How Does Video Interaction Guidance Contribute to Infant and Parental Mental Health and Well-Being?

• Authors: Hilary Kennedy, Kevin Ball and Jane Barlow
• Clinical Child Psychology and Psychiatry, 22 (2017)

This article describes the principles and practices underpinning VIG and discusses this in relation to research on its effectiveness in improving relationships between a parent and their infant.

Theory underpinning VIG

The core theoretical principles underpinning VIG were derived from observations that infants actively develop co-operative interactions with their primary caregiver (usually the mother). The caregiver's responses to these interactions helps to develop a shared understanding between infant and parent, which is the basis of effective communication and learning (Trevarthen and Aitken, 2001).

Children learn by interacting with parents/carers who understand their abilities and are able to "scaffold" their experiences so that they are able to learn without being overwhelmed by things that they do not understand. An important concept of VIG is the "zone of proximal development". This refers to the importance of parents understanding and working within the child's range of abilities so that there are attuned interactions. Helping parents become more attuned with their infant is the primary goal of VIG.

Caregiving environment

The early caregiving environment is important for achieving attunement between the parent and their infant and, in particular, for promoting secure attachment. Key to this is repeated cycles between parent and infant of synchrony, rupture and repair. This cycle depends on the parent's ability to regulate their own emotions as well as interacting with the child.

Also important is the parent's capacity for reflective functioning (the ability to treat their infant as an intentional being) and "mind-mindedness" (the parent's ability to understand their child's mind). These are associated with positive parenting behaviours, such as flexibility and responsiveness and the use of the parent as a secure base by the infant.

A range of parental mental health problems is associated with poorer maternal sensitivity and/or interaction. A parent's attachment status is also important in an infant's attachment security. There is an increased risk to babies of mothers with an insecure attachment of also having an insecure attachment pattern as a result of their parenting behaviours.

VIG in practice

VIG practitioners demonstrate the principles of attuned relationships and help parents to identify their strengths and set their own goals. This is achieved through engaging parents in a change process, which is underpinned by evidence on children's socio-emotional development.

VIG practitioners engage parents in the change process by:

• Helping parents form questions about how to improve their relationship with their infant
• Filming to capture best possible interactions
• Editing the video to select a few short clips of successful interaction
• Helping the parent to work out what they are doing that helps them to build an attuned relationship with their child
• Filming this review process so that attuned interactions between VIG practitioners and the parent can be captured.

How effective is VIG?

Various studies have shown that, for children from birth to eight years old, video feedback produces statistically significant improvements in:

• Parenting sensitivity
• Parenting behaviour and attitudes
• Child development.

VIG has been recommended as an evidence-based intervention by the National Institute for Health and Care Excellence (Nice), the all-party parliamentary group for conception to age 2, and Public Health England.

Implications for practice

• VIG is a useful tool for helping parents to develop attuned relationships with their children.
• VIG can be integrated with other therapeutic approaches to support parents who have been traumatised in childhood.
• It may be particularly helpful when working with mothers who have mental health problems or insecure attachments, or where there are concerns about possible neglect of children. If successful, it may avert the need for children to be removed from their parent's care.
• It may also help foster carers, adopters and special guardians to develop attuned and trusting relationships with children who have been maltreated.

The research section for this special report is based on a selection of academic studies which have been explored and summarised by Research in Practice, part of the Dartington Hall Trust.

This article is part of CYP Now's special report on early childhood development. Click here for more