New systematic review of shared decision-making meetings

13 February 2020

New systematic review of shared decision-making family meetings finds mixed evidence of effectiveness in reducing entry to care 

A new systematic review of shared decision-making family meetings, such as Family Group Conferencing, Family Group Decision Making and Family Unity Meetings, has found there is mixed evidence as to whether these interventions reduce entry or re-entry into care or increase family satisfaction, empowerment or reunification, compared with other approaches. 

What Works for Children’s Social Care, in association with its research partners at CASCADE, Cardiff University, today release a new systematic review of the impact of shared decision-making meetings. 

The systematic review, which included 33 studies, identified and assessed the evidence for shared decision-making family meetings reducing the need for placing children in out-of-home care, and increasing family reunification. As shared decision-making meetings are designed to uphold the participation right of families, the review also looked at how the meetings affected levels of family satisfaction and parental empowerment. In addition, the review examined the published data on the cost-effectiveness of shared decision-making family meetings.

The review found a lack of high-quality evidence of effectiveness – the majority of studies (24 of 33) had a high risk of bias. When all the state care outcomes (care entry, re-entry and reunification) were combined, the evidence leans in a positive direction, but the more robust studies did not show evidence of effectiveness. Family satisfaction and empowerment – proxies for the participation right of families – were only measured in a small number of studies and the findings were not conclusive.

Though the overall evidence for the effectiveness of shared decision-making meetings is weak, there is currently no strong evidence that these types of meetings compromise child safety.

There are positive indications that when they reduce state care, shared decision-making meetings could be cost saving. As shared decision-making meetings are relatively low-cost (less than £4,000 per family), even a small reduction in the number of children needing out-of-home care could justify their use, purely on financial grounds.

The findings suggest there is a need for robust studies on the impact of shared decision-making, as well as studies which consider how well these meetings are actually delivered or whether they are taking place within a wider system of restorative practice.

Michael Sanders, Executive Director of What Works for Children’s Social Care, said: 

“This review has found that the case for family group meetings on the grounds investigated has yet to be made by the research evidence. It also shows that there is substantial work still to be done in building an evidence base around many widely used elements of social care practice. That is why we are pleased to be working with 24 local English authorities and the children’s charity Coram on a large scale test of Daybreak Family Group Conferences. I hope that social workers and leaders in the sector are able to consider this research alongside other vital concerns, including the need for families to be involved in decisions that affect them, and ensuring that social work practice is as humane and inclusive as possible.”

Prof Jonathan Scourfield, Deputy Director, CASCADE, Cardiff University, said;

“Family members have a right to participate in important decisions about children. We don’t conclude, therefore, that people should not be using family group conferences. Perhaps more the point is that these participative meetings may not always be done well, or they are often not part of a wider cultural change within services. Local authorities shouldn’t assume that having FGCs will be a panacea for reducing care. We need a holistic approach which puts family participation front and centre” 


Full report
Evidence Store entry