The evidence–base for the effectiveness of video interaction guidance has been developing
in various ways over the past 20 years and in this article we will outline some of
these. One of the difficulties in the evaluation of any intervention is that the
method may vary from one practitioner to another and between contexts. Furthermore,
interventions which have different names may be almost identical in reality. Therefore,
in determining the effectiveness of video interaction guidance as developed in the
UK since 1995 we can examine not only the relatively small-scale studies carried
out in the UK but also findings using randomised controlled trials from other approaches
that have features in common or are closely related.
Firstly, we draw attention to evidence that the features that are central to video
interaction guidance are features of effective intervention. Meta-analyses of the
effectiveness of attachment-based interventions carried out in the Netherlands (Bakermans-Kranenburg
et al. 2003) found that relatively short interventions using video-feedback were
more effective than those without and that interventions that focused on adult sensitivity
alone were the most effective. In the UK, key findings from a review of studies
conducted by the Department for Children, Schools and Families (Barlow & Schrader-MacMillan
2010) indicate that targeted early interventions that are aimed at increasing parental
sensitivity and promoting attachment are effective in preventing emotional maltreatment.
They cite evidence of the effectiveness of video interaction guidance in improving
parental sensitivity. Video interaction guidance has now been selected to be included
as one of the European evidence–based interventions in the follow-up to the above
review (Dataprev 2011). Video interaction guidance was one of two recommended programmes
in the NSPCC’s evidence to England’s review of the delivery of early interventions
(NSPCC 2010).
A further meta-analysis of studies using video feedback concluded that parents become
more skilled in their interactions with their children, and have a more positive
perception of parenting which helps the overall development of their children (Fukkink
2008). The paper claims that in addition, interventions using video feedback are
not only influential in increasing parental sensitivity, but that this results in
behavioural and attitudinal changes towards their children. The specific gains are
in reducing parental stress and increasing self-confidence in parenting.
We turn now to the effects of video interaction guidance as it has been implemented
and evaluated in The Netherlands. Depending on the employment setting of the practitioners,
the interventions have various names but all have a close resemblance to video interaction
guidance as practiced in the UK. The meta-analysis of 29 video-feedback studies
(Fukkink 2008) contained a subset in which video interaction guidance (mostly Video
Home Training) was utilised. Various family contexts featured, as well as a range
of difficulties (hyperactivity, crying babies, family difficulties etc), and the
ages of the children in the interventions ranged from 0.2 years to 8 years. These
studies suggest positive effects for video interaction guidance (VIG) over and above
the effect of video feedback (VF) alone (figure 1). The aggregated effect sizes in
the meta-analysis for these studies were, 0.76 (i.e. medium to large effect) for
the behavioural domain (the effect on parent skills) and 0.56 (i.e. medium effect)
for the attitude domain (the effects on parent attitudes). The effect size was 0.42
(i.e. small to medium effect) for the development of children in this study. This
meta-analysis provides empirical evidence that video interaction guidance enhances
positive parenting skills, decreases/alleviates parental stress and, finally, are
related to a more positive development of the children.
Figure 1
Effect sizes for experimental outcomes of VF and VIG studies
A criticism that could be made of a number of the studies is that their sampling
methods were insufficiently stringent. However, Fukkink (2008) identified two studies
that used randomised control research designs and both of which reported positive
results. One of these is an evaluation of Video-feedback Intervention to Promote
Positive Parenting (VIPP). This method, very similar to video interaction guidance,
is the result of research carried out by Femmie Juffer and her team in Leiden. They
have produced an important book called Promoting Positive Parenting (Juffer et al.
2007a) summarizing research carried out over the last 20 years. It contains results
of high quality randomised controlled studies, summarised in figure 2, demonstrating
that interventions that promote sensitivity and use video are effective and that
VIPP in particular is effective in promoting sensitivity between parents and young
children with attachment and feeding difficulties.
Fig 2
Effect size for randomised control trials of VIPP compared to a meta-analysis of
attachment-based interventions
Evidence of the enduring impact of parent sensitivity on child behaviour was shown
by Klein Velderman (2005, see also Juffer et al 2007b) comparing VIPP on its own
with a condition in which a “representational” component was added (i.e. VIPP-R,
intervening in how the mother saw her understanding of her own attachment). A group
of 81 first time mothers, selected on the basis of insecure attachment representation,
were randomly assigned to VIPP, VIPP-R or a control group. In the short-term (T1
= 6 months, T2 = 11-13 months) the mothers in both intervention groups were significantly
higher in maternal sensitivity than in the control group. The rate of disorganized
attachment was significantly reduced. At 3 years the children in both intervention
groups exhibited fewer externalizing behaviour difficulties. Interestingly the group
who received VIPP plus discussions of past attachments showed significantly fewer
gains than those receiving VIPP alone.
