Video feedback compared to treatment as usual in families with parent-child interactions problems: a randomized controlled trial

Are changes in mothers' representations of their infants related to changes in observed mother-infant interaction quality?

Infant mental health clinicians aiming to improve mother-infant dyads at risk typically target mothers' representations of their infant or mother-infant interactions, assuming that one port of entry leads to change in the other. However, little is known about the relation between changes in mothers' representations and in mother-infant interactions. Therefore, the current study aimed to investigate this in a low- to moderate-risk community sample of 152 mothers (M = 29.7 years) of infants aged 0-2 years (M = 11.5 months) recruited from rural and urban cities in Norway. The mothers' representations were measured using the Working Model of the Child Interview, and the quality of the mother-infant interactions was measured with the Emotional Availability Scales. We found no evidence of a relation between mothers' changed representations and changed quality of mother-infant interactions. Several explanations concerning the low-risk status of the sample, the observation situation, the time between assessment points, and the homogeneous scores from the instruments used are discussed, as are the implications for clinical practice and future research.

Can mothers' representations of their infants be improved in primary care? A randomized controlled trial of a parenting intervention using video feedback in a predominantly low- to moderate-risk sample

Introduction

Mothers' representations of their infants are important intervention targets because they predict the observed quality of infant-mother interactions. The current study investigated the influence of a video-feedback infant-parent intervention on mothers' representations of their infants beyond the effect of standard treatment.

Methods

Data from a naturalistic, randomized controlled trial of 152 predominantly low- to moderate-risk mothers (mean age = 29.7 years) with infants (mean age = 7.3 months) were used. At Well Baby Centers, all families followed the universal program, which was treatment as usual (TAU), whereas half of the families also received the intervention. The Working Model of the Child Interview categories and scales as well as three latent factors generated from a factor analysis were used to assess maternal representations at baseline and follow-up (9-13 months after baseline). A linear mixed model analysis was used to analyze the data.

Results

There were no differences in representation changes from baseline to follow-up between the control group (TAU) and intervention group. When both groups were combined, there were minor improvements in the mothers' representations at the follow-up.

Discussion

Aspects of the intervention, the quality of TAU, and the homogeneity scores of the predominantly low-risk sample may explain the intervention's lack of effect on mothers' representations beyond TAU. The supportive services at Norwegian Well Baby Centers as well as the infants' increasing age putatively contributed to the improved features of the mothers' representations in the total sample. That standard community care may affect maternal representations has not been shown before. Future research should identify the core components in interventions targeting maternal representations and examine whether those components can be incorporated in primary care. Including measures of mothers' reflective functioning could broaden our knowledge of representations and their changeability.

Clinical trial registration

This study is registered in the International Standard Randomized Controlled Trial Number registry under the reference number ISRCTN 99793905.

Supporting Parenting at Home-Empowering Rehabilitation through Engagement (SPHERE): study protocol for a randomised control trial

INTRODUCTION

Infants with neurodevelopmental disabilities (NDs) show emotional, cognitive and sociointeractive dysregulation dramatically impacting on caregiving behaviour. Early video-feedback interventions (VFIs) are effective in promoting sensitive parenting, which in turn supports infants' development, even in case of ND. In the light of limited resources of the healthcare systems, technological advances in telemedicine may facilitate the delivery of VFI to a greater number of families of infants with ND. To date, no study has implemented a telemedicine VFI (TVFI) for families of infants diagnosed with ND.

METHODS AND ANALYSIS

The Supporting Parenting at Home-Empowering Rehabilitation through Engagement project is a randomised controlled trial aimed at assessing the effectiveness of an early family-centred TVFI parenting support on dyads with infants diagnosed with ND. It includes two arms (TVFI vs Booklet Psychoeducational Intervention) and three assessment phases: T0, baseline; T1, immediate postintervention; T2, 6-month follow-up.

ETHICS AND DISSEMINATION

This study is funded by the Italian Ministry of Health and was approved by the Ethics Committee (Pavia). Results will be published in peer-reviewed journals and presented at national and international scientific conferences.

TRIAL REGISTRATION NUMBER

The study protocol has been also registered on NIH Clinical Trials (protocol code NCT04656483; Pre-results).

Video Intervention Therapy for primary caregivers in a child psychiatry unit: a randomized feasibility trial

BACKGROUND

During child psychiatry hospitalization, working with the families or attachment figures is a challenge, most of the children who are admitted to these units come from multi-problem families, with limited research in this area. Video feedback (VF) interventions have proved to be a powerful resource to promote parental and child well-being in small children and has been used with parents with a psychiatric condition. Parental Reflective Functioning (PRF) is one of the parental abilities that can be improved with VF and could be especially important in coping with conflict and negative emotions in older children. The aim of this study is to implement Video Intervention Therapy (VIT) to enhance PRF in primary caregivers of inpatient psychiatric children. As there is no published research using VF with parents of children with severe psychopathology in a hospitalized context. This report, then, becomes a much needed pilot study providing evidence for a larger randomized control trial (RCT).

