BeST? Trial: Abuse and neglect in families

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Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout their lives. 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 using 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 who enters care due to abuse or neglect a structured assessment of family relationships, 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 middle childhood.

We conducted a feasibility study from December 2011 - 2015, where we recruited around two-thirds of all maltreated children aged 6 months to 5 years coming into an episode of care in Glasgow. Half of BeST? families who took part receive NIM, which is delivered by a multidisciplinary team comprising health and social care professionals. The remaining half of families received usual services, delivered by social workers.

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 are continuing our current Glasgow work and including an additional site in London. We plan to involve approximately 500 children (462 families) in total across the sites, including those recruited in our current Glasgow internal pilot study. This will allow us to determine whether or not NIM is effective in the UK and to follow up Glasgow children for five years to examine longer term effects on mental health.

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