Effects of VIPP-V training (WC2012-058)

Background

Starting date: 01/09/2013

Each year in the Netherlands, approximately 880 (very) young children with a visual or visual-intellectual disability receive care from Bartiméus and Royal Dutch Visio. For parents of infants diagnosed with a visual or visual-intellectual disability such diagnoses may come after a period of worry and uncertainty because infants with these disabilities respond differently to their caregivers (Howe, 2006). The period around the diagnosis is often highly emotional and can be characterized as a period of crisis, giving way, later on, to a gradual process of adaptation (Glidden & Jobe, 2009; Schuengel et al., 2009). It is, however, important to acknowledge that the period of diagnosis and the surrounding emotional and practical upheaval coincides with a very important period in children’s lives, in which they lay the foundations for their development within close relationships with their parents. The development of secure attachment relationships with parents is fundamentally important for healthy and resilient development (Sroufe et al., 2005), especially so for children with disabilities (Baker et al., 2007; Schuengel & Janssen, 2006). Early intervention services have been developed that offer support in adapting to the disability and promoting optimal development. These interventions are not evidence-based and transferable through written protocols. 

Current early interventions for children with a visual impairment or with multiple disabilities are said to focus mainly on social, physical and cognitive development. Interventions take place in the home and use video for focusing on interactions, but there is no protocol. It is therefore unclear to what extent the interventions include the components that have been proven effective for improving the quality of parent-infant interaction. Preisler (1991, 1997) suggested that too little systematic attention is given to the parent-child relationship in early intervention for parents of children with a visual impairment.
 
Scientific insights on the importance of sensitive parenting and secure attachments for social-emotional development increased enormously, for children with (Schuengel et al., 2013) and without disabilities (Juffer at al., 2008). For children without disabilities, this has lead to considerable progress in evidence-based intervention. A meta-analysis on interventions
(Bakermans-Kranenburg et al., 2003) indicated that interventions focusing on sensitive parenting showed significant positive results and were more effective than interventions with a broad focus, for example on social support. Based on these findings, Video-feedback Intervention to promote Positive Parenting (VIPP; Juffer et al., 2008) was developed, with a variant focusing on Sensitive Discipline (VIPP-SD; Van Zeijl et al., 2006). Randomized clinical trials have shown effects on maternal sensitivity, through sensitivity on attachment, and on behavior problems and stress regulation (Velderman et al., 2006; Van Zeijl et al., 2006; Bakermans-Kranenburg at al., 2008; Moss et al., 2011). VIPP-SD has been certified in the Dutch registry of evidence based youth interventions.
 
For parents with children with a visual impairment the focus on the parent-child relationship is very important as the child’s behavior and interaction, their attempts to communicate with their parents, are so different and difficult to understand (Howe, 2006). Also, the parent may experience the child to be unresponsive due to absence of emotional expressions, e.g. the child having a blank face (Tröster & Brambring, 1992). For parents with a child with a visual and an intellectual disability this may also be the case due to the relatively slow speed at which the child processes social information and therefore the delayed reaction given by the child, or even the absence of a reaction (Anderson, 2001). Howe (2006) noted that due to the difficulty to understand and interpret the child’s needs and behaviors, parental stress may increase, reducing the emotional availability of the parent, and therefore the parent may be a less responsive caregiver. Through early intervention programs parents can learn to relate with their blind children in a sensorily appropriate and attuned ways (Affleck et al., 1997). The problem chosen to study is therefore to address the gap in evidence-based early intervention with infants with visual and visual-intellectual disabilities, building on the model of proven effective interventions in other populations.