Theoretical base + evidence base
There are three reasons why you could choose VIG as an intervention:
VIG has a clear theoretical base
VIG works in practice
VIG has a strong evidence base.
VIG has a clear theoretical base
Colwyn Trevarthen’s detailed micro-analysis of videos of successful parent-infant interactions, and his theory of intersubjectivity (Trevarthen 1980), lie at the core of VIG. Video Interaction Guidance (VIG) as an effective intervention would simply not exist without Trevarthen’s work
Trevarthen’s detailed research and ideas gave VIG a core theory, grounded in practice, which has freed VIG from the prescriptive manuals of some other parenting approaches. In the early 1980s, his emphasis on the initiative of the infants, and the wisdom of children, was very different from the prevailing narrative.
Click here to hear Colwyn Trevarthen reflect on why Video Interaction Guidance is a highly effective relational tool.
Click here if you would like to explore the history of VIG more, and understand about how Trevarthen’s legacy continues to sustain VIG development.
Colwyn Trevarthen (1970s)
Harrie Biemens (1980s)
Theories of why VIG is effective suggest that the use of video clips enables a shared space to be created between practitioner and client, where moments of parental sensitivity and attunement can be seen.
The video clips function as a ‘witness’ (Jarvis 2011) to the positive interaction, which may have been missed by the client in the moment, and which can be microanalysed by practitioner and client to enable a new kind of ‘seeing’ and understanding.
Very few therapeutic interventions focus so equally and clearly on increasing both ‘attunement’ between parent and child (Beebe 2010), and ‘mentalization’ - the parent’s capacity for ‘reflective functioning’ - which refers to a parents’ capacity to treat their infant/child as an intentional being, and to understand behaviours in terms of the infant/child’s feelings, beliefs and intentions (Fonagy et al 2002).
VIG clients are supported to improve their relationship skills, by developing their ability to mentalize about their own and their infant’s mental states, and by encouraging mind-minded interactions (Meins 2012).
VIG works in practice
To many practitioners, it is surprising that entrenched and complex presenting problems can start shifting, even after the first VIG session, and that these changes trigger further improvement in many areas of the parent’s life.
Each success makes it easier for practitioners to engage a new family on a VIG journey, meeting the family with authentic hope that things will change.
VIG is a nourishing way for professionals and parents to work together, as the changes for the parents and children are heart- warming and of central importance to all involved.
An evaluation of the Video Interaction Guidance Service in Cornwall was carried out in 2019 by Cardiff university (Maxwell, N. et al). The evaluation focussed on the extent to which VIG training was embodied by practitioners and used across all aspects of their work. This video describes the project
Key findings of the evaluation included:
Carers were positive about their involvement with VIG and the non-judgemental, strengths-based relationship they had with the VIG Practitioner.
Carer narratives showed increased attachment and attunement to their children.
VIG provided new insight into their child’s behaviour and many carers reported that by becoming more attuned to their children and, in particular, listening to their child, they were able to work collaboratively to find solutions.
Regardless of previous experience, professionals and managers reported that VIG training extended worker skills, adding further value to practice in direct work with families and other roles
Embedding VIG into Children’s Services promotes a strengths-based culture denoting a shift away from prescriptive, bureaucratic systems.
VIG was associated with the retention of staff as VIG increased their skills and had a specific career pathway they could embark upon.
Click on the PDF to read the full report.
VIG is already making a significant contribution to infant and children’s wellbeing in the UK, with over 2,000 practitioners using VIG in a variety of services. An increasing number of practitioners are working within perinatal and infant mental health services. Applications to train in VIG continue to increase across the UK.
VIG has a strong evidence base
VIG is one of the evidence-based video feedback interventions recommended by the National Institute for Health and Care Excellence (NICE) to promote secure attachment in children and young people in care, or at high risk of going into care (NICE NG26, 2015).
NICE recommends video feedback to support families with children with autism (NICE CG170, 2013, updated 2021), and to support the social and emotional well-being of children in their early years (NICE PH40, 2012).
The November 2019 Cochrane Review endorses video feedback interventions to enhance sensitivity in parents of children who are at risk for poor attachment outcomes due to a range of difficulties (Cochrane 2019).
In 2008, a meta-analysis of 29 video feedback studies showed that video feedback produced statistically significant improvement in parenting sensitivity (effect size 0.49); parenting behaviour and attitudes (effect size 0.37); and child development (effect size 0.33) for children aged 0 – 8 years (Fukkink et al 2008).
Many of these studies involved ‘high risk’ dyads (e.g. low socio-economic status 63%; parent clinical problems 17%; child clinical problems 52%).
Fukkink explored further this 2008 meta-analysis. In Chapter 4 (Kennedy, Landor & Todd, 2011), he differentiated the impact of VIG from other video feedback interventions: ‘What is the evidence that VIG is effective?’ Click on the PDF below.
[Upload Chapter 4 to Media and then here]
Want to read more?
Click on this PDF if you would like to know more about VIG research.
Click on this PDF for a list of publications about VIG.
VIG with pre-term babies
Two randomised control trials (RCTs) have shown the effectiveness of VIG for parents of premature babies, in terms of enhanced sensitivity and improvements in attachment patterns.
Barlow et al 2016 reported on a pilot randomised control trial to examine whether VIG provides effective support for early interaction between babies born preterm and their parents. 31 parents were recruited from a neonatal intensive care unit in the UK and were randomised into two groups.
