We argue that major health and social care policy initiatives are not too complex for randomised controlled trial (RCT) methodology and illustrate this using the example of the Best Services Trial (BeST?): a RCT of an infant mental health intervention for maltreated children. We suggest that qualitative research, as a core part of the trial process from conception and development through to implementation and evaluation, is crucial in building, understanding and strengthening the partnership required to drive such a complex trial. Data pertinent to trial implementation demonstrate the iterative nature of the process whereby stakeholders are consulted and their views influence the conduct of the trial. Here we reflect on the bi‐directional relationship between qualitative data collection and partnership‐working in a trial. For very complex trials to be possible, significant resource needs to be available for the qualitative component.Key Practitioner Message: • Qualitative research is key to understanding, building and strengthening partnership approaches to researching complex interventions; • Qualitative research is vital to supporting randomised controlled trials involving multiple sectors; • Qualitative research provides essential explanatory power to outcome data in research.

This quote, from 250 years ago, reminds us that growing up bathed in the safe care of adults who consider us special is essential for life. We hope, in this chapter, to give the reader an overview of how attachment impacts on relationships across the lifespan. We will start with some detail about what attachment is and how it is measured. This will include a discussion of the range of attachment patterns and problems. We will touch on the way that attachment interacts with development and we will complete the circle by discussing how adult attachment styles impact on parenting. But what of children and families in which there are attachment difficulties? Children who have had difficult early attachment experiences may give confusing signals to caregivers and professionals. We will discuss ways that this can be overcome, including the part child and adolescent mental health services can play.

This article takes a human rights perspective with a view to articulating the infant's perspective when the infant has been subjected to abuse, neglect, or both and is reliant on the state to ensure his or her health and well-being. When a young child is removed from parental care, important and often difficult decisions have to be made about subsequent contact between child and parent. We consider a number of dilemmas which may arise for practitioners when they are assisting child welfare decision makers in relation to contact, and acknowledge the limited empirical follow-up studies of the impact of child welfare practice and legal decisions on infant outcomes. We draw on the significant and substantive evidence base about infant emotional and cognitive development and infantparent attachment relationships as well as infant mental health to illuminate the infant's subjective experience in these practice dilemmas. We describe innovations in practice from various countries, which seek to shed light on the challenges often associated with contact.

Child maltreatment is associated with life-long social, physical, and mental health problems. Intervening early to provide maltreated children with safe, nurturing care can improve outcomes. The need for prompt decisions about permanent placement (i.e., regarding adoption or return home) is internationally recognised. However, a recent Glasgow audit showed that many maltreated children “revolve” between birth families and foster carers. This paper describes the protocol of the first exploratory randomised controlled trial of a mental health intervention aimed at improving placement permanency decisions for maltreated children. This trial compares an infant's mental health intervention with the new enhanced service as usual for maltreated children entering care in Glasgow. As both are new services, the trial is being conducted from a position of equipoise. The outcome assessment covers various fields of a child’s neurodevelopment to identify problems in any ESSENCE domain. The feasibility, reliability, and developmental appropriateness of all outcome measures are examined. Additionally, the potential for linkage with routinely collected data on health and social care and, in the future, education is explored. The results will inform a definitive randomised controlled trial that could potentially lead to long lasting benefits for the Scottish population and which may be applicable to other areas of the world. This trial is registered with ClinicalTrials.gov (NC01485510).

BACKGROUNDFamily functioning has been implicated in the onset of child and adult psychopathology. Various measures exist for assessing constructs in the areas of parent-child relationships, parental practices and discipline, parental beliefs, marital quality, global family functioning and situation-specific measures.OBJECTIVESTo identify systematically all questionnaire measures of family functioning appropriate for use in primary care and research.METHODSA systematic literature review was conducted, following PRISMA guidelines and searching 14 bibliographic databases using pre-determined filters, to identify family functioning measures suitable for use in families with children from 0 to 3 years old.RESULTSOne hundred and seven measures of family functioning were reported and tabulated and the most commonly used measures were identified.CONCLUSIONSThere are numerous measures available demonstrating characteristics, which make them suitable for continued use. Future research is needed to examine the more holistic measurement of family functioning using integration of multi-informant data.

