Title: The Reflective Fostering Programme – improving the wellbeing of Children in Care through a group intervention for foster carers: a randomised controlled trial
Funder: Department of Health and Social Care

Abstract: In 2018 there were 75,420 children in England looked after by the state - 73% of them in foster care. We know from research that a secure, supportive foster placement gives children the best chance in life. But many children in care have emotional and behavioural difficulties, that can make it challenging to meet their needs. Carers report that they don't receive the support they need, and this can affect the quality of the care they provide. This can lead to placement breakdown, creating yet more disruption for the child. However, there is little evidence to show what kind of support is most helpful, especially for carers of children aged 4-13._x000D_ _x000D_ The Reflective Fostering Programme (RFP) aims to help foster carers do their very best for the children in their care. The Programme consists of ten, three-hour sessions, run by social care staff and experienced foster carers to promote 'reflective fostering'; that is being able to think about the thoughts and feelings of both themselves and the child in their care. Unlike other programmes for foster carers, the RFP focuses on improving the carer-child relationship, by helping carers to attend to their own state of mind. Studies have shown that when carers do this, they build stronger relationships with children. When the Programme was first evaluated, carers reported feeling less stressed, better able to respond to the child's needs, and the children's well-being improved. However the study was on a small-scale, so we don't yet have strong evidence that this approach is effective._x000D_ _x000D_ The aim of the current study is to find out whether offering foster carers the RFP, alongside the usual social care support provided to carers, helps to improve the emotional well-being of Children in Care. We want to know whether the Programme reduces carer stress and burnout and has an impact on how often children have to change foster placement. The study will compare two groups of foster carers: 360 will be offered usual support; and 360 will be offered the same support, plus the Programme. The decision about which group a carer joins will be random. The 720 foster carers taking part will come from 8 local authorities in different parts of England. Using a range of assessment tools, we will evaluate whether offering the Programme alongside usual support is more or less effective than offering the usual support on its own, at 4 months after a foster carer starts the programme, and up to 12 months later. We will also look at whether the Programme is good value for money._x000D_ _x000D_ During earlier development, foster carers gave feedback on how and in what way the programme should be offered. They also helped to design all the information sheets used in the research, so that they can be easily understood. A foster carer is part of the research team and has been involved with setting the aims of the study and ensuring that the design is informed by the needs of Children in Care and their carers._x000D_ _x000D_ We plan to share what we learn with social care professionals and with foster carers. We will also publish the findings in social work journals and newsletters. If the Programme is effective, we will work with colleagues in key organisations (e.g. Barnardos, the Fostering Network), to ensure it can be rolled out more widely. More effective support for foster carers has the potential to make cost savings for social care and society more widely - but more importantly, to make a real difference to the lives of children in care.

Lay abstract: Research question _x000D_ A pragmatic, randomised controlled trial to evaluate whether the Reflective Fostering Programme (RFP) for foster carers, when offered alongside usual social care support, is more effective in improving the emotional well-being of Children in Care, than usual support alone._x000D_ _x000D_ Background _x000D_ In 2018 there were 75,420 children in England looked after by the state - 73% of them were in foster care(1). These children are at high risk of poor wellbeing across the lifespan(2). Foster carers have a key influence on the life of children in their care(3). However not enough is known about the best way to support them in their role(4). The Reflective Fostering Programme is a 10-week intervention, delivered jointly by an experienced foster carer and a social worker. It is designed to promote ‘reflective parenting’ among foster and kinship carers. Unlike other programmes for foster carers, it focuses on improving the carer-child relationship, by helping carers to attend to their own state of mind and experiences. A stronger carer-child relationship is associated with greater well-being in children(5)._x000D_ _x000D_ Aims and objectives _x000D_ The aim of this study is to find out whether the RFP alongside usual support is more effective than usual support alone in promoting chid well-being, reducing levels of foster carer stress and burnout; improving the carer’s reflective capacity and the carer-child relationship; and in reducing placement instability. The cost effectiveness of RFP will also be assessed. Before starting the main trial, an internal pilot study will test recruitment and randomisation procedures, examine retention and response rate for the primary outcome at four months, and explore any issues of contamination across the trial arms. An embedded process evaluation within the main trial will examine how the programme was delivered, provide explanation of any unexpected effects and help identify issues related to implementation and scalability. _x000D_ _x000D_ Methods _x000D_ 720 foster carers, caring for children aged 4-13, will be recruited from local authority fostering teams across England and Wales. Carers will be randomly assigned, with those in the intervention arm receiving the RFP alongside usual support. Carers will complete a range of validated measures at 3 time points (baseline, month 4 and month 12). The primary outcome will be child well-being, as assessed by the Strengths and Difficulties Questionnaire (SDQ) at 12 months. Focus group interviews and observations from four sites will inform the process evaluation. Data related to cost-effectiveness and placement stability will be examined at 12-month follow-up. _x000D_ _x000D_ Timeline for delivery_x000D_ The study is over 40 months, starting in April 2020._x000D_ _x000D_ Anticipated impact and dissemination_x000D_ Findings will be published in peer-reviewed academic journals and circulated via foster carer networks and within social care forums, and a short film will be co-produced with carers and care leavers that can be used in training and available online. Working with key organisations and our partners in children’s social care we will ensure the availability of training in the RFP to local authority fostering teams nationally. If effective, the RFP could be adopted as an evidence-based approach to improving the well-being of children in care across England and Wales.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH