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The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
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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 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
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.
• Identifying Attunement Principles/Microanalysis
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.
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.
Evidence - Rating: 1+ - 4
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.
Infants and Toddlers: 0-36 months - Rating: 3+
Research Design & Number of Studies
One independent Randomised Control Trial (RCT) with parents of preterm infants (Hoffenkampet al, 2015), one Quasi-experimental design (QED) study with mothers in a residential treatment centre due to child protection concerns (Kennedy, Landor and Todd, 2010) and 2 service evaluations undertaken in the UK (Chakkalackal et al, 2017 & Better Start, Better Future Pilot) were identified.
Outcomes Achieved
Child Outcomes
• No Child outcomes reported
Parent Outcomes
• Parents receiving VIG were found to score significantly higher on parental sensitivity post-intervention (Hoffenkamp et al, 2015; Kennedy et al, 2010 & Chakkalackal et al, 2017)
Key References
Hoffenkamp, H., Tooten, A., Hall, R., Braeken, J., Eliens, M., Vingerhoets, A. & Bakel, H. (2015) Effectiveness of Hospital-Based Video Interaction Guidance on Parental Interactive Behavior, Bonding, and Stress After Preterm Birth: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 83;2, 416-429
Kennedy, H., Landor, M., & Todd, L. (2010) Video Interaction Guidance as a method to promote secure attachment. Educational & Child Psychology Vol. 27 No. 3
Chakkalackal, L., Rosan, C., & Stavrou, S. (2017). Through Each Other’s Eyes: An evaluation of a Video Interaction Guidance project delivered by health visitors and family support workers in a disadvantaged urban community. London: Mental Health Foundation.
Better Start, Better Future Pilot Phase 2 Report – Step2 Early Intervention CAMHS
Preschool: 3 to 5 years - Rating: 3+
Research Design & Number of Studies
Three external studies were identified, two were Quasi-experimental design with a pre-test - post-test design (Fukkink & Tavecchio, 2010 and Jilink et al, 2018). The age of the children involved in these two studies was not given either studies but both conducted VIG with Early Childhood Education and Care teachers in childcare centres, which we can presume included children between the age of 3-5 years old. A pilot study was also identified which used VIG with a small number of hearing parents with congenitally deaf children between the age of 6 months – 6 years, 2 months (Lam-Cassettari et al, 2015).
Outcomes Achieved
Child Outcomes
• Congenitally deaf children, whose parents engaged in VIG, showed a significant increase in scores from pre to post-intervention on measures of child responsiveness and child involvement during parental interactions (Lam-Cassettari et al, 2015)
Adult Outcomes
• Parents of congenitally deaf children, engaging in VIG showed a significant increase in scores from pre to post-intervention on measures of parental sensitivity, parental structuring, parental non-hostility and parental self-esteem (Lam-Cassettari et al, 2015)
• When compared with controls, teachers receiving VIG:
• Showed significantly more stimulating caregiving, these changes were maintained at 3-month follow up (Fukkink & Tavecchio, 2010)
• Scored significantly higher on a scale of sensitive responsivity (Fukkink & Tavecchio, 2010)
• Scored significantly better on quality of verbal stimulation, these changes were maintained at 3-month follow-up (Fukkink & Tavecchio, 2010)
• Showed significantly more frequent eye contact with children, verbally received the initiatives of children more often and allowed children to take turns more frequently (Fukkink & Tavecchio, 2010). Changes in the frequency of eye contact and taking turns were still apparent at 3-month follow-up.
