Adapting a video-feedback intervention to support teacher–child interaction and behavior regulation of young children at school: A qualitative pilot study

The evidence-based parenting program Video-Feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) may have potential to also support teachers in primary schools in their interaction with children with behavior problems. We therefore adapted the intervention for use with primary school teachers (VIPP-School). Here we examined the feasibility of VIPP-School, using qualitative analyses of the perceptions of teachers and VIPP-interveners on their experiences with VIPP-School. Three teacher-child dyads from kindergarten and 2nd grade participated in six sessions of VIPP-School. Perceptions of the participants were collected using semi-structured interviews, logbooks, observations and a questionnaire. The data were qualitatively analysed. Thematic analysis showed five main themes: 1) scheduling of appointments, 2) experiences with intervention elements, 3) working alliance, 4) changes in the teacher-child interaction, 5) defining the target group. Teachers mentioned notable time investment, but appreciated the video feedback as a great way to become more aware of subtle signals of the child and their own behaviors. This study shows that with some adaptations VIPP-School is an acceptable and deliverable intervention for teachers in primary education. It has potential for supporting teachers in the interaction with children with behavioral problems. Further research on the effectiveness of VIPP-School is recommended.

daily basis; sharing experiences and creating feelings of contingency on a dyadic level.Therefore, an extended attachment framework can be used to describe this relationship (Sabol & Pianta, 2012;Spilt et al., 2022).This framework builds on the work of Ainsworth et al. (1978) and Bowlby (1969), with a focus on the affective components of the dyadic relationship, and whether or not teachers are able to provide a secure base for children to explore from, and a safe haven to return to in times of stress (Verschueren & Koomen, 2012).The extended attachment framework conceptualizes the teacher-child relationship as a multidimensional construct along positive and negative dimensions of dyadic interactions, most often the dimensions of closeness (i.e., the degree of affection, warmth, and open communication between the teacher and child), conflict (i.e., negative affect in the relationship), and dependency (i.e., developmentally inappropriate possessive and clingy child behaviors directed toward the teacher; Hamre & Pianta, 2001).
The affective quality of the teacher-child relationship (as represented by closeness, conflict, and dependency) impacts children's academic, social, behavioral, and emotional development.Positive teacher-child relationships, characterized by high levels of closeness and low levels of conflict and dependency may act as a protective factor for children with externalizing behavior problems, preventing behavior problems from escalating, and facilitating a successful school career.In contrast, negative teacher-child relationships, characterized by low levels of closeness and high levels of conflict and dependency may act as stressors for children, undermining their behavior regulation and compromising optimal school adjustment (e.g., García-Rodríguez et al., 2023;Hamre & Pianta, 2001;Lei et al., 2016;McGrath & Van Bergen, 2015;Roorda et al., 2021;Spilt et al., 2022).

Coercion Theory
Coercion theory also stresses the importance of positive teacher-child interactions for child development.The theory submits that challenging child behavior increases when children's negative behavior in response to the caregiver's request is repeatedly reinforced by ineffective or harsh disciplinary behavior of the caregiver (Patterson, 1982).Interventions promoting teacher classroom management practices (e.g., positive reinforcement, limit setting, and monitoring) have shown promising results in reducing challenging child behavior (Oliver et al., 2011).

Interventions to Promote Positive Teacher-Child Interactions
O' Connor et al. (2011) suggest that teacher-child relationships can be targeted by interventions to prevent the escalation of behavior problems in children.As attachment theory and coercion theory focus on different aspects of teacher-child interactions, they are complementary in their approaches to enhance teachers' interactive behavior.The two theories have previously been combined in interventions for the school context (e.g., Key2-Teach, Hoogendijk et al., 2018;Teacher-Child Interaction Therapy, McIntosh, Rizza & Bliss-Leslie, 2000;Playing-2-gether, Vancraeyveldt et al., 2015), but these interventions often include many sessions, which are suboptimal for implementation in daily teaching practice.Besides, most school interventions are aimed at children rather than at dyadic teacher-child interactions (Paulus et al., 2016).A short-term behaviorally focused intervention aimed at enhancing teacher-child interactions might be useful.
Based on the results of a meta-analysis of 70 intervention studies aimed at enhancing parental sensitivity (Bakermans-Kranenburg et al., 2003), a short-term, behaviorally focused intervention for families was developed: Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD; Juffer et al., 2008).Combining attachment theory (Ainsworth et al., 1978;Bowlby, 1969) and coercion theory (Patterson, 1982), the intervention aims to enhance parental sensitivity and discipline in order to reduce child behavior problems (Juffer et al., 2009;Van Zeijl et al., 2006).

