Interaction Guidance for parents of young children with a diagnosis of autism in a rural Scottish Local Authority. Heather Sked, Area Principal Educational Psychologist, The Highland Council; Shiona Alexander, Educational Psychologist, The Highland Council; Claire Wraight, Trainee Educational Psychologist, University College London

ASPIRE: Autism Strategies for Parents to Improve Relationships and Experiences.
The development of a training and support programme incorporating Video Interaction Guidance for parents of young children with a diagnosis of autism in a rural Scottish Local Authority (Paper delivered to
Video Interaction Guidance: Closing the Gap. 7th AVIGuk International Conference 2017, Glasgow.)

Heather Sked, Area Principal Educational Psychologist, The Highland Council; Shiona Alexander, Educational Psychologist, The Highland Council; Claire Wraight, Trainee Educational Psychologist, University College London.

Abstract: As part of national and local efforts to close the equity gap and support children and young people with a diagnosis of autism to achieve their potential, multi-agency staff in a rural Scottish Local Authority are developing a training pathway for parents of children with autism. ASPIRE (Autism Strategies for Parents to Improve Relationships and Experiences) is a new initiative within this pathway, incorporating Video Interaction Guidance both on an individual basis and within a group setting. Evaluation of the pilot programme demonstrated that parents felt empowered and supported both immediately after the intervention and also two months later. Video analysis also demonstrated increased attunement between all parents and children. It would be useful now to measure ongoing impact of this parent-mediated approach through planned, longitudinal research as the programme is rolled out across the authority.

INTRODUCTION        

Nationally and locally, it is recognised that there is a need to provide support to enable individuals with autism to achieve their potential in life. (The term ‘autism’ is used throughout this article, except where different terminology is used in direct quotations from other publications.) Recommendation 10 of the Scottish Strategy for Autism (The Scottish Government 2011, p.78) is that, ‘Agencies and services develop a menu of interventions including advice, therapeutic interventions and counselling for children, young people and adults with ASD, that are appropriate and flexible to individual need.’ This also fits with the priority in the National Improvement Framework (The Scottish Government, 2017), ‘Improvement in children and young people’s health and wellbeing,’ (p.2) and the focus on parental engagement: ‘We want to improve and increase the ways in which parents, carers and families can engage with teachers and partners to support their children,’ (p.9).

Recent research (Green et al. 2010; Pickles et al. 2016) has indicated that adopting a parent-mediated approach in interventions and focussing on developing the prerequisite elements of communicative interaction can have long-lasting impact on the development of autistic children. This research has received widespread attention, being reported by the BBC in October 2016 with the headline: ‘Super parenting improves children’s autism’ (BBC 2016).

Video Interaction Guidance (VIG) is an approach which could fit this description. A VIG guider takes a short film of interaction between two participants focussing on an agreed aspect, then identifies short clips where the interaction is particularly attuned. These clips are shared with one or more of the participants in shared review, where the VIG guider supports the participant(s) to see and describe this attunement for themselves.   This provides a basis for discussion about how to build this attunement further. This cycle is repeated, often three times. Essentially, VIG focusses on what could be described as the prerequisite elements of communicative interaction: the principles for attunement (Kennedy, Landor and Todd 2011). Attentiveness and the process of encouraging and receiving initiatives from interaction partners are fundamental in this.  There are numerous examples of VIG being used successfully with parents to support interaction with children (Kennedy et al. 2011) and therefore it can be described as a parent-mediated intervention. It has also been shown to be an effective intervention to support parental understanding of an autistic child (for example Gibson 2013), confirming that supporting the development of attuned interactions is relevant for all.

Furthermore, VIG is an intervention which fits the recommendations in the NICE Clinical Guidelines 170 (National Institute for Health and Care Excellence 2013 pp.10-11). These guidelines recommend that interventions to address the key features of autism in children should:

  • be adjusted to the child or young person’s developmental level
  • aim to increase the parents, carers, teachers or peers’ understanding of, and sensitivity and responsiveness to, the child or young person’s patterns of communication and interaction
  • include techniques of therapist modelling and video-interaction feedback
  • include techniques to expand the child or young person’s communication, interactive play and social routines.

The intervention should be delivered by a trained professional.

The Local Authority where the ASPIRE intervention has been developed has used the National Autistic Society’s EarlyBird and EarlyBird Plus training programme to support parents with young children with autism for some years. EarlyBird is delivered to parents in a group setting, over a period of several weeks, focussing on various aspects of autism and including the sharing of videos of parents and their children, although not using VIG. Although the programme was evaluated well by parents who attended, and indeed is very well evaluated more widely (for example Clubb 2012), the constraints of the programme did not match with geographical needs or training capacity of this large rural Local Authority. The need for an alternative to meet local needs has been recognised for several years. The multi-agency Autism Training Group in this Local Authority has been working towards developing such an alternative, employing the Model for Improvement framework to make a small test of change, using the Plan-Do-Study-Act cycle.

PLANNING

The training group has been working towards developing an autism training pathway, thereby fulfilling an aim included in the Local Authority’s Integrated Children’s Services Plan. As part of this, a subgroup of the Autism Training Group has developed training for parents of young children with a diagnosis of autism called ASPIRE (Autism Strategies for Parents to Improve Relationships and Experiences), using the skills and expertise regarding autism and VIG of multi-agency staff across the Local Authority. The pre-school home visiting teacher co-ordinator, who was one of the EarlyBird trainers in the Local Authority and also a trainee VIG guider, made a strong case for including VIG in this training to provide a more structured way to use video to support the development of parent-child interaction, as she had witnessed the increased understanding and change following VIG in a parent who had experienced EarlyBird with her first child and then VIG with her second child.

The team decided that they wanted to provide opportunities for parents both to attend strategy-based workshops on a range of pertinent themes and also to experience VIG. It was agreed at this stage that combining these two elements in one course could make the training very lengthy and therefore put unrealistic time demands both on parents and trainers. Therefore a model for the pilot of ASPIRE was developed, comprising core training for all parents followed by two routes (Group One using Video Interaction Guidance, Group Two using workshops to focus on strategies) to develop parent networks, competence and confidence in interacting with their child. Training using both routes has been delivered once, centrally in the largest urban area in the Local Authority, as a small test of change.

DOING

Day One of ASPIRE was core training for all: the ‘Understanding Autism’ training event which was already being successfully delivered for parents and professionals across the Local Authority. An ‘Understanding Autism’ day was arranged specifically for the ASPIRE parents and was delivered to both groups together. This was also attended by all the professionals who would be working with the parents during the ASPIRE programme. This is an interactive day of training including sections delivered by a range of professionals: introduction to autism (specialist teacher); communication (speech and language therapist); sensory issues (occupational therapist); challenging behaviour (educational psychologist); practical strategies (delivered by all). This was also an opportunity for the parents who would be experiencing VIG to meet their VIG guiders, who were all either educational psychologists or pre-school home visiting teachers.

The programme for Group One ran for seven further weeks. On Day Two, there was a presentation about the principles for attunement, including films of a parent interacting with her autistic child, without a toy in one film and with a toy in the other. Parents then discussed the interaction targets they wished to work on with their designated VIG guider, recording this on a Target Monitoring and Evaluation (TME) form (Dunsmuir et al 2009). (This form was also reviewed by the guider and parent at the end of the programme so that parents could rate their progress with their targets on a scale of 1 – 10.) Parents and guiders also agreed the focus for their initial video; they were encouraged to choose an activity involving one-to-one interaction between them and their child without toys for this video and it was suggested that they might want to choose an activity involving interaction including toys and/or other people in subsequent videos.

In Week Three, VIG guiders made home visits to the parents to make their first videos. In Week Four, Group One met together to review these edited videos. In the first half of this session, VIG guiders worked with the parents separately to review their individual videos. During this period, parents also chose an activity to focus on in their second video and were encouraged to choose one video clip that they were particularly pleased with which they would like to share with the rest of the group. Then in the second half of the session, all of Group One came together. Each parent/guider group shared a video clip with the rest of Group One, leading discussion about what had gone well in the video. Despite initial nervousness, each parent was willing to share video. As the session progressed, the comments the parents made gave a strong impression that, through sharing and discussing videos, they could see the similarities in the experiences of other parents with their children and also strengths in what they were all doing to support interaction with their children. At the beginning it felt like much of the discussion was coming from the guiders but as time went on the parents spoke up more. The experience of shared group review seemed to extend the self-confrontation element of VIG (Cross and Kennedy 2011), as parents were confronted through the videos not only with examples of effective attunement between themselves and their own autistic child but also with examples of effective attunement between other parents and their autistic children, demonstrating to themselves through their own interactions that this was achievable for them all. For example, throughout the videos there were numerous examples of extended play, turn-taking and shared attention when the various parents encouraged and received their child’s play initiatives. This seemed to engender a sense not just of individual empowerment but also group empowerment. It would not be an over-statement to say that there was a sense of shared joy in the room at these times.

Two further cycles of videoing and shared review took place over Weeks Five to Eight. In their second and third videos, parents chose to include activities involving a toy or game and/or interaction including other family members, thereby exploring their attunement with their children in increasingly complex and socially demanding situations.

Meanwhile, Group Two had six workshop sessions focussing on a range of practical strategies including communication, play, behaviour, occupational challenges, social stories and a final question and answer session. These sessions were led by an autism practitioner and a speech and language therapist, with additional input provided in some sessions by a specialist autism teacher and an occupational therapist.

STUDYING

The hoped-for outcomes for the whole ASPIRE programme were:

  • Reduce parental isolation.
  • Improve attunement between child and parent/adult.
  • Improve management of behaviours.
  • Lessen the impact of autism on communication.
  • Increase parents’ understanding of autism.

However not all of these outcomes would be addressed in the VIG workshop which focused on two of the above outcomes: reduce parental isolation and improve attunement between child and parent/adult. These two outcomes will be discussed.

Method

A mixed method approach was used to evaluate the VIG workshops. This included target monitoring evaluations (TMEs), standardised questionnaires (Parenting Stress Index, Parenting Scale, Eyeberg Child Behaviour, Strengths and Difficulties Questionnaire), non- standardised questionnaires (Parent Experience Questionnaire), semi-structured guider and parent interviews and video analysis. The ASPIRE team had made contact through the AVIG website with a trainee educational psychologist (TEP) at University College London, who wanted to evaluate a project where VIG was used to support children with autism. Because the TEP needed VIG case studies of families with children who had been diagnosed with autism this collaboration made thorough evaluations possible. In addition, ten weeks after the end of the programme the VIG group (Group One) and the practical strategy group (Group Two) were invited to join separate guided discussion groups as part of the Validated Self-Evaluation of the Psychological Service in this Local Authority which was led by Education Scotland.

TMEs

Each family met their guider and targets were agreed at the end of Day Two when there was a presentation about the principles for attunement. The targets agreed variously by parents and guiders were: better communication, better interaction and increased engagement. The targets were then rated on a scale of 1-10 at this point to indicate how the parent currently felt they were doing with this target and what point they hoped to get to by the end of the VIG intervention. The targets were rated again after the last session had finished to indicate the point that parents felt they had reached.

Questionnaires

The standardised questionnaires were chosen and scored by the TEP. They were administered by the ASPIRE team on the Understanding Autism day at the start of the intervention and on the last day of the intervention. The non-standardised questionnaire was administered by the ASPIRE team on the last day of the intervention.

The TEP used thematic analysis as a method of identifying themes / patterns across this set of data. Using the phases of thematic analysis described by Braun and Clarke (2006), a six step process was used to generate themes.

Video analysis

The film analysis was carried out by the TEP using a coding sheet for the attunement principles 1) being attentive 2) initiative and reception 3) interaction 4) scaffolding. The first 10 minute film and the last 10 minute film taken by the guider were rated. At 2 minutes, 5 minutes and 8 minutes the film was rated for the above attunement principles for 1 minute in 10 second intervals. Another rater was used with high inter-rater reliability reported.

Guider and parent interviews

The guider and parent interviews were done on the last day of the intervention by the TEP.

Guided discussion groups

The VIG guided discussion group was facilitated by a VIG supervisor unknown to the group and the practical strategy group was facilitated by the Development Officer for Support for Learning, also unknown to the group. Questions asked were: which parts of the ASPIRE course did you find most helpful, what was the most important thing you learned, what strategies from ASPIRE have you been able to incorporate in everyday life and what else on reflection would you like to be included in the future?

     Participants

In total five families, including two couples and a mother and her mother (i.e. maternal grandmother), participated. Two children were aged 3 years, one 5 years, one 6 years and another 8 years. All children resided within the Local Authority area and had a fairly recent diagnosis of autism.

Results

TMEs

Each parent rated an improvement in their target.

Baseline average = 3.2   Hoped for average = 6.6   Achieved average = 7.4

Averaged difference between baseline and achieved = 4.2.

Standardised Questionnaires

Parenting Stress Index; measured parents’ reported levels of stress in relation to their child’s behaviour – 1 significant, 1 opposite direction, 2 not significant.

Parenting Scale; measuring parents’ perceived parenting style – none significant.

Eyberg Child Behaviour Inventory and Strengths and Difficulties questionnaire: measured parents’ report of frequency of their child’s perceived problematic behaviour – 1 significant for both questionnaires, 2 not significant, 1 did not hand in this questionnaire.

Non- standardised questionnaires

The themes identified were similar for the parent questionnaire and the guider interviews.

  • Parents’ confidence increased; they became aware of their own skills; enjoyment; unsure at the start of the intervention.
  • Parents saw their interactions more positively; video evidence was seen as important.
  • Importance of support from the group and guider.

Table 1.1 Video Analysis Pre- and post- comparisons were made between the frequency and type of attuned interactions. The percentages in the table below refer to frequency percentages in the minute analysed.

