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

Background: Foster carers (including kinship carers) play an essential part in the lives of children in care, but the role can be challenging, necessitating effective support. However, there is a lack of evidence for which types of support are most effective in supporting carers and improving the well-being of the children in care. Design: A definitive, superiority, two-armed, parallel, pragmatic, randomised controlled trial, evaluating whether adding the Reflective Fostering Programme to usual support was more effective and cost-effective than usual support alone, for foster carers of children between 4 and 13 years old. Findings: 524 participants joined the study. Over 12 months, the children of those carers attending the Programme did not yield significantly greater improvements in children's psychosocial functioning (the primary outcome) or emotion regulation compared to usual support; however, there was evidence of significantly enhanced carers' reflective capacity, reduced carer burnout and stress levels and improved child-carer relationships. The health economic evaluation demonstrated the Programme had a higher probability of being cost-effective compared to usual support. Conclusions: The Reflective Fostering Programme found evidence of greater improvements in a range of carer-related outcomes, carer-identified problems and the carer-child relationship, alongside evidence to suggest it is cost-effective compared to usual support. However, there were no significant differences between groups in terms of the child’s emotional and behavioural well-being or their capacity for emotion regulation.