From VIPP-Sd to VIPP-School
The efficacy of VIPP-SD is widely studied in randomized controlled trials and has been shown to have positive effects on caregiver sensitivity, caregiving attitudes, and child attachment security in various groups of parents and caregivers with typically and atypically developing children in different countries.For example, VIPP-SD has been shown to be effective in improving caregiving behavior in families with (high risk of) maltreatment, families living in poverty or struggling with eating disorders, foster and adoptive families, families with children at risk of externalizing problems or autism, and in professional child care settings (see for meta-analyses, Juffer et al., 2017;Van IJzendoorn et al., 2022).Decreases in child behavior problems have also been reported in several studies (e.g., Bakermans-Kranenburg et al., 2008;Klein Velderman et al., 2006;O'Farrelly et al., 2021;Van Zeijl et al., 2006).

The Current Study
Evidence has accumulated that VIPP-SD is also suitable for supporting professional caregivers in improving interactions with children in their care (Van IJzendoorn et al., 2022).The current study reports on the stages of adapting VIPP-SD for use in the elementary school context.Understanding teachers' and VIPP-interveners' experiences with the intervention is vital for establishing the program's acceptability and feasibility.Our aims were: 1. Understanding how teachers and VIPP-interveners experienced the intervention.2. Using their feedback to evaluate the feasibility and acceptability of the intervention program, and to inform its further development.

Method
We used a qualitative approach to describe the adaptation process and explore teachers' and VIPP-interveners' perceptions of the feasibility and acceptability of VIPP-School.Approval to perform this study was received by the Ethics Committee of the Faculty of Behavioral and Movement Sciences at the Vrije Universiteit Amsterdam (VCWE-2020-167R1).

Participants
In Using convenience sampling, three teacher-child dyads from three elementary schools in the Netherlands were recruited from the networks of MO and one of the VIPP-interveners.They were contacted in person, by mail, or by telephone.Two participating schools were located in suburban areas and one on the outskirts of a big city.All participating schools had a five-day school week with days of equal length (5.5 h).Teachers were eligible for participation if they worked in kindergarten, Grade 1 or Grade 2, and spent at least two days a week with the target child.Participating children were selected by the teachers based on difficulties in their interaction with the child or the child's challenging behavior (as perceived by the teacher).
Teacher-child dyads received six VIPP-School visits from one of two VIPP-interveners.Interveners were recruited by placing a call in a private group for VIPP-interveners on social media.An overview of the characteristics of participants can be found in Table 1.All participants, including parents of the participating children, provided written informed consent.It was always possible for teachers and children to indicate if they wanted to stop; however, this did not happen.Researchers did not have any relationship with the participants prior to the study.

Intervention
VIPP-School encompasses six biweekly visits, of which the last five are intervention sessions.The intervener starts each visit by filming three to four short protocolized teacherchild interaction tasks (e.g., reading together, making a puzzle).Afterward, the videos of the previous visit are reviewed and discussed with the teacher according to the theme of that visit (see Supplement A).The intervener verbalizes the child's thoughts and behavior, reinforces positive teacher behaviors, and emphasizes moments of sensitive interaction.The focus of the first two sessions is building a supportive working relationship.From the third session onward, the intervener also offers corrective messages to reinforce and encourage (more) sensitive and emotionally attuned teacher behavior.
The first version of the VIPP-School manual was developed in collaboration with the developers of VIPP-SD, two VIPP-interveners, six educational professionals, and two teachers.In a series of meetings, we discussed how the program could be adapted from the family context to the school context.The most substantial adaptations from VIPP-SD to VIPP-School are the following.First, to accommodate the busy schedule of teachers, the number of visits was reduced from seven to six (i.e., five intervention sessions) by omitting one of the two booster sessions, as has also been done in other studies (e.g., Euser et al., 2021).Second, interactive tasks were adapted to represent school-related activities.For instance, mealtime was replaced by two educational tasks and a task designed to elicit challenging child behavior.Lastly, because of the professional training of teachers, the learning content was adapted and extended.When content was not suitable for the school context, it was replaced by content about underlying causes of child behavior problems.See Supplement B for a complete overview of the adaptations.
After collaborating on the VIPP-School manual, interveners did not receive any training over and above their VIPP-SD training and experience.They implemented the intervention with two kindergarten teachers (Teachers 1 and 2).Feedback from these teachers and the interveners was used to make very minor adaptations to materials and to a few sentences in the manual.Hereafter, Teacher 3 received VIPP-School with these minor adaptations.

