Equity-focused systematic review of interventions for foster carers and adoptive parents

May 14, 2026

Equity-focused systematic review of interventions for foster carers and adoptive parents

Highlights

This systematic review reports findings from 75 quantitative studies evaluating the effectiveness of interventions for foster carers and adoptive parents, as well as findings from 27 qualitative studies on experiences of interventions for foster carers and adoptive parents

Overall, interventions showed mixed but promising effects. Interventions delivered at multiple levels (e.g. individual, group, and system-levels) and interventions with multiple modes of support (e.g. a combination of psychoeducation and peer support) reported more consistent positive findings for both caregiver and child outcomes than the other types of interventions (e.g. those delivered at just the individual or group-level, or with only one mode of support)

Qualitative data yielded 12 key findings about what helps interventions to succeed, including the type of support that carers valued and how it should be delivered, as well as barriers to engagement

Further research is needed to understand the experiences of adoptive and foster families from minoritised backgrounds and with diverse characteristics.

Systematic review: Interventions for foster carers & adoptive parents

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Summary

Foster and adoptive families can provide stable, loving homes for children who enter care. Caregiving in these contexts where children may have experienced significant adversity can be uniquely challenging. Training, support, and practical help for foster carers and adoptive parents can help to improve outcomes for caregivers and the children in their care.

This systematic review aimed to understand the effectiveness of interventions for foster and adoptive families, including examining what works for different families and common elements of effective interventions. The review also focused on experiences and perspectives of caregivers, practitioners, and children.

Aims

This review aimed to answer five research questions:

What works: What is the effectiveness of interventions to support non-related foster carers and adoptive parents of children and young people aged 0–18 placed in out-of-home care or (being) adopted from out-of-home care?
For whom: What are known demographics and characteristics of the foster carers, adoptive parents, and children and young people served by these interventions?
How: What practice elements and intervention components are found in these interventions?
Implementation: What are the enablers and barriers to successful implementation of effective interventions for non-related foster carers and adoptive parents, and children and young people in the UK?
User perspectives: What are the views about the acceptability and usefulness of different interventions in the UK?

Method

This review followed established systematic review methods to identify published and unpublished literature relating to interventions for foster carers and adoptive parents. The protocol was registered and published.

Only randomised controlled trials and quasi-experimental studies were included in the quantitative data. International evidence was included. Risk of bias assessment was undertaken using the Cochrane Risk of Bias 2 (RoB-2) tool. Quantitative findings were synthesised narratively.

Qualitative studies were all from the UK. The Critical Appraisal Skills Programme (CASP) tool was used to assess study quality. Qualitative studies were synthesised using thematic analysis and finding statements were assessed for confidence using GRADE-CERQual.

Key Findings

Quantitative findings

This review included 75 quantitative studies. Of these, 25 studies evaluated interventions for adoptive parents, and 65 studies evaluated interventions for foster carers (15 included both populations). Risk of bias was high across studies.

Interventions were not neatly defined and most interventions included elements of several practices. Where common elements could be coded, most interventions had standardised or set modes of delivery. The majority of interventions included psychoeducational techniques (explaining child development or explaining the impacts of abuse and trauma), skills for caregivers themselves (emotion regulation, problem-solving), proactive parenting, and relationship enhancement.

Studies show a complicated picture on effectiveness with many mixed results. Interventions were grouped based on whether they worked with participants at the individual-level, group-level, or at multiple levels (e.g. individually and in a group). Across levels, interventions were effective at positively changing some carer and child-level outcomes, but confidence in findings across each level was low or very low – primarily due to risk of bias in individual studies and lack of coherence in the data from mixed or null findings. Multi-level and multi-modal interventions reported more consistent positive findings for both caregiver and child outcomes than the other types of interventions.

Although demographics were reported and synthesised from the studies, the lack of sub-group analysis and diversity of the study participants meant that the review could not provide firm conclusions about how different populations may be served more or less effectively by different types of interventions.

Qualitative findings

This review included 27 qualitative studies – nine related to adoptive parents and 19 related to foster carers.

Qualitative findings indicate that the following factors help an intervention succeed:

A clear, strengths-based recruitment approach
Support from social workers and the wider system to encourage attendance
Facilitator warmth and genuine interest
Structured content, with enough flexibility to respond to individual needs.

Content was felt by caregivers to be acceptable and helpful when it focused on:

Peer support, helping caregivers feel seen and heard
Caregiver needs, in addition to children’s needs
Learning strategies that integrate theory and practice
Addressing multiple areas and providing a network around the child.

Qualitative findings highlighted the following challenges and considerations:

More research is needed to understand what works for diverse groups, especially minoritised racial and cultural communities
Gender assumptions: assuming primary caregivers are female can exclude male carers, single women, and same-sex couples
Parents and carers have limited time; interventions must feel relevant and effective quickly to maintain engagement.

Implications for Policy

Practitioners and caregivers should consider the effectiveness and appropriateness of any specific intervention when choosing a programme or considering its implementation with caregivers or families.
Practice should consider a common elements approach, in which effective and/or promising delivery components are delivered in appropriate combinations depending on the local delivery context and or individual participants, rather than standardised manualised programmes.
Qualitative findings from this review can support intervention development and provide useful guidance for implementation of new and existing interventions.
Multi-modal and multi-level interventions should also be explored in practice, for example those that combine psychoeducation with peer support and/or offer navigation and practical support. There were fewer of these studies in the impact evaluations, but they had more consistent positive outcomes.
Future funding opportunities for interventions should consider how they address gaps in support for minoritised racial and cultural groups, male caregivers and same-sex couples. Understanding how practice can be or should be tailored to support caregivers from diverse backgrounds should be prioritised. This could be promoted as a requirement within funding calls.

Implications for future research

This review highlights the following areas for future research:

Exploring the effectiveness and implementation of interventions for adoptive parents – this review highlighted the lack of research focused specifically on adoptive parents.
Research with diverse populations of foster and adoptive families to understand what works for whom and how to drive equity.
Understanding the effectiveness of practice elements using a component network meta-analysis approach, which could highlight effective components within interventions.
Improving the rigour and overall quality of evaluations exploring the effectiveness of interventions for foster carers and adoptive parents – a high proportion of studies within this review were at a high risk of bias which seriously compromises the confidence we can have in their reported findings.
Understanding how caregiver interventions lead to positive changes for children and the longer-term outcomes of interventions to guide practice, policy, and investment.