ID Principles Session 1 (pre) Session 3 (post)
ID 1 Being attentive

Initiative and reception

Interaction

Scaffolding

Total

18%

10%

 

3%

3%

10%

30%

10%

 

3%

2%

15%

ID 2 Being attentive

Initiative and reception

Interaction

Scaffolding

Total

20%

10%

 

6%

2%

11%

24%

13%

 

1%

6%

14%

ID 4 Being attentive

Initiative and reception

Interaction

Scaffolding

Total

18%

8%

0%

1%

9%

28%

9%

4%

1%

13%

ID 6 Being attentive

Initiative and reception

Interaction

Scaffolding

Total

26%

12%

 

1%

5%

14%

27%

10%

 

0%

8%

15%

Guided Discussion Groups

Parents from both groups spoke enthusiastically about what they had learned in their groups. They had all found their groups supportive. However, each group felt they would have liked to have had the input which the other group had in addition to the input they had received in their own group. The VIG group felt they had more knowledge and understanding of their own child’s autism and felt more confident in their own interactions with their children but would have liked more knowledge of autism-specific strategies. The workshop group felt they had good knowledge of autism-specific strategies but felt less confident in their own ability to put these into practice with their own children. Specifically, they would have liked:

  • ‘strategies for both groups and in particular strategies on what video is highlighting to move forward;’
  • ‘personalised support strategies;’
  • taking time after the VIG session to talk about strategies that might help.’

Discussion of Results

Hoped for outcomes for the VIG workshop; 1) reduce parental isolation and 2) improve attunement between child and parent/adult.

  • As can be seen from the thematic analysis of the non-standardised questionnaire given at the end of the intervention and the guider interviews, one of the main themes identified was the support given by the guider and the group. Many of the parents’ comments indicated a reduction in social isolation e.g. ‘’The most valuable thing to me was to have a ‘real person’ – seeing me interacting with my children and being able to show and explain how that interaction went via the video clips….I had a good relationship with the VIG guider – we immediately hit it off.”(ID1)
    “Having the right guider helped. I think if I didn’t have such a good bond it   might not have gone so well.”(ID4)
    “I really liked the group element….watching other people’s videos has been helpful too” (ID6)
    ‘’Being in a group was helpful – realising I was not alone going through these challenges’’ (ID4)

Strength- based discussion was very strongly modelled by the guiders in the individual shared review which preceded the group review and in the group discussion. For example guiders helped parents to see themselves listening attentively to their children and reading their children’s responses accurately. Guiders noted how well parents managed to skilfully share their attention to include their child who has autism as well as their siblings. This particular group of parents were also very positive. There is clear indication to continue with the group part of the intervention and it will be of interest to see if this result continues with different groups of parents.

2) As can be seen from the Table 1.1 Video Analysis the parents were seen to be more attuned to their children. In particular the ‘being attentive’ principle increased for all four families.

The TEP had additional hoped-for outcomes: reduction in parental stress, decrease in parents’ perception of child’s problematic behaviour. These were evaluated using standardised questionnaires with mixed results.

From the TMEs each parent identified a move towards their own target.

These 5 case studies show positive outcomes. Because the study sample was small and from one Local Authority it is not possible to generalise to the rest of the population. However, it is an important test for change and suggests the pathway should be rolled out further. It was clear from the guided discussion group that parents wanted both VIG intervention and strategies, possibly combined, using video to learn and discuss strategies tailored to their child.

ACTING

The Act stage in this exciting and long-term programme will be to roll out ASPIRE across this Local Authority and to continue to evaluate it qualitatively and quantitatively.   The team has felt encouraged to do this by the positive responses from both groups of parents and the positive results from the video analysis. Of course, this has challenges which need to be worked through. The key current challenges are:

1) How to provide both the strategies workshops and VIG to parents

2) How to deliver the programme to the very remote parts of this Local Authority

3) Putting in place robust and focussed evaluation measures.

1) Parents told the team that what they wanted from the programme was both autism specific strategies (which they got from the workshops) and also the increased understanding of their own child’s autism and the confidence to put the strategies into practice (which they got from VIG). The multi-agency Autism Training Group met to discuss two possible models for providing both strategies workshops and VIG: either meshing the approaches so that strategies are discussed during the VIG shared reviews or offering strategy workshops and VIG shared reviews on alternate weeks. It was decided that the second model will be used for the next round of pilots to make most effective use of both the time and expertise of a range of multi-agency staff who will be involved in delivering various aspects of the programme. This will also mean that the programme will now run over a longer period (9 weeks). The training team has discussed that some families may find it difficult to commit to this many sessions. However, it was also noted that parents who took part in the first pilot talked about wanting the support from the programme to last longer. The impact of a longer programme will be one aspect for further study.

2) In order to deliver ASPIRE to the remoter parts of the Local Authority, multi-agency teams are needed with at least one member trained in VIG. The Psychological Service in this Local Authority has trained all the pre-school home visiting teachers in VIG. These teachers are part of the Psychological Service and live and work in all areas of the Local Authority, both urban and rural. Their involvement is seen as a vital part of the strategy to roll out ASPIRE.  Additionally, multi-agency teams already exist delivering other aspects of autism training locally throughout the Local Authority so there is scope to explore further involvement from these multi-agency colleagues in co-delivering ASPIRE in all areas. In the next round of pilots, the ASPIRE programme will run once again in the largest urban area in the Local Authority. It will also run in one or two rural areas with smaller groups of parents. Local groups of multi-agency colleagues have needed to come together and work together in order to make this happen.

3) Whilst the evaluation results from the pilot study were encouraging, the APSIRE development team now recognise the need to be much clearer from the outset regarding hoped-for outcomes and appropriate evaluation measures for these. For example, any questionnaires used need to be sufficiently fine-tuned to demonstrate change that can be seen in a 9 week period   Also, although it was encouraging that the video analysis showed change in the hoped-for direction, the team hypothesise that the change might be seen to be more marked if pre- and post- intervention videos of comparable interactions were analysed rather than analysing the first and third VIG videos. It is to be hoped that clarity regarding evaluation measures will produce even stronger evidence of effectiveness which will in turn support the longer term roll out of this programme.

Heather.Sked@highland.gov.uk

REFERENCES

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

British Broadcasting Corporation (2016) http://www.bbc.co.uk/news/health-37729095 accessed 9.4.17

Clubb, M. (2012) ‘An evaluation of EarlyBird and EarlyBird Plus over seven years: the benefits of parents and school staff being trained together.’ Good Autism Practice, May 13 (1), 69-77.

Cross, J. and Kennedy, H. (2011) ‘How and why does VIG work?’ In H. Kennedy, M. Landor and Todd, L (eds) Video Interaction Guidance: a relationship-based intervention to promote attunement, empathy and wellbeing. London: Jessica Kingsley Publishers.

Dunsmuir, S., Brown, E., Iyadurai, S. & Monsen, J. 2009 ‘Evidence-based practice and evaluation: from insight to impact’ Educational Psychology in Practice Vol. 25 Issue 1

Gibson, K. A. (2013) ‘Appreciating the world of autism through the lens of video interaction guidance: an exploration of a parent’s perceptions, experiences and emerging narratives on autism.’ Disability and Society 29, (4), 568-582.

Green, J., Charman, T., McConachie, H., Aldred, C. et al. (2010) ‘Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial.’ The Lancet, 375, 2152-60.

Kennedy, H., Landor, M. and Todd, L. (eds.), (2011) Video Interaction Guidance: A Relationship-Based Intervention to Promote Attunement, Empathy and Wellbeing. London: Jessica Kingsley Publishers.

National Institute for Health and Care Excellence (2013) Autism spectrum disorder in under 19s: support and management. National Institute for Health and Care Excellence.

Pickles, A., Le Couteur, A., Leadbitter, K., Salomone, et al. (2016) ‘Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial.’ The Lancet, 388, 2501-09.

The Scottish Government (2011) The Scottish Strategy for Autism. Edinburgh: The Scottish Government.