Data Collection
Data consisted of intervener logbooks, researcher notes on the visits, transcripts and notes of evaluation interviews, and a questionnaire filled out by the teachers.Data was collected during and after the intervention.As part of standard practice in VIPP-SD, the VIPP-interveners answered a standard set of open-ended questions about the visit in a logbook after each visit (see Supplement C).Logbook questions focused on the course of the visit (e.g., "Describe the visit briefly"), teachers' attitudes and behavior (e.g., "What was the teacher's reaction when watching the video recordings?"), and teacherchild interaction (e.g., "Give your impression of the teacher-child interaction.").The logbooks were also used to assess the fidelity of intervention implementation.In addition, KS monitored four randomly selected visits (intervener 1: visits 3 and 6; intervener 2: visits 2 and 5).The interveners competently delivered the intervention, and no substantial deviations from the VIPP-School manual were observed.
After the intervention, evaluation interviews with individual teachers together with their VIPP-intervener were carried out using a semistructured topic guide (see Supplement D).Interviews were carried out with the teacher and intervener combined to facilitate a dialog where participants could combine and discuss their perspectives in depth.The interviews were conducted at the teacher's school by MO and KS.Interview duration ranged from 2 to 2.5 h and was minuted.In addition, the interviews with Teachers 1 and 2 were audio-recorded with their consent and transcribed verbatim with identifiers anonymized.Interview data were triangulated with ratings of Teachers 1 and 2 on their opinion on the social validity of intervention components measured with an adaptation of the Social Validity Scale used by Seys (1987).Items were rated on a 5-point Likert scale ranging from 1 to 5. High scores indicate high social validity.In the current study, three subscales were used: (a) Subjective effectiveness (21 items, e.g., "Because of VIPP-School the child's undesired behaviors are changed in … sense"); (b) Workability (eight items, e.g., "How taxing on your time-schedule was participating in VIPP-School?"); and (c) Perception of own abilities (eight items, e.g., "Preventing unwanted behaviors from the child is …").

Enhancing Data Credibility
To provide a more holistic understanding of the feasibility of VIPP-School, this study utilized a triangulation in methods and participants.Data were collected using multiple methods from participants with different roles in the intervention (teachers and VIPP-interveners).KS transcribed the evaluation interviews in the spoken language (Dutch) to facilitate correct interpretation during initial coding (Helmich et al., 2017).Quotes that best illustrated the themes and subthemes were selected and translated from Dutch to English by a native Dutch speaker with a degree in Higher Vocational Education in English.Where literal translation could not convey the intended meaning of the participants, the contextual meaning was used to produce meaning-based translations as recommended by Helmich et al. (2017).To enhance the credibility of the qualitative analyses, all participants were asked to review the minutes and transcripts of their interviews and provide feedback on the accuracy of their representation.All participants responded to the member check.

Thematic Analysis
The data were organized using Atlas.ti22 software for qualitative analysis.The thematic analysis of the data was conducted following the six stages as summarized in Peel (2020).We used a grounded approach with sensitizing concepts to draw attention to important factors and facilitate the sorting of the data (Bowen, 2006;McMillan & Schumacher, 2001).The sensitizing concepts can be found in Supplement E.
First, KS selected relevant extracts from the logbooks, researcher notes, transcripts, and questionnaires and coded these using the sensitizing concepts.New codes were formed for relevant extracts that did not fit the initial concepts.Based on similarities and differences, emerging themes were combined into overarching themes and grouped into categories.Data analysis started during data collection and was conducted iteratively.As a reliability check, the first and second authors independently coded 15% of the data.The inter-rater reliability, based on the percent agreement of the codes assigned to extracts, was 84.5%.For disagreements, a consensus was reached through discussion.Scores on items and subscales of the Social Validity Scale were triangulated with the interview data.

