwright, E., and Webster, C. (2015) ‘Integrating Video Enhanced Reflective Practice (VERP) into Medical Education’ IN ‘Video Enhanced Reflective Practice: Professional Development through Attuned Interactions’London, UK: Jessica Kingsley.

HCPC (2015) ‘Standard of Proficiency. Practitioner Psychologists’. Available at: http://www.hpc-uk.org/assets/documents/10002963SOP_Practitioner_psychologists.pdf(Accessed 9th October 2017)

Hewitt, J., Satariano, S., and Todd, L. (2015) ‘Making Sure that Teaching Assistants Can Make a Difference to Children’ IN ‘Video Enhanced Reflective Practice: Professional Development through Attuned Interactions’London, UK: Jessica Kingsley.

Kennedy, H., Landor, M., and Todd, L. (2011). ‘Video interaction guidance’. London, UK: Jessica Kingsley.

Kennedy, H., Landor, M., and Todd, L. (2015) ‘Video Enhanced Reflective Practice: Professional Development through Attuned Interactions’London, UK: Jessica Kingsley.

Lomas (2016) ‘VIG to VERP in a secondary special school’. Attuned Interactions. Available at:https://attunedinteractions.wordpress.com/2016/07/03/lomas-louise-vig-to-verp-in-a-secondary-special-school-the-participating-school-discussed-in-this-article-is-a-secondary-special-school-with-sen-college-status-with-the/

Murray, S (2016) ‘Using Video Enhanced Reflective Practice (VERP) to support the development of Trainee Educational Psychologists’ Consultation and Peer Supervision skills’. Unpublished thesis. University of Birmingham.

Quinn, K. (2015) ‘Getting to the Heart of Nurturing Relationships in Schools’ IN ‘Video Enhanced Reflective Practice: Professional Development through Attuned Interactions’London, UK: Jessica Kingsley.

Schon, D. (1991) The Reflective Practitioner How Professionals Think in Action. London: Avebury

Scottish Executive (2002) ‘Review of Educational Psychology Services in Scotland. Edinburgh’. Scottish Executive Education Department.

Sen, R., Chasle, C., and Jowett, B (2015) ‘Just Conversation’ IN ‘Video Enhanced Reflective Practice: Professional Development through Attuned Interactions’London, UK: Jessica Kingsley.

Strathie, Strathie and Kennedy (2011) ‘Video Enhanced Reflective Practice’ IN Kennedy, Landor and Todd ‘Video Interactive Guidance’. London, UK: Jessica Kingsley.

Thomas, L. F., and Harri-Augstein, S. (2013). Self-organised learning: Foundations of a conversational science for psychology. Routledge.

Underdown, A. (2015) ‘Perinatal and Infant Mental Health’ IN ‘Video Enhanced Reflective Practice: Professional Development through Attuned Interactions’London, UK: Jessica Kingsley.

Wagner, P. (2000). ‘Consultation: Developing a comprehensive approach to service delivery.’ Educational Psychology in Practice, 16 (1), pp. 9-18.

 

 

 

 

 

 

Using Video Interaction Guidance Directly with Children and Young People – A Case Study. Walker

Anne-Marie Walker, Educational Psychologist, Dumfries and Galloway Council, Annan Town Hall.

Anne-Marie.Walker@dumgal.gov.uk;  Anne_marie_b_walker@hotmail.com

 

Video Interaction Guidance (VIG) is a method which uses video and effective, attuned interactions to support people to bring about change.  As an educational psychologist, I often use this method with the relevant adults around a child, parents, teachers and/or learning assistants.  However, I have been interested in including children and young people more directly in this work ensuring their voices, goals and skills are fully recognised.  To help illustrate how I might do this I am sharing a case study of a boy I will call Ross.

Ross, a Primary 6 boy in in a village school was really interested in buildings and number.  Following a significant period of ill health, Ross who had a diagnosis of Asperger’s, had been unable to manage mainstream classes. He communicated his distress through significant physical behaviours which at times hurt others.  In order to meet his needs at that time he was being educated in a small room initially with 2 members of staff.  Despite “everything” having been tried to help Ross access his mainstream class and peers, including support for his family, after 18 months he was still only managing up to 20% of his school week in class. Ross was an academically able boy and everyone was frustrated by not being able to find a way forward to support him back to his class.  I offered to try VIG at a Childs Plan Meeting (CPM), initially thinking of working with the adults to support Ross.

I met with Ross to find out what he wanted to be better, discuss the idea of VIG and explore his consent to try this.  Ross’s main goal was to improve at maths.  He felt he used to be really good at maths and this was no longer the case since he had been unwell.  Ross showed some interest in the idea of video but was not sure.  Hence, we agreed to a trial where I filmed him in Physical Education, which he was currently accessing with some success, followed by watching some selected clips with him the following week so he could decide if he would consent to the method being used.  After this review, I changed tack and agreed to work directly with Ross using VIG methodology on his goal of getting better at Maths due to his engagement and interest in the approach.  I found his choice of goal challenging but felt it was really important to respect his objective.  We agreed the second film would involve him being part of a class maths lesson for short time and I would bring back clips the week after for us to look at what was working.

The intervention consisted of:

Children very much exist within a range of systems with varying roles, responsibilities, behaviours and dynamics that can help or hinder change.  I was very mindful of the need to include the adults around Ross to support him in this work and contribute to the achievement of his goal.  To this end, I discussed the concept of video feed forward (VFF) with the class teacher after 3 cycles, giving the teacher an active role in supporting Ross.  VFF involves identifying potential future behaviour and either staging or creating it through skilful editing of video (Forsyth & Sked, 2011).   The class teacher agreed to work with Ross on a scripted session where he was working on a maths task and needed to seek help. This focus was chosen because it fitted with discussions in the previous shared review and allowed Ross a safe space to try out new behaviours.   Once this script was written the class teacher and Ross acted it out and filmed it. This video was then shared with me and I offered practical help to the teacher to edit the film before she shared it with Ross.  I also used this film as a basis for a shared review with Ross.  A shared review involves viewing clips which have been specially selected to be positive and relevant to the person’s goal.  These are then discussed within an attuned interaction where the guider works hard to find the ideal balance between supporting the child and activating them to find their own solutions.  This shared review ended with a simplified version of a clear goal to be able to seek and accept help, with a short list of strategies Ross felt able to use.

Again, being mindful of the inclusion of the adults around the child, I considered potential ways to involve the mum. It was not possible to share clips from filming in the class because of the other children being present.  I videoed the shared review with Ross and myself where we discussed the video feedforward film as I normally did with his consent to aid my reflection.  During this review I asked Ross about who in his life might be able to support him with his ideas going forward and he strongly identified his mum as his key supporter.  I wondered aloud about the possibility of sharing clips from our shared review with his mum and Ross liked this idea.  Had Ross not liked this idea alternative ways to include his mum would have been explored.  I then selected clips from this video to share with his mum, including some focus on him smiling with pride in his video, showing some insight into his misunderstandings in communication, and his ideas for the future about what he felt able to do.  I then did a shared review with Ross and his mum at their home as they requested. Ross managed a significant period of time sitting on the couch beside his mum engaged in reviewing the clips, before moving behind the couch to listen and join in from there.  This review proved very successful in sharing with his mum what we had been doing, shared joy (between mum and her son) in being able to see him experiencing success in something, awareness and support of Ross’ ideas but also activation of ideas of her own in how to support Ross to develop his communication further.

We agreed that Ross would have a further edited video feedforward video at home (as only Ross and his class teacher featured) over the summer holidays to support and remind Ross about his ideas to continue to make things better, as well as support the transition over the long break from school by focussing on successful interactions.  We also agreed one further film and review to check up on the success of his strategies into his new class and to evaluate the intervention’s success.

The intervention was evaluated positively by gaining the views of Ross, his parent, and his school.  His inclusion in the mainstream class was also monitored and this significantly changed to managing 70% of his time in class. Ross was able to express that he found the use of video and “not talking about the problems” as helpful.  My view of the turning point for Ross was in his realisation that he expected the adults in the school to know when he was stuck and what with, and know exactly how to help him without him communicating with them.  This was leading to very significant frustration for Ross.  One of his key ideas to make things better was a script where he said “ I am stuck with qx” which helped initiate the helping interaction. Sharing this perception with school staff and his parent allowed others to also change their interaction in helpful ways.

