How can we BeST ? meet the needs of adoptive families? Relevant findings from a major Randomised Controlled Trial of infants in foster care in the UK

The BeST ? services trial represented the first time that an infant mental health approach to assessing and treating cases of maltreatment had been tested in the UK. While the main outcomes have been reported, the findings regarding our cohort of 488 children were yet to be examined in the context of adoption. This article discusses two key areas of findings that we interpret to be most relevant to supporting adoptive families: first, those related to child mental health and neurodivergence, and second, those related to children’s journeys through care. We then make recommendations for practice that are grounded in our data. First, children’s significant and multiple difficulties, and complex patterns of recovery over time, amplify the call for timely holistic assessment and support of maltreated children by mental health services so that adopters can develop informed expectations, knowledge and skills in relation to their child. Second, significant delays to children reaching permanent placements, and consequent concern over the effects of prolonged uncertainty on mental health, lead us to recommend a move to a dual registration system. Although system reform is challenging, the significant differences that we found between neighbouring jurisdictions demonstrate the influence of systemic effects, which are changeable.