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Fostering Changes (FC) is a 12-week group-based training programme for foster and kinship carers, which aims to build positive relationships between carers and children and encourage positive child behaviour through a practical skills-based approach. The Confidence in Care consortium was funded to deliver FC in all provider agencies in Wales, UK, over a 5-year period. The aim of this randomised controlled trial with embedded process evaluation, was to determine whether FC can deliver improved long-term outcomes compared with usual care.
Methods
Foster carers (319) recruited from provider agencies were allocated to intervention or control arms on a 2:1 ratio. Intervention arm participants were offered enrolment onto the next FC programme at their site. Control arm participants were offered FC at the end of the follow-up period. Data were collected at baseline, immediately following the programme, and at 12 months from programme start. The primary outcome assessed carers’ self-reported ability to cope with and make positive changes to the lives of their foster children (Carer Efficacy Questionnaire (CEQ)) at 12 months. Secondary carer-reported outcomes included placement breakdown, engagement in education, carer-child relationship, carer’s coping strategies, child behaviour and emotional problems, carer defined problems and service use. An Intention To Treat approach was used and the primary comparative analysis was a mixed-effects three-level linear regression model (allowing for clustering by block in the intervention arm) for the CEQ score (adjusting for baseline score). Additional covariates included were those balanced at randomisation (type of carer and age of child in foster care). Secondary outcome measures were analysed using multilevel linear or logistic regression at 3 and 12 months. The process evaluation included qualitative interviews with participants and FC Facilitators, examining contextual factors and fidelity of programme delivery.
Results
Follow-up rates at 3 and 12 months were 77% and 73% respectively. Baseline characteristics of participants in both arms were comparable. 65% of intervention participants adhered to the FC programme. There was no difference between groups in the primary outcome (CEQ) or secondary outcomes at 12 months. However, the intervention group saw some improvements in child behaviour and emotional problems at 3 months. Themes from the foster carer interviews included the benefits of being part of a group, sharing experiences and consolidating knowledge. However, course content was described as too basic for experienced foster carers and not sufficient in supporting managing complex behaviours.
Conclusions and implications
The trial found that although FC was implemented as intended it had no long-term effect on foster carers’ sense of efficacy, behaviours or relationships with their foster children compared to usual care. Further work should look at sustaining short-term benefits over the longer-term, greater targeting of training at newer carers and adaptations addressing more complex needs. While this trial only found limited support for the programme, such trials remain comparatively rare in UK social work. Successful trial recruitment and follow-up in this trial holds promise that rigorous outcome evaluations can be delivered in this setting - essential in developing the evidence base for supportive fostering interventions.