• Fostered significantly more peer interactions between children (Jilink et al, 2018)
Key References
Fukkink, R. & Tavecchio, L. (2010) Effects of Video Interaction Guidance on early childhood teachers. Teaching and Teacher Education , 26:8, 1652-1659
Jilink, L., Fukkink, R. & Huijbergts, S. (2018) Effects of early childhood education training and video interaction guidance on teachers’ interactive skills. Journal of Early Childhood Teacher Education , 39:4, 278-292
Lam-Cassettari, C., Wadnerkar-Kamble, M. & James, D. (2015) Enhancing Parent-Child Communication and Parental Self-Esteem With a Video-Feedback Intervention: Outcomes With Prelingual Deaf and Hard-of-Hearing Children. Journal of Deaf Studies and Deaf Education, 20:3, 266-274
Primary school: 6 to 12 years - Rating: 4
Research Design & Number of Studies
The best evidence for Video Interaction Guidance for children aged 6-12 years comes from two external studies. The first was an experimental mixed methods design with a pre-test - post-test design which took place in Aberdeen, children’s ages ranged from 6 to 11 years old (Primary 2 to Primary 6) (Musset and Topping, 2017). The other a pilot study which used VIG with a small number of hearing parents with congenitally deaf children between the age of 6 months – 6 years, 2 months (Lam-Cassettari et al., 2015).
Additionally, two external Video Interaction Guidance service evaluations were identified one in Cornwall Council, England (Maxwell, Rees and Williams, 2016) and one from the NSPCC (Whalley and Williams, 2015). The age of the children involved in these two respective evaluations ranged from 6 months to 16 years, with an average of 6 years (Maxwell, Rees and Williams, 2016), and children aged between 2 to 12 years respectively (Whalley and Williams, 2015).
Outcomes Achieved
Child Outcomes
Congenitally deaf children, whose parents engaged in VIG, showed a significant increase in scores from pre to post-intervention on measures of child responsiveness and child involvement and non-verbal responsiveness and engagement with their parent, (Lam-Cassettari et al., 2015).
Significantly improved self-esteem of learners who experienced VIG sessions, the greatest impact of VIG was on increasing the self-esteem of younger children (aged 6-7 years; Musset and Topping, 2017).
Parents reported significant decreases in emotional symptoms, conduct problems and hyperactivity among their children, as well as the total difficulty scores, and an improvement in pro-social scores, between the beginning and the end of VIG (Whalley and Williams, 2015).
A reduction in the proportion of children experiencing difficulties at a very high level of need, from 72 per cent to 56 per cent of the sample (Whalley and Williams, 2015).
Adult Outcomes
Parents of congenitally deaf children engaging in VIG showed a significant increase in scores from pre to post-intervention on measures of parental sensitivity, parental structuring parental non-hostility and parental self-esteem (Lam-Cassettari et al., 2015)
Parents referred to VIG service where parental sensitivity to their children, attachment difficulties and lack of reflective capacity identified, VIG improved parenting self-efficacy (Maxwell, Rees and Williams, 2016).
All parents (n=27) made progress towards their goals during the intervention (Maxwell, Rees and Williams, 2016).
Parents referred due to initial concerns of neglect perceived a reduction in their own ineffective parenting practices and improvements in their relationship with their child (Whalley and Williams, 2015).
Parents moved from a high level of need to within the normal range by the end of VIG in four of the six subscales of the Parent-Child Relationship Inventory, notably in their involvement in the lives of their children and communication (Whalley and Williams, 2015).
Key References
Lam-Cassettari, C., Wadnerkar-Kamble, M. and James, D. (2015) ‘Enhancing Parent-Child Communication and Parental Self-Esteem With a Video-Feedback Intervention: Outcomes With Prelingual Deaf and Hard-of-Hearing Children’, Journal of Deaf Studies and Deaf Education, 20 (3), pp. 266-274.
Maxwell, N., Rees, A. and Williams, A. (2016) Evaluation of the Video Interaction Guidance Service, Cornwall Council. Cardiff: CASCADE.
Musset, M. and Topping, K. (2017) ‘Video Interaction Guidance in Collaborative Group Work: Impact on Primary School Pupils' Self-Esteem and Behaviours’, Educational Psychology , 37(9), pp. 1067-1081.
Whalley, P. and Williams, M. (2015) Child neglect and Video Interaction Guidance: an evaluation of an NSPCC service offered to parents where initial concerns of neglect have been noted . London: NSPCC.
Adolescents: 13 to 18 years - Rating: 1+
Research Design & Number of Studies
No research was identified that indicated the effectiveness of Video Interaction Guidance for families where the child was aged between 13-18 years old.
Need
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?
Need Score
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Fit
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?
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Capacity
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?
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