METHODS

The study is a single-center, two-arm feasibility randomized control trial with a qualitative component. Block randomization was done to generate a 2:1 allocation, leaving more participants in the intervention group. The intervention comprises four modules; every module has both one video-recorded play session and one VIT session (in a group setting) per week. Evaluation of the caregivers included assessments of PRF and well-being, and child assessment included parent-ratings and clinician-ratings of symptomatology and general functioning.

RESULTS

Thirty participants were randomized; eligibility and recruitment rate were 70.6% and 83.3%, respectively. The compliance-to-intervention rate was 85% in the VIT group and 90% in the control group. All participants completed entry evaluation and 90% at the 3-month follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. Outcome data must be treated with caution due to the small numbers involved, yet indicate that the VIT may have a positive effect in improving parental and child mental health outcomes.

CONCLUSIONS

VIT for primary caregivers of child inpatient children was feasible to deliver and acceptable for participants, therapist, and the staff unit involved; there is sufficient evidence to undertake a full-scale effectiveness RCT.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03374904 . Registered on 14 December 2017.

Like Taking a Magnifying Glass Into Everyday Life: Vulnerable Parents' Experiences With Video Guidance in an Infant Mental Health Clinic

Background: Parents are a central focus in clinical infant mental health interventions because of the key importance of the caregiver-infant relationship, especially when dyads are burdened by psychosocial and parental mental health problems. However, knowledge is scarce about the lived experience of vulnerable parents who undergo video-based guidance.

Aim: The study explores how parents in an infant-psychiatric outpatient clinic who struggled to mentalize and remain emotionally connected to their infant experienced helpful and challenging elements in video guidance.

Method: We analyzed the interviews of a strategic sample of 12 parents after undergoing Marte Meo video guidance, using a team-based, reflexive thematic analysis (TA).

Results: We identified four main themes: (a) Handling initial feelings of fear and loss of control; (b) Filming as a disturbing or agentic experience; (c) Feeling validated or devalued in the therapeutic relationship; and (d) Bringing insights from video guidance into everyday life. Therapeutic and existential factors became apparent in the main themes of adjustment to the guidance, experiences with filming, the therapeutic relationship and integration of new experiences.

Conclusion: The parents’ sense of agency, dignity, and shame may be important for their ability to integrate new ideas about themselves.

Implications: Video guidance for vulnerable parents in specialized clinical treatment should address relational challenges, parental mental health, and issues of recognition.

The porridge-like framework: A multidimensional guidance to support parents of children with developmental disabilities

Parents of children with developmental disabilities face many daily challenges that can lead to emotional and affective problems, difficulties in caregiving, and partial mental representations about themselves and their children. The multi-faceted nature of these parents' needs requires a multi-component approach that should include the analysis of priority support goals and the planning of tailored therapeutic actions. Despite different types of validated interventions are available, the choice of the most appropriate strategy to pursue a family-centered approach to support parents of infants with developmental disabilities is not obvious. In this scenario, we propose a multi-dimensional model, the porridge-like framework of parenting. It considers three interrelated domains in parents' experience - affective (A), behavioral (B), and cognitive (C) aspects - that are intertwined with the specific degree of the child's impairment (D). This ABCD model may provide professionals with pragmatically valid guidance to plan and deliver family-centered healthcare interventions. By covering the multi-dimensional nature of parenting challenges, it provides clinicians with conceptual categories to recognize the specific needs and to choose the most suitable therapeutic action to address them. In addition, it aims to promote an ethical approach to family-centered rehabilitation for children with developmental disabilities, maximizing the potentials of a collaborative assessment approach.

Learning to mentalize: Exploring vulnerable parents' experiences of change during video guidance in an infant mental health clinic

BACKGROUND

Interventions that promote infant mental health face challenges when applied for parents who struggle with psychosocial and psychological burdens. Video-based guidance using the Marte Meo method is used in specialized clinical settings with high-risk families to improve parent-child interaction, parental sensitivity and mentalizing. However, knowledge about the lifeworlds of these parents and their experiences of the therapeutic process during video guidance is limited.

AIM

This qualitative study explores how parents in an infant mental health outpatient clinic who had difficulties mentalizing and maintaining an emotional connection with their infants experienced the change process during Marte Meo video guidance.

METHODS

We identified a strategic sample of parents with difficulties mentalizing and maintaining an emotional connection with their infants through the Parent Development Interview. Twelve parents received video guidance and were afterwards interviewed in-depth. The research interviews were qualitatively analysed via a team-based reflexive thematic analysis.