Reflexivity
The team engaged in reflexive dialogue throughout the research (Olmos-Vega et al., 2022).We reflected on our role as researchers professionally trained in child development and directly involved in the development of VIPP-School.We may, therefore, be inclined to expect positive outcomes from VIPP-School.However, we cross-checked for rivaling explanations by reminding ourselves of other well-substantiated approaches aimed at improving teacher-child interaction.We placed much weight on the experiences and knowledge of participants, who are professionals in the field.Negative or critical comments on VIPP-School were considered useful to improve the intervention.We believe that the active engagement of the researchers in the development of VIPP-School facilitated the dialogue with the participants, allowing us to delve into specific aspects of the intervention that might have remained unexplored otherwise.Prior to the evaluation interviews, the participants had met the researchers up to three times at most.We believe this encouraged them to express their experiences openly and did not hinder truthful responses, as there was no strong connection.Finding a good balance between doing justice to the input from professionals and remaining faithful to the working elements of the original VIPP-SD program was essential in the development of VIPP-School.Moreover, MBK, being one of the developers of VIPP-SD, was not involved in data collection and analysis.

Summary of Themes
Five main themes and 12 subthemes were identified.The main themes can be defined as: (1) scheduling, (2) intervention elements, (3) working alliance, (4) changes in the teacher-child interaction, and (5) defining the target audience.These themes and subthemes are discussed and illustrated with quotes from the data.See Supplement F for more details and additional quotes.Pseudonyms were created to maintain confidentiality for participating children.

Theme 1: Scheduling
Teachers commented that they had limited time available and that the scheduling of visits should be flexible and accommodate their schedules.Overall, Teachers 1 and 2 rated the workability of VIPP-School high on the questionnaire (M = 4.04), with the component of time investment rated lowest (M = 2.00).
Conflicting Responsibilities.During the intervention weeks, teachers sometimes felt that participating in VIPP-School interfered with other commitments such as teaching, supervising interns, and administrative work.Especially for Teacher 3, who started the intervention during the COVID-19 pandemic, with partial school closings and both online and face-to-face education, lack of time and conflicting responsibilities were issues.
Teacher 2: "A few weeks ago I was doing administration work and then I thought, wait a minute, because of VIPP-School I do not have enough time left for this.The visits take more than an hour." Finding Replacement.A colleague took over their classroom while teachers participated in VIPP-School.For Teacher 2, it was easy to find replacement, but for the other two teachers, this was sometimes difficult.
Logbook intervener Teacher 3: "The director, who would take over the class while the teacher participates in VIPP-School was fifteen minutes late.(…) Just an hour later he knocks on our window to let us know that he has to get on with other tasks.Thus, we were not able to finish the session." Theme 2: Intervention Elements Tasks.All teachers appreciated the variety of tasks, emphasizing the importance of alternating structured and unstructured play.The teachers suggested varying the difficulty of tasks (e.g., the choice between an easy and more difficult puzzle).Teachers felt that the tasks represented actual school tasks, thus providing realistic situations for teacher-child interaction.However, some activities were not practical or did not evoke the desired behavior of the child.For example, the clean-up task did not effectively evoke challenging child behavior, because "cleaning up" is standard practice during a school day.
Dyadic Interaction.For all teachers, the focus on the dyadic teacher-child relationship seemed to offer a new perspective on child behavior problems.Teachers enjoyed working individually with the child.Teachers 2 and 3 commented that VIPP-School had made them prioritize time for short dyadic interactions.
Teacher 3: "I became more aware of the importance of giving personal attention to children.I do this more often in my class now.For example, during time for independent work, I now more often invite a child or some children to my table to work together, play a game or help them with their tasks." In addition, working one-on-one during VIPP-School offered children the opportunity to enjoy individual time with the teacher outside the classroom.
Teacher 1: "Nathan's parents let me know that at home he talks about what he did with me during VIPP-School, that he likes it and that he thinks I am really nice.Yes, he really liked VIPP-School, especially the individual contact with me.Many children like that." Video Feedback.Teachers enjoyed reviewing the videos and found them informative.Teacher 2 commented that it made her more aware of her own behavior.
Teacher 2: "The video-feedback should be kept as a part of the intervention, because you look back on your actions.You can learn so much from it.You see your own behavior and it sometimes makes you think: 'Oops that was not very clever, I did that unconsciously'." Being filmed and watching themselves on screen was not awkward for the teachers.They reported that they were used to being filmed as part of their training.Teacher 3 expressed some unease when she saw the first videos, but she got used to it quickly.
Protocolized Learning Content.The learning content covered a broad range of topics related to child problem behavior.Not all content was applicable to the target child.In addition, some content from the first version was considered specific to parentchild relationships.
Intervener Teacher 2: "For example, there was something on how teachers and children can share such a special bond that outsiders cannot understand.I did not find that appropriate for a teacher-child relationship." The teachers and interveners acknowledged that the learning content did expand their knowledge to some extent, but they also noted that it could have been more.Since the teachers had substantial knowledge of child development and interaction processes, they needed more in-depth content and thus appreciated the additional information about underlying processes in child behavior problems.
Intervener Teacher 1: "I noticed that the teacher was really interested in the additional information about how children with behavior problems may be very sensitive to stimuli.I felt sorry that I could not give her more in-depth information, as the content often did not offer her much new insight." Both interveners expressed that the learning content was too repetitive, and distracted from the messages in the video feedback.Sometimes the amount of information was not evenly divided over the course of the visit.

