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The New Orleans Intervention Model: Early Implementation in a London Borough

Children’s Social Care Innovation Programme Evaluation Report 57

The New Orleans Intervention Model (NIM) is the name given to a service approach that provides intensive assessment and treatment for families of children aged 0-5 years in foster care, which informs recommendations to the court about adoption or permanent return to birth families. It was developed by Professor Charles Zeanah of Tulane University, Louisiana, United States (US), in the late 1990s. The intervention focuses on relational assessments by exploring the relationship between, for example, the child and mother, child and father, and child and foster carer. A multidisciplinary team undertakes attachment-based assessment and intervention work using structured clinical tools. The model has been adopted in various parts of the US, as well as in South Australia, but implementation has not always been consistent with the original model.

NIM has been part of the National Society for the Prevention of Cruelty to Children’s (NSPCC’s) services in Scotland since 2011, where it is known as the Glasgow Infant and Family Team (GIFT). This is subject to a randomised controlled trial (RCT) as part of the BeST? services trial / Evaluation of the New Orleans Intervention for Infant Mental Health led by Professor Helen Minnis of the University of Glasgow. The NSPCC successfully applied for funding to the Children’s Social Care Innovation Programme (IP) – a programme of support run by the Department for Education (DfE) – to introduce the model into England for the first time and to evaluate its implementation. A pilot service was developed in the London Borough of Croydon, known as the London Infant and Family Team (LIFT), and it is this service which is the focus of this report.

The total number of looked after children in England has increased steadily over the last 8 years. There were 70,440 looked after children at 31 March 2016, an increase of 1% compared to 31 March 2015 and an increase of 5% compared to 2012. Over 800 of these are from the London Borough of Croydon, where the rate of LAC per 10,000 children in the population is the highest in London and one of the highest in the UK. However, it should be noted that the total includes over 400 unaccompanied asylum seeking LAC (Wilder and Dembour, 2015) almost of whom will be aged over 16. The overall population aged 0-19 in Croydon is also one of the highest in the country.

Being a LAC is linked with a range of adverse mental health, psychological and social outcomes (Luke et al., 2014, Sempik et al., 2008, Moriarty et al., 2016). There are no published results of services for babies and young LAC that have been tested in RCTs in the UK, although it is likely that some trials have included at least some LAC aged under 5 (for example, Carpenter et al., 2016, Robling et al., 2016). One of the key challenges to any RCT with this group is how to set up the process of randomisation before a final decision about a looked after child’s placement has been made. This report describes some of the ethical, legal, and practical arrangements that need to be in place before this process can be achieved.

Evaluating the London Infant and Family Team (LIFT) service
A two part evaluation was commissioned to help NSPCC to implement the intervention in the London Borough of Croydon (LB Croydon). The first, based on 54 interviews undertaken in early 2016 with key stakeholders, considered Croydon’s feasibility as the second site for the RCT being conducted in Glasgow and what was needed to develop the approach and methodology for a rigorous evaluation of the programme if an RCT was not possible. It also examines the initiative within the English social care and legal contexts.

The second, which ran until January 2017, investigated what data would need to be collected, and the arrangements for sharing data that would be needed to establish outcomes for all children and their families referred to LIFT. A comprehensive database was developed for the purpose of the evaluation by Dennis Ougrin and Kerry Middleton. The database covers sociodemographic, psychosocial and clinical data on all children and their families referred to LIFT. The database comprises 236 data points; 63 data of which collect information on sociodemographics, care journey details and levels of service contact, while the remainder record information about the mental health of children and birth parents (all potential assessments included).

Given the focus and timing of the evaluation, it was unable to establish whether NIM has made a difference to children and young people’s outcomes, or those of their birth parents. Instead, one of the main themes of this report is the process of deciding how it might be possible to set up a system for obtaining this information. The report itself is divided into three parts. The first (pages 17-20) describes the context, and methods for the evaluation as a whole. The second (pages 21-43) presents the findings from the qualitative evaluation while the third (pages 46-60) summarises referrals made to the LIFT team, and presents progress towards establishing an RCT over the past 12 months.