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

Nick Midgley, Karen Irvine, Beth Rider, Sarah Byford, Antonella Cirasola, Poushali Ganguli, Thando Katangwe-Chigamba, Jamie Murdoch, Martin Pond, Benita Pursch, Sheila Redfern, Zena Louise Richards, Lee Shepstone, Erika Sims, Caroline Smith, Eva Sprecher, Ann Marie Swart, Solange Wyatt, David Wellsted

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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.

Original languageEnglish
Article number841
Issue number1
Publication statusPublished - 25 Nov 2021


  • Children in care
  • Foster care
  • Parenting
  • Reflective Fostering Programme
  • Reflective parenting

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