March 2022

Summary

This report reviewed the existing evidence around improving the chances of successful reunification for children who return home from care to understand which services and interventions are successful, and the types of support included in these interventions.

Although there was some promising evidence for some interventions, broadly there was a lack of high quality evidence of effectiveness in this area.

The report identifies a number of themes for the types of support available in the interventions studied.

Objectives

The aim of the review was to contribute to the knowledge base on how to improve the chances of a successful reunification for children who return home from care. The objectives were to answer the following research questions:

1. What specialist services and interventions have been found to improve the outcomes of reunification? 
2. What types of support (for children, parents, families, networks) included in these services help to improve the outcomes of reunification?

How we went about it

The study was a rapid evidence review undertaken using systematic methods. A keyword search was carried out on five electronic databases. The database search was supplemented by a manual search of reviews and key websites, including for grey literature.

Two stages of screening, first of titles/abstracts and second of full text articles, were undertaken in specialist software for collaborative reviews using a decision-making flowchart to help standardise responses. For the final sample of included full texts, the quality of research including potential sources of bias was appraised using the Mixed Methods Appraisal Tool (MMAT).

A pro-forma was used to extract data from each study and an adapted Framework method was used to guide the analysis and synthesis of findings. Preliminary themes and definitions of quality were discussed by the review team and summarised in table format. Finally, quantitative and qualitative material were brought together and reported using a narrative approach.

Key findings

Effectiveness

Evidence on effectiveness was examined in relation to the service user groups targeted by the interventions. Some of the specialist programmes included in the review  have been used to improve the rate and timeliness of reunification, with some demonstrating promising results in terms of greater stability and fewer re-entries to care.

Interventions for all children in care – some evidence of effectiveness for the Casey Family Reunification Programme, Pomona Family First Program, and the Iowa Parent Partner Programme

Focus on parental substance misuse – promising evidence for London Family Drug and Alcohol Courts

Focus on children in residential care – limited evidence for interventions with a focus on children in residential care

Support offered to families

The support offered to families by these interventions was analysed in terms of the systemic context, i.e. whether individual, family or environmental factors were being addressed, and whether services were being provided post-reunification or while the child was still in care.

Individual factors

• Various types of direct work with children and parents, pre- and post-reunification
• Areas addressed: self-regulation, peer relationships, practical skills, drug and alcohol education, behaviour management, understanding child development, stress management, domestic abuse, mental health, homework support, advocacy
• Therapeutic support to encourage parents to understand their child’s emotional and social needs, as well as their own, sometimes offered (e.g. Promoting First Relationships)

Family factors

• Most programmes assigned a family caseworker, working on a combination of case coordination and direct work
• Areas addressed: needs assessment, care planning, family conferences, team decision-making, family skills, relationships, empathic communication, positive activities
• Parent mentors featured in some interventions (e.g. Iowa Parent Partner Programme)

Environmental factors

• Many of the programmes addressed environmental factors like school attendance, peer groups, support networks, community resources, housing problems, family-school partnerships, financial assistance
• Others looked at transition planning and hand-over to community services and neighbourhood support

Implications

Reunification from care is an important and challenging area of practice, which in England has arguably been overlooked and under-resourced in comparison with other permanency routes such as adoption and special guardianship. Although the risk factors for re-entry to care are well known, there is little evidence on how this knowledge has been applied to reunification services. A large majority of evaluation studies are carried out in the United States, where specialist programs have been used to improve the rate and timeliness of reunification, with some demonstrating promising results in terms of greater stability and fewer re-entries to care. These programs may have varying transferability to the UK, although an experiment with family drug treatment courts has shown signs of success. Whether services choose to develop a model intervention or augment their mainstream provision, improving outcomes for children who return home requires strategic planning to ensure that resources are available to meet the diverse needs of the reunified cohort. 

Reunification is a lengthy process, starting at the point of admission to care and continuing well after children return home. The core components of interventions generally include targeted individual work with children and parents, as well as family work and activities to promote school attendance, social inclusion, positive activities and support networks. Best practice includes careful preparation and planning of transitions, individualised care plans, coordination of multi-agency provision, therapeutic and psychoeducational skills training, specialist drug and alcohol services, and educational and social support. 

There is a risk that the benefits of intensive, time-limited support will not be sustained if services are withdrawn too early, or without a plan for hand-over to appropriate support in the community. The prospects for children who return home will also be harmed if the neighbourhoods and communities where they live are suffering from social problems associated with disproportionately high rates of entry to care. Policies to improve the socio-economic circumstances of families are therefore required alongside investment in targeted interventions for children in care and their families.

Next steps

This work was commissioned by the Independent Review of Children’s Social Care. The commissioner did not influence the reporting of our findings. The findings will be considered as part of the Review’s upcoming report and recommendations.

Read the report

Read the evaluation protocol