Reflections

The medium of video proved really successful in working with a child with social communication issues.  The facility to focus on the video made it easier for the child to interact with me in this type of work.

I found it very challenging to be attuned to Ross, and videoing and reflecting on the shared reviews was fundamental to my success.  Reflecting on film of shared reviews allowed me to pick up on very subtle cues which were different than I am used to, to see his engagement when I wasn’t sure I was getting it right, and in supporting me to alter my interaction style to more closely meet his needs and attune better.

The inclusion of video feed forward also worked really well, not just in including the class teacher to take an active role in the intervention, but in allowing Ross to fully consider and try out ideas in a very safe way, before reflecting on which of his strategies were possible for him to use in a real life context.

Using clips of a shared review with the parent was really powerful and opened up additional possibilities based on the child’s views, perceptions, success and hard work.

Conclusion

VIG can be successfully used directly with children, although careful consideration of how to make the best uses of the adult resources around the child is needed.

 

Reference

Forsyth, P. & Sked, H. (2011). VIG when working with children and adults on the autistic continuum.  In H. Kennedy, M. Landor, &L. Todd (eds.) Video Interaction Guidance, London: Jessica Kingsley Publishers, p144-156.

Further links

A selection of articles around the use of VIG and autism can be accessed at the VIG knowledge site: http://vigknowledge.wikispaces.com/space/content?tag=autism

 

 

Introducing the use of Video Interaction Guidance in Gloucestershire: Experiences of Educational Psychologists and specialist Health Visitors Bushell, Cooper and Davies

Introduction

The evidence-base highlighting the transformative impact of using Video Interaction Guidance (VIG) with families continues to grow[1]. Educational Psychology Services (EPS) and Health Visitor (HV) Teams and other services across the UK are increasingly choosing this compassionate relationship-focused intervention to broaden and strengthen the support they offer to families (https://www.videointeractionguidance.net/). Across the UK, there is a range of services now well established in the use of VIG[2]. For those services that are beginning or considering the use of VIG, this paper seeks to highlight early insights and learning from a project in Gloucestershire, where Educational Psychologists and Perinatal Mental Health Champion Health Visitors are working collaboratively, to develop the use of VIG in their respective contexts.

The following study was commissioned by Gloucestershire Educational Psychology Service (EPS), with two University of Bristol Trainee Educational Psychologists conducting the research, overseen by a Specialist Senior Educational Psychologist (SSEP). The SSEP’s specialism in mental health and therapeutic interventions, and longstanding interest in the critical role of relationships in promoting wellbeing, had led to the introduction of VIG in the EPS. This new tool was to be employed for its empowering, positive influence on relationships and strong evidence-base for effectiveness. Similarly – and rather fortuitously – the Perinatal Health Visitor Leadin Gloucestershire also had a strong interest in VIG, having heard of its impact from Alain Gregoire, the consultant psychiatrist who set up and leads Hampshire’s perinatal mental health service. The SSEP, following a successful bid from NHS Commissioning, worked collaboratively with the Lead Perinatal Health Visitor, to set up a small group of Educational Psychologists (EPs) from Gloucestershire EPS and 7 Perinatal Mental Health Champion Health Visitors[3]from Gloucestershire Health Visiting Service (GHVS), to train in parallel and deliver VIG in theirown settings. Alongside monthly AVIGuk supervision by Maureen Granger, an AVIGuk National Supervisor, were opportunities for peer supervision.

In future, the SSEP hopes the EPS will support the establishment of an area-wide multi-professional ‘team’ or network of VIG practitioners. To foster sustainability, training and supervision would eventually be available from home-grown AVIGuk practitioners from the EPS and GHVS. The following research was commissioned to capture the early experiences of those delivering and operationally managing VIG in Gloucestershire. It was hoped that these experiences may inform the planning and set-up of this broader, multi-professional VIG ‘team’ in Gloucestershire, and would also assist other services – EPS, Health Visiting or others – who might be considering setting up VIG elsewhere.

