Dr Karen Irvine is Manager of the Clinical Trials Unit at the University of Hertfordshire and led on the delivery of the evaluation of the Reflective Fostering Programme. In this blog, she lifts the lid on the findings of the Reflective Fostering Study, the largest ever impact evaluation study of a parenting programme with kinship and foster carers conducted in the UK to date.

Foster and kinship carers play an important role in looking after the wellbeing and development of children unable to be cared for in their family home. So it is important that these carers are well supported by good quality supervision and training that enhances their wellbeing. However, there is a lack of high quality evidence for what training works well, particularly for longer term impact.

The Reflective Fostering Programme was developed by a team at Anna Freud to meet that need. It sets out to improve the ability of carers to reflect on what internal thoughts and feelings might be influencing a behaviour – both their own and those of the children in their care. Previous research has suggested that improving this reflective capacity results in a reduction in stress levels and in burnout and an improvement in the carer–child relationship.

All good in theory – but does it work? A research team from UCL, the University of Hertfordshire, and University of East Anglia set out to check this in the Reflective Fostering Study, funded by the National Institute of Health Research. We recruited 517 foster and kinship carers of children aged 4–13 from across England and Wales, and the Programme was offered to half of those, while the other half continued to get their usual support from their local fostering support service. We looked at how the carers who attended the Programme (and the children they cared for) fared on various aspects of carer and child wellbeing compared to carers who did not attend the Programme.

Carers reported valuing the Programme, and reflected on how it quickly became “their” time. Many said that they had often been told to look after themselves, but this was the first a training had shown them how to look after themselves. The Programme also provided strategies – e.g. to reflect on when to “pick their time” to address a behaviour or issue with the children in their care.

The comparison of outcomes showed some interesting results. As predicted, there were greater improvements in the foster and kinship carers’ ability to be reflective, compared to those who didn’t attend the programme, and these differences remained eight months after the Programme ended. At that final time-point, carers attending the Programme had less stress, lower levels of burnout, and an improved relationship with the child in their care compared to those who didn’t attend. However, there were no differences between the groups for the children’s emotional wellbeing, their behaviour, nor on placement stability. The study also found that the Programme was “cost effective”.

It is something of a puzzle about why there was such clear and sustained impact on the carers themselves, but that this didn’t seem to translate directly into changes in the wellbeing of the child in their care. It may be that improvements in children’s wellbeing would become apparent later, and a longer follow-up is needed. Alternatively, it may be that changing children’s behaviour requires some direct work with the children themselves. Further research is needed to better understand the results.

What next? Ideally, we would like to follow children of carers who attend the Programme for a longer period, to see whether the anticipated benefits become apparent 18 or 24 months after the Programme starts. But long-term research is difficult; it can be hard to keep participants engaged and it is expensive. In a future study, it may be possible to collect consent to go back to participants to collect data after the study has finished. Or we may be able to follow up participants recruited early in the lifetime of a study for a longer period.

This is the largest study in the UK to provide evidence for an intervention that works to support foster and kinship carers of school-age children. Reducing burnout and stress is essential to retain existing foster and kinship carers and encourage new carers to join the profession. We are pleased that the results have influenced the evidence base used by Foundations in producing the Foster Care Practice Guide, which provides evidence-based recommendations on support for foster carers.

If you are interested in learning more about the Programme, you can watch this video, or read a more detailed report of the study findings here.