Finally, we turn to data reported by Kennedy, Landor & Todd (2010) from an intervention
in the UK using video interaction guidance to promote early attachments in families
who were considered hard-to-reach. Robertson and Kennedy (2009) looked at the effect
of VIG as an intervention in a residential treatment centre where parents are placed
with their children for three months as a result of court orders due to child protection
concerns. Results from naturally occurring data suggests that video interaction guidance
is effective in families where there are severe attachment needs such that there
is a danger of family breakdown and child care placement. In this study, video interaction
guidance was offered to all parents and delivered to those families who wished to
take up the offer. Parents in these circumstances are traditionally thought of as
being very hard to engage, having often had abusive backgrounds themselves or having
lost older children within the care system. Pre-and post-intervention data was collected
on 15 parent-child dyads that received ‘treatment as usual’ and 8 parent-child dyads
that received VIG as an intervention alongside the standard treatment. The VIG intervention
took the form of 3-5 films and shared review sessions for each parent. For the ‘pre-score’
a brief film of 3-4 minutes of interaction was taken between parent and baby ‘as
they would normally do’.
Data was collected using the CARE-index (Crittenden 2005) as providing a reliable
score for seven aspects of behaviour for both caregiver and infant . For this research,
the maternal sensitivity score was used. Scores are calibrated as follows: 8-14 indicates
the interaction is ‘good enough’; 4-7 indicates ‘of concern’ and 0-3 indicates that
the interaction between the infant and parent is ‘seriously compromised’. Results
showed that the mean pre-intervention CARE-Index score was very similar for each
group. The mean post-intervention CARE-Index score of the control group deteriorated
slightly whereas it improved by 3.13 for the video interaction guidance intervention
group. This result is equivalent to a medium-sized and statistically significant
effect size (ES = 0.5). Before the intervention only 25% of the video interaction
guidance intervention group were scoring in the ‘good enough’ range whereas afterwards
87.5% were now considered ‘good enough‘ and all families who were ‘of concern’ had
made improvements by at least 2 points. This is in stark contrast to the control
group who started the intervention with 46% and ended the intervention with 27% in
the ‘good enough’ category. The tentative conclusion that can be drawn from this
pilot study is that video interaction guidance has been successful in increasing
parental sensitivity as measured by the CARE-Index and that a more substantial study
is justified.
This brief review focuses on studies concerned with situations where attachment issues
are foremost as this is where the most rigorous research effort has been made to
date. However, evidence has been accumulating that indicates the effectiveness of
video interaction guidance in many other settings. Full details can be found in
the book.
REFERENCES
Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H. & Juffer, F. (2003). Less is more:
Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological
Bulletin, 129,195–215.
Barlow, J. & Schrader-MacMillan, A. (2010) Safeguarding children from emotional maltreatment:
What works? London: Jessica Kingsley.
Crittenden, P. (2005) ‘Using the CARE-Index for Screening, Intervention, and Research’,
accessed on 19 july 2011: http://www.patcrittenden.com/include/docs/care_index.pdf
DataPrev. (2011) 'Mental health prevention focusing on parenting.' DataPrev, accessed
on 3st January 2011: http://www.dataprevproject.net/Parenting_and_Early_Years
Juffer, F., Bakermans – Kranenburg & van IJzendoorn, M.H. (2007a) Promoting Positive
Parenting: an attachment based intervention New York: Lawrence Erlbaum.
Juffer, F., Bakermans – Kranenburg & van IJzendoorn, M.H. (2007b) Attachment-based
Interventions: heading for Evidence-based ways to Support Families in W.Yule and
O.Udwin (eds) Attachment: Current Focus and Future Directions ACAMH Occasional Papers
No.29
Fukkink, R.G. (2008) Video feedback in the widescreen: A meta-analysis of family
programs Clinical Psychology Review, 28(6), 904–916.
Kennedy, H., Landor, M. & Todd. L. (2010) Video Interaction Guidance as a method
to promote secure attachment Educational and Child Psychology Vol. 27 No. 3.
Klein Velderman, M., Bakermans-Kranenburg, M. J., Juffer, F., Van IJzendoorn, M.
H., Mangelsdorf, S. C., and Zevalkink, J. (2006) 'Preventing Preschool Externalizing,
Behavior Problems Through Video-Feedback.' Infant Mental Health Journal, 27, 5,
466–493
NSPCC (2010) 'The National Society for the Prevention of Cruelty to Children (NSPCC)
Evidence to the independent review of the delivery of early interventions intended
to fulfil potential and reduce dysfunction in the lives of children and young people.
November 2010.' Accessed on 29/1/2011 at http://www.nspcc.org.uk/Inform/policyandpublicaffairs/
consultations/responses2010_wda70544.html.
Robertson, M. and Kennedy, H. (2009) Relationship-Based Intervention for High Risk
families and their babies : Video Interaction Guidance – an international perspective’
Seminar Association Infant Mental health, Tavistock, London, 12th December 2009