Broader context

Following an investigation by the Children and Young People’s Mental Health and Wellbeing Taskforce in September 2014, Public Health England and NHS England developed Future in Mind(2015); this report presented a vision for transforming mental health and wellbeing support for CYP in the UK. The Future in Mind report summarises the key priorities for mental health and wellbeing. It highlights the importance of the promotion of resilience, prevention and early intervention, employing effective, evidence-based interventions, and developing the skills of the whole workforce to provide better support.

The role of the HV

In the last few years, HVs have taken on growing responsibilities for mental health and wellbeing.  The Public Health England document, ‘Evidence into Action: Opportunities to protect and improve the nation’s health’ (2014), outlined seven priorities, one of which is ‘Ensuring every child has the best start in life’ (p.18).  The document stresses the importance of prevention and highlights the effects of early experiences on the development of CYP.   In addition to this, the Healthy Child Programme (HCP; DofH, 2009) provides guidance for commissioners and those delivering health services in Local Authorities and Primary Care Trusts.  It includes a focus on providing support for parents to develop strong, healthy attachments with their children through attuned parenting (pp.10 -11) and places the HV role as the lead co-ordinating the HCP.  It also advises the use of evidence-based interventions and structured programmes delivered by HVs to reduce risk factors.

Developing the role of Health Visitors to incorporate the use of VIG is also highly relevant for ‘The National Framework for Continuing Professional Development for Health Visitors: Standards for professional practice’ (iHV, 2015).  Standard One focuses on ‘Working Therapeutically to effect change with children and families’ (p.21) and describes how Health Visitors need to have ‘excellent interpersonal skills and personal qualities’ to be able to do this. By training as a VIG Practitioner, not only are Health Visitors able to meet this standard by having a therapeutic intervention to use with their clients, but it may also develop their interpersonal skills more generally, benefitting their practice in the wider context.

The role of the EP

There has been a growing body of literature reviewing the role of the EP, and the many ways in which it can provide help working towards the goals of the legislation outlined above.  First and foremost, the main role of the EP can be summarised as “enhancing the children’s achievement and well-being, as opposed to identifying deficits, or problems, in functioning” (p. 15, Beaver, 2011).  This places EP work within a positive framework and identifies wellbeing as a key focus.  The Future in Mind report (2015), posits that the wellbeing of CYP is a factor that underpins their academic achievement and success in all areas of life.  Secondly, the delivery of therapeutic interventions is an aspect of the EP role that is gaining interest and commonality. Burns et al(1995) demonstrated how many mental health services are not actually provided by specialist mental health sectors, highlighting the significance of education settings in meeting the needs of CYP in this area.  Further to this, Squires (2012) describes how EPs can help meet CYP’s mental health and wellbeing needs by training in the delivery of specialist, therapeutic interventions for use in schools.

Therefore, there is a rationale to train EPs and HVs as VIG Practitioners, equipping them with specialist therapeutic skills that can help them intervene early and effectively.

Video Interaction Guidance (VIG)                                                                    

VIG is a form of video feedback intervention (VFI) “where the clients are guided to reflect on video clips of their own successful interactions” (Kennedy, 2011, p.21). Through recognising their strengths in their interactions with a child, clients (parents, carers, teachers) are supported to develop their skills and confidence in their relationships. VIG is a strengths-based intervention built upon principles of attunement, intersubjectivity, empowerment of clients, reflection and self-modelling (Kennedy, 2011). It resonates with current legislation and guidance in supporting the mental health and wellbeing of CYP by improving attachments and relationships between children and their parents, carers or teachers. Fostering these positive connections can help to reduce incidences of mental health difficulties and improve wellbeing (Ttofa, 2017).

Additionally, VIG meets the requirements of the National Institute of Clinical Excellence (NICE, 2012) and current legislation in that it has a developing research base. Two meta-analyses of experimental studies found VFIs to be effective as agents for positive change (Fukkink, 2008; Bakermans-Kranenburg, Van-Ijzendoorn and Juffer, 2003). Smaller scale qualitative studies also found support for the use of VIG (e.g. Robertson and Kennedy, 2009; Savage 2005). However, the majority of these studies took place outside of the UK, and considered a range of VFIs, rather than VIG specifically.

