Video interaction: another point of view

27 April 2017

When it comes to mental health, prevention is key. Janice Toyne and Clare Dhanushan describe how a video-based intervention is successfully enhancing communication between parents and their babies.

Infant mental health is one of the most exciting and rapidly developing areas of healthcare research. There’s a growing body of evidence indicating that support for parents during their baby’s first year can signifi cantly increase the proportion of infants securing a bond with their parents. The UK government is committed to improving mental health and wellbeing (DH, 2011), and early interventions such as video interaction guidance (VIG) could prevent the later development of mental health issues.

The Peterborough health visiting team within Cambridgeshire and Peterborough NHS Foundation Trust deliver a 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 NICE guidelines on children’s attachment (2016) and the 1001 critical days manifesto (Leadsom et al, 2013) highlight the potential use of VIG in health visiting. Health visitors have a universal contact with all families and are already familiar with the power of positive reinforcement, so are well placed to deliver this service.


VIG is a strengths-based intervention that promotes attunement and empathy by using video clips of authentic situations to enhance communication between a parent and baby. The technique allows parents to see for themselves what works well in their interactions with their baby and, crucially, how it can be enhanced.

Development psychologist Colwyn Trevarthen provided the theoretical inspiration for the development of VIG and developed the principles of attunement that are likened to the building blocks of communication. Using these principles is at the heart of VIG and is embedded into every contact between both parents and their babies, as well as with the VIG guider. The VIG principles of attunement include: being attentive; encouraging initiatives; receiving initiatives; attuned interactions; guiding; and deepening discussion.

Six health visitors in Peterborough (caseload 15,216; 42.36 whole-time equivalents) have completed the initial two-day VIG training and dedicate one day per week to this. Three stages of supervised practice follow initial training, which involves maintaining a comprehensive log of cases and having regular supervision before becoming accredited. Referrals for the VIG team are either from the perinatal mental health nurse or a health visitor who has identified an early attachment difficulty.


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 (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 fi lm focusing on the positive interactions, using the principles of attunement. The ‘evidence’ of the video encourages refl ection 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 signifi cant change, but the number of sessions can be flexible. At the end, the parent is given a DVD of special moments with their baby. More than 30 families in Peterborough have been supported through VIG to date.


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 infl uence policy to ensure infant mental health is a public health priority.


These scenarios describe just some of the situations where VIG has been eff ectively 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-monthold 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 confi dence 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.


Leadsom A, Field F, Burstow P, Lucas C. (2013) The 1001 critical days: the importance of the conception to age two period. See: wavetrust.org/sites/default/files/reports/1001%20Critical%20Days%20-%20The%20Importance%20of%20the%20Conception%20to%20Age%20Two%20Period%20Refreshed_0.pdf (accessed 17 March 2017).

NICE. (2012) Social and emotional wellbeing: early years. See: nice.org.uk/guidance/ph40 (accessed 17 March 2017).

NICE. (2016) Children’s attachment. See: nice.org.uk/guidance/qs133 (accessed 17 March 2017).


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