Core Components

Video Interaction Guidance (VIG) is a strength-based approach which is used to help build effective communication and strengthen the quality of relationships. The principals are versatile and can be applied to any relationship and with any age range. Most typically it is used with children and parents. It aims to help parents reflect on their interactions with their child, drawing attention to elements that are successful, and supporting parents to make changes where desired.

The target population is often parents/carers and their children who are at risk of social exclusion and mental health difficulties due to parent-child relationship difficulties.
The intervention is not a manualised programme but follows a set procedure and focuses on a set of principles. The steps involved in the delivery of VIG include:

• The VIG Practitioner helps the family to set their own goals, identifying what they would like to change. VIG guiders try to help parents focus on identifying a goal which is relationship based rather than focused on the child’s behaviour
• A short interaction (5 – 10 minutes) between the parent and child is filmed
• The VIG Practitioner then edits the film to produce short clips that focus on the moments of successful interaction and attunement.
• The clips are reviewed with the family, during which the guider uses the Principals of Attuned Interactions (being attentive, encouraging child’s initiatives, receiving initiatives, developing attuned interactions, guiding and deepening discussion). Parents set themselves goals based on the review. Practitioners interact with parents during the reviews in an attuned way and follow the parent’s initiative, as parents are enabled to with their child.
• After reviewing the video clips the parent and child are videoed interacting again and the cycle starts again.

On average 3 or 4 cycles are thought to be optimum for significant change in the interactions and relationship between the parent and child.

VIG has been implemented in a variety of services throughout the UK, such as Educational Psychology and NHS services. In Scotland, it has mainly been adopted by local authority services.

Fidelity

There is no formal tool for measuring fidelity or delivery monitoring, however, The Association of VIG UK (AVIGuk) has developed a Skills Development Scale (SDS). Trainees use this tool to reflect on their practice with their VIG supervisor and it is also used to assess whether practitioners have the required skills to meet criteria to become an Accredited Practitioner and an Advanced Practitioner.
Six of the thirteen items on the scale are identified as skills which should be present in every session when delivering VIG. These are:

• Identifying Attunement Principles/Microanalysis
• Use of Video Technology to maximise client activation
• Embodiment of AVIGuk values and beliefs
• Attuned dialogue
• Attuned guiding
• Co-construction new meanings

Modifiable Components

The principals and practice of VIG are versatile and can be applied to any relationship and any age range. For example, it has been used with families and children with neuro development conditions, deaf children and children with attachment difficulties. VIG has also been adapted to use with parents with Learning Difficulties. Adaptions include adjusting consent procedures, using easy read versions of the principals, separating recording sessions from review sessions and focusing on concrete skills and behavioural strategies.

The Association of Video Interaction Guidance UK (AVIGuk) is an association of VIG accredited practitioners and those in training. It does not directly provide training but regulates training and trainers in the UK.

Support for Organisation / Practice

Implementation Support

VIG is not a manualised programme; once guiders are trained and have paid their registration fee they are able to access the AVIGuk resources.

VIG does not provide any detailed implementation supports. Trainers are independent and can register and advertise training through the AVIGuk website. Prior to delivering training, VIG Trainers can provide consultation; supporting sites to identify the appropriate staff to train and how to implement the intervention. AVIGuk recommends that a site considers the intended targeted population, the need and staff attrition when identifying staff numbers. The developers believe that the success of effective implementing sites is due to ongoing organisational support for the intervention and dedication to the intervention by the VIG guiders. The developers noted that the approach is more successful when there is a community of practice is developed in an implementing site.

Other than the trainer consultation, VIG do not offer any supports around technology, administrative needs or organisational considerations. Policies regarding filming, collecting and storing video clips and equipment need to be considered locally.
Additional administrative support, beyond a services’ regular support, is not thought to be required if VIG guiders are delivering with their regular client group.

AVIGuk do not have supports available to consider data management plans. Local decisions are required regarding measuring effectiveness of the intervention.

Licence Requirements

No licence is required.

Start-up Costs

The initial 2-day training course cost is set by the local VIG trainer but is usually £375 - £475.

Additional cost per practitioner usually comes to around £1500 which includes 15 hours of supervision (£1200), or if a service has a trained in-house VIG supervisor this cost is reduced (£300), additional half-day training mid-way through accreditation process (£160), AVIGuk registration fee (£60), accreditation and certification (£80).

Cost of resources such as video equipment and editing software also need to be considered in the start-up costs.

Building Staff Competency

Qualifications Required

No qualifications are required to access VIG training. It is recommended that practitioners receiving VIG training have a supportive attitude to parents and are able to challenge them through strength-based communication.

Training Requirements

Practitioners are required to attend a 2-day initial training course to become a Trainee VIG Practitioner. Another half day training is required around the mid-point of their accreditation journey.

VIG Trainers are available throughout the UK including a number of trainers in Scotland.

Supervision Requirements

To become an accredited VIG Practitioner trainees are expected to work with a minimum of 6 clients and to undertake 18 cycles of VIG (a cycle consists of taking a film and a shared review of the clips with the client). At the mid-point of this process trainees receive another half-day training. Each trainee normally requires 15 hours individual supervision with an accredited VIG supervisor to become an accredited VIG practitioners. Candidates for accreditation must provide a full shared review with a parent (60-minute session) which is then scored by an external VIG supervisor using the VIG-SDS. Candidates for Accreditation must achieve a score of 3 across all items on the VIG-SDS and candidates for Advanced Practitioner must achieve a score of 5. Once they have been accredited as a VIG Practitioners they may register with AVIGuk and practice independently.

