Protocol 15PRT/6090:The Best Services Trial (BeST?): effectiveness and cost-effectiveness of the New Orleans Intervention Model for Infant Mental Health − NCT02653716

Abused and neglected children are at increased risk of mental and physical health problems throughout life, placing an enormous burden on individuals, families and society. These negative effects can largely be reversed if children are placed in secure, loving homes early enough in life. However, it is not known whether it is better for children’s long term development to place them with substitute (foster or adoptive) families or to attempt to reform birth families in order to return them there. Efforts to improve the mental health of maltreated children in birth families or foster placements have had mixed success and researchers have recommended more intensive approaches.
We have carried out a feasibility randomised controlled trial (RCT), in Glasgow, of an intensive approach, the New Orleans Intervention Model (NIM) delivered by a multidisciplinary team comprising health and social care professionals. NIM offers families in which a child has been maltreated a structured assessment of family relationships followed by an intensive treatment that aims to improve family functioning and child mental health. If timely adequate change is achieved a recommendation is made for the child to return home. If not, the recommendation is for adoption. Preliminary research from the US suggests that NIM might reduce future maltreatment of the child, and subsequent siblings, and improve mental health in middle childhood.
In our feasibility RCT we have recruited around two-thirds of all maltreated children aged 0- 5 years coming into an episode of care in Glasgow. Families are randomised, in a 1:1 ratio, to NIM or social work services. Process data suggest that NIM and social work services-as-usual are acceptable to parents, foster carers, social workers and legal professionals and that there is equipoise. We now need to test whether or not NIM is clinically and cost effective in the different legal systems across England and Scotland.
Here we present the protocol of a substantive RCT of NIM involving a continuation of our current Glasgow work and including a new Scottish and a South London site. We plan to recruit approximately 500 children and their families across the sites, including those recruited in our Glasgow feasibility RCT. This will allow us to determine whether or not NIM is cost-effective in the UK.