Following discharge from the unit all families were offered usual community health care; the intervention group received three additional visits where VIG was offered. Semi-structured interviews were conducted following the intervention. The analysis indicated that all parents found the VIG intervention acceptable, and many found it extremely beneficial.Hoffencamp et al 2015 carried out a large scale randomised control trial in the Netherlands where VIG was delivered to both parents while the infants were in a neonatal intensive care unit. There were 210 infants (70 term, 70 extreme pre-term, and 70 near-term) from 7 hospitals.One of the interesting results showed that 3 sessions of VIG in the first week of life has a significant positive effect on parent-infant bonding (as measured by the Post-partum Bonding Questionnaire, PBQ, Brockington et al 2006). There was an enhanced effect for all fathers and mothers who experienced the birth as traumatic.
VIG with parents with mental health difficulties
Several studies have shown that VIG can be very effective where parents are struggling with mental health difficulties. Increasingly, VIG is being used by NHS perinatal services.
Gray (2017) carried out a pilot study which demonstrated that Video Interaction Guidance is an extremely effective intervention that meets a need that may otherwise be unmet.
Parent-infant dyads with difficulties within the relationship, ranging from mild to severe, were helped effectively with a relatively brief intervention of VIG (3- 14 sessions). Average scores significantly improved following the intervention, on measures of parental anxiety, depression, confidence, maternal perception of the relationship with her baby, and on individualised goals.
For many parents, video footage showed improvement in parent-infant interaction from the first to last film; due to limited resources it was not possible to formally evaluate this improvement within the scope of the pilot. The feedback from the women who took part, and the referrers, has been overwhelmingly positive.
The evidence is clear and compelling that VIG is an essential piece of the jigsaw for supporting women and their babies in the perinatal period. VIG enhances the effectiveness of other interventions.
When VIG is missing, some women remain stuck in difficulties that will have a huge impact on the socio-emotional development of their babies, and their own future mental health.
VIG and neglect
VIG can be helpful in supporting families where there has been neglect. The NSPCC service evaluation (2015) documents VIG as an effective intervention in supporting parents to listen to, and understand, their children better. The NICE Guideline on Child abuse and neglect (NG76, 2017) recommends support for parent-child interaction. Although the Guidance does not explicitly mentioning video feedback, VIG is an intervention that can help to meet this goal.
NSPCC evaluation report:
Social worker: "I find VIG to be the most effective intervention in my toolkit to help parents gain confidence and build attachment with their children. The short turnaround and low number of sessions with VIG makes it particularly effective, as it fits in with the timescales of the child and court. I have used VIG successfully with families on PLO and child protection plans where there have been concerns about neglect."
VIG on the edge of care
VIG is effective in working with families on the edge of care, to support parents and carers to engage in change that is crucial to the question of whether or not the family can meet the child’s needs.
Celebi and Carr-Hopkins (2018) report on the use of VIG by the family courts. VIG may be recommended by an expert witness (a psychologist or social worker):
as part of an assessment process (to see whether the parent is motivated and has the capacity to make use of VIG), or
as part of an intervention package.
By increasing a parent’s capacity to mentalize through VIG, there is the potential for increased parental sensitivity and a reduction in risk.
The authors offer two important caveats:
1) Complex cases need experienced practitioners, with sufficient clinical and court experience, plus appropriate reflective supervision
2) VIG is often successful yet not a panacea. A successful VIG intervention does not mean that a parent will be able to successfully meet all their child’s needs.
In addition, if VIG is ordered by the court, rather than chosen by the family, the family may show superficial engagement, which does not equal a desire to change.
The VIG Data Collection System (DCS)
In 2020, the Association for Video Interaction Guidance UK (AVIGuk) was successful in bidding for external funding for an exciting project to establish a ‘smart’, national data collection system to collect VIG pre- and post-intervention data. In 2022, we have secured additional funding to engage services further in using the DCS.
The VIG Data Collection System (DCS) has been designed to serve two purposes in improving infant and children’s mental health:
clinical data regarding individual parent-infant/child dyads that will help the VIG practitioner to assess the effectiveness of the intervention, and make a decision about the need for any further therapeutic input
outcome data that will enable AVIGuk to improve the delivery of VIG, and its effectiveness, by monitoring the impact of VIG across different services, regions, populations etc.
The DCS is an ambitious project, aiming to provide evaluation data to individual practitioners, and their services, on a national scale. We aim to collect data, pre- and post-VIG intervention, from everyone involved in VIG delivery. Practitioners who are training in VIG will provide anonymised data from the families they are working with, and will be able to access their own data, and data for their service. The DCS data will provide evidence of the short-term, and likely long-term, impact of a brief VIG intervention.
Following consultation with perinatal practitioners and experts on what outcome measures are already being used in services, the research team completed an initial survey report (Glass & Cristescu, 2022).
The team devised a user-friendly data entry system which can be accessed live in client sessions by all VIG trainees and accredited practitioners.
Contact AVIGuk if you would like more information about the DCS, and how you/your team can sign up to contributing your data to this important project.
VIG online journal
Click here for Attuned Interactions, the online journal for VIG, featuring articles by VIG practitioners and supervisors.
Celebi, M. (2017) Weaving the cradle: facilitating groups to promote attunement and bonding between parents, their babies and toddlers. London: Jessica Kingsley
Kennedy, H., Landor, M. and Todd, L. (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 Interaction. London: Jessica Kingsley
Click on this PDF for a list of publications about VIG.