Development of a radical foster care intervention in Glasgow, Scotland.

Abstract

Services for maltreated children are inadequate and lack infant mental health input in many parts of the world. A recent audit of Glasgow services revealed that children frequently 'revolve' between maltreating birth parents and various temporary foster placements for many years. Addressing infant mental health in this population will require radical change to current services. The New Orleans programme developed by the Tulane Infant Team in Louisiana is one such radical programme. Prior to the design of a randomized controlled trial (RCT) to test this programme in Glasgow, it was essential that policy-makers had some insight into the local model of service delivery and how a New Orleans model could impact. This article explores the structure and costs of the current Glasgow system and the potential costs and consequence impact of implementing a New Orleans model in Glasgow, using data obtained from the research literature, Glasgow City Council audit data and expert's opinion. A New Orleans-Glasgow model would likely shift resources from social services on to the NHS. The resource intensive nature of this model could increase the cost of an episode in care from £66 300 in the current system to £86 070; however, the probability of repeated episodes in care is likely to fall substantially, making the cost per child fall from £95 500 in the current system to £88 600. This study informed the design of a phase II explorative RCT, identified appropriate outcomes for measurement and areas of uncertainty for further research.