The Scottish Government (2016). National Improvement Framework for Scottish Education: achieving excellence and equity. Edinburgh, Scottish Government.

 

 

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Supporting adoptive families through Video Interaction Guidance. Jane Leighton

Supporting adoptive families through Video Interaction Guidance.

Jane Leighton

Introduction

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

Video Interaction Guidance and the concerns of adoptive families

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

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

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

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

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

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

Aims

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

Method

Participants

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

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

Procedure

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

Measures

Questionnaires

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

Video Analysis – Parenting sensitivity

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

Qualitative analysis

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

Results  

Parenting confidence

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

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

Impact on child psychopathology and prosocial behaviour

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

Impact on parenting sensitivity

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

Impact on client intervention goals

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  1. Changes in self-perception: VIG helped clients to be confident in themselves as parents and not to feel judged by others. It improved their self-efficacy giving them a ‘can do’ attitude.

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

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

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

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

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

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

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

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

 These are further illustrated in the graphic below:

Discussion

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

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

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

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

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

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

Jane.Leighton@schoolschoice.org

 

 

 

References

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

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

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

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

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

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

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

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

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

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

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

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

Kennedy, H, Landor, M., and Todd, L. (eds) (2011). Video Interaction Guidance: A Relationship-Based Intervention to Promote Attunement, Empathy and Wellbeing. London: Jessica Kingsley.

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

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

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

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

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

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

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

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

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

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

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

Appendix I

TARGET MONITORING AND EVALUATION FORM

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

Target IA – initial:

Describe target

 

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

 

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

 

Target IB – initial:

Describe target

 

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

 

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

 

Target IC – initial:

Describe target

 

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

 

 

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

 

EVALUATION. TO BE FILLED IN AT THE END ONLY

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

VIG GUIDER:  

 

 

CLIENT:  

 

 

 

Appendix II

Video analysis scoring sheet

Video coding table

Scorer__________________ Participant_________________________

Pre__________ Post___________

Contact time Adult initiative Child initiative Attuned Discordant Missed

 

Distance learning (DL) in VIG and VERP. Miriam Landor

Distance learning (DL) in VIG and VERP (Text taken from poster presentation to Association of Video Interaction Guidance UK (AVIGUK) 7th International Conference in Glasgow ‘Video Interaction Guidance- Closing the Gap’ May 2017)

Miriam Landor

Introduction

Increasingly, Video Interaction Guidance (VIG) and Video Enhanced Reflective Practice (VERP) trainees and supervisors are availing themselves of cloud video platforms such as Skype or Zoom to meet together virtually, and of cloud storage such as Dropbox or Google Docs to share video clips, in order to facilitate ‘distance learning’ (DL).

The following survey responses came from a convenience sample of 9 (3 trainees in Stages 2, 3 and 4; 3 full supervisors and 3 national supervisors). They engaged in distance learning methods for:

  • training (Introductions to Stages 2, 3 and 4);
  • transition / accreditation meetings at Stages 1-3;
  • shadowing experienced supervisors delivering the above training and transition / accreditation meetings;
  • supervision at Stages 1 – 4.

Reasons given for distance learning were: being in a different area or country; avoiding time-consuming city travel; and supporting an anxious new trainee.

Quality of relationship with DL

There were more positive comments about the quality of the DL relationship than negative; some examples follow:

+   Can even be closer as trainee can have uninterrupted time in relaxed setting, often in own space;

+   Supervisor can extend safe challenge as trainee feels relaxed;

+   Greater depth achieved in reflective discussion during supervision as trainee has to prepare more fully in advance;

+   Not negatively affected by distance learning;

–     Takes more time to warm up and get to know each other;

  • Not so good in group setting;
  • Can be difficult understanding different accents
  • Some trainees find technology challenging making difficult conversations easier when face to face.

Pros and cons of the DL technology

Some of the technological features were named as pros by some and cons by others, so DL technology can be facilitating when it works well and a barrier when it does not:

+   Overcomes constraints of distance and travel time;

+   Less obtrusive during observation e.g. can note-take;

+   Clear sound and vision;

+   Can ‘share screen’ to show video clips;

+   Access is free;

+ Can share group training session with supervisor and trainees each in a different country, saving supervisor time and allowing trainees to share fees;

  • Can’t see other’s desktop (video clip) and their face at the same time (may be bandwidth / connection problem or organisation’s firewall);
  • No / poor sound when sharing screen (video clip) on Skype; better quality on Zoom, but payment required after short initial free period if using a group call;
  • Takes time – to learn how to use the technology, to share video in advance and to prepare transcriptions;
  • Tools to video record a Skype meeting (e.g. for intervision) are expensive or incomplete;
  • When joining a physical group virtually, can be hard to take a turn or to hear people further away from camera; need to appoint a facilitator for each virtual participant and use table microphones.

‘What I appreciated about this DL opportunity’

Most respondents made similar points. They are grouped and summarised here:

  • Great learning experience, enjoyed the challenge;
  • Overcame barrier of distance, eased financial constraints; couldn’t have done it without DL;
  • Opportunity to work with others from different cultures and settings and with greater expertise;
  • Observations less intrusive;
  • Made me more proactive in networking, more competent with technology, more organised.

‘Could be (even) better if….’

  • Face to face meetings built in at key points / from time to time;
  • Better video conferencing package:
    • Group facilitation enabling more natural conversation;
    • Better screen sharing;
    • Better sound;
    • Easier access to video recording DL meetings.

Next steps for distance learning in VIG and VERP? – some comments

  • “I would like to do more VIG training and supervision through distance learning…”
  • “I’d love to explore VERP options for distance learning…”
  • “We need AVIGuk to work on adapting the training for alternative methods of delivery.” 

A final quotation as summary:

“I was just amazed that technology could make a 3 way training session with each participant in a different country possible! It was a great opportunity.”

Acknowledgements

With thanks to all the participants for their full and thoughtful answers.

If you have any queries please contact Miriam.landor@gmail.com

Reading recommendations

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

Kennedy, H., Landor, M. and Todd, L. (2015) Video Enhanced Reflective Practice: Professional Development through Attuned Interactions. London: JKP

http://www.iadl.org.uk/FreeeBooks.htm (free downloads from International Association for Distance Learning

 

 

NEW! AVIGuk VERP training pathway – a pilot. Miriam Landor, Clare Lowry, Michelle Sancho (AVIGuk Board Members)

NEW! AVIGuk VERP training pathway – a pilot. (Text taken from poster presentation to Association of Video Interaction Guidance UK (AVIGUK) International Conference in Glasgow ‘Video Interaction Guidance- Closing the Gap’ May 2017)

Miriam Landor, Clare Lowry, Michelle Sancho (AVIGuk Board Members)

What is the VERP training pathway?

It is a parallel training to VIG. Like VIG training, it consists of three stages to full accreditation as a VERP guider (with a Stage 4 for those who wish to train to be a supervisor).

Who is the VERP training pathway designed for?

This ‘VERP training pathway’ is about becoming a VERP guider as an alternative to becoming a VIG guider, from beginner level up until full accreditation; it is for those who do not work with families but who do have an involvement with the professional development of others, and who espouse the VIG values, beliefs and method. Accredited VERP guiders and VERP trainee guiders will deliver VERP sessions, 1-1 or in small groups, to VERP participants who wish to improve their interaction skills in their workplace.

