Intervention for foster care: Effectivity of Video-feedback Intervention to Promote Positive Parenting in Foster Care (VIPP-FC).

Children placed in foster homes have often had a rough start of their lives
while being taken care of by their biological parents. Foster children are
significantly more insecure- or disorganized attached than children raised by
their biological parents. The insecure- and especially disorganized attachment
forms a risk for the later development of psychopathology within these foster
children.

Scientific research shows that insecure and disorganized attached children can
still form a safe attachment relation with their foster parents if they have
positive attachment experiences in new nurture situations. Foster parent are,
more than often, confronted with foster child behaviors that denote an insecure
and disorganized attachment past of that child. It is thus most important that
the foster parents develop skills that give way to cope and deal with the
individual problems of their foster child(-ren).

The intervention VIPP-SD (Video-feedback Intervention to promote Positive
Parenting and Sensitive Discipline; Juffer, Bakermans-Kranenburg, & van
IJzendoorn, 2008) is an intervention designed to support parents in coping with
disrupted and troublesome behavior of their children. This method enhances the
sensitivity of the parents and their sensitive disciplining towards the child.
VIPP-SD is approved and proven to be effective by the *Nederlands
Jeugdinstituut*.
VIPP-SD has been extended with two components in order to be applied within the
foster care. The following components are added:
1.Foster parents will be trained in recognizing and adequately responding to
the signals that are distinctive for foster children with attachment
difficulties.
2.Activities will be implemented that are explicitly designed to promote
physical contact between the parents and their foster child.
The extended version of the VIPP-SD, designed to address foster care, will be
named VIPP-FC (Video-feedback Intervention to promote Positive Parenting *
Foster Care).

The aim of the present study is to test the effects of VIPP-FC. If this
intervention will be effective in enhancing the sensitivity of the parents and
their sensitive disciplining towards the child, it should be implemented widely
in foster care. The VIPP-FC intervention could thereby improve the mental
wellbeing of the parents and their foster child.

The goal of this study is to test the effects of the VIPP-FC within a
Randomized Controlled Trial (RCT). The expectations of this study will be
fourfold:
- Sensitivity of the parents and their sensitive disciplining towards the
foster child will improve in the experimental condition.
- The first expectation can be partly explained by improved stress regulation
of the foster parent.
- The quality of the attachment relationship between foster parent and child
will improve and the child will be better able to regulate its behavior.
- The preceding expectation could be explained by an improved stress regulation
of the child.

The primary goal of this study is to test the following hypotheses.
- VIPP-FC has a stronger positive effect on sensitivity of the parents and
their sensitive disciplining towards the child during interaction with the
child than *care as usual*.
- Oxytocin production in foster parents and their foster child will show
stronger increase when interacting with one another in comparison to oxytocin
production of foster parents in the *care as usual condition*.
- A stronger decrease in cortisol production shall be observed Within foster
parents and children in the experimental group compared to foster parents and
children in the *care as usual condition*. The increase in
sensitivity/sensitive disciplining will be mediated by an increase in oxtocin
production and decrease in cortisol production.
- The increase in oxytocin production mediates the effect of the VIPP-FC
intervention on the increase in sensitivity/sensitive discipline.
- VIPP-FC has a more pronounced effect on the reduction of behavioral problems
in foster children when compared to the behavioral problems of children in the
control condition.
- VIPP-FC has a stronger effect on the decline of emotional and attachment
problems in foster children compared with the emotional problems of children in
the control condition.

The study design will be a RCT with an experimental- and a control condition.
Families with a new foster child ( from age 1 to 5 years) will be recruited
after placement of the child within the foster family. Only after receiving
fully signed informed consent from the parents and/or legal guardian will the
families be included into the study. No later than one month after inclusion,
an baseline assessment will be conducted in which the quality of the foster
parent * child interaction will be measured, a mapping of the characteristics
of child and parent and physiologic measurements in the form of saliva swabs.
After the baseline measure, families will be randomly assigned to either the
control or intervention condition. In the control condition, families will
receive care as usual. The VIPP-FC condition will contain the intervention that
will last for approximately 3,5 months. After the intervention, or after 3,5
months *care as usual*, a effect measure will take place. Two months after the
post-study assessment there will be a follow-up measurement.

VIPP-FC is aimed at foster care and foster families. The intervention will be
implemented by trained staff (foster employees) of the participating
institutions. The intervention will take place in the home of the foster
family. Given the fact that mothers spend more time with their children, the
intervention will be primarily be directed at foster mothers. The father of the
family will be invited for the last part of the intervention. Daily routines
and interactions of mother and child will be recorded by video. The recordings
will last approximately between 10 and 30 minutes each. The trained staff
member will give feedback on the interaction between mother and child, on the
basis of the video footage. Feedback will concern positive interaction and
sensitive disciplining primarily. During the intervention sessions, information
will be given to the mother about the general development of young children
and sensitive disciplining. Each family in the intervention will receive six
hose visits. In the first four sessions there will be two weeks apart from one
another, between session four-five and five-six, a four week pause will be
maintained. The overall duration of the intervention will be 3,5 months.

The VIPP-FC protocol comprises the construction, themes and assignments for the
mother and child for each session. In this manner all sessions are
standardized, and equal for all families. Although the sessions are equal for
all participants, feedback on the basis of the video recordings as well as the
practical implementation of the intervention will be tailored on the specific
mother-child pairs. Next to the general verbal information on the upbringing
and development of children, each session will contain specific information on
the themes sensitivity and disciplining. Tips are given each session to the
mothers, these tips are expected to be executed and practiced with for the
following session. In the last two sessions, all the themes will be repeated.

VIPP-SD themes:
Sensitivity themes
1.Exploration versus attachment behavior: showing the difference between a
child*s play and a child looking for contact, including comments on the various
reactions parents should be able to give;
2.Speaking for the child: improving accurate perception of (subtle) signals of
the child by verbalizing the facial expressions and non-verbal expressions of
the child not visible on the videotapes;
3.Sensitive chain: explaining the importance of adequate responses on signals
of the child (chain: signal from child * parent*s response * child*s reaction).
4.Sharing emotions: showing en encouraging the affective alignment from parents
on positive and negative emotions of the child.

Boundaries and disciplining themes
1.Inductive discipline and distraction. Induction (eg. indicating why something
is forbidden or desired) and distraction are recommended strategies in reaction
to provoking situations or difficult behavior. Using induction will promote
empathy in the child.
2.Positive reinforcement by praising the child for desirable behavior, and
ignoring negative attention seeking.
3.Using a sensitive time-out to avoid escalation of tantrums and keeping the
situation under control in a sensitive way
4.Empathy towards the child, combined with consistent discipline and clear cut
boundaries

Foster care themes
1.Responding to missing or minimum signals from foster children in a sensitive
way;
2.The importance of physical contact on stress regulation.

Participants will not be submissive to procedures that hold serious risks.
Participants are asked to fill out questionnaires, be subject of behavioral
observations and supply physiological data (saliva swabs). None of these
measurements are intrusive nor dangerous for child and/or parent. During the
VIPP-FC trail, numerous themes will be discussed dealing with parenting and the
participants individual case. Participants could experience these themes as
difficult or confronting. If the participant is indeed having trouble with
discussing these themes, the staff will be able to counsel the participant in
order to resolve these troublesome experiences. Staff that is confronted with
to complex problems can discuss these difficulties during (peer-) supervision.