Theme 3: Working Alliance
The interveners, who were used to working with parents, had to find their way in the relationship with another professional-the teacher.The interveners sometimes felt that they were perhaps too directive while giving feedback.
Intervener Teacher 2: "That was something I was struggling with.The teacher had 35 years of teaching experience and then I would tell her how to handle things?(…) I thought that I came across as pedantic.It would have been easier if I had coached a younger teacher."However, the teachers did not experience the interveners as directive and were happy to receive constructive comments.The teachers appreciated the interveners' structured and calm interaction.

Theme 4: Changes in the Teacher-Child Interaction
The effectiveness of VIPP-School on the Social Validity questionnaire was rated above average by Teacher 1 (3.43) and Teacher 2 (3.81).The data show that the intervention was most effective in helping teachers to (1) interpret signals of the child, (2) support the child's explorative behaviors, (3) prevent and handle difficult child behavior, and (4) create a more understanding perspective on child behavior problems.This is supported by data from the evaluation interviews.
Teacher-Child Interaction.After the intervention, teachers noticed that their interactions with the child had improved and felt this could be attributed to VIPP-School.
Teacher 3: "During the first few visits Rebecca was really quiet, but I noticed that secretly she was enjoying it.'The teacher is here for me!' In the later visits she opened up more in the individual interaction with me and later on she opened up more in the classroom.We had our own jokes about tasks in VIPP-School: 'hey monkey, hey sheep' (puppets).Rebecca began to flourish during the trajectory.I am not sure how our relationship would have developed without VIPP-School." Teachers and interveners experienced that the teachers more often noticed subtle child signals and responded more in line with the child's alternating needs between exploration and proximity seeking.
Logbook intervener Teacher 2: "More often the teacher refrains from interfering and lets Daniel take the lead.On his own terms he seeks contact with the teacher and she responds." In the first four visits, teachers practiced their interactions with the child outside the classroom to facilitate a calm environment.To foster the application of learned skills to daily practice, the fifth visit took place in the classroom.Teachers found some skills easy to implement in daily practice, such as complimenting positive child behavior more often and being aware of the effect of their own actions.Other skills were more difficult to implement.Teacher 2 had difficulty figuring out how to apply what she had learned in the dyadic interactions in a wide variety of classroom situations.
Teacher 2: "I find VIPP-School useful.I look at Daniel differently than before, but I am missing a piece in the intervention.(…) I now understand better how to react to Daniel, but how do I do that in the presence of all the children he reacts explosively to?" Changes in Child Behavior in the Classroom.Teacher 3 noticed changes in Rebecca's behavior in the classroom.Before the intervention she was shy, during the intervention she opened up to her teacher and classmates.The other teachers did not see substantial behavior changes in the classroom.They rated the class climate as the component on which the intervention had the smallest effect (M = 2.50).Impulsive behavior of the children decreased during the dyadic moments with the teacher, but in the classroom, it was still present.However, even when teachers did not experience a decline in the children's impulsive behavior, they found it easier to correct them, thanks to improvements in their relationship.
Teacher 2: "Daniel is more accepting of my 'no's'.Of course, there are days that are more difficult for him, but there used to be days that I would have to call his name a hundred times to correct him.Now, I only have to look at him to correct him." Shift of Perspective on Child Behavior Problems.All teachers showed a shift in their perspective on the children's behavior problems.Instead of merely experiencing the behavior as disturbing, the teachers showed more empathic understanding after the intervention.