Who can deliver VERP training and supervision?

In line with AVIGuk practice, only Advanced / National supervisors can lead the delivery of the VERP ITCs (Days One, Two and Three) to VERP trainee guiders.

Stages of VERP training

The first stage is experiential, and trainees will undertake VERP courses as a participant, working on some aspect of their own professional development. Following a half-day VERP Initial Training Course (ITC), they will micro-analyse video of themselves in their workplace, in accordance with the Principles of attuned interactions and guidance (PAIG) and with their self-set goal (helping question) in mind. At least some of this experience must be in a group of 3-5 VERP trainees (using virtual means e.g. Skype if necessary). They will sign up with an AVIGuk supervisor, who may provide some of their VERP sessions or who will help them access other VERP sessions.

A second half-day ITC (Day One part 2) follows for VERP trainees only. In total both half-days cover similar input to Day One of VIG ITC.

In Stage 2 the VERP trainee will take part in a one-day VERP ITC Day Two (similar to VIG ITC Day Two), and will then deliver VERP to participants, in 1-1sessions. These participants are people who wish to improve their professional skills in their work practice and who have a genuine ‘helping question’. During Stage 2 the VERP trainee will video-record all their VERP and take these videos to supervision.

In Stage 3 the VERP trainee will now take on small groups of VERP participants (2-4), following a one-day training session (VERP ITC Day Three). They will deliver the half-day VERP ITC part 1 to the groups, observed (in person or by video) by their supervisor. In all other respects Stage 3 follows the same practice as Stage 2.

There will be transition / accreditation sessions with a different supervisor to the trainee’s own, at the end of each Stage, finishing with AVIGuk registration as a full VERP guider – i.e. able to work independently with regular intervision. Work on Stage 4, training to be a VERP supervisor, will follow.

AVIGuk-accredited VIG guiders / trainee guiders delivering VERP

The following groups will continue to be able to deliver VERP sessions to participants without being required to undertake the new VERP training:

  • Stage 3 VIG trainees who wish to deliver some VERP sessions whilst they are still under supervision themselves.
  • AVIGuk-accredited full VIG guiders who wish to deliver VERP sessions.

In line with the apprenticeship model of VIG training, they should first observe an experienced guider delivering VERP, and then be observed themselves, before beginning to deliver VERP independently.

VERP participants

The full VERP training pathway will not be necessary for professionals who want to engage in a VERP course as a participant in order to improve their own professional skills in their workplace, as long as they are not intending to facilitate the development of others by delivering VERP.

If you have any queries please contact Miriam.landor@gmail.com

References

Kennedy, H., Landor, M. and Todd, L. (2015) Video Enhanced Reflective Practice Professional Development through Attuned Interactions. London: JKP

 

 

 

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

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

Caroline Feltham-King and Jane Leighton

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

Introduction

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

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

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

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

Interaction and Guidance – theories of intersubjectivity and mediated learning:

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

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

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

Based on research by developmental psychologist Colwyn Trevarthen, a video feedback method using the ‘principles of attuned interactions and guidance’ (Kennedy, Landor & Todd 2011) was developed in the 1980’s by Harrie Biemans in the Netherlands. Since then, VIG’s therapeutic approach has been applied across the world in an increasing variety of contexts, including classrooms and care homes (Brooks, 2008). Instead of directing or demonstrating to a client how to improve their interpersonal skills, the guider negotiates goals for change and then videos a short sequence of the client sharing an activity with the person they wish to engage more effectively, in their usual setting (e.g. home). The guider shares carefully edited examples of attuned sensitivity shown by the participant in response to the other and invites them to identify the specific verbal and non-verbal skills that are proving positive within the relationship they seek to deepen. This ‘cycle’ of filming and shared review is repeated, new narratives considered and progress towards the client’s goals celebrated. Insights and working points are recorded on a collaborative ‘traject’ plan that captures the systemic nature of the approach.

Service models

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

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

Research Projects

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

Evaluation Methods

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

Examples of ‘helping questions’ negotiated with parents include:

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

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

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

Evaluation Themes

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

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

These are illustrated in the graphic below:

Issues to hold in mind

Fear of professionals

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

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

Loss

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

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

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

Trauma

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

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

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

Blocked trust and blocked care

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

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

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

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

Rage

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

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

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

Invitations and Patterns

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

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

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

Concluding comments

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

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

caroline.feltham-king@hants.gov.uk

References

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

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

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

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

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

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

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

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

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

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

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

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

Kennedy, H, Landor, M., and Todd, L. (eds) (2011). Video Interaction Guidance: A        Relationship-Based Intervention to Promote Attunement, Empathy and Wellbeing.       London: Jessica Kingsley.

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

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

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

Appendices

Appendix A: Traject Plan for Adoptive Families

Appendix B: Target Monitoring Evaluation Tracking Form

Appendix C: Parent Evaluation Form 

Video Interaction Guidance Traject Plan / Summary for adoptive families

Child development

 

 

 

 

 

 

 

Adult communication skills and

personal development needs

Family development

Daily living

 

 

 

 

 

 

 

Wider support and inclusion

Name(s):

 

Date:

Helping question(s):

Appendix A: Traject Plan/Summary for adoptive families CFK

 

 

 

 

Hampshire and Isle of Wight Educational Psychology Service

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

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

 

Helping Question 1:

 

Helping Question 2:

 

Helping Question 3:

 

 

 

 

Hampshire and Isle of Wight Educational Psychology Service

Family Support using Video Interaction Guidance (VIG)

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

 

Name:  ______________________________________________________                  Date: __________

 

Name of child(ren):_______________________________________________________________________

Relationship to child(ren) (please tick):

Birth parent □                     Prospective adoptive parent □                    Adoptive Parent □

Foster parent □                  Special Guardian □                                               Other □

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

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

 

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

 

 

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

 

 

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

 

 

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

 

 

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

i. For yourself?

 

ii. For your child?

 

iii. For your family life?

 

 

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

i. In yourself?

 

ii. In your child?

 

iii. In your family life?

 

 

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

 

Yes, definitely                                    Maybe/not sure                               No

 

Please say why you have chosen your answer:

 

 

  1. Please add any other comments:

 

 

 

Video Interaction Guidance: Closing the Gap. 7th AVIGuk International Conference 2017, Glasgow. Report on Day Two. Ailsa Darling and Eveline Chan

Video Interaction Guidance: Closing the Gap. 7th AVIGuk International Conference 2017, Glasgow. Report on Day Two

Ailsa Darling and Eveline Chan

Introduction

The VIG 2017 International Conference was held in Glasgow and had strong contributions from Glasgow and North Lanarkshire Psychological Services. Following on from the first day of the conference, Fiona Williams (Senior Educational Psychologist in Glasgow North-East and Advanced VIG Supervisor) introduced the second day of the conference hosted by Glasgow City Council. The event was held in Glasgow City Chambers and attended by VIG trained practitioners. The day took a ‘World Café’ format, with ten tables thematically linked to the National Institute for Health and Care Excellence (NICE) guidance where VIG is recommended, to allow discussions about practice issues and consultations about how the method and its governance should develop.

Five ‘practice’ tables provided practitioners with an opportunity to share their knowledge and expertise from their respective roles. Five ‘process’ tables also enabled members of AVIGuk to put forward their ideas and opinions to influence the future direction of the Association. This paper details a summary of the day’s discussions written by two Trainee Educational Psychologists highlighting key themes and reflections.

