A maltreated child removed from their birth family in Scotland or England will enter a trial testing whether an intensive therapy programme, originally developed in New Orleans, can repair family relationships and prevent further harm. This matters because child maltreatment has lifelong consequences for mental and physical health, and current social work interventions have shown mixed results. The New Orleans Intervention Model (NIM) offers a structured, attachment-based assessment and intensive therapy to families whose child has entered care. If the family improves sufficiently, the child returns home; if not, the recommendation is adoption. US pilot data suggest NIM reduces future maltreatment and improves children’s mental health, but it has never been tested in a UK legal and healthcare setting. If this trial of 462 families shows NIM is clinically and cost-effective, it could change how child protection services respond to maltreatment across England and Scotland. A proven, intensive alternative to standard case management would give social workers a clearer, evidence-based path for deciding whether a child should return home or be adopted, potentially improving long-term outcomes for thousands of vulnerable children.
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The negative effects of child maltreatment on mental and physical health amplify across the lifespan and costs to society are enormous. Regardless of the extent of early life maltreatment, placement in a nurturing family is associated with rapid development of secure attachment and improved mental health – but only if that nurturing placement is achieved early enough in life. The best type of placement is not yet clear: randomised controlled trial (RCT) evidence has shown that placement of maltreated children in substitute family care (i.e. adoption or fostering) is associated with significant developmental catch-up, but other studies suggest that placement within the birth or extended family may be even better than substitute care. Efforts to improve the mental health of maltreated children in birth families or foster placements have had mixed success and researchers have recommended that far more intensive approaches are required. We are conducting a two-arm UK-based RCT of such an intensive approach. The programme we are evaluating, the New Orleans Intervention Model (NIM), is currently the only one that is well evidenced, although only in a US setting. NIM offers families whose child enters care due to maltreatment a structured attachment-based assessment followed by an intensive intervention aiming 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. US pilot research suggests that NIM is associated with a reduction in future maltreatment of both the index child and other siblings as well as improved mental health in middle childhood. Our control intervention, Case Management (CM), comprises standardised social work contact and referral to other services where necessary. In order to translate NIM for the Scottish context, we conducted extensive mapping and modelling in both New Orleans and Glasgow to understand how best to develop NIM to take account of the differing healthcare and legal context. Since beginning our feasibility RCT, in December 2011, we have recruited 65% of all maltreated children aged 6 months to 5 years coming into an episode of care. Preliminary findings suggest that the intervention is acceptable to parents, foster carers, social workers and legal professionals, but this study will not be large enough to say definitively what impact NIM has on the health of the children involved or how much it will cost in the long term. We are currently conducting similar detailed mapping and modelling work in South London, and a NIM team is going to be launched there in 2015. We now want to test whether NIM is clinically and cost-effective in the different legal jurisdictions across England and Scotland. We propose a multi-centre RCT of NIM involving a continuation of our current Glasgow RCT, including a further 2 sites in Scotland and 1 site in London, England. We plan to involve 462 families in total across these sites, including those recruited in our current Glasgow study. This will allow us to test, definitively, whether NIM is clinically effective and cost effective in the UK.
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