RESULT

We identified four themes: a) feeling inadequate or disconnected as a parent; b) discovering the infant as a relating and intentional person; c) becoming more agentic and interconnected; and d) still feeling challenged by personal mental health issues.

CONCLUSION

Parents described positive changes in their interactions, in mentalizing their infants, the relationship and themselves as parents, in their experiences of self-efficacy and on a representational level. They also described increased confidence and improved coping despite ongoing personal mental health challenges. The findings suggest that video guidance using the Marte Meo method can be a critical intervention for vulnerable parents but should be coordinated with parents' primary treatments when complex parental mental health issues are involved.

Measuring mothers' representations of their infants: Psychometric properties of the clinical scales of the working model of the child interview in a low- to moderate-risk sample

The Working Model of the Child Interview (WMCI) is frequently used to measure parents' representations. Beyond the global categories (balanced, disengaged, distorted), the reliability, factor structure, and validity of all the 15 clinical scales have not previously been studied. The WMCI was administered to 152 Norwegian mothers of infants (mean age = 7.3 months) recruited from community well-baby clinics. Interrater reliability was adequate for the global categories and moderate for the clinical scales. Exploratory factor analysis and confirmatory factor analysis yielded three factors with evidence of factorial validity: Factor 1 balanced; factor 2 resentful; factor 3 apprehensive. Factor 1 corresponded with the original category balanced, while factor 2 and factor 3 corresponded with the original category distorted. Concurrent validity was supported as mothers with balanced representation (factor 1) were less stressed and the mother-infant interaction was more positive than that of mothers with resentful representation. Mothers with resentful or apprehensive representations (factor 2 and factor 3) reported more stress. The extracted factors and demographic variables correlated weakly or not at all, confirming discriminant validity. Our findings show that the clinical scales of the WMCI can be used in research with low- to moderate-risk samples.

Short-term psychodynamic infant-parent interventions at Child health centers: Outcomes on parental depression and infant social-emotional functioning

Randomized controlled trials (RCTs) demonstrate efficacy of parent-infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short-term Psychodynamic Infant-Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers' questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect-sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.

Bipolar offspring and mothers: interactional challenges at infant age 3 and 12 months-a developmental pathway to enhanced risk?

BACKGROUND

Bipolar offspring are considered a high-risk group for developing mental disorders. Developmental outcomes result from additive and interactive effects of biological vulnerability and environmental influences. Mother-infant interactions represent important early environmental influences that may modify infants' risk of mental disorders. The aim of the current prospective study was to investigate the patterns and development of mother-infant interactions in the first year of life in dyads in which the mothers have bipolar disorder (BD).

METHODS

Twenty-six dyads in which the mothers had BD and 28 dyads in which the mothers had no mental disorder were video-taped in a free play interaction. The Parent-Child Early Relational Assessment (PCERA) was used to assess the quality of the interactions on three domains (maternal behaviour, infant behaviour and dyadic coordination) at 3 and 12 months of infant age. First, we compared the mother-infant interaction patterns between the two groups at 12 months. Second, we investigated how the patterns developed within and between the groups from infant ages 3 to 12 months.

RESULTS

BD dyads demonstrated significantly more challenges in all three interaction domains at infant age 12 months compared to the healthy dyads. This observation was in line with the findings at infant age 3 months. Subdued expression of positive affect and mutual underinvolvement represented core challenges in maternal and infant behaviours in the BD dyads. Continuous difficulties with dyadic coordination and reciprocity were the most concerning interaction behaviours at 3 and 12 months. On the positive side, there was little expression of negative affect or tension in maternal, infant and dyadic behaviour, and some positive changes in infant behaviour from 3 to 12 months.

CONCLUSIONS

The current results suggest that challenges in mother-infant interaction patterns in the first year of life may enhance the developmental risk for bipolar offspring. Clinical interventions should address both the BD mothers' needs in relation to postpartum mood deviations and mother-infant interactions. We suggest interaction interventions to promote dyadic coordination and reciprocity, such as helping mothers being more sensitive to their infant's cues and to provide attuned contingent responses.

Marte Meo Counselling given to African caregivers of institutionalised infants a three-case study

BACKGROUND

Studies from Western countries state that video interaction guidance programmes can support caregiver sensitivity in infant-caregiver dyads.

OBJECTIVES

The aim of this study was to investigate if Marte Meo, which is such a programme, could contribute to increasing emotional and social support towards motherless infants at an institution for motherless infants in rural Africa.

METHOD

Three caregivers participated in five Marte Meo Counselling sessions. The first guidance naïve film and the last film were analysed qualitatively and quantitatively and organised according to two supportive categories: 1) caregiver responds to infants' initiative, 2) caregiver takes initiative to supportive interaction, and two non-supportive: 3) caregiver behaves in an intrusive manner and 4) caregiver does not respond to the infants' initiative.

