The evidence base
Many young children separated from their parents on grounds of abuse or neglect spend long periods in temporary placements or are subject to failed rehabilitation plans. This lack of stability of care has profound implications for their future development and emotional wellbeing (Wade et al, 2010).
Recovery from the effects of early abuse can be rapid if safe nurturing care is achieved early enough, ideally in the first year of life (Stovall-McClough and Dozier, 2004).
In a systematic review, the New Orleans Intervention Model was identified as the only evidence-based programme to use an infant mental-health approach to improve the quality of permanent placement decisions (Jamieson, 2015). Infant and Family Teams is the name given to the New Orleans Intervention Model in the UK.
Evaluation of the New Orleans Intervention Model in the USA has shown promising results in terms of the difference it aimed to make in the lives of children (Zeanah, 2001).
Evaluation of Infant and Family Teams
We have adapted the New Orleans Intervention Model which was developed by Professor Charley Zeanah and colleagues at the University of Tulane, New Orleans for our services in the UK.
We are working in partnership with the University of Glasgow, King’s College London, Barking and Dagenham Council, Bromley Council, Croydon Council, Glasgow City Council, Sutton Council, Renfrewshire Council, and Tower Hamlets Council, as well as with the NHS Greater Glasgow and Clyde and the South London and Maudsley NHS Trust, to carry out a randomised controlled trial (RCT).
Infant and Family Teams will be compared with a similar service delivered through local social-care agencies in London and Scotland. The National Institute of Health Research (NIHR) is funding the trial and full findings are due to be published in 2023.
Initial findings from research into participants’ perceptions and experiences of the service and from a case audit of the first 50 children allocated to the Glasgow-based service have been published.
What we learnt
We asked the University of Glasgow to undertake a qualitative evaluation of perceptions and experiences of the Glasgow Infant Family Team (GIFT). The programme was compared to the Family Assessment and Contact Team (FACS), a social-work service delivering enhanced assessments.
- The mental health focus of the GIFT service was viewed by participants as a positive addition to the way infants and families are treated after abuse.
- GIFT takes longer than social-work permanence reviews, but trial participants felt this was necessary to improve the quality of evidence in a case and the accuracy of decision-making. GIFT’s evidence for care proceedings was perceived as very influential.
- Although some foster carers viewed their involvement with GIFT as burdensome, many appreciated GIFT’s thorough assessment, which supported them in understanding the child’s needs. They described it as a level of support they had never received before.
(Turner-Halliday, Watson and Minnis, 2016).
> Read the process evaluation
We’ve also produced a report summarising what we’ve learnt from the first five years of the Glasgow Infant and Family Team (GIFT) through a case audit of the first 50 children allocated to GIFT.
Key findings include:
- The GIFT team were often the first professionals to systematically assess the quality of the caregiving relationship between parents and children. Similarly, they were the first team to provide families with sustained help to improve the caregiving relationship.
- The GIFT experience suggests that it isn’t helpful for young children to attend Children’s Hearings (this is where legally binding decisions are made by a panel of lay members about the care of the child based on the child’s protection, guidance, treatment or control needs). Having a young child in attendance at a Hearing isn’t a reliable way for the panel to understand the child’s views and experiences.
- A child’s case was often dealt with by the same Children’s Reporter (this is a local, independent official who receives and investigates referrals and supports the work of the Children’s Hearing). However, if there were multiple Children’s Hearings about a child it was rare for the case to be dealt with by the same panel members.
- Half of the GIFT children were first known to social-work services at birth, however the average age when they were taken into care (when GIFT became involved) was 2 years 8 months. This raises the question of whether the GIFT support is being offered at the ‘right time’.
> Read the summary report
How we’re evaluating this service
We are working in partnership with the University of Glasgow, Glasgow City Council, Renfrewshire Council, and the NHS Greater Glasgow and Clyde to carry out a randomised controlled trial (RCT). The Infant and Family Team will be compared with a similar service delivered through local social-care agencies. The National Institute of Health Research (NIHR) is funding an evaluation of the trial, which will report in 2023.
A separate, but linked, study to develop and test the model is running in south London with Croydon Council, Tower Hamlets Council, Bromley Council, Sutton Council, Barking and Dagenham Council and the South London and Maudsley NHS Foundation Trust. Findings will be published in 2023.
The UK evaluations are testing:
- impact on infant mental health
- the quality of the child’s relationship with their birth parent and with their foster carer
- the impact of the model on early decisions about a child’s placement
- the cost benefit of the intervention.
The evaluation uses the following tools:
- Ages & Stages Questionnaire
- Beck Depression Inventory
- Behaviour Screening Questionnaire
- Child Behaviour Checklist
- Circle of Security Interview
- Crowell Procedure
- Davidson Trauma Scale
- Disturbances of Attachment Interview
- Infant and Family Team intake interview
- Life Stressor Checklist
- Parenting Stress Index – short form
- Partner Violence Interview
- Still Face procedure
- Trauma-Related Dissociation Scale
- Traumatic Events Screening Inventory – Parent Report Revised (TESI-PRR)
- Working Model of the Child Interview.