Video Interactive Guidance (VIG) service for infants 0-12 months The Peterborough health visiting team within Cambridgeshire and Peterborough NHS Foundation Trust deliver an innovative VIG programme for infants from birth to one year and their parents, as part of a universal plus package.
Winners - National CYPMH Awards 2019
From start: No
During process: Yes
In evaluation: Yes
PP Collaborative: Yes
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Michelle Espley - Interim Deputy General Manager, Cambridgeshire and Peterborough NHS Foundation Trust
Video Interactive Guidance (VIG) service for infants 0-12 months The Peterborough health visiting team within Cambridgeshire and Peterborough NHS Foundation Trust deliver an innovative VIG programme for infants from birth to one year and their parents, as part of a universal plus package. It is well documented that early interventions like this could have a far-reaching impact on outcomes for a child and their family. The perinatal period is a time of vulnerability often associated with the onset or aggravation of mental health problems. In this period, the relationship between mother and baby is established. This relationship is crucial for the baby’s physical, social, cognitive and emotional development. Experiencing a mental health problem can interfere with the parent’s ability to provide sensitive care to the baby. Not all parents experiencing mental health problems display this lack of sensitivity; however when it is displayed it can lead to adverse mental health and behavioural outcomes for the child. Research suggests that addressing mothers’ mental health alone does not improve outcomes for babies.To improve mother and baby interactions, interventions are needed that focus specifically on the quality of this relationship. Video feedback interventions such as VIG have been designed to do just this and have been shown to increase maternal sensitivity and child attachment security across a wide range of populations. VIG is recommended by NICE and Public Health England as an evidence-based intervention for health visitors and midwives.
VIG has been adopted by the Health Visiting Services in Peterborough and Cambridgeshire to supplement the interventions offered to mothers and babies in the perinatal period. The perinatal VIG service consists of health visitors who have trained, or are training in Video Interaction Guidance. Referrals can be made to the VIG Co-ordinators in Peterborough or Cambridgeshire who will triage the referrals and allocate them to an available VIG health visitor. The VIG health visitor will liaise with the referrer and then arrange to visit the family to explain the VIG process and gain consent for filming. Usually 2-4 cycles of VIG will be offered (where a cycle consists of a visit to obtain the film followed by a shared review visit to discuss the edited clips of film). The edited video clips of ‘better than usual’ communication between mother and baby are used as the basis of reflective dialogue about how to develop the relationship further. When the VIG package of care is completed the VIG health visitor will complete any outcome measures, liaise with the referrer, if appropriate, and handover care to the named health visitor for the family. Referrals into the perinatal VIG service are considered from the specialist perinatal mental health service, specialist midwives and from health visitors. The following criteria apply: – Referrals made within perinatal period : antenatal up to the child’s first birthday – Evidence of possible attachment issues or concerns around parental sensitivity – Evidence of significant mental health issues likely to impact on the parent-infant relationship
The following 4 scenarios describe just some of the situations where ViG has been effectively used in Peterborough: 1. A mother believed her son didn’t like her because she felt he didn’t want to look at or play with her. The videos were focused on play, and after just one session her beliefs system changed as she identified many positive interactions and examples of attunement. English was not her first language, but she said the ViG was ‘like magic’ and completely changed her relationship with her son. 2. The mother of a six-month old with Down’s Syndrome was concerned about how they communicated. The videos focused on her physical interactions with him and one in particular captured a special moment of her singing Twinkle Twinkle, Little Star, in which he touched the top of the star shape she made with her hand without any prompting. an emotional moment followed when the mother realised just how attuned they were. 3. A mother with a history of poor mental health believed her son had a developmental delay and feared he would die of SIDS. The ViG focused on interactions in which she could see his development was age-appropriate and that he was a healthy and happy baby. She started to believe there was no evidence to support her previous beliefs and her confidence grew. 4. A mother had been admitted to a mental health unit shortly after delivery with postpartum psychosis, while the father cared for their daughter. When she returned home she felt guilty for going away and inadequate. The sessions focused on her recognising the richness of their relationship and their attunement, which grew as they went on.
Wider Active Support
Monthly meetings are held in conjunction with Perinatal MH Services in adult mental health. This enables mutually beneficial peer supervision and also smooth transitions of individuals accessing support between services as required. Quarterly meetings are held with NSPCC to share learning and provide professional support in relation to implementing and sustaining VIG services.
A continual cycle of feedback and improvement is adopted. Changes and adaptations are made in response to elicited feedback, prompted from evaluation and discussion with all those using the service and their family.