Teacher 1: "This morning with my intern Nathan was interrupting again to give the answers.He wants it so badly.I can laugh about it now.It is just his enthusiasm, I do not want to hold him back too much." Theme 5: Defining the Target Audience VIPP-School Fills a Gap in the Available Support for Teachers.According to Teachers 1 and 2, currently, no structured interventions focusing on behavior problems from a relational perspective are available.VIPP-School would add meaningfully to what is currently offered, by explicitly targeting the relational perspective.Teachers would recommend VIPP-School to their colleagues.
Usefulness Related to Years of Teaching Experience.Teachers differed in their views on how much VIPP-School can support teachers with extensive teaching experience.Teacher 2 had 35 years of experience and still felt that she had learned from the intervention.Her intervener noticed that the teacher's eagerness to learn enabled her to benefit from the intervention.
Teacher 2: "I feel like, I can have 35 years of teaching experience, but even I can learn new things.I have really gotten some useful tips from VIPP-School that I knew but did not actively apply in the classroom.Those 'of course' moments.You are never too old to learn." However, the intervener working with Teacher 1, who had 15 years of teaching experience, felt that the intervention would be more suitable for teachers with less experience as VIPP-School may not offer much new information for experienced teachers.The questionnaire shows that Teacher 1 had more positive perceptions of her own abilities (4.88) than Teacher 2 (2.88).
Importance of Selecting the Right Target-Child.Teacher 1 did not experience much difficulty in handling Nathan's behavior, which might explain why she felt VIPP-School may not have offered many new insights.The teacher would rather have participated with another child, but these parents did not consent.She commented that VIPP-School would be most valuable if delivered to teachers with a child with whom they experience substantial difficulties.
Overall, teachers felt that VIPP-School will be most useful for teachers who experience difficulties in interacting with children with behavior problems in lower elementary grades.Early intervention may help prevent the onset of more serious behavior problems.Teacher 1 commented that most behavior problems emerge in Grade 1 because children have to meet more expectations than in kindergarten.The target population of VIPP-School should thus not be limited to kindergarten teachers, but include Grade 1 and Grade 2 teachers.Teacher 3 thought that VIPP-School might not be suitable for children in Grade 3 and higher.
Teacher 3: "Maybe VIPP-School is not suitable for children from Grade 3 and higher.They are often more assertive in the relationship with the teacher and do not always like to work individually with their teacher." Including the Child's Network.Teacher 2 suggested that VIPP-School would be even more effective if the child's caregiving network was included in the intervention.She shared her new insights with her colleague and Daniel's parents to encourage them to use a similar approach.

Discussion
The aim of this study was to obtain information on teachers' and VIPP-interveners' experiences with VIPP-School, with an eye toward the intervention's potential to support teachers in lower elementary grades.This study indicates that VIPP-SD can be adapted to the school context to be applied in lower elementary grades.Our findings indicate mostly positive and some negative experiences of VIPP-interveners and teachers and reveal valuable suggestions for further development.These suggestions can be clustered under five main themes: (1) scheduling, (2) intervention elements, (3) working alliance, (4) changes in the teacher-child interaction, and (5) defining the target audience.

Subjective Effectiveness
We found preliminary evidence that VIPP-School may support early elementary school teachers in their interaction with children showing behavior problems.Our findings suggest that there may be improvements in teacher sensitivity as well as a growing empathic understanding of the child's behavior, as supported by both qualitative and quantitative findings.This is in line with a meta-analysis of 25 randomized controlled trials of VIPP-SD, showing positive effects on parenting behavior (r = .18;Van IJzendoorn et al., 2022).Even though teachers did not always observe direct improvement in the child's externalizing behavior in the classroom, they noticed that it was easier to correct the child's behavior.

