New Orleans Intervention Model

Last updated: 16 Jan 2019
Introduction

Helping professionals make the right decision on care

The New Orleans Intervention Model helps social workers and judges decide whether a child on a care plan should live with their birth family or enter care permanently.

Our aim is to help reunite the child with their family where possible, or place them permanently into care if not.

How it works

How the New Orleans Intervention Model works

The New Orleans Intervention Model brings together specialists in infant mental health and social care, and works with a family over a 9- to 15-month period.

The New Orleans Intervention Model assesses each parent’s health and wellbeing, including:

  • mental health
  • any addiction issues
  • exposure to trauma or violence.

It then establishes treatment goals and offers tailored support to address problems and strengthen the parent-child relationship. Treatment might include one or more of a range of evidence-based interventions.

We report on the findings of our assessments to social work and legal teams, and give advice about the help the child needs. And, later on, we produce another report about the results of our work, which helps inform decisions about the child’s care.

Decisions about whether the child should be placed in care permanently are only made following the treatment programme, and are based on the parents’ capacity to strengthen their caregiving relationship with the child. Where parents can achieve significant change, children are rehabilitated back into their birth family. If nothing changes, we recommend adoption.

Evidence base

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).

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).

Who it is for

Who is the New Orleans Intervention Model for?

Our Infant and Family team works with the birth parents and foster carers of children aged between 6 months and 5-years-old:

  • who are in local authority care for the first time, and
  • where there are court proceedings because of maltreatment, and
  • who are in a foster-care placement.

Making a referral

If you are interested in finding out more about the New Orleans Intervention Model, get in touch with one of the service centres offering this service, as listed under the Locations tab.

Evaluation

Evaluation of the New Orleans Intervention Model

We’re working with South London and Maudsley NHS Foundation Trust, NHS Greater Glasgow and Clyde, Croydon Council and Glasgow City Council, as well as researchers at the University of Glasgow, to assess whether the New Orleans Intervention Model helps young children in foster care who have been abused or neglected.

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.

Full findings from a randomised controlled trial (RCT) of the service are due to be published in 2020.

What we learnt

Process evaluation

We asked the University of Glasgow to undertake a qualitative evaluation of perceptions and experiences of the New Orleans Intervention Model delivered by 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

Summary report

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’.

(Bryce, 2018).

> Read the summary report

How we’re evaluating this service

We are working in partnership with the University of Glasgow, Glasgow City Council and the NHS Greater Glasgow and Clyde to carry out a randomised controlled trial (RCT). The New Orleans Intervention Model 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 2020.

A separate, but linked, study to develop and test the model is running in south London with Croydon Council and the South London and Maudsley NHS Foundation Trust. Findings will be published in 2020.

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.

Evaluation tools

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
  • Genogram
  • 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.
References and resources

References and resources

Evaluation reports

Bryce, G. (2018) GIFT unwrapped: the New Orleans Intervention in Glasgow: summary report. London: NSPCC.

Turner-Halliday, F., Watson, N. and Minnis, H. (2016) Process evaluation of the New Orleans Intervention Model for infant mental health in Glasgow. London: NSPCC.

Evidence base

Jamieson, M. (2015) Therapeutic interventions with birth parents and foster carers of maltreated children: a systematic review. [Unpublished].

NSPCC (2016) Looking after infant mental health: our case for change: a summary of research evidence. London: NSPCC.

Stovall-McClough, K.C. and Dozier, M. (2004) Forming attachments in foster care: infant attachment behaviors during the first 2 months of placement. Development and psychopathology, 16(2): 253-271.

Wade, J. et al (2010) Maltreated children in the looked after system: a comparison of outcomes for those who go home and those who do not (PDF). London: Department for Education (DfE).

Zeanah, C. et al (2001) Evaluation of a preventive intervention for maltreated infants and toddlers in foster care. Journal of American Academy of Child and Adolescent Psychiatry, 40(2): 214-221.