RESULTS

After receiving Marte Meo Counselling, all three caregivers showed impressive augmentation of awareness and sensitivity in their care towards the infants' emotional and social needs.

CONCLUSION

We found indications that professional caregivers of institutionalised infants in an African country can profit on Marte Meo Counselling, showing positive effects on augmenting caregivers' sensitivity towards the infants, and thereby meet the infants' need of emotional and social support.

Finding focus in a difficult landscape: Therapists' experiences with challenging video guidance processes for parent-infant dyads

Marte Meo video guidance uses filmed interaction of the actual parent-infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent-infant dyads may illuminate important aspects of the method itself as well as the therapists' role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent-infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent-infant dyads where child protective issues arise, where caregivers' insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists' role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges.

Early Parenting Intervention - Biobehavioral Outcomes in infants with Neurodevelopmental Disabilities (EPI-BOND): study protocol for an Italian multicentre randomised controlled trial

INTRODUCTION

Neurodevelopmental disability (ND) represents an adverse condition for infants' socio-emotional and behavioural development as well as for caregiving (eg, parental sensitivity) and mother-infant interaction. Adverse exposures are associated with altered neuroendocrine hormones concentrations (eg, oxytocin and cortisol) and epigenetic regulation (eg, methylation of stress-related genes), which in turn may contribute to less-than-optimal mother-infant interaction. Parental sensitivity is a protective factor for childrens' development and early parental interventions (eg, video-feedback intervention) can promote parental caregiving and better developmental outcomes in children. The present multi-centric and longitudinal randomised controlled trial aims to assess if and to which extent early VFI could benefit both infants and mothers in terms of behavioural outcomes as well as neuroendocrine and epigenetic regulation.

METHODS AND ANALYSIS

Dyads will be randomly assigned to the video-feedback Intervention Group or Control Group ('dummy' intervention: telephone calls). Infants with ND aged 3 to 18 months will be recruited from three major child neuropsychiatric units in northern Italy. A multi-layer approach to intervention effects will include videotapes of mother-infant interaction, maternal reports as well as saliva samples for hormones concentrations and target-gene methylation analysis (eg, BDNF, NR3C1, OXTR and SCL6A4) that will be obtained at each of the four assessment sessions: T₀, baseline; T₁, post-intervention; T₂, short-term follow-up (3 month); T₃, long-term follow-up (6 month). Primary effectiveness measures will be infant socio-emotional behaviour and maternal sensitivity. Neuroendocrine hormones concentrations and DNA methylation status of target genes will be secondary outcomes. Feasibility, moderation and confounding variables will be measured and controlled between the two groups.

ETHICS AND DISSEMINATION

Ethics approval has been obtained in all three participating units. Results of the main trial and each of the secondary endpoints will be submitted for publication in peer-reviewed journals and international conferences.

TRIAL REGISTRATION NUMBER

NCT03853564; Pre-results.

Evidence and Open Questions for the Use of Video-Feedback Interventions With Parents of Children With Neurodevelopmental Disabilities

The Video-Feedback Intervention (VFI) is a technique aimed at promoting positive parenting that has been found to be supportive of child development and parent-child interaction in different at-risk and clinical populations. The application of VFI with parents of children with neurodevelopmental disabilities (ND; e.g., cerebral palsy, sensory and/or psychomotor delay, and genetic syndromes) is growing. Nonetheless, no systematic review is currently available documenting whether this type of intervention improves children's developmental outcomes (e.g., behavioral stability and cognitive abilities), parental caregiving skills (e.g., responsive parenting), and parental emotional well-being (e.g., depressive symptomatology). In the present mini-review, 212 VFI records were retrieved from three databases (i.e., PubMed, Scopus, and Web of Science), and 10 papers were finally included. Abstracted information included age, diagnosis, methodological aspects (timing, setting, and themes), and child/parent outcomes. Significant improvements from pre- to post-VFI were observed in all studies. Specifically, the VFIs were significantly associated with better children developmental outcomes and parental caregiving skills. Inconsistent findings emerged for the VFI effects on parental emotional well-being. Overall, the current mini-review supports the potential effectiveness of parent-focused VFI interventions for parents of children with ND, despite the presence of open questions that need to be addressed in future clinical trials.

Newborn Behavioral Observation, maternal stress, depressive symptoms and the mother-infant relationship: results from the Northern Babies Longitudinal Study (NorBaby)

BACKGROUND

Families can experience the postpartum period as overwhelming and many report a special need for support. The Newborn Behavioral Observation (NBO) aims to promote a positive parent-infant relationship by sensitising parents to the infant's signals. This article evaluates the NBO as a universal preventive intervention within the regular well-baby clinic service on measures of maternal depressive symptoms, parental stress, the mother-infant relationship and satisfaction/benefit of the postpartum follow-up.