Whilst information is available for managers on the Association of Video Interaction Practitioners UK website[4], the authors could find no research to date which examines the practicalities of delivering VIG. This was identified by Colley (2013) as an area in which further research is required:

It would be beneficial for readers like me to have a clearer idea of costings for the equipment used, and for there to have been some discussion about the practicalities for delivering VIG. I am thinking, for example, of the skills required to edit recordings, the software required, and even the position of cameras, one-way mirrors etc.  (Colley, 2013, pg. 348-349)

Given the growing interest in the intervention, information about considerations when setting up a VIG service would seem beneficial. With this in mind, the current study explores the early experiences of HVs and EPs in one Local Authority. It examines the practicalities of using VIG, and the lessons that can be learnt for the future development of VIG services as a tool to support mental health and wellbeing strategies.

Research Questions

Having identified a lack of research relating to the initial set up of VIG, and considering the interests of the commissioning authority, the current research hopes to identify the lessons that can be learnt from the early experiences of VIG Trainee Practitioner HVs and EPs, at practitioner and Service Area Lead (SAL) levels. The SAL level VIG Trainee Practitioners, as well as delivering VIG themselves, were also responsible for the operational management of VIG within their respective services (for example, negotiating access to equipment and software with relevant departments). By including the SAL level VIG Trainee Practitioners in the study, it was hoped that the range of issues arising from setting up a VIG service, at practitioner and operational management level, could be reviewed.

The research questions considered are:

  • How have the delivery and logistics of using VIG been experienced by EP and HV Stage One VIG Trainee Practitioners?
  • How have the delivery and logistics of using VIG been experienced by the EP and HV SAL Stage One VIG Trainee Practitioners?
  • How might these experiences inform the set-up of a multi-agency VIG service?

Research Methods

Participants

5 Perinatal Mental Health Champion HVs took part in this study. This included 4 HVs at practitioner level, and 1 SAL HV. 3 EPs participated, including 1 SSEP (the SAL). All participants were female and were currently in Stage One of their VIG training. This meant that they had all attended the initial two days of training together, and were currently receiving monthly supervision as they worked on their first cases.

Procedure

Practitioner level VIG Trainee Practitioners took part in either a focus group (HVs), or 1:1 semi-structured interviews (EPs), based on availability. SAL VIG Trainee Practitioners took part in semi-structured interviews. Information sheets[5]and confidentiality protocols[6]were given to all participants, who signed a consent form[7]confirming their agreement to participate. The focus group and interviews[8]were recorded and interviews transcribed.

Data analysis

On the completion of data collection, thematic analysis was conducted. Transcripts were summarised and a Constant Comparative Method was then used to identify similarities and differences, and identify themes (Harding, 2013).

Results

On completion of data analysis, six core themes were identified. It was noticed that for practitioners and SALs, many of the same responses were given across HV and EP groups. Where differences were found, these are highlighted in the following description of the themes.

Time

All participants noted the time costs of VIG. This can be broken down into a number of different areas. Firstly, there were the time costs associated with attending the initial training, and with the monthly supervision sessions. The face-to-face delivery of VIG also had time implications. Participants noted that it had been difficult to organise their VIG activities around their other, often statutory, responsibilities. Some participants explained that they had needed to carry out VIG administrative tasks in their personal time to meet these requirements. Time restrictions meant that informal VIG peer support could not always be accessed. In addition, time needed to be factored in for the development of the relationship between the client and VIG Trainee Practitioner, prior to the start of the intervention. It was highlighted that it was important for managers to be fully aware of the time costs of VIG and to have a commitment to releasing staff to carry out their VIG activities. 

Technical infrastructure

The EPs and HVs at practitioner and SAL levels described the challenges of using new information technology (IT) and video recording equipment.  Challenges ranged from choosing equipment and learning how to use it, to building an awareness of common problems, such as the video recorder accidentally entering standby mode. SALs additionally described the time required to make arrangements for IT provision that was compatible with other IT systems. The purchase of new equipment and enlisting technical support from an IT department also has cost implications.