Practice Themes

VIG & Attainment: Facilitated by Rhiannon Quinn and Imogen Wootten

Aim: The overarching question considered by the group was, ‘How do we evidence impact?’

In Scotland, the poverty related Attainment Challenge is at the forefront of practitioners’ practice in education and increasingly, VIG has been used across local authorities to tackle attainment issues, though the overarching question considered by the group was ‘How do we evidence impact?’ Discussions reflected the recognition of VIG as having a positive impact but it seems evidencing the effect on attainment outcomes is challenging and yet to be done. With the increased pressure to evidence attainment, a key theme which emerged was the methodological complexities of capturing quantitative data for an intervention which typically yields that of a qualitative nature. It was recognised that research indicates the positive impact of VIG / Video Enhanced Reflective Practice (VERP) on the development of relationships and resilience in children and that building our personal knowledge and awareness of that will support our practice. Practitioners shared ideas and experience of measurement tools used for attainment outcomes. Some of these include the ‘How Nurturing is Our school?’ (HNIOS) framework developed by Education Scotland, use of the York Assessment of Reading Comprehension (YARC) to track literacy and use of video-coding pre-and -post VIG intervention. It was acknowledged that the interpretation of attainment and its measures may differ across authorities, though the increase in demand for outcome measures calls for better collaborative working between local authorities to allow for the development of evidence based practice.

VIG & Autism: Facilitated by Jo Birbeck and Heather Sked

Aim: The overarching question of, ‘How is working with autism different to working with other families?’ was posed to the group.

Practitioners reflected on and shared their practice with the general feeling that they bring the same components and qualities to their work whether autism is presented or not. The VIG process remains the same in relation to videoing, micro analysis and the shared review. Attention was given to the significance of analysing non–verbal communication when working with autism. VIG enables practitioners to break down something that might feel quite simple and straightforward, such as eye contact, though in reality, this is a complex process where VIG can facilitate the finer analysis of non-verbal communication which is crucial for autism. Furthermore, the role of ‘being curious’ for both the parent and VIG guider was recognised as a key component to success in the process. Other factors such as timing, a willingness to change and being mindful of the parent’s goals versus the VIG guider’s goals were also considered as key elements to success.

Difficulties in embedding and adopting VIG as ‘a way of working’ were identified. It was recognised that the implementation issues to systemic working were similar to that of direct individual work. These related to establishing buy-in and getting people on board, commitment of time and availability of resources such as funding and staff capacity. Factors which support the practice of VIG were identified as a shared understanding of the roles and responsibilities of the VIG guider and support from management to fulfil this role. 

Video Enhanced Reflective Practice (VERP): Facilitated by Heather McLean and Maureen Granger  

Aim: The overarching issue of how to approach the implementation of VERP was considered by the group.

Potential issues regarding the complex process of implementation were considered. Discussions reflected the potential barriers in engaging clients with VERP. Highly vulnerable clients were highlighted as particularly difficult to engage, therefore practitioners considered the use of other interventions to first promote engagement before using VERP.

The involvement of managers in VERP training was viewed as a positive way to effectively engage practitioners within an organisation to participate in VERP sessions and to value VERP as an intervention. Discussions also explored the use of VERP alongside other initiatives such as precision teaching, numeracy and literacy programmes and nurturing approaches. Positive experiences in implementing these were highlighted when initiatives have been flexible enough to allow the focus to be on attunement and relationships.

Clear group expectations from the initial stages of VERP training were also perceived to support the implementation of VERP, through establishing a supportive group environment and ethos required for reflection for personal learning and progression. The balance of group participation versus the power of the individual reflecting on their own practice was considered, alongside the role of the facilitator in supporting this through effective questioning and appropriate modelling.

VIG and Attachment: Facilitated by Sandra Strathie and Anita Heyes

Aim: The question of ‘Should we be talking about VIG in relation to attachment?’ was addressed by this group.

The overarching question stimulated conversation, with a general agreement that this depends on what we mean by attachment and also the context in which we work. Practitioners agreed that instead of attachment we should perhaps be considering relationships, attunement and wellbeing. Although many practitioners acknowledged the term ‘attachment’ is often used within a professional context as it often forms part of their training, it was felt that the language of ‘attuned relationships’ is much more supportive and makes more sense for families. Practitioners perceived attachment to be more of a professional descriptor which can often come with a connotation of blame that is contrary to the principles and values of VIG, which focuses on the idea that positive change is possible and all are trying the best they can. Furthermore, categorising individuals as having a particular attachment style was viewed as unhelpful to VIG as an intervention, as a label can encourage individuals to feel change is less likely. Furthermore, practitioners suggested this could be addressed by promoting the power of VIG in detracting from these labels and by developing a philosophy of encouraging positive relationships and attunement. On the other hand, practitioners felt that VIG should still be suggested as an effective intervention for promoting positive attachments within the NICE guidance. The use of VIG as a strength-based assessment method for attachment was also highlighted as a supportive strategy in encouraging engagement with families.

VIG for Children on the edge of Care: Facilitated by Calum Strathie and Fiona Williams

Aim: The overarching question of how to appropriately implement VIG with children on the edge of care was considered by the group.

VIG was considered a highly relevant intervention in supporting children and young people on the edge of care and was used by a range of practitioners to support families. VIG was perceived to be beneficial for particularly vulnerable groups of children such as young people within kinship care who often do not receive a lot of support from services. Although kinship care placements were highlighted as more robust in terms of susceptibility to breakdown, several difficulties of implementing VIG as an intervention with this group were recognised. Practitioners identified challenges in engaging families such as the vulnerability of parents and carers, their priorities and their motivation to become a carer. Practitioners discussed the need for the implementation of VIG to be appropriately timed and dependent on individual circumstances. Furthermore, it can act as a positive assessment and evidence of parenting skills.

The implementation of VIG at a systemic level in order to support parents to prevent a child from going into care was also considered. Practitioners shared positive experiences of building staff capacity in VIG in a number of settings, whilst recognising the difficulties in managing dependence of families requiring long-term support. It was suggested that VIG could promote positive relationships and attuned interactions for families who return to services to seek support.

Process Themes 

Training: Facilitated by Helen Gibson and Monika Celebi

Aim: Discussion of the current training model.

It was discussed that the current training model is much more advanced compared to the model 20 years ago. This related to factors such as accountability and level of competency. It was suggested that accountability is perhaps higher nowadays due to the number of complex cases experienced by VIG trainees and practitioners, leading to higher levels of competency. It was also felt that the speed with which practitioners complete the stages does not necessarily reflect a higher level of competency as there are a number of variables which have an impact on trainees’ progression through the stages. These related to the nature of the cases experienced, the receptiveness of parents and teachers to the process, existing skills of the trainee and their circle of support and supervision provided within their role. Practitioners explored how they could adapt the current training model to better support trainees to develop their theoretical knowledge as well as skills in practice. Suggestions of developing new resources were made; however practitioners acknowledged they must be mindful not to re-invent the wheel and thus methods of sharing practice need to be developed. It was agreed that the practice element of each stage of training enables trainees to develop the relevant experience and the process of supervision allows trainees to target their personal learning and working points.