METHODS

This investigation is part of a larger longitudinal study comprising 220 women and 130 of their partners recruited between 2015 and 2017. The study had a non-randomised cluster-controlled design with 6 measurement points. This article is based on a sample of 196 women using data from T1 (gestational weeks 13-39), T4 (5-15 weeks postpartum) and T5 (3-9 months postpartum). Participants were allocated to a group receiving the NBO (n = 82) and a care as usual comparison group (n = 114). We measured maternal depressive symptoms and parental stress using the Edinburgh Postnatal Depression Scale (EPDS) and the Parenting Stress Index (PSI). The mother-infant relationship was assessed with the Parental Reflective Functioning Questionnaire (PRFQ), the Maternal Postnatal Attachment Scale (MPAS) and the Maternal Confidence Questionnaire (MCQ). Participants also answered questions about satisfaction/benefit of the postpartum follow-up.

RESULTS

A Mann-Whitney U test indicated that participants in the NBO-group learned significantly more than the comparison group from the follow-up about the baby's signals in relation to sleep/sleep patterns, social interaction and crying/fuzziness. Multivariate analyses of covariance (MANCOVA) and repeated measures ANCOVA found no significant differences between the groups for the mother-infant relationship domain and few differences in depressive symptoms and parental stress. The repeated measures ANCOVA found that participants in the NBO-group scored slightly higher on parental stress, although the difference was small.

CONCLUSIONS

The results indicate that the NBO-group learned more than the comparison group about reading their child's signals in important everyday situations. However, the benefits of the NBO were limited for depressive symptoms, parental stress and self-reported mother-infant relationship. The study sample was generally well-functioning, and the results indicate that the benefits of the NBO may be limited within a well-functioning sample.

TRIAL REGISTRATION

ClinicalTrials, NCT02538497, Registered 2 September 2015.

Video feedback for parental sensitivity and attachment security in children under five years

BACKGROUND

Children who are securely attached to at least one parent are able to be comforted by that parent when they are distressed and explore the world confidently by using that parent as a 'secure base'. Research suggests that a secure attachment enables children to function better across all aspects of their development. Promoting secure attachment, therefore, is a goal of many early interventions. Attachment is mediated through parental sensitivity to signals of distress from the child. One means of improving parental sensitivity is through video feedback, which involves showing a parent brief moments of their interaction with their child, to strengthen their sensitivity and responsiveness to their child's signals.

OBJECTIVES

To assess the effects of video feedback on parental sensitivity and attachment security in children aged under five years who are at risk for poor attachment outcomes.

SEARCH METHODS

In November 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, nine other databases and two trials registers. We also handsearched the reference lists of included studies, relevant systematic reviews, and several relevant websites SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that assessed the effects of video feedback versus no treatment, inactive alternative intervention, or treatment as usual for parental sensitivity, parental reflective functioning, attachment security and adverse effects in children aged from birth to four years 11 months.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

