Involving families meaningfully in decision-making to keep children safely at home


Shared decision-making is a feature of a number of service-delivery models, such as Family Group Conferencing, Family Group Decision-Making and Family Unity Meetings. Underpinning all these models is a commitment to ensuring that children and families are involved in decision-making about their own lives.

This rapid realist review aims to test and develop our understanding of what good practice is for meetings that facilitate shared decision-making between professionals and families in order to safely reduce the need for children to be in care. This review is part of a wider suite of work on the topic of shared decision-making, which is currently underway.

Shared Decision-Making: What is good practice in delivering meetings? Involving families meaningfully in decision-making to keep children safely at home: A rapid realist review

We have also produced a number of supporting reports, including a practice guide for conducting successful meetings.



The objectives of this realist review were to:

  1. Summarise the evidence on shared decision-making meetings.
  2. Provide guidance on best practice for shared decision-making meetings.
  3. Support future evaluations by providing the initial theoretical basis for shared decision-making meetings.


How we went about it

This realist review consists of two stages and five distinct steps:

  • Stage 1: Building initial programme theory
    Step 1: Synthesis of evidence from a previous scoping review (17 studies)
  • Stage 2: Testing and refining programme theory
    Step 2: Synthesis of evidence from additional literature (67 studies)
    Step 3: Focus group with young people (n=6)
    Step 4: Focus group with Child Protection Case Conferencing (CPC) professionals (n=14)
    Step 5: Focus group and interviews with Family Group Conferencing (FGC) professionals (n=3)


Key findings

There are three core stages to shared-decision making meetings (1) pre-meeting preparation, (2) the meeting itself and (3) follow-up.

Importantly, there are three mechanisms, when observed over the three stages, that make shared decision-making meetings more likely to be effective:

  • Enabling collaboration and engagement:
    Creating a meaningful dialogue between professionals and family members.
    Professionals enable true collaboration with families and their network
  • Building trust and reducing shame:
    This includes parents and the wider family feeling able to participate in a meeting in a way that is open and solution focused.
  • Enabling participation in decision-making:
    This involves in-depth preparation and a willingness to listen and be flexible.

A broader finding from the focus groups was that such meetings needed to be consistent with the wider culture, values and practices of the organisation. Shared decision-making meetings were seen to be just part of the wider system, rather than a standalone intervention.



In developing a theory about effective shared decision-making meetings, we have identified what is important and meaningful in delivering these meetings to reduce the need for children to be in care. There are three key implications:

  • The delivery of shared decision making meetings varies considerably. This report provides a basis for reviewing practices to promote consistency in delivery.
  • For practitioners considering how to involve families in meetings this report provides a description of good practice for developing and delivering effective services.
  • The detailed theoretical basis for shared decision-making provides the foundation for further research on what needs to be delivered, how it should be implemented and evaluating the difference it makes. These are urgent research priorities.


What next?

This report, which seeks to provide practical, helpful guidance on how to conduct successful shared decision-making meetings, is part of a wider programme of research on the effectiveness of the approach.

A review summarising the evidence on the effect of these meetings – with a focus on their effectiveness at preventing out-of-home care and improving family empowerment and satisfaction with services – is currently underway. As part of Supporting Families: Investing in Practice we are also using a randomised control trial to evaluate the effectiveness of Family Group Conferences in a number of local authorities.