Barriers and facilitators for supporting care placement stability among looked-after children and young people

Barriers and facilitators for supporting care placement stability among looked-after children and young people

Looked-After Children and Young People

Evidence review B

NICE Guideline, No. 205

London: National Institute for Health and Care Excellence (NICE); 2021 Oct.

ISBN-13: 978-1-4731-4291-6

Barriers and facilitators for supporting care placement stability among looked-after children and young people

Review question

What are the barriers to, and facilitators for, supporting care placement stability among looked-after children and young people?

Introduction

This review will consider interventions to support placement stability in children and young people who are looked after. In March 2018, 75,420 children and young people in England were looked after. Care placements for looked after children and young people may include: foster placement (73%), residential accommodation (including secure units, children’s homes, and semi-independent living arrangements) (11%), placement with birth parents (6%), placement for prospective adoption (3%), another placement in the community (4%), or placement in residential schools or other residential settings (3%). For looked after children and young people only 29% of placements are long term and 50% of long-term teenage placements have been found to break down. Placement break-down is associated with poor outcomes for looked-after children and young people including educational and relational outcomes, and physical, mental, and emotional health and wellbeing.

The broad system of care offered by local authorities in the UK aims to support placement stability. For example, regular review meetings are held with looked after children and young people during which problems with the placement can be raised and extra support can be requested. In addition, looked after children are assigned individual social workers to provide direct one-to-one care. Additional interventions may also be offered, for example, carer training courses or peer support. However, there is uncertainty about which aspects of statutory and non-statutory care are found to be helpful and accessible by looked after children and young people, their carers and support providers, for supporting placement stability.

The aim of this review is to explore the barriers to, and facilitators for placement stability in looked-after children and young people as perceived by looked after children themselves, their carers, and support providers and to synthesise overarching themes that can highlight ways that placement stability can be improved.

SPIDER table

Table 1

SPIDER table for barriers and facilitators for supporting care placement stability among looked-after children and young people.

Methods and process

This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. For further details of the methods used see Appendix N. Methods specific to this review question are described in this section and in the review protocol in Appendix A.

The search strategies for this review (and across the entire guideline) are detailed in Appendix B.

Declarations of interest were recorded according to NICE’s 2018 conflicts of interest policy.

Qualitative evidence

Included studies

A single search was conducted to inform all of the review questions that formed part of this guideline. After removing duplicates, a total of 36,866 studies were identified from the search. After screening these references based on their titles and abstracts, 118 studies were obtained and reviewed against the inclusion criteria as described in the review protocol for barriers and facilitators for supporting care placement stability (Appendix A). Overall, 40 studies (39 original studies) were included (see Appendix D for full evidence tables).

Excluded studies

In total, 78 references were excluded because they did not meet the eligibility criteria. See Appendix J for a list of references for excluded studies, with reasons for exclusion.

Summary of studies included in the qualitative synthesis

Of the 40 included studies, there was an example of papers presenting the same population (Chase 2010, 2013). In this textual summary these two studies will be counted as one to prevent duplication of themes.

The number of participants ranged from four to 258 across all studies. A sufficient number of UK-based studies were identified, meaning that the review focussed on UK-based evidence alone. All studies were published after 2010.

The means of data collection in 21 studies used individual semi-structured interviews, in addition, 13 studies used focus group methodology. Five studies were less clear and simply referred to “in-depth interviews” with an additional study using an inductive “mosaic approach” with interview questions developed by participants.

Most studies were among children in care, broadly. However, four studies were among children in foster care and two among children in residential care, specifically. One study concerned children in care receiving drug and alcohol treatment, three studies considered sub-populations with mental health problems, three studies concerned unaccompanied asylum seekers, two studies considered trafficked children, two studies considered parents in care including one study considered black and ethnic minority mothers in care, one study considered those who are LGBTQ, and one study considered those with criminal involvement. A broad age range was included in most studies, however two studies considered looked after children (<11 years old) and 16 studies considered looked after young people (>11 years old), specifically. Twelve studies did not report the age of the looked after children considered, often where the perspectives of carers or support staff alone had been canvassed.

No studies focused on looked after children who were babies and young children, who were placed out of area, or with Special Educational Needs.

Further study characteristics are presented in table 2.

Table 2

characteristics of studies included in the qualitative synthesis for this review.

See Appendix D for full evidence tables

Summary of the qualitative findings included in the evidence review

Studies were critically appraised using the CASP qualitative study checklist. See appendix D for appraisal of individual studies.

Figure 1

Summary of the qualitative themes observed in this review.

Table 3

Summary of qualitative findings: barriers and facilitators for supporting care placement stability among looked-after children and young people.

See appendix F for full CERQual tables.

Economic evidence

Included studies

No existing economic studies were reviewed for this question given its focus on qualitative evidence.

Economic model

No economic modelling was undertaken for this review question.

The committee’s discussion of the evidence

Interpreting the evidence

The outcomes that matter most

The committee heard qualitative evidence from an original piece of qualitative work commissioned for NICE (see Appendix O); and several UK-based qualitative studies. The committee noted that qualitative evidence could not provide strong evidence of the effectiveness of any particular approach or intervention but rather could highlight the priorities, values, and perspectives of those involved in the care system as well as the perceived barriers and facilitators to successful care outcomes experienced by their carers and workers. Qualitative evidence could also help to answer the question of “how” interventions and statutory systems of care could be delivered, rather than “what” interventions or systems work best. The committee valued certain themes more highly if they had been derived from many studies or studies at lower risk of bias, if the meaning of the theme was unambiguous, and where themes had been drawn directly from looked after children and young people themselves (see below).

The quality of the evidence

The methodological quality of the studies included in this review were variable. Common reasons why qualitative evidence was marked down for quality included: unclear descriptions of the method of recruitment and selection of participants; unclear method of interview (for example, the topic guide used for semi-structured interview); unclear method of thematic analysis (for example, were multiple analysts used); and whether methods to validate findings were employed (for example, triangulation and respondent analysis). