What’s BeST? For Infant Mental Health? The Best Services Trial (BeST?): Effectiveness and Cost-Effectiveness of the New Orleans Intervention Model for Infant Mental Health The Best Services Trial (BeST?): Professor Helen Minnis (Chief Investigator) and Dr. Dennis Ougrin (Principal Investigator) Jennifer O’Connor (Project Manager), Helene Engelvin (Recruitment Coordinator) and Barbara Jacobs (Research Administrator) Research Question: What is the best way to improve the mental health and placement stability of pre-school children who have come into foster care because of abuse and/or neglect? Is an infant mental health model (LIFT) or a social work model – service as usual (SAU) the best way to achieve this? What is the BeST? Study? The Best Services Trial (BeST?) is a research collaboration between the University of Glasgow and King’s College London, with the support of NSPCC, East London Family Court Judiciary, and the Boroughs of Croydon and Tower Hamlets. Funded by the Nation Institute of Health Research (NIHR). BeST? is a randomized controlled trial (RCT) which aims to evaluate whether a parenting intervention (the New Orleans Intervention Model - NIM) delivered by the London Infant Family Team (LIFT), is clinically and cost effective in improving the mental health of maltreated young children, compared to Services as Usual (SAU). ALL ELIGIBLE FAMILIES in care proceedings with children 0-5 who are placed in care (foster, mother & baby and family placements), are given the opportunity to participate in the BeST? study. Once a birth family consents to participating they are randomly allocated to receive - LIFT or SAU. How does BeST? trial fit into LIFT and SAU? Children and their carers visit the research team, at KCH Clinical Research Facility, 3 times over 2.5 years. Regardless of receiving LIFT or SAU. BeST? Research Assessments: 3 assessment visits over 2.5 years, completed by research team – KCH Clinical Research Facility. Each assessment takes between 1-3 hours. Families are free to decline an assessment visit, re- schedule or withdraw at any time without impacting on their service. Assessments Types: Infant care observations Children's relationship functioning Child’s attachment to caregiver Observations of behavior Social and emotional development Why is this study important? We simply do not know which service is better for children. The BeST? study can help us understand the best way to improve mental health and placement stability of children who have come into care due to abuse and/or neglect. If the study is successful, it can radically transform the way social services is implemented for children and families. This ground-breaking research is the first of it’s kind to explore what is best for children’s long-term outcomes. Context: Why are we doing this? Long-term Development Placing children with a nurturing family can help them to recover rapidly. Although, it is unknown whether it’s better for children’s long term development to be placed with substitute (foster or adoptive) families, or return them to birth or extended families. Zero to Three “A child’ brain undergoes an amazing period of development from birth to three – producing 700 new neural connects every second” Impact on Health Children who experience abuse and neglect - are at a higher risk of mental and physical health problems throughout life. The ACES Load How can we reduce this load for children who have been abused and /or neglected? ..… So as to improve mental health. Adverse Child Experiences (ACES) https://www.zerotothree.org/early-learning/brain-development

What’s BeST? For Infant Mental Health? The London Infant & Family Team aim to improve decision-making and support for children, their family and carers Dr Zoe Hyde (Clinical Psychologist) and Liana Sanzone (Social Worker), LIFT practitioners The context Neurological and psychological research show how critical the first months and years are to a child’s development1 We need services to identify and look after the mental health of babies and infants, and to reduce the risk of placement breakdown. Evidence from the New Orleans Intervention Model (NIM)2 68% reduction in subsequent incidents of maltreatment 75% lower risk of harm to subsequent children Children’s mental health differed only slightly from general population The London & Infant Family Team based on New Orleans Intervention Model (NIM) East London Family Courts NSPCC SLAM NHS Trust (NHS) Croydon and Tower Hamlets (Social Care) Case management hearing and randomisation Assessment & Court report Case management hearing Intervention mid way report Final report & IRH and date for Final Hearing INNOVATIVE PARTNERSHIP BeST? attends initial case management hearing of eligible families If families consent to the trial they are randomised to either LIFT or assessment as usual. When randomised to LIFT they liaise with the child’s social worker to gather information. The case is allocated to a lead clinician, and each caregiver is allocated an individual worker. Clinicians separately but simultaneously complete an assessment with the child and his/her carer and with the child and his/her birth parents. Developmental assessment of child is also completed. LIFT findings and treatment plan are shared with the wider professional network (e.g. social care, the guardian). The LIFT report is completed, containing recommendations for the family based on the outcome of the assessment, and is submitted to court. Intervention is tailored to the individual needs of parents and carers, based on the best interests of the child. Monthly progress reports are sent to the judge. Mid-point and final professionals meetings are held and reports submitted to court at these times. COURT DIRECTED KEY CONCEPTS Early intervention and investment Capacity-building LIFT is an early intervention service, working with infants from the age of 0 to 5 years old. Focuses on parents’ capacity to change, and provision of associated support. Improvements made can benefit subsequent children Multi-disciplinary team Personalised and intensive treatment Combined mental health and social work expertise and capacity supports real integration Bespoke treatment model Draws on attachment-informed, relationship focused interventions e.g. Circle of Security3, Video Interaction Guidance4 Focused on child-caregiver relationships Focused on evidence Detailed, holistic assessment of the child and all care-giving relationships Evidence gathered by LIFT helps authorities and judiciary make more informed and timely decisions What’s BeST? for infant mental health Randomised control trial RCT asking whether NIM in the UK context is clinically and cost effective in improving the mental health of maltreated infants & young children compared to services as usual. References 1 Zeanah, C. H. (Ed.). (2009). Handbook of infant mental health. Guilford Press. 2 Zeanah, C. H., Larrieu, J. A., Heller, S.S., et al. Evaluation of a preventive intervention for maltreated infants and toddlers in foster care. Journal of the American Academy of Child and Adolescent Psychiatry. 2001;40(2):214–221.  3 Cooper, G., Hoffman, K., Powell, B., & Marvin, R. (2011). The circle of security intervention. Disorganized Attachment and Caregiving, 318. 4 Kennedy, H., Landor, M., & Todd, L. (2011). Video interaction guidance. London, UK: Jessica Kingsley.

What’s BeST? For Infant Mental Health? The Best Services Trial (BeST?): Effectiveness and Cost-Effectiveness of the New Orleans Intervention Model for Infant Mental Health The Best Services Trial (BeST?): Research Question: What is the best way to improve the mental health and placement stability of pre-school children who have come into foster care because of abuse and/or neglect? Is an infant mental health model (LIFT) or a social work model – service as usual (SAU) the best way to achieve this? Why is the study Important? We simply do not know which service is better for children. The BeST? study can help us understand the best way to improve mental health and placement stability of children who have come into care due to abuse and/or neglect. If the study is successful, it can radically transform the way social services is implemented for children and families. This ground-breaking research is the first of it’s kind to explore what is best for children’s long-term outcomes. Professor Helen Minnis (Chief Investigator) and Dr. Dennis Ougrin (Principal Investigator) Jennifer O’Connor (Project Manager), Helene Engelvin (Recruitment Coordinator) and Barbara Jacobs (Research Administrator)