The Reflective Fostering Programme—improving the wellbeing of children in care through a group intervention for foster carers: a randomised controlled trial

Abstract

Background The needs of children in care are a government priority, yet the evidence base for effective interventions to support the emotional wellbeing of children in care is lacking. Research suggests that supporting the carer-child relationship, by promoting the carer’s reflective parenting, may be an effective approach to improving the wellbeing of these children. Methods The study comprises a definitive, superiority, two-armed, parallel, pragmatic, randomised controlled trial, with embedded process evaluation and economic evaluation, and an internal pilot, to evaluate the effectiveness, and cost-effectiveness, of the Reflective Fostering Programme. Randomisation is at the individual level using a 1:1 allocation ratio. The study is being conducted in local authority sites across England, and is targeted at foster carers (including kinship carers) looking after children aged 4 to 13. Consenting participants are randomly allocated to the Reflective Fostering Programme (intervention arm) in addition to usual support or usual support alone (control arm). The primary outcome is behavioural and emotional wellbeing of the child 12 months post-baseline, and secondary outcomes include the following: foster carer’s level of stress, quality of life, reflective capacity, compassion fatigue and burnout, placement stability, the quality of the child-carer relationship, child’s capacity for emotional regulation, and achievement of personalised goals set by the carer. Discussion A feasibility study has indicated effectiveness of the Programme in improving the child-carer relationship and emotional and behavioural wellbeing of children in care. This study will test the effectiveness and cost-effectiveness of implementing the Reflective Fostering Programme as an additional aid to the support already available to local authority foster carers. Trial registration ISRCTN 70832140.

The Reflective Fostering Programme fidelity rating scale: development and inter-rater reliability

“…These models deserve investigation with a new data set. Work is currently under way to collect a larger sample of RFFR ratings in the context of a randomized controlled trial (Midgley et al , 2021a), and it is our intention to revisit the dimensionality question in that study. Pragmatically adopting a single factor for now, we found that a summary score calculated from all items with equal weights yielded a highly reliable measurement (McDonald’s omega = 0.93).…”

“…These models deserve investigation with a new data set. Work is currently under way to collect a larger sample of RFFR ratings in the context of a randomized controlled trial (Midgley et al, 2021a), and it is our intention to revisit the dimensionality question in that study.…”

“…Video recordings of programme sessions were taken as part of the second pilot of the RFP (Midgley et al, 2021a(Midgley et al, , 2021b. The video recordings were made on tablets by facilitators during all programme sessions, except where technological issues prevented this.…”

“…The development and validation of the RFFR is an important step towards evaluating the RFP. If proved to be an effective intervention in a randomised clinical trial currently underway (Midgley et al, 2021a(Midgley et al, , 2021b, it is anticipated that the RFP will be established as a professional qualification in which social care workers and foster carers can become accredited Facilitators. Therefore, it is vital to ensure that the programme is being delivered in a consistent and standardised way which reflects the aims and key components of the intervention.…”

“…Results from this study showed a significant reduction in parenting stress (parenting stress index, short form; Abidin, 1995) and child difficulties (strengths and difficulties questionnaire; Goodman and Goodman, 2012) following the completion of the programme. A further pilot evaluation of the programme has since been completed with comparable outcomes to the initial feasibility study (Midgley et al , 2021b) and a large-scale randomized control trial of the programme is currently underway in the UK (Midgley et al , 2021a) .…”