New Orleans Intervention Model Evidence, impact and evaluation

We’re testing the New Orleans Intervention Model to see if it helps improve decision making about permanent placements for children in foster care.

How returning children home from care affects children

The most common outcome for children leaving care is to return home to a parent or relative. But research shows that around half of children who come into care because of abuse or neglect suffer further abuse if they return home, with up to half of those going back into care again (NSPCC, 2012).

Children who return to care are rarely able to live with their previous carers (Hannon et al, 2010), significantly damaging their chances of developing lasting relationships. As a child gets older their chances of being adopted also decrease (Selwyn et al, 2006).

To improve outcomes for children, robust assessments should inform the decision to return a child home. Parents should also receive better support to help change family dynamics.

Read more about returning children home from care.

How New Orleans Intervention Model is helping prevent child abuse and neglect

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).

The New Orleans Intervention Model, first developed in the USA, helps social workers and judges to make timely decisions about whether a young child should stay with their birth family or enter care permanently.

The New Orleans Intervention Model aims to:

  • improve decision making about entry to care or assessing the parents' ability 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 the harm to subsequent children in a household.

To make the best decision for a child we use detailed assessments and intensive support for birth parents, the foster carers and the child from a team of psychologists, psychiatrists, social workers and support workers. 

The specific interventions used by the service include:

  • Circle of Security: an evidence-based early intervention which uses attachment theory as a basis to develop better parent-child relationships.
  • Parent-Infant psychotherapy: an intervention based on developmental and clinical research, this specifically targets the infant-parent relationship, improving the ability of the parents to reflect on their child's needs. The infant experiences a more secure relationship, laying the foundations for improved mental health.
  • Video-interaction guidance (VIG): a research-based intervention used to improve communication and understanding in parent-child relationships.

While we're working with a family, we keep in close contact with the child's local authority social worker to discuss progress. 

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. Decisions 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. 

 

How we're evaluating this service

Funded by the Big Lottery Fund in Scotland, and in partnership with the University of Glasgow, we are evaluating a pilot of the New Orleans Model in Glasgow over two years using a randomised controlled trial.

The impact focus in this evaluation is an exploratory randomised controlled trial (RCT). This design requires that the intervention is compared with another service.

We will compare the New Orleans Intervention Model that we deliver to a similar service delivered through local social care agencies.

This exploratory RCT aims to establish feasibility and inform the design of a definitive RCT evaluating the New Orleans intervention for maltreated children.

Some of the measures will be tested over a 5 month implementation period.

The study is being undertaken over 17 months. The number of children being received into care in Glasgow over a similar period suggests that 78 children would be randomised to the New Orleans Intervention Model, and 78 to the control service.

However, the numbers involved in the study are likely to be lower as not all children will consent to taking part.

We anticipate a consent rate of 65%. The families of all children between the ages of 6 and 59 months who are received into care will be invited to take part in this study.

Details of challenges faced and relevant solutions will follow the completion of recruitment to the randomised controlled trial.

This service is being evaluated by The University of Glasgow. It uses the following tools:

  • Strengths and Difficulties Questionnaire (child mental health)
  • Development and Wellbeing Assessment (child mental health)
  • Strange Situation Procedure (attachment)
  • Disturbances of Attachment Interview (attachment)
  • This is My Baby Interview (parental perceptions of relationship)
  • Parent-Infant Global Assessment of Functioning (parent-child relationship)
  • Bayley Scales (child development).

Find out more about the tools used to measure outcomes

Contact Richard Cotmore for more information.

What we've learnt so far

The mental health focus of the New Orleans Intervention Model delivered by the Glasgow Infant Family Team (GIFT) was viewed by trial participants as a positive addition to the assessment and treatment of infants and families after abuse. GIFT's evidence for care proceedings is perceived as very influential. 

GIFT's timescales exceed those of social work permanence reviews, but trial participants felt this was necessary to improve the quality of evidence in a case and therefore the accuracy of decision-making. 

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. The described it as a level of support they had never received before. 

Findings are published in our evaluation report, Process evaluation of New Orleans Intervention Model for infant mental health in Glasgow.

What we're doing next

We’re working with South London and Maudsley NHS Foundation Trust, NHS Greater Glasgow and Clyde, Croydon Council, Glasgow City Council, as well as researchers at the University of Glasgow.

With their help we’re assessing whether delivering the New Orleans Intervention Model to young children in foster care who have been abused or neglected:

  • improves parents’ capacity to care for their children
  • improves children’s mental health outcomes whether they enter care or return home
  • contributes significantly to the evidence necessary to take a child into care where it is in the child’s best interests
  • reduces subsequent incidents of maltreatment of children and their siblings.

The Big Lottery Fund in Scotland and the Department for Education in England are providing funding for the NSPCC to deliver the New Orleans Intervention Model in Glasgow and South London. The National Institute of Health Research is funding the University of Glasgow to assess the difference it makes to children and families. 

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New Orleans Intervention Model

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References

  1. Hannon, C., Bazalgette, L. and Wood, C. (2010) In loco parentis (PDF). London: Demos.

  2. Selwyn, J. et al. (2006) Costs and outcomes of non-infant adoptions. London: British Association for Adoption and Fostering (BAAF).

  3. 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.