What Interventions Might be Effective, Feasible and Acceptable to Improve the Outcomes of Kinship Carers in Wales? a Mixed Methods Systematic Review and Thematic Synthesis

Background and Purpose

Research has shown that kinship carers, whether arrangements are made formally through social work intervention or informally between families, are more likely to be from minorized communities, live in poverty and overcrowded conditions and suffer from mental and physical health conditions than parents in the general population. There are gaps in the provision of support for these families and inequitable eligibility. Results of empirical studies where kinship carers are a subgroup of a wider group often fail to demonstrate how effective an intervention is for kinship carers. Systematic reviews have either focused on a subgroup of the kinship carer population, or not explored the contextual factors that would indicate whether an intervention would be appropriate for implementation in specific contexts. This makes it difficult for policy makers and practitioners to identify which interventions may work for this group of carers. There is a dearth of research from Wales, meaning any interventions may not be transferable to the specific Welsh context.

The aim of this study therefore was to identify interventions that could work to improve outcomes for kinship carers in Wales.

Methods

A mixed-methods systematic review of interventions for kinship carers was conducted. A framework (TRANSFER) was applied. The TRANSFER approach builds in consultation with key stakeholders about the transferability and relevance of the review question and the findings. The TRANSFER approach was developed as an explicit framework for supporting collaboration between review authors and stakeholders from the outset of the review process to systematically and transparently consider factors that may influence the transferability of findings. Consultation took place through three paired interviews with stakeholders - kinship carers (n=2), social welfare professionals (n=2) and voluntary service workers (n=2). Through consultation, outcomes of interest, the parameters of the review, and transferability factors were determined.

Results

1572 studies were screened, with thirteen studies included. Effectiveness, feasibility and acceptability data were extracted from each. Narrative synthesis of quantitative and qualitative data from studies indicated some evidence that interventions aimed at this population improve mental health and well-being of kinship carers. Nine studies indicated some effectiveness, although limited feasibility and acceptability data, or subgroup data, made the assessment of transferability difficult. Elements of interventions that seemed effective, or acceptable to practitioners, carers or children were identified, including the use of coproduction in designing interventions and peer facilitators in delivering interventions. These were fed back to stakeholders and discussed based on the Welsh context.

Conclusions and Implications

The use of collaborative method for conducting a systematic review can help to ensure that findings of a review are relevant to the context. Consulting with a range of stakeholders also helps to ensure that the views of those involved in delivering and receiving the services are fully integrated into shaping what services are commissioned. This is particularly important for groups such as kinship carers who are often marginalized and excluded from services. This is reflected in the findings of the review where elements of interventions involving coproduction were most acceptable to participants and stakeholders.