Looking Back/Challenges Faced
In the early stages of implementation, the demands of high level of caseload work was at risk of compromising the project. In response to this, practitioners trained in delivering VIG are now allocated protected days to complete these interventions and associated administrative work to ensure the project continues to provide support for all those that require it; and that it is sustainable for the practitioners providing this important intervention. Additionally true co-production alongside service users would have been embedded within the implementation and review processes from the outset.
The health visiting service in CPFT is in the process of aligning with another Trust. There will be one person who will lead on the coordination of this service across the 2 trusts. The processes for this coordination are known by many of the practitioners within the service; therefore if the lead coordinator left it would be straightforward to take on this role. VIG is now well embedded, with a number of staff trained and all new staff will continue to receive training to ensure a sustainable model is maintained.
Evaluation (Peer or Academic)
The VIG service in Peterborough is yet to undergo formal peer or academic evaluation, however the principles and processes of utilising VIG are evidence based. The process of VIG involves being seen and being felt to be seen in a positive light, which is amplified by the visual image in conjunction with the attuned primary intersubjective experience with the guider. This can be termed ‘benign mirroring’ (Celebi, 2013). The experience can activate and strengthen neural pathways in the limbic system , which can reinforce secure attachment and link to the calm and connect system (Uvnäs-Moberg and Francis, 2003). This can create a sense of wellbeing, receptivity and self-acceptance (Siegel, 2009). It is an area on which further future research will be able to shed more light. Patient self report evaluation questionnaires also demonstrate both quantitative and qualitative improvements to the mental health and wellbeing of parents and their, sensitivity attachment and attunement to their baby.
Each person that the service works with establishes a goal that they want to achieve through VIG. At the end of the work the individual completes an evaluation tool and considers their outcomes in relation to their goals. Comments from those accessing the service in relation to their progress has included: “As soon as I look at my son, I know everything is worth it for him, even though most of my life is difficult. This has given me confidence.” “These are the things that you don’t see, even just changing a nappy, I’m not doing anything important, part of me thinks, oh why didn’t I see that before. I should have been able to pick that up for myself, but I needed the video to see that I am doing ok.” “On a bad day it shows that I am a good mum, mmm, I don’t really say that to myself, actually I don’t say that ever to myself. I always think that I am doing something wrong, but seeing the video shows me that I am doing all that I need to do …I just couldn’t see it before this.” References: Celebi M (2013) Helping to reduce parental anxiety in the perinatal period. Journal of Health Visiting 1(8): 438–42 Siegel DJ (2009) Mindsight: The New Science of Personal Transformation. Google Tech Talks. www.youtube.com/watch?v=Gr4Od7kqDT8 Uvnäs-Moberg k, Francis R (2003) The Oxytocin Factor: Tapping the Hormone of Calm, Love and Healing. Da Capo Press Inc, Cambridge, MA
Never has there been a greater need to deliver a VIG programme within health visiting. Early intervention in the first year of life has positive outcomes for babies and their parents. As “1001 critical days” states, early intervention can seem challenging in the current economic situation, but without a focus on prevention, the costs of managing these issues will continue to rise. The potential is there to make a real difference to families now as well as to future generations. The challenge is to continue to promote interventions like VIG, prove their value and influence policy to ensure infant mental health is a public health priority. Before the service was initiated Health Visitors in Peterborough did not have access to any therapeutic services for this age range and had limited access to adult mental health services.
This service has improved outcomes for not only the infants but the mothers who prior to this had no recourse to help with developing their relationship with their infant. The process starts with an introduction session to gain consent and help the parent negotiate their goals. A parent often focuses at the start of the process on what they want to work towards, and at the end of the process they tend to explore more how they can make changes and how that would feel. A VIG cycle involves two sessions – a filming session of an interaction (eg an activity such as feeding or playing for about five minutes) and then a shared review (of about an hour) the following week. The VIG guider then microanalyses and edits two or three short clips of film focusing on the positive interactions, using the principles of attunement. The ‘evidence’ of the video encourages reflection and this deepens discussion about the feelings and emotions observed. This can develop a parent’s capacity to mentalise (interpret behaviours in terms of underlying feeling states) about their baby, supporting optimal outcomes. It also challenges their belief system and creates new meanings and ideas for change. Three to four cycles usually produce significant change, but the number of sessions can be flexible.
At the end, the parent is given a DVD of the video clips of special moments with their baby. Over 20 families in Peterborough have been supported through VIG to date.
Two members of the team have published an article about the service in a national health visiting journal. They have also presented their work at the national health visiting conference in October 2017. They meet with other VIG practitioners in NSPCC on a quarterly basis and have contributed to training events for perinatal adult mental health locally and across the East of England.
Can you please tell us who your service is commissioned by and provided by?
Commissioned by Cambridgeshire and Peterborough CCG; Provided by CPFT
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