Children who have experienced abuse and neglect are at a higher risk of mental health problems and other poor outcomes throughout their lives. Very young children are particularly vulnerable to abuse and neglect and the impact on their development can be profound. For children who end up in care, the effects of maltreatment are often compounded by placement instability or failed reunifications when children are returned to a home that can’t support them well, something strongly associated with poor outcomes and higher costs to services.
The New Orleans Intervention Model provides intensive assessment of and intervention for young children up to the age of five in foster care due to abuse or neglect, their parents and foster cares. A multidisciplinary team, the London Infant and Family Team (LIFT), works with children and families over a 9-15 month period. The team provides a holistic service, working within the statutory social care and family court systems to ensure the highest quality interventions are provided and permanence decisions reflect the best evidence about child, family and relationship functioning.
The project succeeded in establishing the LIFT service and negotiated with the judiciary on inclusion criteria for the service. When treatment was offered, flexibility around the adherence to Public Law Outlines were introduced. This enabled a treatment plan to be undertaken in addition to assessments.
During the initial phases of the project there were a number of challenges including delays to staff appointment, a limited number of referrals at the outset and confusion among local stakeholders about whether or not LIFT could be regarded as ‘experts’ in care proceedings. Some key stakeholders, in particular the judiciary, were initially opposed to the introduction of a Randomised Control Trial (RCT) to test effectiveness of the model.
Learning from the project has highlighted how unusual RCTs are at the intersection of the legal, health, social professions. There is no precedent for the implementation of an RCT within family proceedings. Barriers were explored through a series of meetings with key stakeholders resulting in a commitment from the judiciary to support the introduction of the RCT which commenced in October 2017.
Julia Mayes or Nicola Cosgrave
Kings College London, University of Glasgow
Croydon Council, South London and Maudsley NHS Foundation Trust