Finalizing VIPP-School
In the further development of VIPP-school, attention should be paid to the following suggestions.First, scheduling intervention visits can pose practical difficulties.More specifically, teachers may struggle in finding a substitute teacher during the visits.This is in line with earlier implementation studies (e.g., McIntosh et al., 2000;Vancraeyveldt et al., 2015).Successful implementation of VIPP-School requires flexibility of the intervener, coordination of coverage, or conducting visits during lunchtime or other nonclassroom moments.Barnicott et al. (2023) found that interveners' flexibility in (re-)arranging VIPP-SD sessions was also experienced as a helpful factor by mothers with personality disorder.
Second, the content of the intervention should be carefully reviewed.Although the interactive tasks used in the intervention were evaluated as varied and realistic, some minor adaptations can be made using the teachers' suggestions.Although teachers appreciated focusing on the dyadic relationship, the learning content did not always expand their knowledge, arguably because of the considerable experience of two of the participating teachers.Examining prior knowledge and experience at baseline may help to better attune to the specific needs of the teacher and to place the learning alliance in the Zone of Proximal Development (Vygotsky, 1978).The use of video feedback was experienced as a great means to become more aware of subtle signals of the child that had been difficult to see when the teacher was caught up in the interaction with the child.This is in line with research by Barnicott et al. (2023) also indicating that reviewing videos helped mothers to discover new aspects of the interaction with their child.
Third, one teacher experienced difficulty in applying what she had learned in daily classroom practice.Careful consideration of the context is important for the successful implementation of interventions (Murray et al., 2010).For this reason, a focus on teachers' daily experiences and generalization of skills from the intervention visits to the classroom is essential.Moreover, to bridge the gap between intervention visits and classroom, recordings for the final VIPP-school intervention visit are made in the classroom.
Finally, interveners struggled somewhat in positioning themselves in relation to the teacher.Research into effective teacher-coaching emphasizes equality in the working relationship.Ideally, a balance should be found between building a supportive relationship as peers and giving guidance to incorporate research-based instructional methods into daily practice (Heineke, 2013).The importance of a warm, supportive, and trusting relationship where interveners present the feedback in a nonjudgmental way is also stressed in other VIPP studies (e.g., Barnicott et al., 2023).

Study Strengths and Limitations
An important strength of the study was the close collaboration with professionals from the field.Using semistructured interviews enabled in-depth exploration of experiences with VIPP-School.Triangulation of methods and the inclusion of various stakeholders provided multiple perspectives and increased reliability and validity of the results.
Because the study was exploratory, the number of participants was limited.As a result, data saturation may not have been reached and transferability of findings may be limited.
The convenience sampling method implies potential bias.To eliminate any influence of the researchers on the course of the intervention trajectories, independent VIPP-interveners were hired to deliver the intervention.Working with multiple interveners helped reduce therapist-specific effects.Participant bias was minimized by assuring the participants that they could give their unbiased opinions.The difference in time frame in which the intervention was scheduled may have affected the participants' experiences.The trajectories of Teacher 1 and Teacher 2 were done in 6 weeks from first to last visit.In contrast, Teacher 3's trajectory was stretched out to 16 weeks due to pandemic-related school closings and restrictions.

Clinical Implications
The qualitative findings in tandem with the quantitative findings indicate that VIPP-School is an acceptable and deliverable intervention for teachers in lower grades in elementary education.This corresponds with recent evidence showing that VIPP is feasible and acceptable in other populations, including mothers with personality disorder, Turkish immigrant families, child care, and children with behavior problems (Barnicott et al., 2023;O'Farrelly et al., 2021;Werner et al., 2018;Yagmur et al., 2014).VIPP-School may be most valuable for teachers who experience difficulties in interacting with a child due to behavior problems.The primary aim of VIPP-School is promoting teacher sensitivity and sensitive discipline, leading to improved teacher-child interaction quality and fewer behavior problems in the child.This study suggests that VIPP-School has the potential to support these key drivers of positive caregiving and child socioemotional health.To establish the effectiveness of the intervention, VIPP-School needs to be tested in randomized controlled trials.
the Netherlands, children start kindergarten at age 4 and attend elementary school for eight years (until age 12).

Table 1 .
Characteristics of Participants