Testing Evidence Based Solutions

The New Orleans Intervention Model and LIFT

The New Orleans Intervention Model

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What is it?

A relationship-focused intervention for families where

maltreatment has occurred

Developed and tested over 20 years by Professor

Charles Zeanah at Tulane University

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Aims

• Improve decision making about entry to care or

parents’ capacity to support children safely at

home

• Improve mental health, both for children who

return home and those who remain in care

• Increase placement stability

• Significantly reduce reunification breakdown

• Significantly reduce the harm to subsequent

children in a household

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Evidence

Evaluation 4 and 7 years post intervention

Parental capacity cannot be predicted reliably

from the information available prior to the

intervention.

The intervention contributes significantly to the

evidence necessary to take a child permanently

into care where it is in the child’s best interests.

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UK Evaluation

ScotlandRandomised Control

Trial (RCT) designed

to:

Determine whether the New

Orleans Intervention Model is

clinically and cost effective in

improving the mental health of

maltreated infants and young

children compared to services as

usual.

LondonLinked evaluation to understand:

– Acceptability of New Orleans Intervention Model in Croydon

– Care journeys of looked after children aged 0-5 in Croydon (before and after NIM)

– Mental health symptoms in looked after children aged 0-5 who have experienced Croydon NIM assessment and intervention

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Early intervention and investment

Truly an early

intervention - with a

focus on infants (under

5s)

• Rigorous assessment of

maltreated children under the

age of five

• In-depth assessment helps to

directly address problems and

achieve timely permanency

plans for a child

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New Orleans in Croydon – London Infant Family Team LIFT

Partnership between Childrens Social

Care, South London and Maudsley

NHS, NSPCC, East London family

Court

Multi disciplinary team

• Social workers, psychologists, within a

dedicated team (the Infant and Family

Team)

Relationship Focused

• assessments of child attachments and

all care giver relationships, & provide

bespoke treatment

Improved decision making

• Brings high levels of expertise to

decision-making about children in care

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Relationship-focused

Holistic assessment

and support provided

for all relationships

around the child

• Child’s attachment relationships

at the heart of decision-making

• Detailed, holistic assessment of

the child and all care-giving

relationships

• Bespoke support for all

relationships

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Capacity-building

Focuses on parents’

capacity to change,

and provision of

associated support

• Looks to address problems and

rebuilding relationships

• Designed to maximise chances

of child returning to birth parents

• Improvements made can benefit

subsequent children

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Personalised and intensive treatment and intervention

Tailored/bespoke

treatment model, with

intensive intervention

offered in every case

• Intensive treatment tailored to

the needs of parents

• Draws on attachment-informed,

relationship focused

interventions, eg. Circle of

Security, Parent Child

Psychotherapy, VIG

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Focused on evidence

Designed to gather

evidence for better

decision-making

across the system

• Assessment and treatment

processes generate detailed

evidence from a range of

perspectives

• Evidence helps authorities and

judiciary make more informed,

more timely decisions about the

the best care setting for the

child

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How it’s different

o Improved support for birth parents is offered in order to benefit the child worked with as well as subsequent children in the family

o Families receive combined infant mental health and social work support, recognising the importance of attachment between the child and primary care giver

o Decision making about permanent entry to care is made only after an intervention programme – it is based on parents’ capacity to change their behaviour and strengthen their care-giving relationship with the child

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The London Infant and Family Team (LIFT)

o Local authority Children’s Services retain statutory responsibility for

the child’s care plan

o The local authority will retain responsibility for identifying and

assessing the viability of other potential carers

o Children’s Services remain the lead agency for decision making in

respect of any child protection concerns

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Children’s Services Involvement

o Child under 60 months (five years old) in foster/kinship care due to abuse or neglect

o On an Interim Care Order (ICO) or Section 20 where case is in legal proceedings

o Includes family and friends placements where there has been viability assessment and current regulation 24 assessment (kinship care)

o Parents and carers are able to access NSPCC service centre in Croydon

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Referral criteria

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Four stages over 8 months

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Clip of assessment

Video Interaction Guidance (VIG)

Circle of security (CoS)

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Clips of interventions

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Evidence from New Orleans

When children were returned home there

was a reduction in subsequent incidents

of maltreatment of that child

Subsequent children in a household at

significantly lower risk of harm

irrespective of whether the first child

entered care or returned home

Children’s mental health several years

later differed only slightly from the

general population, whether they

remained in care or were rehabilitated to

birth families

-68%

75% lower risk

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So What? Why is this significant

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Very young children

Are particularly vulnerable to abuse

and neglect

Their development can be profoundly

effected by trauma

The importance of looking after their

mental health is well-evidenced

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Very young children continued

Neurological and psychological

research show how critical the first

months and years are to a child’s

development

‘During this time the building blocks of a

baby’s mind are being put in place, with

new connections that form the permanent

architecture of the brain being created at a

rate of 700 per second.’

Center on the Developing Child (2009) Five numbers to remember about the developing child

Harvard: Center on the Developing Child.

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How it’s different

o Improved support for birth parents is offered in order to benefit the child worked with as well as subsequent children in the family

o Families receive combined infant mental health and social work support, recognising the importance of attachment between the child and primary care giver

o Decision making about permanent entry to care is made only after an intervention programme – it is based on parents’ capacity to change their behaviour and strengthen their care-giving relationship with the child

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Support for better parenting

Foster carers need…

specialist support to give children

the best care possible

Birth parents need…

help to learn to care for their

children – now and in the future

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Rubin, D. M., Alessandrini, E. A., Feudtner, C., Mandell, D. S., Localio, A.

R., Hadley, T. (2004), James, S., Landsverk, J., Slymen, D. J., Leslie, L. K.

(2004)

When infants who have suffered neglect or

maltreatment are placed with loving carers,

whether family or not, they demonstrate

rapid, healthy brain development that is

comparable to peers who aren’t in care.’

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Implications for policy & practice

If the New Orleans Intervention Model

proves to be clinically and cost effective, it

could:

Transform outcomes for young children in care

Reduce the number of placement breakdowns

Reduce the number of repeat removals from the

same mother

Provide robust, UK-based research evidence in

this area of children’s social care, for the first

time

Lead to ground-breaking multidisciplinary

teams supporting children in care across the UK