Attachment has been studied as an important measure of early social-emotional development (e.g., greater exploration during play, improved peer relationships and decreased psychopathology). A way to strengthen parent-child attachment relationships is through relationship-based interventions.

New York University School of Medicine- Bellevue Hospital Center, is currently examining the impact of a relationship-based, pediatric primary care intervention (The Video Interaction Project, VIP) on attachment security in low socio-economic, at-risk, ethnically diverse families. A pediatric primary care setting offers frequent well-child visits (10-12 in the first three years) and universal, comprehensive care for children in the early years (e.g. vaccinations).

VIP involves the use of videotaped interactions by child development specialists (CDS) while parents wait to see their child's pediatric provider for well-child visits. The CDS builds a caring relationship with each family that forms the foundation for the intervention, which takes place from the first week the child is born through age 3. The CDS has appointments with each child at 1 week, 1, 2, 4, 6, 9, 12, 15, 18, 21, 24, 27, 30, 33, and 36 months. This follows the schedule of recommended pediatric visits, with additional visits added to maintain contact at least every three months.

There are four components to each VIP visit:

1. Videotaped parent-child interactions: The CDS videotapes parent and child playing with a developmentally appropriate toy provided by the project (see below) for approximately 5 minutes. Once recorded, the parent, child and CDS view the tape together. The CDS discusses verbal, cognitive, and social-emotional child and parent behaviors observed on the tape. In addition, the CDS offers strategies for the parent to engage the child and encourage emotional and behavioral responsiveness. A copy of the taped interaction is provided to families with the direction to watch the tape with other family members at home, keeping in mind the points discussed with the CDS. By encouraging the parent to reflect on their interactions on the videotape, the CDS attempts to build the attachment relationship and strengthen parental nurturance and responsiveness.

2. Guided questions: The CDS and parent discuss issues related to the child's development and behavior. The CDS uses a set of open-ended questions to guide families' observations and reactions to their child. These questions are designed for the purpose of guiding parents, but also to learn about the impact of the videotape on parent behavior. Questions query whether families reviewed the videotape and/or used any of the CDS's suggestions at home. Activities are suggested to facilitate verbal and emotional parent-child interaction and reinforce responsiveness.

3. Pamphlet: Parents are provided a written pamphlet regarding development and behavior. The pamphlet includes a back page with summary questions to be completed in collaboration with the CDS. Once completed, it is recommended that this form be shared with the child's pediatrician during the well-child visit. There is a place for the pediatrician to sign the form to represent his/her endorsement of the project as well as the strong ties to pediatric care in the clinic.

4. Learning material: A developmentally stimulating, age-appropriate learning material (e.g., toy and/or book) is given to the family. Learning materials were selected to promote affective and verbal parent-child interaction. The CDS provides an explanation of how to use each visit's learning materials and various suggested activities and ways to interact via modeling the material. She provides various suggested activities and ways to interact, often modeling the use of the material for parents by labeling colors and demonstrating ways to interact with the child using the learning material.

For more information about this project, please contact:
Samantha B. Berkule, Ph.D
Research Assistant, Professor of Pediatrics
Project Manager, The BELLE Project
New York University, School of Medicine, Department of Pediatrics
550 First Ave.
New York, NY 10016
(212) 562-2522
samantha.berkule@med.nyu.edu