External Communication: Facilitated by Hilary Kennedy and David Gavine

Aim: Practitioners explored methods to better establish communication and relationships between VIG guiders.

Various methods to maintain engagement with accredited practitioners were considered and explored. It was felt that often accredited practitioners do not wish to continue their training to become a VIG supervisor and as a result they will often lose contact with AVIG. One method identified was the possibility of engaging accredited members via CPD registration which would allow AVIG to track, monitor and support the use of VIG beyond the practitioner’s accredited training. Discussions reinforced the need for effective external communication to ensure AVIG can promote what they do, to ensure consistency and fidelity of VIG methodology across countries and to allow for the sharing of good practice. Practitioners explored avenues such as increased use of Skype between VIG guiders to share practice, adapting the website to make this accessible to the relevant people and increasing the promotion of VIG conferences around the world to support effective external communication.

Video Enhanced Reflective Practice (VERP) Training: Facilitated by Miriam Landor and Clare Lowry

Aim: Facilitators delivered a brief around the new VERP training pathway which is currently being developed.

A workgroup within the AVIGuk board were asked to develop a VERP training pathway as a parallel to the VIG training pathway. This was designed for those who wish to espouse the VIG values and principles and way of working but who do not have a remit of individual case work; rather their remit is to support the professional development of others, for which they could use VERP. Traditionally within the VIG pathway, trainee guiders have the opportunity to try VERP during stage three of their training whilst still under supervision. The new VERP pathway will allow non VIG trainees to take up full VERP training as an alternative to the current VIG training. The four-staged pathway of the VERP training was described by the facilitators with questions from current VIG/VERP practitioners. The new VERP training pathway is currently in pilot and will be evaluated at the end of the year. It is anticipated there will be many questions that will be teased out upon review of the model.

Internal Communication: Facilitated by Jenny Jarvis and Sophie Levitt

Aim: Discussion of strengths and areas for development within current methods of communication within AVIGuk.

The internal communication session allowed practitioners to feedback to the board what was working in terms of how the board communicate with AVIGuk members and what could be improved; it also allowed board members to share new developments and changes within the organisation. Members felt receiving updates and alerts via email were helpful in communicating important information. However, facilitators recognised that it can be difficult to relay important information to all members due to the demands of practitioners’ everyday work. Some practitioners felt using a personal email address encouraged them to check for updates.

Furthermore, some practitioners had experienced difficulties providing subscription payments when these are meant to be funded by their organisation, which meant practitioners were often self-funding their subscription and attempting to claim back payments. Some organisations had access to purchase cards (rather than relying on practitioners using personal card details) which it was suggested works well.

Proposed changes in terms of payments from new trainees were highlighted. Trainees will now be asked to pay their subscription at the beginning of their training and will not be able to access the website until they have paid their invoice to make this an easier process. Furthermore, due to difficulties experienced by some organisations, if a contract is taken out organisations will be able to pay the subscriptions directly to the supervisor who will then be responsible for paying the individual subscriptions, rather than using an automatic system. Further information regarding topics highlighted and charging methods for renewal fees will also be announced on the AVIGuk website.

Research: Facilitated by Martin Carey and Stephanie Satariano  

Aim: Discussion of challenges in conducting research and how AVIGuk can support practitioners.

This session acknowledged the challenges practitioners face when conducting research due to the demands of their day to day job and the time consuming nature of research. Facilitators understood the need for research to be manageable and therefore encouraged practitioners to consider ways AVIGuk could support members to conduct research. A number of suggestions were identified such as receiving advice and support from experienced members regarding routine outcome measures and methodologies that practitioners could utilise. The possibility of developing a searchable systematic database of tools, where practitioners could also input data which could later be analysed and reported in research, was highlighted as useful method of collecting and analysing research data. Practitioners also felt setting up a forum to communicate and share knowledge and expertise between members would be beneficial. Furthermore, the idea of a holding a specific research conference which members could attend to seek advice and support in conducting research was highlighted. This was considered to also provide opportunities for networking with other practitioners to conduct collaborative research across the association.

Conclusions

Key themes from the day were summarised and highlighted by facilitators, with each table generating many questions and avenues for future developments of AVIGuk. Practitioners were invited to reflect on how to best take forward these ideas at an individual practice level and also at a systemic level. Practitioners’ ideas captured on the paper tablecloths will be carefully considered by board members to ensure the voices of AVIGuk members are heard and to inform next steps for the Association.

On the whole, Day Two of the International VIG conference 2017 was filled with intellectual discussions and enthusiasm from AVIGuk members, stimulating inspiration and hope that VIG can foster and promote positive outcomes for children and families.

Ailsa Darling, Trainee Educational Psychologist, Glasgow North East Psychological Service.  University of Dundee.  a.darling@dundee.ac.uk                                                                       

Eveline Chan, Trainee Educational Psychologist, Glasgow South Psychological Service. University of Dundee.  e.chan@dundee.ac.uk 

 

 

.

 

 

 

The Fields Children’s Centre VERP Project, Cambridgeshire. Miriam Craddock and Kirsten Branigan

The Fields Children’s Centre VERP Project, Cambridgeshire

Miriam Craddock and Kirsten Branigan

Background:

Video Enhanced Reflective Practice (VERP) has been adapted from Video Interaction Guidance (VIG) in order to support professional development. As described by Landor (Kennedy, Landor & Todd 2015), VERP ‘…uses video to help people (parents, setting staff, professionals) to understand and improve their communication with others. […] VERP uses the VIG approach specifically to increase effectiveness in inter-professional or professional-pupil interaction. It is an effective way of applying VIG to various training, team-building and professional development projects, leading to sustainable growth in communication skills in an organisation. VERP participants bring videos of themselves in a work context to a shared review with an AVIGuk-accredited Guider/s and are supported to reflect on what works well in terms of their attuned interactions’.

VERP uses video to help group members reflect on their communication and skills and consider how things can be ‘even better’. Each member of the VERP group set their own personal goal of what they would like to achieve by the end of the VERP project.

The sessions are led by a VERP guider (an AVIGuk-accredited guider) who supports and encourages participants to identify their ‘attuned interactions’ (communication where two or more people have an effect on each other by being mutually receptive and sensitively responsive) (Kenney, Landor & Todd 2011) and, through micro-analysis of video, to reflect on clips that help them towards their personal goal.

VERP takes place over a number of sessions, with breaks in-between in order to enable participants to record videos. During the sessions, each participant will share their video clip as the rest of the group take on a ‘reflective team’ role. As the sessions develop the VERP guider moves from a supportive, teaching role to a facilitator enabling the VERP participants to take more ownership of their development.

Rationale for the Fields Children’s Centre VERP project

A Video Enhanced Reflective Practice project was commissioned through conversations with a Children’s Centre manager, who was keen to explore training in Video Interaction Guidance (VIG) for family workers in the setting, although financial constraints were a limiting factor. VERP was proposed as a model that would be able to meet the best hopes of the commissioner:

1) to empower and increase confidence of the workers to use video in their work with families

2) to increase the reflective capacity of the team by looking at short clips of their interaction with the parents they work with.

