The Reflective Fostering Programme – improving the wellbeing of Children in Care through a group intervention for foster carers: a randomised controlled trial

Research question 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. Background 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). Aims and objectives 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. Methods Up to 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. Timeline for delivery The study is over 57 months, starting in April 2020. Anticipated impact and dissemination 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.