VIPP-SD Rachel James, Consultant Clinical Psychologist Paul Dugmore, Senior Social Worker

1. VIPP-SDRachel James, Consultant Clinical PsychologistPaul Dugmore, Senior Social Worker

2. Video-feedback Intervention to Promote Positive Parenting and Sensitive Discipline • Origins • Developed by researchers Leiden University (in Holland) based on 30 years of video-feedback with adopters • Draws on Attachment Theory (Bowlby) • Evolutionary base • Attachment behaviour : contact & proximity • Goal: comfort & protection • Differences in quality of attachment

3. Video-feedback Intervention to Promote Positive Parenting and Sensitive Discipline Context: T&P started delivering clinical intervention 2014 in CAMHS early years CVAA Post-adoption support grant awarded to TACT & T&P Jan 2015 to recruit adopters, deliver VIPP & train staff over two year period

4. Funding to provide VIPP to at least 40 adopters • Subsidised training programme in 2015 & 2016 open to participating agencies • 15 places per course – to train staff in delivering VIPP • Supervision of trained staff ongoing & provided by the T&P to ensure programme fidelity and to develop skills and confidence • Aim: wider roll-out of VIPP enabling a community of practice • Develop critical mass of trained VIPP interveners & supervisors nationwide • Ambition: all adopters may have access to VIPP as part of wider post-adoption support services • T&P will become the UK centre of VIPP training Sustainability

5. Children feel (in)secure depending on how their parents comfort/support them • How parents react when children are frightened, tired, ill Crucial role of parental sensitivity* • Resulting in different patterns of (in)secure child-parent attachment relationships • Parental sensitivity: • Perceiving child’s signals in an accurate way • Responding in an adequate & prompt way • *Confirmed in meta-analysis by De Wolff & Van IJzendoorn, 1997 The model: Attachment and sensitivity

6. Effectiveness in randomised studies • Significant effects on sensitivity & attachment • Less is more – short term interventions - up to 16 sessions more effective than longer interventions • Sensitivity-focused interventions promote secure attachment Effectiveness of interventions on sensitivity and attachment

7. Introductory visit – consent; outcome measures; initial filming • Visits 1 – 2: first part of sensitivity definition: • Learning to observe children’s attachment & exploration behaviour • ‘Speaking for the child’ VIPP: the intervention

8. Visits 3 – 4: second part of sensitivity definition: reinforcing sensitive parenting • Relevance of adequate & prompt responses to the signals of the child (‘sensitivity chain’: signal- response –reaction) • Sharing emotions & affective attunement • Visits 5-6 booster sessions VIPP: the intervention

9. VIPP sensitive discipline

10. VIPP: key principleskres f VIPP • Focus on parent-child • interaction • Standardised & individualised • Written information • Video feedback • Practice observational skills • Reinforce parental sensitive • behaviours • Home-based & short-term • Parent is her/his own model • Parent & child are filmed during daily situations at home • Short episodes 2 or 3 for approx. 5 minutes each • Strengths based, positive moments • Active involvement of parent (expert) • Supportive relationship

11. Screen tape for suitable moments to show • Show videotape to parent using script & manual • Focus on positive interaction • Repeat positive fragments: emphasising important messages or counterbalancing negative interactions • Rewarding for parent • Proves capable to act sensitively • Parent keeps a mental picture Video feedback

12. Where child is under 6 and carer willing to be videoed & child has been placed for at least 3 months & within 12 months • Placements that would benefit from: • Enhancing carer’s sensitivity to their child’s emotional & behavioural signals • Improved parental discipline strategies to prevent or reduce behavioural problems • Promoting & improving the child’s attachment security • Promoting and encouraging positive interactions between carers and children Inclusion criteria

13. Feedback from parents • "Throughout the sessions, I always felt supported in my parenting and never felt judged. I soon got used to being filmed and I didn’t expect I would benefit in the ways I did from watching myself and my son on the videos and seeing the world through his eyes. I was able to stand back and see myself and my son as people as well as mother and child. I’m a better parent for it and my partner and I talk through different ways of dealing with situations now. Our son knows I listen to him and is happier as a result." • "The biggest positive for me is that it highlights how well I am doing, and that isn’t always at the forefront of my mind - I only remember the challenging behaviour. It’s a clear message that we are getting on together, and I don’t always see that. Hearing about the significance of the little signals gives me confidence in how well we are attaching

14. Feedback from staff training • The training was well paced, informative and supportive. • Delivering the intervention was really exciting, watching the mother progress as she increased her understanding of what the child was communicating and feeling. She said she looked more at her child, and really understood that the child is an emotional being, not ‘just a toddler’ • One of the aspects that I have enjoyed the most in this experience is seeing the relationship between the mother and son of my practice family become more attuned. There is no doubt in my mind that this has been a powerful intervention that has increased the sensitivity of an already sensitive parent. This view is also shared by both parents in my practice family.

15. Initial Findings

16. Average Goal Proximity for all service users 10 9 8 7 6 5 4 3 2 1 0 Mean T1 Goal Proximity Mean T2 Goal Proximity Goal Based Measure

17. Average PIR-GAS scores at T1 and T2 100 90 80 70 60 50 40 30 20 10 0 PIRGAS T1 PIRGAS T2 Parent Infant Relationship Global Assessment Scale

18. Average total difficulties at T1 and T2 40 35 30 25 20 15 10 5 0 Total Difficulties T1 Total Difficulties T2 Strength & Difficulties Questionnaire

19. Average BCL total difficulties score at T1 and T2 20 18 16 14 12 10 8 6 4 2 0 BCL T1 Score BCL T2 Score Child Behaviour Checklist

20. Average mental wellbeing score at T1 and T2 40 35 30 25 20 15 10 5 0 Mental Wellbeing T1 Mental Wellbeing T2 Edinburgh Warwick Mental Wellbeing

21. Leiden Attitudes towards sensitivity scale

22. Emergent dilemmas • Reduction in adoptions: SGOs included • Complexity of Adoption Orders not being granted during intervention • Resource intensive – travel, script writing • Intensity of training – staff drop out • Sustainability – local supervision requirement • Technological issues – data protection & governance; availability & compatibility

23. Juffer, Bakermans-Kranenburg, & Van IJzendoorn, (2005) Journal of Child Psychology & Psychiatry, vol. 46, pp. 263-274. • Juffer, F., van IJzendoorn, M.H. and Bakermans-Kranenburg, M.J. (2008) ‘Supporting adoptive families with video-feedback intervention’, in F. Juffer, M.J. Bakermans-Kranenburg and M.H. van IJzendoorn (eds), Promoting Positive Parenting: An attachment-based intervention (Monographs in Parenting), New York, Psychology Press. • Feltham-King, C. (2009) What are the perceived benefits of an adoption support package using video interaction guidance with prospective adopters? An exploratory study.  Children’s Work Force Development Council. References/further information

24. Questions?