Policy and procedural infrastructure

The initial establishment of a VIG service required clear protocols for confidentiality, data protection and information sharing. Practitioner level Trainees spoke about challenges in terms of having confidential spaces to micro-analyse video clips and negotiating with clients and other agencies the information that could be shared. Furthermore, SALs needed time and support to establish service policies and protocols on these matters, including processes such as storage for the videos. For the SSEP SAL, consideration was also needed regarding the pricing structure for delivering VIG in a traded context.

VIG Trainee Practitioner identification

All participants described their initial enthusiasm for VIG, stating that it aligned with their interests and values. VIG Trainee Practitioners appreciated the strengths-based nature of VIG and the fact it has a developing evidence-base. Several EP and HV participants welcomed the chance to increase their direct work with clients and undertake continuous professional development opportunities. Whilst sharing this perspective, SALs also considered their Service Development Plans. Their identification of staff to train was often logistical (i.e. training one staff member in each geographical base), and considered broader service priorities such as the HV service establishing Perinatal Mental Health Champions.  A common discussion point related to the need for staff to be fully informed of the requirements of VIG so that they could make an informed decision before committing to training.

Skill development

All participants experienced the initial two-day training as positive and inspiring and recognised the value of the subsequent supervision sessions in enhancing their skill development. Discussions with one of the EPs highlighted that many of the skills required for VIG were skills that EPs generally already have, but that training in VIG provided opportunities to develop and practise these skills. Some EP and HV participants described how they had been able to transfer the skills developed through VIG into other areas of their work and personal lives. However, other participants felt that it was too soon in their training to notice such effects.

Client identification

Client identification was the main area of difference between the HVs and EPs. The HVs worked within a non-traded context and as such had increased and easier access to clients. Indeed, the HVs expressed they could potentially reach a point where they are unable to meet the referral demands for VIG.  For the EPs, working in a traded context meant different issues arose. The SAL needed to consider how to inform potential customers (e.g. schools) about VIG and promote its effectiveness to generate custom. This led to an increased emphasis on the need to consider ways of measuring impact. Aside from the traded/non-traded dichotomy, a positive relationship between the client and VIG Trainee Practitioner was noted as essential. The attitude, motivation and wellbeing of the client were key factors in the intervention being successful.

Discussion

It was noted earlier that supporting the mental health and wellbeing of CYP is a key focus in guidance such as Future in Mind (2015). A consideration of the roles of EPs and HVs revealed that both practitioner groups are well placed to use evidence-based interventions to work towards the goals outlined in this paper. VIG was identified as a form of support that could be utilised by EPs, HVs and other professionals in supporting CYP and their families. There is a developing research base which demonstrates the effectiveness of VIG. A smaller amount of research or consideration has been carried out into other factors related to VIG, such as its impact on professional development.

The current study aimed to explore the practical considerations needed when setting up a new VIG service in response to the aspirations of Gloucestershire EPS in setting up a multi-professional VIG team. As noted by Colley (2013) this is an area lacking in guidance and information, which may be of use to others.

Through the literature review, guidance for managers to consider when implementing VIG, published on the VIG UK website, was discovered. This guidance resonates with several of the themes identified in the current research.

The most salient theme noted was that of time. Consideration was needed of how time would be managed to allow VIG Trainee Practitioners to carry out the range of tasks associated with the intervention: building relationships with clients, preparing equipment, carrying out the client face to face sessions, analysing video clips, engaging in supervision, and writing policies.  Difficulties with time featured in all our interviews and our focus group. The HV group hypothesised that using VIG as an early intervention, as promoted through Future in Mind (2015), would mean that time and money would be saved in the future. Additionally, this fits with the HCP (DofH, 2009), which HVs are commissioned to deliver. Services will need to consider how they might manage and track this.

Similar findings were found in the ‘Through Each Other’s Eyes’ (Chakkalackal, Rosan, & Stavrou, 2017) paper.  This paper looked at the implementation of VIG in a Health Visitor service in Haringey.  The research found many positives for the use of VIG, including reduced stress and anxiety and increased confidence in the parents, and the Health Visitors and managers felt the intervention was very effective in terms of developing practitioner skills and having it as a therapeutic tool. However, they also noted the practical challenges of the intervention, such as the differing referral routes and the impact on caseload and need for team support to manage this.

As well as time, the current study identified that services need to consider how they would manage the development of the policy and procedural infrastructure, e.g. with respect to confidentiality, data management and trading agreements. Technical considerations were also needed to ensure that staff members were fully equipped to deliver VIG, both in terms of equipment and technical skills. Other themes included the identification of Trainee VIG Practitioners and clients, and the skills of the Practitioners.

On reflection of all the themes, a commonality was identified. It was noted that, for all the challenges of delivering VIG to be met and for staff to be supported properly, a full commitment to VIG was required across all system levels.The following outlines how this might be achieved:

  1. Collective Strategic Direction

A collective strategic direction needs to be held by all, beginning with national legislation and initiatives and extending through to local operational managers. Where missing links occur in this direction, it is likely that issues such as managing time demands and supporting policy development may become increasingly challenging.

  1. Principle of Attunement Across all Systems Levels

The values and beliefs of VIG include being attuned to others, recognising strengths, and believing that people are doing the best they can. Ideally, across all systems levels, this view is taken of clients, VIG Trainee Practitioners, SALs, and others involved in the direct support of VIG, in order that they will be best supported to meet the practical challenges. Indeed, the VIG training and supervision model ensures that the VIG ‘Principles of Attuned Interactions and Guidance’ are developed in clients, trainee Practitioners and supervisors alike.

  1. Capacity and Collective Drive for Change

As Fullan (2005) identified in his paper which outlines the Tri-Level Solution approach to change, capacity and collective drive for change needs to occur at three levels of a system for improvements and success to happen.  With regards to this study, this would mean “building capacity” at the bottom level (those delivering VIG), the middle level (LAs, Health Commissioners) and top level (National legislation and guidance).  There needs to be accountability at all three levels and a collective belief in the purposes, efficacy and utility of the intervention.

Recommendations for a self-sustaining multi-agency VIG intervention

On the basis of this study, the following issues could be considered by services exploring the set-up of a VIG intervention:

  • All involved in the strategic planning and delivery of VIG need to understand and demonstrate a commitment to the practical issues related to VIG (e.g. Time, Technical Infrastructure, Policy and Procedural Infrastructure, Trainee Practitioner and Client Identification) and its overall ethos and values.
  • Time for all staff involved to implement all aspects of VIG. This will likely require flexibility and reassessment of work responsibilities including the provision of cover to release staff from their other responsibilities in order that they may complete their VIG activities effectively.
  • Clear and precise policies and procedures will be needed at an early stage, considering matters such as data storage and confidentiality (e.g. selecting the videoing equipment and software to support it; deciding on data protection processes; time planned in to train and support practitioners in using the equipment; the sharing of sample ‘IT solutions’ from other services would be helpful).
  • Staff will need confidential spaces in which they can analyse and edit clips.
  • Consideration is required for how VIG will be utilised in multi-agency cases, such as how information will be shared, and how other agencies will be supported to understand VIG. Agreements will need to be in place from the beginning of multi-agency partnerships.
  • Prior to committing to training in VIG, staff will benefit from being fully informed about the time and extent of involvement the role of the VIG Practitioner requires.

Limitations and Considerations

  • The researchers are aware that the participants were very new to their delivery of VIG. Therefore, the views and opinions shared during the focus group and interviews reflect their very early and initial thoughts. The researchers wondered whether results might have been different had the study occurred later on in their training in VIG, and whether responses might have been affected by the passage of time. It would be interesting to compare responses at these two different times. For example, IT challenges are likely to be more of an issue in Stage 1 of training, whilst practitioners are still coming to grips with using the camera and editing.
  • Another consideration was how the training routes for EPs and HVs may have impacted upon their views and opinions. For example, perhaps the initial professional training for EPs, which includes training in consultation and solution-focused approaches, may have better prepared some VIG Trainee Practitioners. This may need to be a consideration for other agencies looking into the set-up of a VIG service.

