Foster and kinship care support
Interventions to support children living in foster and kinship care placements, and their carers
- Effectiveness of the support programmes was variable
- Some evidence of positive effects for child behaviour, placement outcomes and attachment
- Some evidence was very low strength
- Attachment and Biobehavioural Catch-up (ABC)
- Foster carer-foster child intervention
- Keeping Foster Parents Trained and Supported (KEEP)
- Kids in Transition to School
- Middle School Success (subsequently renamed Keep Safe)
- Parent-Child Interaction Therapy
- Promoting First Relationships
- Short enhanced cognitive–behavioural parent training
Overall effectiveness: 2 (maximum 2)
Strength of evidence: 1 (maximum 3)
Overall effectiveness: 1 (maximum 2)
Strength of evidence: 2 (maximum 3)
Overall effectiveness: 2 (maximum 2)
Strength of evidence: 0 (maximum 3)
What is this?
Children who live in foster or kinship care placements have often had a range of challenging experiences including abuse, neglect and loss of significant relationships. As a result, many of these children are living with trauma and have a range of related emotional and behavioural difficulties. A range of foster and kinship care interventions have been developed to support high quality care for this group of children, with the aim of improving their outcomes and the stability of their placements.
How is it meant to work?
Foster care and kinship care support interventions are intended to improve the quality of children’s care, as well as the stability of their placements. This is achieved by strengthening the relationship between carers and the children they care for, and by increasing carers’ resilience and skills for parenting children who may have complex needs resulting from trauma. These support interventions are based on a range of theoretical components, including attachment, social learning theory and trauma psychoeducation. In some cases the support is delivered only to the carers (either 1-1 or in groups) and in some cases children and young people are also directly involved.
What are the evaluated outcomes?
- Child behaviour
- Attachment and relationships
- Placement outcomes
How effective is it?
Overall, foster and kinship care support interventions had a consistently positive effect on child behavioural outcomes. This is based on low strength evidence.
Six of the 12 studies included in this analysis found that there were significantly fewer child behaviour problems in groups who received a foster or kinship care support intervention, compared with the control group. The interventions demonstrating these positive effects were Attachment and Biobehavioural Catch-up (ABC), Short Enhanced Cognitive-Behavioural Parent Training, Keeping Foster Parents Trained and Supported (KEEP; in both study 1 and study 2), Kids in Transition to School, Middle School Success, and Parent Child Interaction Therapy.
Three additional studies also showed a reduction in behavioural problems but these changes were not significantly different to those in the control group.
Attachment and relationships
Overall, foster and kinship care support interventions tended to show a positive effect on attachment and relationship difficulties. This is based on moderate strength evidence.
Three studies included in the analysis reported on attachment and relationship outcomes. All of these showed some significant improvement in some outcomes; these were studies of ABC, Foster Carer-Foster Child Intervention (FFI) and Promoting First Relationships (PFR). In the study of PFR, the differences were no longer significant six months later.
Overall, foster and kinship care support interventions had a consistently positive effect on placement outcomes. This is based on very low strength evidence.
Six studies included in the analysis reported on placement outcomes and two of these reported a significant improvement in placement outcomes compared with a control group. Children who received the KEEP intervention were almost twice as likely to have a positive placement change (e.g. reunion with their birth family or adoption) than children in the control group, although there were similar rates of negative exits. Children who received the Middle School Success intervention had significantly fewer placement changes compared to the control group, up to two years later. However, these studies did not meet the What Works Centre’s criteria for acceptable quality.
Where has it been studied?
Seventeen studies were analysed for this review. Eleven of the included studies were carried out in the USA, with three in the UK, two in the Netherlands and one in Romania.
The three studies carried out in the UK were of Foster carers’ communication training (FCCT), Cognitive–behavioural parent training (CBT-PT), and Incredible Years. None of these UK studies found significant effects in comparison to control groups on the outcomes reviewed here.
It is important to note that the studies that found significant effects (as summarised above) were non-UK based, therefore these findings may not be transferable to the UK.
Who does it work for?
The analysis conducted for this review did not provide a breakdown of which sub-groups of participants the interventions were effective or ineffective for. Participant groups are summarised below for the interventions that studies found to have positive effects.
|Intervention name||Who receives direct intervention?||Child characteristics||Parent/ carer characteristics|
|ABC study 1||Foster carers and their child||Aged 15-24 months (average age 20 months). 59 per cent female||Not reported|
|ABC study 2||Foster carers or adoptive parents and their child||Aged 4-6 (average age 3.5 years). 49 per cent female||Average age of 40 85 per cent female|
|Foster carer-foster child intervention||Foster or kinship carers and their child||Aged 0-5 (average age 18.8 months). Half female||Not reported|
|KEEP||Foster or kinship carers only||Aged 5-12 (average age 8.9 years). Half female||Average age of 50 94 per cent female|
|Kids in Transition to School||Foster or kinship carer and their child||Average age 5.3 years. Half female||Not reported|
|Middle School Success||Foster or kinship carer and their child||Aged 10-12 (average age of 11.5), in their final year of primary school||Not reported|
|Parent Child Interaction Therapy||Foster carer and their child||Aged 3-6 (average age 4.6). 56 per cent female||Aged 23-79 (average age 44) 89 per cent female|
|Promoting First Relationships||Carers (foster, kinship or birth parents) and their child||Aged 10-24 months (average age 18 months). 44 per cent female||Average age of 35 years|
When, where and how does it work?