Maltreated children are at high risk of both family and school-based difficulties which may be related to emotional and behavioural problems. New research on brain development and attachment has demonstrated that these difficulties may be rooted in maltreatment that occurred during the first few months and years of life. Interventions likely to prevent these difficulties throughout the life-course need, therefore, to be targeted at this early stage of development. This paper describes an intervention developed in New Orleans that aims to provide intensive assessment and intervention to families in which a child has been maltreated in order to give the family the best chance of having the child returned. A group of clinicians and social workers in Glasgow are attempting to implement and test the intervention in the Scottish context.

Children in care have higher rates of mental health problems than the general population and placement instability contributes to this. Children are both most vulnerable to the effects of poor quality care and most responsive to treatment in the early weeks and months of life yet, in the UK, permanency decisions are generally not in place until around the age of four. We aimed to understand the components of an innovative system for assessing and intervening with maltreated children and their families developed in New Orleans and to consider how it might be implemented in Glasgow, UK. During and after a visit to New Orleans by a team of Glasgow practitioners, eight key interviews and meetings with New Orleans and Glasgow staff were audio-recorded. Qualitative analysis of verbatim transcripts identified key themes. Themes highlighted shared aspects of the context and attitudes of the two teams, identified gaps in the Glasgow service and steps that would be needed to implement a version of the New Orleans model in Glasgow. Our discussions with the New Orleans team have highlighted concrete steps we can take, in Glasgow, to make better decision-making for vulnerable children a reality.

The Scottish Needs Assessment Programme (SNAP) was established in 2000 to advise the Scottish Government on the emotional health of the country's children and young people. The second phase, conducted in 2002–2003, involved surveying professionals who provide specialist mental health services to children and young people, and also those who work with children and young people in a variety of settings but whose training is not in mental health. Based on the survey, this paper outlines the emotional difficulties faced by children and young people in educational settings, and describes how teachers in particular are responding to these difficulties. It also discusses teachers' experiences of working with other professionals and agencies, in particular the frustrations they feel in their efforts to make suitable arrangements on behalf of young people.

AIM This paper is a report of a study to describe the workload of health visitors and school nurses in relation to children and young people with psychological, emotional or behavioural problems, and to identify perceived challenges, obstacles and sources of satisfaction associated with this aspect of their work. BACKGROUND There is little published information on the work performed by non-specialist community nurses with children and young people who have psychological, emotional and behavioural problems. METHOD We analysed data from a survey conducted in 2002 - 2003 of 1049 Scottish professionals working with children and young people. Data included quantitative responses and free-text describing the cases seen by respondents. Responses from a sub-sample of 71 health visitors and 100 school nurses were analysed using a combination of descriptive statistics and analysis of themes emerging from the text. FINDINGS Although community-based nurses saw a relatively small number of children with psychological, emotional or behavioural problems each week, dealing with these problems took up a disproportionate amount of time. The commonest types of problem were self-harm, externalizing behaviours and family difficulties. Few respondents had received specific training in child and adolescent mental health but most expressed a wish to receive such training. CONCLUSION The work of health visitors and school nurses in caring for children with mental health problems is substantial and important. Development of their public health role should not be at the expense of this important contribution. There is a need for rigorous evaluation of nursing mental health interventions among children and young people.

This paper aimed to describe the experiences and perspectives of residential child care practitioners in dealing with the mental health difficulties of the children for whom they are responsible and to compare their experience with that of other professionals. it draws on the findings of the Scottish Needs Assessment Programme (SNAP) which surveyed a wide range of professionals who worked regularly with young people but whose main focus of work was not mental health. This article focuses on the findings from questionnaires sent out to 289 residential workers in Scotland. Replies were received from 104 staff, giving a 36 percent response rate. Residential workers were asked about their most recent experience of working with a child or young person with mental health, emotional or behavioural problems, the most worrying case they had worked with in the last three years and the case that had given them the most satisfaction in the same timescale.