Systematic review of what works to support reunification and its associated outcomes

A mixed-methods systematic review, combined with primary research

Relationships for care experienced children
July 9, 2026

Systematic review of what works to support reunification and its associated outcomes

Highlights

This mixed-methods systematic review reports findings from 73 studies on interventions to support children and young people to return home safely after a period in care. This included 20 studies providing causal evidence on effectiveness, 47 studies examining implementation, and six studies contributing to both areas.
Overall, reunification interventions had a small but meaningful positive effect on outcomes associated with successful reunification. Families receiving supportgenerally hadbetter outcomes than those receiving usual care, particularly in helping children remain at home and avoid re-entering care.
No single intervention model was consistently more effective than all others. However, there was tentative evidence that longer-duration, community-based,and holistic approaches, which combine practical, relational, therapeutic,and parenting support, may offer added benefit.
Implementation findings highlighted that support is most acceptable and workable when it is guided by clear frameworks and robust assessment, tailored to each family’s circumstances, and delivered through trusting, consistent relationships with professionals. Housing, financial hardship, mental health, substance use, cultural and linguistic needs, and wider family support should be addressed alongside parenting and safeguarding concerns.
Further high-quality research is needed, particularly in the UK, to understand which approaches work best for different families and circumstances. This should include stronger reporting of equity characteristics, longer-term outcomes, cost-effectiveness, and the experiences of fathers, families with younger children, and families from minoritised backgrounds.

Systematic review: What works to support reunification and its associated outcomes

Summary

Reunification can be challenging, particularly where families have experienced trauma, poverty, housing instability, mental health difficulties, alcohol/drug misuse, or previous involvement with children’s social care. Tailored, sustained support before, during, and after return home can help to improve outcomes for children, young people, and parents.

This systematic review aimed to understand the effectiveness of interventions that support reunification, including what works, for whom, how and why. The review also examined the barriers and enablers to implementing reunification support, alongside the experiences and perspectives of parents, young people, and professionals.

Aims

This review addressed five questions:

What works?
Which interventions or services are most effective in improving reunification outcomes for families with care-experienced children and young people aged 0–18, and under what conditions do they achieve the best results?
For whom?
How do the effectiveness and applicability of reunification interventions vary across different family characteristics, circumstances, and care experiences? Which approaches are most effective for specific groups of families?
How and why?
What practice elements and components are associated with successful reunification interventions, and how do they contribute to family stability, child safety, and longer-term wellbeing?
Implementation
What barriers and enablers affect the successful implementation of reunification interventions, and how can these insights support practice?
Perspectives and experiences
How do parents, young people, and practitioners experience reunification interventions, including their acceptability, relevance, and usefulness? What barriers and enablers do they identify?

Method

This mixed-methods systematic review followed established methods to identify published and unpublished evidence on interventions supporting reunification. The protocol was published and registered on the Open Science Framework.

Randomised controlled trials and quasi-experimental studies from international settings were included in the quantitative synthesis. Risk of bias was assessed using RoB 2 and ROBINS-I, and findings were combined using meta-analysis.

Process evaluations and qualitative studies were included to examine implementation, barriers, and enablers. These findings were synthesised using best-fit framework analysis, informed by Proctor’s implementation framework. Study quality was assessed using CASP or ASSESS, and confidence in implementation findings was assessed using GRADE-CERQual. Primary qualitative research with parents, young people, and professionals in England was also undertaken.

Key Findings

Quantitative findings

This review included 26 studies contributing causal evidence on the effectiveness of reunification interventions. Most studies were from the United States, with one from England. Risk of bias was moderate to serious in most studies, so findings should be interpreted with caution.

Overall, families receiving a reunification intervention had better outcomes than those receiving usual care. The clearest positive effects were for children remaining at home and not returning to care. Effects on child safety and wellbeing, parent wellbeing and social support were weaker.

No individual intervention type was consistently more effective than all others. Holistic approaches that combine several forms of support may also be more helpful than single-component interventions, particularly where families need help with parental substance use, parenting skills, relationships and practical difficulties.

The review found limited evidence about what works best for different groups of families. In many cases there was incomplete reporting of ethnicity, socioeconomic circumstances, SEND, and other equity characteristics means that firm conclusions cannot be drawn.

Implementation and lived-experience findings

Fifty-three studies contributed implementation or qualitative evidence, alongside primary research with parents, young people, and professionals in England.

Support was most acceptable and workable when it was:

Guided by clear frameworks, robust assessment and realistic plans
Flexible and tailored to the family’s cultural, linguistic, communication, mental health and practical needs
Delivered through trusting, non-judgemental and consistent relationships with professionals
Provided before, during and after return home, with gradual transitions and continuing support
Holistic, addressing housing, finances, mental health, substance use, parenting, relationships and wider family networks.

Families valued clear communication, being involved in decisions, and practical support that helped them manage day-to-day pressures. Young people wanted to be informed, listened to and supported with the emotional impact of returning home. Professionals highlighted that high caseloads, staff turnover, limited funding and gaps in local services can undermine consistency, trust, and long-term support. Fathers and families with younger children were less likely to receive reunification interventions, indicating inequalities in access.

Implications for Policy

National and local policy should position reunification as a planned, supported process rather than a single decision to return home. Families should have access to support before, during, and after reunification, with sufficient flexibility to respond to changing needs.
Commissioning should prioritise a tailored, whole-family approach rather than a single standardised intervention. Support may need to combine parenting, relationship-based, therapeutic, mental health, alcohol/drug misuse, housing, financial, and wider-network support.
Policy should support robust assessment, clear care planning and meaningful involvement of children, young people, and parents. Plans should recognise the emotional impact of separation and return home, and ensure children’s views influence decisions.
Local systems should address barriers that undermine effective delivery, including high caseloads, workforce instability, short-term funding, limited specialist provision, and weak coordination between children’s social care, housing, health, education, and community services.
National guidance and local monitoring should promote equitable access to reunification support. Particular attention is needed for fathers, families with younger children, families from minoritised racial and cultural backgrounds, and children and parents with SEND or additional communication needs.
Funding and evaluation requirements should support longer-term follow-up, consistent outcome measurement, reporting of equity characteristics, and stronger evidence on cost-effectiveness and implementation in England.

Implications for future research

This review highlights the following priorities for future research:

More high-quality evaluations of reunification interventions are needed in the UK, across all intervention types. This includes parent-focused skills building, peer mentoring or coaching, multi-agency approaches, therapeutic problem-solving courts, family finding, child-focused programmes, family group decision-making, and financial support.
Research should improve the rigour of effectiveness evaluations. Most studies contributing to the meta-analysis had a moderate to serious risk of bias, which limits confidence in the findings. Future studies should use robust comparison groups, clear reporting, and sufficiently large samples.
Studies should examine what works for whom. Consistent collection and reporting of equity characteristics, including ethnicity, culture, language, socioeconomic circumstances, age, SEND, family composition and place of residence, are needed to understand whether support is equitable and how it should be tailored.
Future research should include groups who are under-represented in the evidence base and in access to support, particularly fathers, families with younger children, and families from minoritised racial and cultural backgrounds.
Studies should measure a wider range of outcomes and follow families for longer. This should include children remaining at home, re-entry to care, safety and wellbeing, education, youth justice involvement, family relationships, parental wellbeing, and permanency outcomes.
More evidence is needed on the implementation, reach, sustainability, and cost-effectiveness of reunification support, particularly in comparison with usual care and in the context of English children’s social care.