BeST? is a randomised controlled trial comparing an infant mental health service (the New Orleans Intervention Model (NIM)) with a Social Work Model (Case Management (CM)). It aims to find out what is the best service for young abused and neglected pre-school children coming into foster care.
Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society. Regardless of the severity of this abuse and neglect, these negative effects can largely be reversed if children are placed in secure, loving homes early enough in life. Placing children in nurturing foster placements can help them recover rapidly, but it is not known whether it is better for children’s long term development to place them with substitute (foster or adoptive) families or return them to birth or extended families who have been helped to get over their problems.
We have carried out careful exploratory research, in Glasgow, on an intensive approach, which was developed in the United States. We have called this the New Orleans Intervention Model (NIM). NIM offers families who have a child who enters care due to abuse or neglect a structured assessment of family relationships followed by an intensive treatment that aims to improve family functioning and child mental health. If adequate change is achieved, a recommendation is made for the child to return home but, if not, the recommendation is for adoption. Preliminary research from the USA suggests that NIM might reduce future maltreatment of the child and other children in the family, and improve mental health in middle childhood. However, this US research was conducted in a context where there were virtually no preventative child social services. It might be that the much better preventative social work services that exist in the UK could be as good as or even better than NIM.
We are currently conducting a study in which, since December 2011, we have managed to recruit around two-thirds of all abused and/or neglected children aged 0 to 5 years coming into an episode of foster care in Glasgow. We are now recruiting children from South London into the trial. Half of the families who are taking part receive NIM, which is delivered by a multidisciplinary team comprising health and social care professionals. The remaining families receive CM, which is delivered by social workers. Preliminary findings suggest that NIM is acceptable to parents, foster carers, social workers and legal professionals.
In 2021, we will be able to report which is the service that works best for these very vulnerable children. In the meantime, our qualitative interviews and focus groups with foster carers, birth families, social workers and members of the legal system will continue to give us rich information about how services work and how families respond.