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Parent Infant Interaction Observation Scale (PIIOS)


PIIOS at the University of Warwick

The quality of the parent-infant (P-I) relationship shapes the baby's brain development and lays the foundations for the promotion of a secure attachment. Secure attachment is associated with optimal functioning across a wide range of developmental domains. Babies who receive sensitive responsive care are more likely to form a secure attachment.

Relation-based practice is fundamental to effective infant mental health work. PIIOS practitioners can keep in mind the three dimensions of interactional behaviour of engagement, predictability and genuineness and identify interactional patterns. They are enabled to assess the quality of the P-I relationship and identify dyads with interactional patterns that may give rise to concern regarding the social and emotional development of the baby. Therefore, the PIIOS offers an opportunity to promote early intervention and support change and improvement in the P-I relationship.

PIIOS is a validated, easy-to-use tool, designed with front line perinatal and infant mental health practitioners in mind. It is a short easily accessible screening tool to assess the P-I interaction between 6 weeks and the end of the seventh month.

The PIIOS was developed and validated by Dr P.O. Svanberg in collaboration with colleagues at Warwick Infant Family Wellbeing Unit (WIFWU) and has been shown to be reliable and also ‘teachable’ with significantly improved ability to recognise ‘risky’ interaction following the training.

About the course

PIIOS training is usually delivered over a 12-15 week period and involves pre-reading activities prior to the two days training. The two days training includes relevant theoretical content, establishing recognition of the three interactional patterns of:

  1. sensitive responsivity
  2. intrusive and over-engaged
  3. unresponsive, un-engaged

Complex patterns of behaviour are then introduced and practitioners learn how to use the PIIOS scale.

The PIIOS scale consists of thirteen items assessing different dimensions and practitioners learn how to interpret the total score.

Post days 1 and 2 practitioners are required to engage with the PIIOS practice clips and then progress to their PIIOS reliability assessment.

Day three is designed to review performance of the PIIOS reliability assessment and share the video clips the practitioners obtain of a P-I interaction.

On completion of PIIOS training reliable practitioners are accredited by Warwick Medical School and receive 50 hours CPD accredited against the new specialist UK Infant Mental Health Recognition Register.


Our PIIOS teams are able to deliver face-to-face courses at venues arranged by commissioners, or online variants. Many cohorts are bespoke for specific professional groups but individual practitioners may contact us to join one of our online cohorts.

International Reach

As well as providing training in the UK, our teams provide PIIOS training in Sweden and in Malta.