Deborah Michelle James

Implementing good-quality health and social care requires empowerment of staff members within organizations delivering care. Video Interaction Guidance (VIG) is an intervention using positive video feedback to empower staff through reflection on practice. This qualitative study explored the implementation of VIG within an autism care organization in England, from the perspective of staff members undergoing training to deliver VIG. Semi-structured interviews were conducted with a purposive sample of 7 participants working within the organization (5 staff undergoing training to deliver VIG; 2 senior managers influencing co-ordination of training). Participants were asked about their views of VIG and its implementation. The topic guide was informed by Normalization Process Theory (NPT). Data were analysed inductively and emerging issues were related to NPT. Five broad themes were identified: (1) participants reported that they and other staff did not understand VIG until they became involved, initially believing it would highlight negative rather than positive practice; (2) enthusiastic feedback from staff who had been involved seemed to encourage other staff to become involved; (3) key implementation challenges included demands of daily work and securing managers’ support; (4) ideas for future practice arising from empowerment through VIG seemed difficult to realise within an organizational culture reportedly unreceptive to creative ideas from staff; (5) individuals’ emotional responses to implementation seemed beyond the reach of NPT, which focused more upon collective processes. Implementation of VIG may require recognition that it is not a ‘quick fix’. Peer advocacy may be a fruitful implementation strategy. Senior managers may need to experience VIG to develop their understanding so that they can provide appropriate implementation support. NPT may lack specificity to explain how individual agency weaves with collective processes and social systems to embed innovation in routine practice. This exploratory study has provided broad insights into facilitators and barriers to the implementation of an intervention to empower staff within an autism care organization. Further research is needed into similar interventions, including a focus upon staff members’ emotional responses and resources, and how such interventions may relate to the culture of the organization in which implementation occurs.

Background: In this study, we explored the impact of staff training that used video feedback to help staff see the effect of their interactional work with service users. The study was based at a large organization delivering services for children and adults with autism.Materials and Methods: A longitudinal qualitative study with semi‐structured interviews was conducted to explore changes over time in 10 staff participants who received the intervention. Five participants were interviewed twice before they received the video feedback intervention to gauge the degree to which their perspective changed as part of the natural course of their working lives.Results: The results showed that the staff talked differently after they had the intervention. The most notable change was their talk about the service user perspective which was evident after the intervention but not before.Conclusions: The outcomes suggest that the use of video feedback of in situ practice could help staff develop person‐centred work practices.

Background Recent research shows that parental sensitivity can explain a significant and unique amount of growth in speech and language outcomes in children with cochlear implants. In this intervention study we explored the impact of an intervention designed to support parental sensitivity on children's communication development. Aims This study tests the effect of a complex intervention in the context of childhood hearing impairment using a case study design of three families. Propositions for each case were made using parental report of the child's development in an attempt to identify change in outcome measurements that were not likely to be due to general development in the child or a halo effect from the intervention. Methods and Results Multiple pre- and post-intervention measures were taken. Outcome measures were mother–child contingencies to vocal utterances, emotional availability and an assessment of early communication in the child. Results for each case showed that improvements in some outcome measurements were found after the intervention and were maintained at follow-up. Conclusions & Implications Taking account of developmental change in intervention studies with children is challenging. Single-subject intervention studies can be designed to allow research interventions to be tailored to meet families’ specific needs. Video interaction guidance may support pre-linguistic communicative development in children with hearing impairment.

This study describes a moment during clinical supervision when a student speech and language therapist reported that she had a moment of illumination that changed her trajectory from failing her clinical placement to passing it. The student’s self-report of the moment is provided. The clinical supervision was conducted using video feedback where the student watched successful edited clips of herself interacting with a patient in the university clinic. The clinical supervision where the moment of illumination occurred was recorded and two short extracts of this moment were analysed for evidence of a transformative process using Mezirow’s theory. The content of the student’s speech during the moment of illumination followed the steps and sequence of the transformative learning model. An analysis of the way the speech sounded showed that the moment was characterised by slow speech rate and flat monotonous pitch in both speakers and preceded by the educator modelling stopping and thinking. The use of video footage in student clinical supervision may be used with differential effect. Footage of strengths may be an effective trigger for disorientation and especially when feelings of failure or weakness are most prominent. The way the discussion of the video footage is led by the clinical educator may also support deep reflection.

Accessible Summary: Staff who care for people with autism were shown video of themselves at work. Only good bits of video were shown to staff. Good bits were chosen because the video showed that the staff and the people with autism were enjoying being with each other. We asked four members of staff how watching the good bits of video made them think and feel. In this paper, we report what the staff said. We grouped their ideas into sets. In this paper, we report exactly what the staff said. We found that all staff felt more confident after watching the videos. They could see more ways that the people with autism were communicating with them. They could imagine being better at making relationships with people with autism. We think that finding positive moments of enjoyment using video is a good way to make things work better for staff and for the people with autism. Summary: This paper provides preliminary findings of the impact of a workforce coaching intervention that used video feedback in a service for children and adults with autism. The proposed mechanism for change in the intervention was the way that video footage was highlighted through editing on the part of the practitioner and the positive coaching conversation that was used to review the video edits. Four participants who had received the intervention were interviewed after the intervention. Thematic analysis of the participants' responses during the narrative style interview was conducted. The results suggest that the participants found the intervention a positive experience that raised their confidence in their work role. They reported heightened awareness of the individual needs of the people they worked with and a new appreciation of the potential for relationship between themselves and the services' users.