How boosting attachment reduces number of babies going into care

Project

Norfolk Parent Infant Mental Health Attachment Project

Funding

£625,000 Transformation Challenge Award from the Department for Communities and Local Government, covering the project's first year

Background

Under-twos entering the care system in Norfolk averaged 10 per month in the first six months of 2014. In an effort to reduce this and improve parent and infant mental health services, Norfolk's children's services teamed up with the county's mental health services provider, Norfolk and Suffolk NHS Foundation Trust (NSFT) to look at ways they could work together.

The partnership was awarded government funding and the Norfolk Parent Infant Mental Health Attachment Project started working with families in March 2015.

Action

Families of under-twos are referred if there are safeguarding concerns and their parents have high emotional and mental health needs, such as postnatal depression.

NSFT clinical psychologist Dr Richard Pratt, one of the project's two clinical leads, says the majority of parents whose children are the subject of safeguarding concerns have mental health difficulties that have not always been diagnosed or treated.

"The majority have probably experienced developmental trauma, which means they had significant attachment needs when they were children, so it's an inter-generational issue," he says. "They don't always easily fit a simple psychiatric diagnosis." In addition, a significant proportion have had previous children removed, making them wary of children's services.

The project is run from three children's centres in deprived parts of Norwich, King's Lynn and Great Yarmouth. Weekly multi-agency meetings are held at each centre, attended by social workers, family support workers, health visitors and specialists from the mental health trust. Social workers take suggested referrals to a weekly Norfolk Council-chaired panel, which agrees tailored care packages.

A professional who has a positive relationship with the parent is chosen to make contact and engage the family in the support process. Members of the project's specialist mental health team assess parents' mental health and wellbeing, as well as their attachment to their children. Three-quarters of the 48 families accepted on the programme since January needed therapeutic input from Dr Pratt's team. The remaining quarter received mental health and community support.

"With some families, the emphasis is on parents' mental health needs and with others, it's about focusing on their relationship with their babies," Dr Pratt says.

The therapeutic work is underpinned by attachment theory, helping parents reflect on their own feelings and those of their children. Techniques include filming parents and their babies together and picking out moments of positive interaction to build on.

Sessions take place in families' homes and sometimes in children's centres or other community venues. "Many of these families need long-term, ongoing therapy, so we have closed relatively few cases so far," says Dr Pratt. "Our aim is for families to continue getting the support they need but not necessarily at the level of intensity and specialism we provide."

Outcome

Data from the council shows 40 of the 48 children whose families were involved in the project have stayed at home. Of the remaining eight, four remained with their parents in supported care, three in parent and child foster placements and one in the care of extended family. The remaining four are no longer in their parents' care.

The project has contributed to a 27 per cent reduction in the number of under-twos entering the care system. Between January and June 2014, 60 under-twos became looked-after children. In the same period this year, this reduced to 44. Four families supported by the project were no longer on safeguarding plans by last month.

The council calculated that keeping a third of participating families' children in their parents' care would save £816,000, based on the £51,000 average annual cost of a looked-after child. This would result in an annual saving of £192,605 after subtracting the £623,395 project costs. The scheme achieved this after seven months.