This review includes 22 studies from seven countries in Europe and two countries in North America, with a total of 1889 randomised parent-child dyads or family units. Interventions targeted parents of children aged under five years, experiencing a wide range of difficulties (such as deafness or prematurity), or facing challenges that put them at risk of attachment issues (for example, parental depression). Nearly all studies reported some form of external funding, from a charitable organisation (n = 7) or public body, or both (n = 18). We considered most studies as being at low or unclear risk of bias across the majority of domains, with the exception of blinding of participants and personnel, where we assessed all studies as being at high risk of performance bias. For outcomes where self-report measures were used, such as parental stress and anxiety, we rated all studies at high risk of bias for blinding of outcome assessors. Parental sensitivity. A meta-analysis of 20 studies (1757 parent-child dyads) reported evidence of that video feedback improved parental sensitivity compared with a control or no intervention from postintervention to six months' follow-up (standardised mean difference (SMD) 0.34, 95% confidence interval (CI) 0.20 to 0.49, moderate-certainty evidence). The size of the observed impact compares favourably to other, similar interventions. Parental reflective functioning. No studies reported this outcome. Attachment security. A meta-analysis of two studies (166 parent-child dyads) indicated that video feedback increased the odds of being securely attached, measured using the Strange Situation Procedure, at postintervention (odds ratio 3.04, 95% CI 1.39 to 6.67, very low-certainty evidence). A second meta-analysis of two studies (131 parent-child dyads) that assessed attachment security using a different measure (Attachment Q-sort) found no effect of video feedback compared with the comparator groups (SMD 0.02, 95% CI -0.33 to 0.38, very low-certainty evidence). Adverse events. Eight studies (537 parent-child dyads) contributed data at postintervention or short-term follow-up to a meta-analysis of parental stress, and two studies (311 parent-child dyads) contributed short-term follow-up data to a meta-analysis of parental anxiety. There was no difference between intervention and comparator groups for either outcome. For parental stress the SMD between video feedback and control was -0.09 (95% CI -0.26 to 0.09, low-certainty evidence), while for parental anxiety the SMD was -0.28 (95% CI -0.87 to 0.31, very low-certainty evidence). Child behaviour. A meta-analysis of two studies (119 parent-child dyads) at long-term follow-up found no evidence of the effectiveness of video feedback on child behaviour (SMD 0.04, 95% CI -0.33 to 0.42, very low-certainty evidence). A moderator analysis found no evidence of an effect for the three prespecified variables (intervention type, number of feedback sessions and participating carer) when jointly tested. However, parent gender (both parents versus only mothers or only fathers) potentially has a statistically significant negative moderation effect, though only at α (alpha) = 0.1 AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that video feedback may improve sensitivity in parents of children who are at risk for poor attachment outcomes due to a range of difficulties. There is currently only little, very low-certainty evidence regarding the impact of video feedback on attachment security, compared with control: results differed based on the type of measure used, and follow-up was limited in duration. There is no evidence that video feedback has an impact on parental stress or anxiety (low- and very low-certainty evidence, respectively). Further evidence is needed regarding the longer-term impact of video feedback on attachment and more distal outcomes such as children's behaviour (very low-certainty evidence). Further research is needed on the impact of video-feedback on paternal sensitivity and parental reflective functioning, as no study measured these outcomes. This review is limited by the fact that the majority of included parents were mothers.

Video feedback intervention to enhance parental reflective functioning in primary caregivers of inpatient psychiatric children: protocol for a randomized feasibility trial

Background

Children requiring hospitalization for psychiatric care have serious disorders, high use of psychotropic medication, and frequent readmissions. The development and implementation of therapies focused on incorporating primary caregivers or attachment figures is necessary for working with children with severe psychiatric disorders. Mentalization or parental reflective functioning (PRF) is the ability of parents to understand their children’s behaviors as an expression of internal emotional states and act accordingly to help them regulate their emotions; in this way mentalizing is a key component of sensitive parenting. Video-assisted therapies have proven to be effective in promoting change in parent–child relationships. The majority of studies have been carried out with mothers of pre-school children and in an outpatient setting. Video intervention therapy (VIT) is a flexible manualized therapy, which allows the intervention to be individualized to the context where it is applied, according to the needs and resources of the people who participate in it. The objective of the study is to evaluate the feasibility and acceptability of applying VIT to improve the PRF of the parents as primary carers of children hospitalized in a psychiatric service.

Methods

This is a pilot randomized, single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 2:1 allocation (with more people allocated to the intervention arm). The intervention consists of four modules; every module has both one video-recorded play session and one VIT session per week. People assigned to the control group will receive treatment as usual plus weekly play sessions. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Evaluation of the caregivers will include assessments of PRF, wellbeing and personality structure; assessments of children will include parent-ratings and clinician-ratings of symptomatology and general functioning. After every video feedback (VF) session, PRF, the caregiver’s wellbeing and children’s general functioning will be reassessed.

Discussion

This study will contribute to the currently scarce evidence on how to provide family attachment-based interventions in a child inpatient psychiatric unit. It will also inform the design and implementation of a future randomized clinical trial.

Trial registration

ClinicalTrials.gov, NCT03374904. Registered on 14 December 2017 (retrospectively registered).

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3310-y) contains supplementary material, which is available to authorized users.

Marte Meo as a port of entry to parental sensitivity - a three-case study

BACKGROUND

Early parent- child relations play an important role in children's development. Therapeutic intervention towards infants and toddlers at high-risk intends to prevent mental health problems. In this work, the parent-child-dyad is crucial. The video interaction guidance method, Marte Meo, is one among different methods used in attachment-based treatment in an outpatient infant mental health clinic. Parental sensitivity towards infants and toddlers needs is considered significant in developing secure attachment. Secure attachment is further considered decisive for mental health and the extent to which children are at risk of developing mental health problems. Different treatment methods aim at strengthening parents' sensitivity. This study's purpose was to gain further understanding about parent's experiences with Marte Meo - therapy and highlight the importance for parental sensitivity.

METHODS

This is a cross-sectional phenomenological hermeneutical study. Four biological parents of three infants and toddlers aged 0-20 months who received Marte Meo- therapy in a clinical context were selected. Data was collected using semi structured interviews.

RESULTS

This article presents the study's key-finding; we suggest that sensitivity increases. The key components of this are: watching edited video interaction in a therapeutic context, emotional activation, mutuality, self-esteem / self-confidence and reflective function. These are further elaborated and discussed.

