Authors' objectives: This report aims to identify and summarise evidence that addresses the following research question: What is the effectiveness of video feedback interventions to improve outcomes for children and their families who are at risk of or suffering significant harm?

Authors' results and conclusions: The evidence included in this review suggests there are some statistically significant outcomes to support the effectiveness of video feedback interventions (VFI) among the relevant population group, including outcomes relating to parental sensitivity, parent-child interaction, attachment, child compliance, and child placement decisions. However, there are some outcomes that appear weaker in terms of statistical significance such as some outcomes relating to child placement decisions, maternal discipline, outcomes relating to child behaviour, and reports of maltreatment. Differences were also reported in a service evaluation in relation to target monitoring evaluation goals, although these were not prospectively compared to an alternative intervention. It is uncertain whether statistically significant differences or changes would be impactful or meaningful without additional calculations, although some experts suggest that even small differences in outcomes can be impactful. The evidence in this review includes a variety of different VFI including differing video feedback models, referral mechanisms and different settings where VFI are carried out. The included evidence base raises some concerns regarding the generalisability of findings from international randomised controlled trials (RCT) i.e., whether the findings of the studies and the setting (e.g., residential care clinics) would be applicable to a setting where VFI would be carried out in Wales and/or UK. There are also concerns relating to the longer-term and sustainable impact of VFI. Experts raised some potential organisational issues to consider, including the commissioning of VFI, the storage of data, resourcing, and capacity. Further research into the use of VFI among families at risk of harm in relevant UK and Welsh settings is needed. We identified one US cost benefit analysis, which was assessed as partially applicable with potentially serious limitations. Applicability is limited as there are likely to be differences in service arrangements and processes. Both placement decisions and the care received by children and their families are likely to be highly context specific, which will influence costs and outcomes. An original cost-consequence analysis was developed, and costs were presented for each of the three RCTs included in the effectiveness section of the EAR which reported out-of-home placements. The results based on one RCT show that VFIs are cost saving at one year, whereas in the two other RCTs, VFIs are cost increasing. This is consistent with the differing effect sizes on out-of-home placements reported in the studies. The cost analysis was based on out-of-home placements and does not consider other outcomes for children and families. Therefore, the cost analysis results should be considered alongside the effectiveness results described in this report. The cost effectiveness of VFI compared with standard care in children at risk of harm remains uncertain.

Authors' recommendations: The evidence supports the adoption of VFI to support children and their families who are at risk of or suffering from harm. Improvements in parental sensitivity, parent-child interaction and attachment have been identified using VFI. The impact of VFI on out-of-home placement and longer-term outcomes are uncertain. Parents who used VFI report improvements in family relationships and parental confidence. Uncertainty in the effect of VFI on out-of-home placement translates into uncertainty in the costs of VFI compared with standard care. The Appraisal Panel concluded, however, that the evidence to support the benefits of VFI justifies any possible increase in costs, and that the economic evidence does not preclude adoption. The Panel would encourage further data accumulation to support this intervention.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Project Status: Completed

Year Published: 2024

URL for published report: https://healthtechnology.wales/reports-guidance/video-feedback-interventions/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk