The method is based on a model developed in the Netherlands by Harrie Biemans and colleagues in the 1980’s. The concept is to use principles which promote successful interactions between mothers and infants in the earliest months as a framework for identifying positive moments in communicative exchanges.  These moments are selected by focusing on the way in which children’s communicative initiatives are responded to by adults.  These principles are fundamental to video interaction guidance and are known as the  ‘principles for attuned interactions and guidance’.

Professor Colwyn Trevarthen at Edinburgh University has provided the central theoretical core (Primary and Secondary Intersubjectivity and Mediated learning) of this method and has been personally involved in its development from the start. The idea is to use principles which promote successful early mother-infant dialogue as the framework for picking out positive moments in any communication.

Professor Trevarthen has been a supporter of VIG from its beginnings and you can listen to him talking about it on Soundcloud.





This section of this website describing evaluation studies that demonstrate the impact of VIG only cites studies where the guiders have been trained using the 18 month training programme initially developed in The Netherlands and subsequently adapted to the UK context by members of AVIGuk over the past two decades.  Other approaches may appear to be similar to VIG but only an AVIGuk accredited guider can reasonably claim to have practice similar to that used in the published research.

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.


Video Interaction Guidance
A Relationship-Based Intervention to Promote Attunement, Empathy and Wellbeing
Edited by Hilary Kennedy, Miriam Landor and Liz Todd
The book explains the theory behind the approach, reviews research evidence, and offers case studies that document how VIG has been successfully applied to family relationships, schools and higher education, individuals with communication and developmental disorders, and as a reflective professional development tool. The approach is then discussed from a range of theoretical perspectives and within the contexts of narrative therapy, infant and attachment interventions, positive psychology and mindfulness.








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



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