CONCLUSION

The findings indicate that Marte Meo contributes to facilitate development-supportive interaction, strengthen parental sensitivity, emotional availability, reflective functioning and coping - experience.

Moderating Role of the Form of Maltreatment Experienced by Children on the Effectiveness of a Parent Training Program

The study examines whether the form of maltreatment experienced by the child moderates the effects of a parent training program (PTP) on the probability that the child's case will be closed. This study involved 736 children on whom the Montreal child protective services (CPS) agency had an active file between 2007 and 2015. The experimental group was composed of all children with a parent who participated in the PTP Incredible Years ( n = 368). A control group was matched with the experimental group based on a propensity score. Cox regression revealed that once parents have participated in the PTP, the probability that their children's cases will be closed increases more for children being followed because of neglect than for those being followed because of emotional maltreatment. Results show that a parent's participating in a PTP is associated with an increase of the probability that his or her child's CPS case will be closed and hence with a reduction of the length of time that the child must receive protective services.

Maternal personality disorder symptoms in primary health care: associations with mother-toddler interactions at one-year follow-up

BACKGROUND

Research is scarce on how mothers' symptoms of personality disorders are linked to the mother-toddler relationship. In this study we have explored the extent to which these symptoms are associated with mutual mother-toddler interactions assessed 1 year after the initial assessment.

METHODS

Mothers and their 0-24-month-old children (n = 112) were recruited by nurses at well-baby clinics due to either self-reported or observed mother-toddler interaction problems. At inclusion (T1), mothers filled out the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q), which measures symptoms of ten personality disorders. A year later (T2), mother-toddler interactions were video-recorded and coded using a standardised observation measure, the Emotional Availability Scales.

RESULTS

Only maternal schizotypal personality disorder symptoms predicted both the mothers' and the toddlers' interactional styles. Mothers with schizotypal personality symptoms appeared less sensitive, less structuring and more intrusive in their interactions with their toddlers, while mothers' borderline personality disorder symptoms were associated with increased hostility. Furthermore, toddlers who had mothers with schizotypal personality symptoms were less responsive towards their mothers.

CONCLUSION

Measured dimensionally by self-report, maternal schizotypal personality symptoms were observed to predict the interaction styles of both mothers and their toddlers in the dyad, while borderline personality disorder symptoms predicted mothers' interactional behaviour only.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN99793905 , retrospectively registered. Registered on (04/08/2014).

Effects of parenting interventions for at-risk parents with infants: a systematic review and meta-analyses

OBJECTIVES

Infancy is a critical stage of life, and a secure relationship with caring and responsive caregivers is crucial for healthy infant development. Early parenting interventions aim to support families in which infants are at risk of developmental harm. Our objective is to systematically review the effects of parenting interventions on child development and on parent-child relationship for at-risk families with infants aged 0-12 months.

DESIGN

This is a systematic review and meta-analyses. We extracted publications from 10 databases in June 2013, January 2015 and June 2016, and supplemented with grey literature and hand search. We assessed risk of bias, calculated effect sizes and conducted meta-analyses.

INCLUSION CRITERIA

(1) Randomised controlled trials of structured psychosocial interventions offered to at-risk families with infants aged 0-12 months in Western Organisation for Economic Co-operation and Development (OECD) countries, (2) interventions with a minimum of three sessions and at least half of these delivered postnatally and (3) outcomes reported for child development or parent-child relationship.

RESULTS

Sixteen studies were included. Meta-analyses were conducted on seven outcomes represented in 13 studies. Parenting interventions significantly improved child behaviour (d=0.14; 95% CI 0.03 to 0.26), parent-child relationship (d=0.44; 95% CI 0.09 to 0.80) and maternal sensitivity (d=0.46; 95% CI 0.26 to 0.65) postintervention. There were no significant effects on cognitive development (d=0.13; 95% CI -0.08 to 0.41), internalising behaviour (d=0.16; 95% CI -0.03 to 0.33) or externalising behaviour (d=0.16; 95% CI -0.01 to 0.30) post-intervention. At long-term follow-up we found no significant effect on child behaviour (d=0.15; 95% CI -0.03 to 0.31).

CONCLUSIONS

Interventions offered to at-risk families in the first year of the child's life appear to improve child behaviour, parent-child relationship and maternal sensitivity post-intervention, but not child cognitive development and internalising or externalising behaviour. Future studies should incorporate follow-up assessments to examine long-term effects of early interventions.

Video feedback promotes relations between infants and vulnerable first-time mothers: a quasi-experimental study

Background

Supporting early mother-infant relationships to ensure infants’ future health has been recommended. The aim of this study was to investigate whether video feedback using the Marte Meo method promotes a healthy early relationship between infants and vulnerable first-time mothers. Video feedback or usual care was delivered by health visitors during home visits in Danish municipalities.

