WillisPalmer launches Remote Assessment Service

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Interview with Amanda De Leon Capdesuner

Local authorities are being urged to use Video Interaction Guidance to work with a whole range of service users. Amanda De Leon Capdesuner, a social worker with more than 22 years post-qualifying experience, says the process, which is a strengths-based interaction used to improve attachment, communication and sensitivity between children and their carers, can be used in a huge range of social work services.

"VIG can be used with pregnant parents to be using the scan photo to build sensitivity with the baby, with mothers of babies in neonatal units who were born prematurely, it is used in mother and child mental health services, in schools where teachers need to understand a child's needs," says Amanda. "It can be used with children in care at any time during their experience of care, I have used it where a family member had a Special Guardianship Order of her granddaughter where they though their relationship had broken down but the process proved there was a lot of love there and helped repair their relationship"

"VIG can be used in fostering where to help the foster carer build up their attunment to the child or where there are issues around behaviour and potential for placement breakdown. There are many situations it could apply to - residential homes for older people, residential homes for children, people with learning disabilities - it can be used in so many situations, we don't yet know the full power of it," she added. "It is used in child protection cases where children have been removed from their families and have contact with their children make contact is a more positive experience for the child."

Enhance communication

VIG can also be used with practitioners as part of reflective supervision and in business settings too as well as with couples needing to improve their communication.

VIG uses video to record a carer's interaction with their child in order to help improve their responsiveness to their child's emotional needs and to promote a secure attachment by focusing on the strengths seen in the film footage. It can enhance communication in relationships, prevent problems from escalating and can be a useful tool to highlight a family’s capacity to change.

Video interaction guidance is used in more than 15 countries and by at least 4000 practitioners in social care, health and education settings. It is often delivered by psychologists, health visitors and social care workers. In fact, it was brought to the UK by a small group of educational psychologists working in Tayside, Scotland in the 1990's although the method is based on a model developed in the Netherlands by Harrie Biemans and colleagues in the 1980’s.

Amanda's interest in VIG was sparked two years ago when she was working as a team manager for the NSPCC for five years. The NSPCC has service center’s where staff delivered services which were developed, delivered and evaluated in order to provide evidenced based services to improve outcomes for children and families. Some of these being scaled up to other organisations and local authorities such as Letting the Future In, Graded Care Profile and Babysteps.

For example, one of the pilots focused on addressing the drift and delay in cases where children were at risk of neglect. "With physical or sexual abuse, cases meet the thresholds for intervention but often in cases of neglect, it is difficult for families to meet thresholds. As a result, where concerns are raised about a family, a social worker would intervene and work with the family and improve situations, however when cases are stepped down, situations at home often revert to the way they were or another issue will emerge. Due to the periods of improvement often followed by a deterioration in the family’s ability to sustain the changes and sometimes a change of workers wanting to provide a new opportunity to evidence change this can often mean that children experience neglectful parenting for many years. As a result, the NSPCC created an assessment service to support social worker to prevent further drift and delay," explains Amanda.

"One of the services we were providing at the NSPCC was a standalone project delivered to families using VIG which was then incorporated into the domestic abuse service we piloted. In order to understand its effectiveness, I felt I needed to train in VIG and this was supported by Hilary Kennedy from AVIG UK and so when I was offered the training, I took it and utilised it in supervision with staff - that's how it began," she adds.

Strengths-based intervention

Amanda completed the two-day initial training which enabled her to become a trainee Video Interaction Trainee Guider. However, to become accredited, Amanda has to work with six different families undertaking three to four cycles of VIG with each family in her own time. She has completed work with four families including an asylum-seeking family and a foster carer whose self-esteem was "on the floor" due to difficulties with her son's behaviour.

Amanda will work with two more families before becoming fully accredited as a VIG Guider, although she currently uses techniques in her assessments. "In my practice I am much more confident to say 'look how well you are doing at this, and looking at attunement principles in everyday interactions’ she adds.

The training involves highlighting to the VIG trainees how to engage with families to show that they are being actively listened to and supported through a 'coaching' rather than 'teaching' model. As a strengths-based intervention, trainees must focus on the positive aspects of what is seen during interaction with families in a bid to show families what they can, rather than what they can not achieve, thus bolstering lagging self-esteem amongst children and carers.

