The Best Services Trial (BeST?): Effectiveness and cost-effectiveness of the New Orleans Intervention Model for Infant Mental Health

Record ID 32015000643
Authors' objectives: 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. 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 have carried out careful exploratory research, in Glasgow, on an intensive approach developed in the United States. We have called this the New Orleans Intervention Model (NIM). NIM offers families who have a child entering care due to abuse or neglect a structured assessment 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 US suggests that NIM might reduce future maltreatment of the child and other children in the family, and improve mental health in later childhood. We are currently conducting a preliminary study in which, since December 2011, we have managed to recruit around two-thirds of all maltreated children aged 6 months to 5 years coming into an episode of care in Glasgow. 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 half of families receive usual services, which is delivered by social workers. Preliminary findings suggest that NIM is acceptable to parents, foster carers, social workers and legal professionals. We are currently conducting detailed exploratory work in South London and a NIM team is going to be launched there in 2015. We now need to test whether NIM is effective, in terms of both clinical outcomes and cost, in the different legal systems across England and Scotland. We, therefore, propose a study of NIM involving a continuation of our current Glasgow work and including a new South London site. We plan to involve 462 families in total across the two sites, including those recruited in our current Glasgow study. This will allow us to determine whether or not NIM is effective in the UK.
Project Status: Ongoing
Anticipated Publish Date: 2022
Requestor: NIHR Health Technology Assessment programme
English language abstract: An English language summary is available
Publication Type: Full HTA
Country: England, United Kingdom
MeSH Terms
  • Child, Preschool
  • Infant
  • Child Health Services
  • Parent-Child Relations
  • Child Abuse
  • Foster Home Care
  • Mental Health Services
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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