The review looked at evidence for a range of support interventions for children in foster or kinship care. These interventions drew on a variety of theoretical influences and techniques, including attachment theory; social learning theory; cognitive behavioural approaches; child development theory; educational theory; family systems theory and emotional regulation.
Specific programme components that the review identified across the whole group of interventions included trauma psychoeducation, positive parenting skills, relational skills for carers, behaviour management skills for carers, problem solving skills for both carers and children, cognitive or academic skills for children, activities to promote social skills for children and support for parents to improve their self-regulation, stress management, self-reflection and perceptions of their children.
The review found that some combinations of components were more effective than others in achieving the outcomes identified.
Components influencing child behaviour
In the 12 programmes targeting child behavioural problems, all except one (ABC) included a component of behavioural management. The review findings show that, as not all programmes were effective, behavioural management strategies on their own may be insufficient to improve child behaviour.
The six interventions that were effective in influencing child behaviour had more comprehensive content and most had a combination of components (e.g. trauma psychoeducation and strategies to help carers participate in the programme, such as childcare or travel reimbursement).
Components influencing placement outcomes
The interventions that sought to influence placement outcomes included a range of components. The two interventions that reported a significant improvement in placement outcomes were KEEP and Middle School Success. It was not possible to identify components in these two interventions that distinguished them from the ineffective interventions. KEEP includes components of trauma psychoeducation, positive parenting skills, behaviour management, problem solving skills for parents and children, cognitive skills for children, activities to promote children’s social skills and parental self-regulation and stress management. Middle School Success includes components of trauma psychoeducation, behaviour management, problem solving and activities to increase children’s social skills.
Components influencing attachment and relationships
As well as content drawing on attachment theory, the three interventions that were effective in influencing attachment and relationships (ABC, Foster Carer-Foster Child Intervention (FFI) and Promoting First Relationships (PFR))had some common components, including trauma psychoeducation, positive parenting, relational skills, coaching parent skills and parental self-reflection. Positive effects on attachment outcomes were found for all three of these interventions. It is not clear which components might be more important than others for achieving this change.
What are the costs and benefits?
There is no information on the cost-benefit of foster and kinship care support interventions.
How is it implemented?
This review considered the evidence for 14 foster care and kinship care support interventions, and eight of these interventions had at least one study showing that they were effective in improving child behaviour, placement outcomes or attachment and relationships. The implementation information provided here relates to the eight interventions that had at least some evidence of their effectiveness against these outcomes.
Six of the effective interventions involved some direct delivery to both the carer and the child. Two of the interventions (KEEP and Short Enhanced Cognitive–Behavioural Parent Training) involved direct delivery with the foster or kinship carer only.
Location and intensity
Three of the effective interventions were delivered to the carer and child as a pair in their home. For ABC this took the form of 10 one hour sessions. For the Foster Carer-Foster Child Intervention this was delivered as six 90 minute sessions on a fortnightly basis. Promoting First Relationships was delivered as ten sessions of between 60-75 minutes on a weekly basis.
Two interventions were delivered to carers only in a group setting in the community. KEEP provided 16 sessions, each 90 minutes long, on a weekly basis. Short Enhanced Cognitive–Behavioural Parent Training involved four sessions that each lasted for four hours on a weekly basis. There was also a four-hour follow-up session three months later.
One intervention (Kids in Transition to School) was delivered to carers and children in a group setting in the community. In phase one, children received 16 two-hour sessions on a twice weekly basis. In phase two, children received eight two-hour sessions on a weekly basis. In both phases, carers received four two-hour sessions.
One intervention (Parent Child Interaction Therapy) had some delivery via a group setting and some delivery to the carers and their children as a pair. It involved two seven-hour sessions plus phone support (and in one variant, an additional seven-hour booster session).
One intervention (Middle School Success) had some delivery to parents and children in a group setting in the community and some individual follow-up support for the child and group follow-up support for the parent. Initially this was delivered as six two-hour session on a twice weekly basis for three weeks. Then for the follow-up, two-hour sessions were provided on a weekly basis throughout the first year of school.
Strategies for supporting participation
Five of the effective interventions involved at least one strategy for supporting carers and/or children’s participation. Two interventions provided childcare during the session, four interventions reimbursed participants for travel, three interventions provided credit towards foster carers’ training requirements and three interventions provided an opportunity to catch up on missed sessions.
Opportunities to practice new skills
The eight effective interventions all included some opportunity for participants to practice new skills in the session and receive feedback. Three of the interventions provided direct coaching, three involved role play and two interventions included both direct coaching and role play.
- Overall, foster and kinship care support interventions tended to have a consistently positive effect on child behavioural outcomes (based on low strength evidence), a positive effect on attachment and relationships (based on moderate strength evidence) and a consistently positive effect on placement outcomes (based on very low strength evidence).
- Eight of the 14 interventions included in the review had some evidence of their effectiveness in improving these outcomes.
- The interventions that were effective in improving behavioural outcomes had a combination of components in addition to behaviour management, such as trauma psychoeducation and strategies to support carers’ participation.
- Interventions that were effective in improving attachment and relationship outcomes included components of trauma psychoeducation, positive parenting, relationship skills, direct coaching to support parenting skills and parental self-reflection on their perceptions of their foster child.
- Only two interventions were successful in improving placement outcomes. These interventions were KEEP and Middle School Success, and each included a range of components.
This summary comes from an original systematic review called: Program Components of Psychosocial Interventions in Foster and Kinship Care: A Systematic Review (Jacqueline Kemmis-Riggs, Adam Dickes, John McAloon). Published 2018.