A new specialist intervention to change the trajectory away from care for some children

In a presentation at the recent COMPASS Jobs Fair in London, Sherma Charles and Siobhan Ray of LIFT (London Infant and Family Team), discussed the programme run by the NSPCC in the UK. It brings together specialists in infant mental health and social care to provide a bespoke service, supporting children aged 0-5 years who are involved in care proceedings.

LIFT is based on an approach developed in New Orleans in the USA. The NSPCC’s adapted programme is being applied and evaluated extensively across England and Scotland.

Ms Charles said that the aim is to provide a more stable environment for the child, increase placement stability and provide safe, nurturing care as early as possible. A key element is to improve mental health for the child, whether they return home or remain in care.

She said that the USA programme found that ‘between 4-7 years post-intervention, there was a 68 per cent reduction in subsequent incidence of maltreatment and there was a 75 per cent lower risk of subsequent harm to children. Also the children’s mental health differed only slightly from that of the general population when they had been through this model.’

Siobhan Ray, a social worker in the team, said, ‘a key component is that we are one central multidisciplinary team – social workers, psychology and we have psychiatry input. What was different for me coming from statutory social work was that here we offer both the assessment for court and we are also in a position where we can offer treatment and intervention after a decision has been made.

‘A lot of our work is multi-agency work so we are working with the networks around the children. We are really invested in narrative work so we’re helping the system and other agencies to understand this child’s experience and their journey, and keeping that central to all the thinking that we are doing.’

After referral, the team works on an intensive assessment process which takes place over 12 weeks.

‘The core part of the LIFT assessment is that it is really relationship-focused. We are looking at interaction between parent and child and we’ve got a range of tools to do that. We have really structured interviews for family history but we also have structured and unstructured play observations where we try to see how this child is able to make use of their parents,’ Ms Ray said.

‘Are their needs met? Are parents and carers able to respond to the child in stressful situations? We are also working with the child’s main caregiver which is often at that time the kinship carer or foster carer, to get their views on the child and see how they are managing that relationship, so we’ve got something to compare with.

‘At the end of the assessment process we have a professionals meeting so that would include the allocated social worker for the child, their court guardian and any other relevant professionals working closely with the family. That might include the mental health worker or substance abuse worker for the parent… we would share information really carefully to share whether we felt reunification was appropriate for this child at this time or not.

‘If it wasn’t, we would do safety planning to think about the parent in the immediate aftermath of that, and we’d have a separate meeting with the parent.

‘We’d also be thinking about what treatment and interventions does this child need or what other support do the parents also need? We would work with families for up to four months afterwards.

Sherma Charles said that strengthening the caregiver-child relationship was crucial.
‘Sometimes when people have all these other things going on they are functionally doing what they need to do but emotionally the connections not there; then later on, things come up in the child’s presentation. They can get labelled as bad behaviour but the issue lays within the relationship.’

A narrative book is compiled very early and its use is led by the child. ‘We find a way to give the child a narrative about the really difficult things that people quite often in our profession will avoid talking to the child about. This leaves the child with gaps in their information which leads them to make their own conclusions -- or people tell them things that later they find aren’t true.

‘For some, the messages may be difficult but it is important the child knows about that and that they know that it is not their fault.’