Working with hope

Explaining the process, Amanda says she visits a family in their home as that is often where they are the most comfortable. She asks the family a helping question - what challenges are they facing and what would they like help with. Naturally, the answer will vary from case to case but it may be a parent or carer is struggling with their child's behaviour or emotional problems.

Amanda asks the carer to rate themselves on a scale of 1 to 10 on how they are currently dealing with the situation and then on a scale of 1 to 10 where they would like to be at the end of the process. She

then asks the carer to carry out an everyday activity with their child, for example, reading a book, playing a game or baking a cake and the activity is filmed for around 10 minutes.

Amanda then leaves and edits the 10 minute clip to focus on the strengths and positive moments between the child and carer, and she stresses that as a VIG trainee or VIG Guider you do need a keen eye for editing. She then revisits the family to play the edited version back to them. She asks the carer to explain what they are doing in the clip, what is happening, what they are seeing and how they are feeling. The carer is also about what the child is doing, thinking and feeling to help the carer to start to mentalise and develop their attunment. "Throughout this process the VIG Guider/trainee has to actively engage with the carer, show they are listening to what they are saying, validating them along with smiling and encouraging them and building a rapport with them and activating them to effect change," says Amanda.

"The carer may have been told beforehand that they are not doing x or y correctly but this is focusing on the strengths and then looking at ways the carer can embed their learning in to every day life," she adds. "With some families you may only get one still of positive interaction or a smile but it is about working with hope."

Boost self-esteem

Amanda repeats this cycle three to four times with the family and their 'helping' question may change over time. For instance, if initially a child is not listening but the process helps to address that issue, the family may ask for help regarding another aspect of their behaviour. After three-four cycles Amanda says you would expect to see some change and whether the intervention is working so in that respect it is quite a "short and sharp" intervention.

In one family who Amanda worked with, there was a nine-year-old boy who was frequently late for school. His mother struggled every morning to get him to wake up and get in the shower and was lifting him into the shower and getting him dressed meaning the mornings were stressful and charged with conflict and he would often be late for school. After engaging with VIG, the mother realised she was not allowing her son enough independence and they changed the whole morning routine so that the son would get himself up and showered and with gaining more independence, the son was co-operating better and getting to school on time. By the end of the process, the mother was working, her confidence had increased, she had gained refugee status, they had moved house from a fairly isolated position and both mother and son were socialising more and engaging in the community. The child reported that there was less arguments at home and he was happier as he was allowed to do more for himself and the morning routine meant that he got to school on time and wasn’t seen as different form the other children. Amanda explains that often changing the small issues can have a positive knock on effect on family life. The focus on 'strengths' and positives often boosts self-esteem in both parents and children, she adds.

"At the end of each session, I ask the carer to rate themselves and explain what they think has changed. Positive outcomes may include parents and children going out more, feeling more positive, feeling calmer, engaging in the community and I look at what has changed for them and what has changed for

the child. You then look at what the carer can do with the skills they have learnt and it may be that they want to return to education or become employed - it can have a wider impact," says Amanda. "Even if it is something small that has changed - people are trying their best and giving what they can to the situation and we build on the strengths."

Passionate

While Amanda has experienced positive outcomes, she adds that some families disengage from the process and some refuse to participate through fear of being filmed and how the footage could be used. She adds that while the process focuses on strengths, this needs to be balanced against any concerns she may have for the child, for example if a child is not making eye contact, they may be displaying avoidant attachment and may need help addressing that.

Furthermore, VIG can be used in reflective supervision, although this is often referred to as Video Enhanced Reflective Practice (VERP). "I have used it as a tool to carry out reflective supervision or it could be used if two members of staff are not getting along - any situation where the aim is to improve communication. VERP tends to be used more with group work, supervision and professional reflection."

Some, but not all, local authorities are offering VIG and despite it being recommended in the National Institute of Health and Care Excellence guidelines on attachment, "it has taken a while to get off the ground," says Amanda, adding that this could be down to the technical and recording equipment required and editing suites needed to complete the work - as well as GPDR issues. "It's not straightforward, there are a few hurdles to overcome."

Once Amanda gains her accreditation to become a VIG Guider, she can go on and train to become an advanced practitioner so that afterwards she can continue training as a supervisor where she could supervise trainees and deliver training. "It might be something I would do in the future although I would like to gain more practice first. I'm certainly very passionate about it," she concludes.

Amanda is practice manager in Wales for WillisPalmer.

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