Methods

This quasi-experimental study included pre- and post-tests of 278 vulnerable families. Mothers were allocated to an intervention group (n = 69), a comparison group (n = 209) and an exactly matched video subsample from the comparison group (n = 63). Data consisted of self-reported questionnaires and video recordings of mother-infant interactions. Outcomes were mother-infant dyadic synchrony (CARE-Index), maternal confidence (KPCS), parental stress (PSS), maternal mood (EPDS) and infant socialemotional behaviours (ASQ:SE). The data were analysed using descriptive and linear multiple regression analysis.

Results

The levels of dyadic synchrony in the intervention group had significantly improved (p < 0.001) at follow-up with a mean score of 9.51 (95%CI;8.93–10.09) compared with 7.62 (95%CI;7.03–8.21). The intervention group also showed a higher level of maternal sensitivity with a mean score of 9.55 (95%CI;8.96–10.14) compared with 7.83 (95%CI;7.19–8.46) in the matched video subsample (p < 0.001). With respect to infant cooperation, similar improvements were found with a mean score of 9.43 (95% CI;8.88–9.99) in the intervention group compared with 7.73 (95%CI;7.13–8.33) in the matched video subsample from the comparison group (p < 0.001). Furthermore, mothers in the intervention group reported significantly lower levels of parental stress with a mean score of 32.04 (95%CI;30.13–33.94) compared with 35.29 (95%CI;34.07–36.52) in the comparison group (p = 0.03), as well as higher levels of maternal confidence with a mean score of 41.10 (95%CI;40.22–41.98) compared with 40.10 (95%CI;39.65–40.56) in the comparison group (p = 0.04). No significant differences were found in EPDS and ASQ:SE.

Conclusion

The findings support the assumption that video feedback using the Marte Meo method early after birth may strengthen the relationship between infants and vulnerable firsttime mothers as well as improve maternal psychosocial functioning. Further research applying random assignment is needed to strengthen these conclusions; further research is also needed to assess any long term effects of the video feedback intervention using the Marte Meo method.

Trial registration

This study was registered on 24 January 2013 in ClinicalTrials.gov with the identifier: NCT01799447.

Electronic supplementary material

The online version of this article (10.1186/s12884-017-1568-1) contains supplementary material, which is available to authorized users.

How does video interaction guidance contribute to infant and parental mental health and well-being?

This article describes the contribution of video interaction guidance (VIG) to the development of infant and parental and VIG practitioners' mental health and well-being. The theoretical core of VIG was depicted in terms of concepts such as intersubjectivity, attunement and mediated learning. The way the VIG principles alongside the underpinning values and beliefs promote a process of attunement between parent and infant, the VIG practitioner and parent, and the VIG practitioner and supervisor is described. This article also describes some of the evidence about the effectiveness of video feedback techniques more generally and the way in which the underpinning theory of change enables VIG to target key ports of entry in terms of areas that have been highlighted by numerous epidemiological studies as being important in terms of supporting or derailing infant attachment security. A case study is used to demonstrate the way in which VIG can be integrated within broader therapeutic approaches such as parent-infant psychotherapy to support the interaction of parents who have been deeply traumatised in childhood. It also demonstrates how the parallel process of practitioner 'attunement' to mother is key to the mother's recovery and her new ability to form attuned relationships herself with her children and other adults.

Pediatricians, Well-Baby Visits, and Video Intervention Therapy: Feasibility of a Video-Feedback Infant Mental Health Support Intervention in a Pediatric Primary Health Care Setting

This case series study evaluated the feasibility and acceptability of a behavioral/cognitive psychological intervention in a pediatric primary health care setting during standard well-baby visits. The aim of the intervention was to support caregivers' sensitivity and mentalization in order to promote infant mental health (IMH). Four neonates from birth to 8 months were consecutively enrolled to test a short video-feedback intervention (Primary Care - Video Intervention Therapy, an adaptation of George Downing's Video Intervention Therapy to primary care) conducted by a pediatrician. The 5 min interaction recording and the video-feedback session were performed during the same well-baby visit and in the same pediatrician's office where the physical examination was conducted. During the study period, six video-feedback sessions were performed for each baby at different ages (1, 2, 3, 4, 6, 8 months). A series of different interactional situations were filmed and discussed: touch, cry, affective matching, descriptive language, feeding, separation and autonomy. The intervention was easily accepted and much appreciated by all four families enrolled. This study aimed to answer a dilemma which pediatric providers generally face: if the provider wishes to respond not only to physical but also IMH issues, how on a practical level can this be done? This case series study indicates that Primary Care - Video Intervention Therapy can be a promising new tool for such a purpose.