An accredited VIG Practitioner can proceed on to become an Advanced VIG Practitioner, followed by a VIG Trainee Supervisor and finally to become a VIG Advanced Supervisor and Trainer. There are set criteria which must be met for each stage of accreditation.

Throughout this process practitioners are receiving supervision and reviewing videos with their supervisor, who uses the same VIG principals in their interactions with practitioners as practitioners do with parents, these parallel processes are repeated throughout the stages of training in VIG.

The evidence base for Video Feedback approaches (which includes VIG) is an international one and includes all interventions using the video feedback technique as its main component of change. For the purposes of this review only studies evaluating the effectiveness of the UK version – Video Interaction Guidance (VIG) have been included.

Three NICE guidelines feature Video Feedback approaches (of which VIG is one) as a recommended intervention; Autism, Social and Emotional Wellbeing 0-5, and Attachment Difficulties.

Theory of Change

VIG is based on the theories of intersubjectivity, attachment, social learning theory and theories of mediated learning. The process of VIG involves attuned guidance, observing the moments between people, such as between a parent and infant. Supporting parents, through observations, to become more sensitive to the child’s communication attempts and to respond in an attuned way. This aims to strengthen the parent’s sensitivity and ability to mentalise about their child, and in turn the child’s attachment. By showing parents their own positive interactions, they observe themselves succeeding, learning through self-modelling. This leads to positive change as parents develop their own new narratives and are motivated to change in line with their new belief about themselves. The VIG Principles of Attuned Interaction and Guidance (PAIG) are used during the intervention with the family to highlight different types of interaction between the parent and child.

Values

VIG practitioners are trained to be guided by values of respect and empowerment; it is a strengths-based intervention, looking for what works rather than what doesn’t and starts from a belief that change is possible. 

• Does this align with the key values and priorities of your organisation?

Priorities

• Is working with parents of babies and young children in an early intervention approach a priority for your organisation?

Existing Initiatives

• Does your service already provide early intervention programmes aiming to improve child-parent relationships?

Workforce

To deliver VIG one practitioner is required, however, the developers recommend that more practitioners are trained as the model encourages the development of a community of practice. The developers recommend that the anticipated need of the population should be considered when deciding how many practitioners to train and that practitioner attrition should be accounted for.  

• Have you identified how many practitioners need to be trained to meet the anticipated need?
• Have you taken into account practitioner attrition?
• Do you have enough practitioners available to deliver this intervention?
• Do your practitioners have the skills and experience to deliver this intervention to parents and infants in a supportive, strengths-based way?

It is recommended, if training a cohort of practitioners, that a couple of practitioners are identified early on to potentially go onto become VIG Supervisors. 

• Have you identified staff with the skills and motivation to advance to supervisor level?

Technology Support

To deliver VIG, video recording equipment, a device to review videos and editing software are required.

• Do you have the technology to support practitioners to deliver the programme?

Administrative Support

• Do you have policies and procedures in place regarding the videoing recording and storing of these recordings in place?
• Do you have procedures in place around gaining consent to video record families?

Financial Support

Initial 2-day training course - £375 - £475

15 hours of Supervision - £1200 (or £300 if Supervisor in-house)

Half-day training at mid-point to accreditation - £160

Registration fee - £60

Accreditation and Certification fee - £80

Cost of resources such as video equipment and editing software also need to be considered in the start-up costs.

• Do you have the finances to pay for practitioners to attend this training and advance onto accreditation?
• Do you have finances available to purchase the required technological equipment?

Costs of training staff to become supervisors are additional, this involves a £50 per annum registration fee and ongoing supervision costs (as above).

• If you wish to train staff to become VIG Supervisors do you have the ongoing funds to support this?

Comparable Population 

Video Interaction Guidance is aimed at parents/carers and their children who are at risk of social exclusion and mental health difficulties due to parent-child relationship difficulties. 

Evidence of its effectiveness comes from studies which include parents and children from infancy through childhood. In infancy, research suggests VIG is effective in situations when a child has been born pre-term or where there are concerns about the attachment relationship. VIG has also been found to be effective in childcare settings and with children who are congenitally deaf.

• Are these identified populations of particular concern to your organisation?

Desired Outcome

Video Interaction Guidance aims to build effective communication and strengthen the quality of relationships between parents and children. It aims to do this through helping parents reflect on their interactions with their child, drawing attention to elements that are successful and by supporting parents to make changes where desired.

VIG has some evidence to suggest it is effective in improving the sensitive interactions between parent and infants in situations when a child has been born pre-term or where there are concerns about the attachment relationship. VIG also has evidence to suggest it is effective with Early Years Teachers in increasing stimulating caregiving, sensitive responses, verbal stimulation, eye contact with children, verbally receiving the initiatives of children, allowing children to take turns more frequently and fostering peer relationships. It has also been shown to increase parental sensitivity, parental structuring, parental non-hostility, child responsiveness, and child involvement as well as improving parental self-esteem with parents of congenitally deaf children.

• VIG aims to improve the relationship between a parent and infant, is this a priority outcome for your organisation?
• Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?