Potential Areas for Future Research

  • Further research into the effectiveness and utility of VIG may be helpful in providing more insight for relevant commissioners into how the intervention works.
  • It may also be helpful to consider how the effectiveness of VIG can be demonstrated to stakeholders across the variety of organisational levels, in order to promote investment, enthusiasm and commitment to the intervention across multiple system levels.

Conclusion

VIG is an intervention that resonates with the current national drive to support CYP and their mental health and wellbeing. It has potential to be used by a variety of professionals and appears to sit well within the EP and HV role. However, for successful early implementation of VIG, services need to be fully aware, prior to commitment, of the practical matters relating to the delivery of the intervention. This study has identified key themes in the early experiences of VIG Trainee Practitioners and has made suggestions for how these challenges may be navigated.

It also points to a potential area of further work within AVIGuk: the clarification of the requirements that need to be fulfilled in order for VIG to be introduced into a service.  For example, local services need to consider meeting with senior management and training departments/staff to make the case for VIG, liaising with IT departments and writing or adapting data protection policies.  Sample data storage policies to be used by services could be made available on the AVIGuk website, and an outline of the time requirements could be presented.

Arguably, for VIG to be successfully delivered, a collective strategic direction is required at all levels, from national through to local leadership. VIG practitioners see almost immediately its positive impact. They appreciate what clear benefits can be achieved for families and professionals alike, so are motivated to overcome operational barriers because of their commitment to and enthusiasm for this method. The challenge for management is to ensure that adequate practical support is available, in both time and resources, so that practitioners’ enthusiasm is fully harnessed and best possible outcomes are achieved for our families.

Authors 

Amy Bushell and Pauline Cooper are Trainee Educational Psychologists at the University of Bristol, who were on placement at Gloucestershire Educational Psychology Service, when they conducted the research.

Dr Oonagh Davies is a Specialist Senior Educational Psychologist for Gloucestershire Educational Psychology Service and passionate Trainee AVIGuk Practitioner, who initiated and coordinates the use of VIG by Health Visitors and Educational Psychologists in the county.

Oonagh.Davies@gloucestershire.gov.uk

Acknowledgements 

Amy and Pauline would like to express their thanks to Dr John Franey, for all his support, guidance and sense of humour throughout this commission. They would also like to thank Dr Oonagh Davies for all her energy, enthusiasm and vision for the research.

Oonagh would like to thank Catherine Whitcombe (Perinatal Health Visitor Lead), Dr Deborah Shepherd (EPS), Helen Ford (Lead Commissioner CYP and Maternity, NHS Gloucestershire/Gloucestershire County Council), and Laura Phipps (Commissioning Manager), without whom this joint project would not have got going! For keeping it going, in the face of not inconsiderable challenges, a very special thanks to our supportive supervisor Maureen Granger, and especially all the VIG EPs andVIG Health Visitors.

References

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[1]See The Mental Health Foundation’s 2017 report on it’s use in Haringey; and Cardiff University’s 2016 ‘Evaluation of Cornwall’s VIG Service’, for recent examples.

[2]EP Services who are reported to be well-established in the use of VIG, include Cornwall, Glasgow, North Lanarkshire, East Lothian, Kent, Hampshire and Camden. Also see Manchester Child and Parent Service, Wessex Perinatal Service (Mother and Baby Units and Community), and SWIFT (Specialist Family Service) in East Sussex, and the NSPCC has a number of projects in different areas of the country.

[3]Health Visitors with additional responsibilities for promoting positive mental health and wellbeing in parents and promoting early intervention for vulnerable families.

[4]This information is available from the authors, as an appendix, if requested.

[5]This information is available from the authors, as an appendix, if requested.

[6]This information is available from the authors, as an appendix, if requested.

[7]This information is available from the authors, as an appendix, if requested.

[8]A copy of the interview questions and prompts, which related to experiences of the initial training and information received about the intervention, to experiences of delivering VIG, and to the issues and difficulties that had arisen, can also be made available if requested.