Methodology

An introductory meeting was held with the family workers (n=5) in July 2016. This aimed to share the aims of VIG and VERP approaches, introduce the VIG Attunement Principles (Kennedy, Landor & Todd 2011), outline expectations for VERP training including the content of the course and discuss practicalities around videoing. A two day Initial Training Programme was held over a two week period in September. Day 1 included the co-construction of two group goals and the group’s name, videos to illustrate the principles for developing attunement (Kennedy, Landor & Todd 2011), and the concept of following the client’s initiatives, exercises for identifying attuned interactions on video, and initial videoing practice. Day 2 included completion of baseline measures, setting, scaling and recording personal goals, identifying a parent to work with and support around engagement, preparation and consents for videoing, introducing expectations around recording and micro-analysing video clips for group supervisions and next steps for supervision dates.

Group Goals:

“Use the VIG Attunement Principles to listen to parents/carers and receive what they are saying/thinking/doing to develop a common goal.”
“To further develop confidence in maintaining positive relationships with parents/carers alongside being able to have complex and challenging conversations.”

Individual Goals:

“To develop my confidence in deepening the discussion with parents in order to support the sharing of information during initial meeting.”
“To develop my confidence in noticing, recognising and responding to parents’ initiatives.”
“To be able to empower parents to do something different or to feel they have more control over situations so that they can make changes that will impact on their lives.”
“To help parents to see that they can make changes that will impact on their lives.”
“To feel more confident in my work, letting the parent take the lead more and giving time between conversations.”

Four group supervisions (of 1.5 hours) were held approximately every month between October and February 2017. The Family workers brought videos to supervision where they had found positive moments that showed them using the Attunement Principles in their interactions with parents. Two VIG practitioners worked collaboratively with a team of 5 family workers to explore video together in shared reviews. The VIG practitioners took turns to facilitate with the family workers, supporting each to identify positive moments of attuned interaction and next steps to take forward. A final celebration session was held in March to celebrate the strengths and next steps of interaction of each family worker, re-rating of the VIG Attunement Principles and re-rating of individual and group goals and completion of an evaluation questionnaire. Certificates of attendance were given to each participant as an acknowledgement and celebration of completion of the VERP course for the purposes of CPD record.

Results

Target Monitoring and Evaluation (TME) (Dunsmuir, Brown, Iyadurai, & Monsen, 2009) was used as an evidence-based outcome measurement to measure impact. This is a common tool widely used in Educational Psychology practice to measure the anticipated impact of an intervention, through the use of goal setting over time on a numerical scale. Goal setting with TME pre- and post- data was used with group and individual goals, at baseline and on completion of the VERP course. The TME data revealed positive shifts of 1.5 points for group goal 1, and a positive shift of 3 points for group goal 2 when re-rated on completion of the project. The TME data revealed a mean positive shift of 2.8 points in relation to progress with individual goals, with an overall effect size 1.4  (d= 1.4, where d is mean post TME scores – mean pre TME scores/ SD) which is considered to be a large effect size  (Coe, 2002). However, it must be recognised that the sample size was small, and that the measures were based on self-reports. Participants also completed a self-rating scale on their use of the VIG Attunement Principles pre- and post- project. The self-rating scales showed increased frequency in the participant’s use of the VIG Attunement Principles in their interactions with parents. When analysed by sub-section on the VIG Attunement Principles, the overall effect sizes were significant across all building blocks of the VIG Attunement Principles for attuned interactions:

  • Being Attentive (supporting and attending to a parent’s initiative) d = 63
  • Initiatives and Reception (encouraging and responding to a parent’s initiative) d = 70
  • Attuned Interaction (encouraging turn-taking, giving a parent a second turn on the same topic, receiving their second turn) d =21
  • Scaffolding (extending parent’s responses, balancing leading and following): d = 78 

Qualitative feedback from responses from participants gathered in the evaluation questionnaire and video of final celebration session revealed positive responses from the participants, and an overall sense that the team was more cohesive and connected on completion of the project:

“A brilliant opportunity to reflect on my own practice”      

“I’m much more aware of what I’m doing and able to think ‘why is that happening?’ ”   

 “I found looking at the videos together with trainers who modelled how to home in on small positive interactions really useful.”      

“I am more aware of finding opportunities to introduce appropriate challenge with parents.”       

“I am now more conscious of what I am saying and how I am interacting with others.”    

“I liked being able to see the tiny moments of change … of realisation that something is happening that you don’t normally pick up.”  

“ It is like it has changed the way my brain works … and I can now ask questions at the right time and pick up on parent’s initiatives.”

“It’s been really helpful to watch other people’s videos.” 

“I’ve slowed down and think about what the parent is really saying – it’s like a little seed has been planted and when I’m talking to parents I consciously think about what they are thinking.”

Illustration of a VERP Group Supervision session

Discussion: reflections, spin-offs, and implications for future practice

In addition to the significant effect sizes across all blocks of the VIG Attunement Principles for attuned interactions evidenced in the statistical analysis, the five family workers also reported increased confidence in their interactions with parents. Moreover both VERP guiders reported increased confidence in facilitation of a VERP shared review with respect to attuned reception of initiatives of up to 5 participants within a Group supervision session. Although not formally evaluated with a self-rating scale, it was concluded that this could be considered for the evaluation of future VERP projects.

A poster presentation of the project was delivered at the AVIG UK International Conference ‘Video Interaction Guidance – Closing the Gap’ Glasgow May 2017, and again at an Eastern Region Video Interaction Guidance Practitioner Day, Suffolk June 2017. This led to further conversations with VIG practitioners about setting up similar projects in up to three Local Authorities across the UK, with whom the lead author has been in email correspondence subsequent to the conference. Moreover, interest in the commissioning of future VERP projects has also been generated locally with Cambridgeshire based VIG practitioners across a range of contexts: Social Care, Children’s Centres and a local area Special School. Four out of five family workers from the Field’s Children Centre reported enthusiasm and motivation to begin VIG training, when funding becomes available.

The VERP facilitators have reflected with whom to share the results from this current VERP project to engage potential commissioners. Reflection on completion of the Project has also concluded that participants were observed to need additional modelling on how to identify positive attunement at the start of the project. They also reflected on physical positioning within the shared review to enable empowerment, as well as how to support the organisation of time to support micro-analysis of videos between supervisions within the context of the demanding role of a family worker in a Children’s Centre. The commissioner of the current VERP project joined the final celebration session, and shared the impact that the project had had for staff confidence; they also felt empowered to report the significant outcome data and qualitative feedback into Cambridgeshire’s LA Ofsted inspection, when the setting was selected to feed into the inspection. Project costings have been reflected on, with conclusions in respect to market value, indicating that the project is a ‘good spend’ in being able to evidence the impact of its overall aim: to support the continuing professional development of a team.

Miriam.Craddock@cambridgeshire.gov.uk

References

Coe, R. (2002) It’s the effect size, stupid. Paper presented at the British Educational Research Association annual conference, Exeter, 12-14 September 2002

Dunsmuir, S., Brown, E., Iyadurai, S. & Monsen, J. 2009 ‘Evidence-based practice and evaluation: from insight to impact’ Educational Psychology in Practice Vol. 25 Issue 1

Kennedy, H, Landor, M., and Todd, L. (eds.) (2011). Video Interaction Guidance: A Relationship-Based Intervention to Promote Attunement, Empathy and Wellbeing. London: Jessica Kingsley.

Kennedy, H., Landor, M., & Todd, L. (eds.) (2015). Video Enhanced Reflective Practice: Professional development through attuned interactions. London: Jessica Kingsley