Taking Time to See
Enhancing home visiting programs through video
intervention and reflective practice.
Betsy J. Byker
 B.A. in Child Psychology
University of Minnesota, 1988
 25 Years in Home Visiting
 11 Years as Program
Coordinator/Parent Educator
Family Resource Center St Croix
Valley
 Certificate in Infant and Early
Childhood Mental Health
My Experience
Learning Opportunities
1. Parent-Child Relationship
2. Home Visiting Relationship
3. Home Visitors Reflective Capacity
4. Supervisory Relationship
Parent-Child Early
Relational Assessment
Clark.(1985)
PCERA
Designed to measure the quality
of affect and behavior in parentchild interactions.
ERA Procedures
 Observations of 5-minute video-taped interaction
 Situation #1-Feeding
 Situation #2-Structured Task
 Situation #3-Free Play
 Situation #4-Separation/Reunion
 Assessment of areas of concern and strengths
 Profiles can be developed for clinical purposes
 Presentation of video to family
 Post Interview regarding childhood relationships
(Clark, 1985, 2006, 2010)
Introducing Video to your Home Visiting Program
Things to consider:
 Numerous screening tools already being administered.
 Demands on home visitors and supervisors time.
 Disruption to home visiting relationship
 Not possible to intervene with all families
Where did we
start?
Identify Families
 Families that don’t
seem to fit standard
home visiting
program
 Families not
accomplishing
personal goals, who
are “stuck.”
 “I’m not sure why I
am there.”
Procedure
 Week 1: Video-taping
(Observation/Review by Supervisor)
Create Profile
 Week 2: Reflective Supervision/Viewing of Tape
(Guidance for viewing and interview)
(Reflection on experience)
 Week 3: Family Viewing and Interview with Home Visitor
 Week 4: Reflective Supervision/Intervention
Advantages to having Supervisor
involved in video-taping.
 Gaining a visual of families and their homes discussed in
supervision.
 Opportunity for home visitor to observe without
interaction.
Our place in the family.
Strengths and challenges
What did the Video show us?
Strengths
 Mom consistently and creatively
structures the environment.
 High quantity of verbalization.
Challenges
 Lack of visual contact
 Flat affect and lack of joy
displayed.
 Absence of negative affect.
 Quality of exploratory Play
 Apathetic/withdrawn affect
 Persistent
 Lack of visual contact
 Little social behavior initiated
Change and Progress
Parent-Child
 Increased interest in play and her
role in development of her child
 Acknowledging lack of eye
contact and buy-in to try to
improve.
 Made connection between eye
contact and language
development.
Home Visitor- Family
 Change in approach and
teaching methods to draw
attention toward mom.
 Reflection from Susan, “Mom has
always looked to others for
approval; Grandma or me. This
seems similar to what Timothy
does with me.”
 Reminder of the Mother’s many
strengths despite the apparent
lack of progress.
Family Goals
Let go of the goals and focus
on the relationship.
Next Steps to intervening with all
families: Where do we go next?
Visual Learning strategy
New home visitors needing practice in reflection
Parents benefitting from attention to their child
and their strengths
“Self reflection is a legitimate professional
competency”
Linda Gilkerson
Reflective Capacity
Clarifying our Role/Family Dynamics
Life Skills Progression(LSP)
Nurturing Behavior
Nurturing Behavior
6
5
4
3
2
1
0
1
2
3
4
Pre
90 days
5
6 months
6
7
Life Skills Progression(LSP)
Support of Development
Support of Development
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
1
2
3
4
Pre
90 days
5
6 months
6
7
Home Visitor’s Experience and Reflections
 It was a challenge to have all the silence and not be able to ask
questions.(Marla)
 “I felt more compassion for the parents and understood why they
parented the way they do.”(Julia)
 “The hardest thing about this job is how slow the progress can
be.(Julia)
 It was frustrating because that is not what I am seeing in my home
visits.(Julia and Lesley)
 I was surprised at how much I saw.(Lesley)
Take the time to just observe.
Current Practice

Opportunities for growth for staff and families
 Available Intervention by in-house referral
 Video-Tape Home Visitor with Family
 Growth through supervision

Improve Supervisory Role
 “What are you wondering about today, Betsy?”
 Observation

Drug Court Pilot Project
 Practicing mindfulness

Continue tracking outcomes.
 30 days, 90 days, 6 months.
References:

Clark, R. (1985, 2006, 2009, 2010) The Parent-Child Early Relational; Assessment. Instrumental and
Manual. Department of Psychiatry, University of Wisconsin Medical School, Madison, WI.

“Special Play”, Parent-Infant and Early Childhood Program, UW Department of Psychiatry,
January 2013, adapted by Dane County Public Health-Madison, WI.

Eugster K.(2014) Special Play Time: an Important Way for Parents to Spend Time with their
Children.

Fraiberg, S., Adelson, E. & Shapiro V.(1980) Ghosts in the Nursery In. S. Fraiberg(Ed.) Clinical Studies
in Infant Mental Health: The First Year of Life,(pp. 164-203). New York, NY: Basic Books

Hack, J. & Noddings, C. Reflective Practice, University of Wisconsin Infant, Early Childhood and
Family Mental health Capstone Certificate Program, Madison, WI. October, 2014.

Heller, S. & Gilkerson, L. (Eds.). (2009). A practical guide to reflective supervision. Washington D.C.
ZERO TO THREE.

Slade, A. (2002). Keeping the Baby in Mind: A critical factor in perinatal mental health. Zero to
Three, June/July 2002, 10-16

Slade, A. (2015). Attachment, Threat, and Mentalization in Mother-Infant Intervention. University of
Wisconsin Infant, Early Childhood and Family Mental Health Capstone Certificate Program.
Madison, WI. May 2015

Wollesen, L & Peifer, K. (2006) Life Skills Progression (LSP): an outcome and intervention planning
instrument for use with families at risk. Brooks Publishing Co., Inc.
Don’t just do something. Stand there and pay attention.
Sally Provence
SelmaFraiberg