Researchers call for changes in Scotland’s care system following largest study of its kind

The University of Glasgow-led study, run in partnership with the NSPCC and other universities, looked at improving the mental health of almost 500 children aged 0–5 years in foster and kinship care. It highlighted that authoritative and consistent oversight of a child’s journey through the care system was crucial in safeguarding children’s well-being.

Evidence shows that infants and pre-school children require committed family care to thrive. Children who go into foster care are at high risk of mental health problems and research shows that early intervention is likely to be more effective than intervening later.

The researchers in this new study believe that if a single Sheriff or expert chairperson oversaw a child’s journey through care proceedings in Scotland, better and quicker decisions would be made and children and their families could receive mental health support, without having to wait unacceptable periods for life-changing decisions to be made.

The study was the largest of its kind—involving 488 children and their families from Glasgow and London. It compared the impact that infant mental health services delivered by a multi-disciplinary team of psychologists, psychiatrists, and social workers (the New Orleans Intervention Model (NIM)) had on a child’s well-being, with that of social work care and support that families usually received. The treatment in NIM focused on helping the relationship between the child and their birth parent and between the child and their foster carer.

Researchers followed up on children two-and-a-half years after they joined the trial and found no significant difference between the two groups. The investigators believe that crucial features of the care system in Scotland meant that NIM, which had shown promise in the US, could not be delivered to everyone eligible in the trial.

In the London sites, the short legally imposed timescales for decision-making in family courts meant that not all families had a chance to access treatment. Whereas in Scotland, with a panel of lay people overseeing hearings in the Children’s Hearings System rather than a Sheriff, the lack of legally imposed timescales meant that a backlog developed, and not all families offered NIM were able to receive it.

The rate of children getting into a permanent placement in England, where a judge oversees the process, was nearly four and a half times faster compared to Scotland. The long timescales in Scotland also impacted costs, which were almost twice as high as in England for both groups.

In light of the study’s findings, which have been published in Nature Medicine, the researchers are calling for:

• Authoritative and consistent oversight of a child’s journey through Scotland’s care system, encouraging strict adherence to court-mandated timescales, balancing time for the birth family to access therapy with making timely decisions about the young child’s future.
• Mental health services for infants to become an integral part of social and legal systems, so reports are timed to inform crucial decisions about permanent placements.

The forthcoming Promise Bill provides a timely opportunity to make these fundamental changes to the Children’s Hearings System.

Helen Minnis, Professor of Child and Adolescent Psychiatry at the University of Glasgow and Chief Investigator, said, “We know infant mental health interventions work well in many circumstances, and our study targeted the children who most need these services. Yet, our study showed it was impossible to deliver infant mental health services to these children because of failings in our systems.

“Short timescales in England affected families’ ability to access treatment. Yet in Scotland, with no legal timescales, we found there were significant delays and drift in the care system, having an unacceptable impact on young children’s mental health and also creating massive unnecessary costs to the Scottish economy.

“It is urgent that changes are made to the care system in the UK so that young children in foster care, and their families, can receive the help they need.”

Matt Forde, NSPCC Partnerships and Development Director, said, “Sadly, children in foster care are more likely to have mental health difficulties. Experiences of abuse and neglect are part of this, and what happens once a child is in care can also affect their mental health.

“Our first relationships and experiences are the building blocks of our well-being and development. Providing early mental health support for infants and their parents and foster carers, helps build trusting relationships between the child and the adults caring for them. This can break down barriers and help parents better understand their child’s experiences and find new ways to connect.

“Such services need to be an integral part of the social care and family justice system, so recommendations from treatment can properly inform life-changing decisions for these children. For that to be made possible, it is crucial that we have clear authoritative leadership at every stage of a child’s journey through the care system to make sure timely decisions are made.”

Sheriff David Mackie led a working group looking at reforms to the Children’s Hearings System, which produced a report in May last year calling for transformational change.

Sheriff Mackie said, “The joint research in Glasgow and London has shown that processes in Scotland are fragmented, too slow and too expensive by far, all to the disadvantage of the babies and infants involved and their prospective adopters. Practitioners and researchers know this and want change. We must recognize that something of a revolution in policy and practice around adoption is coming down the road.”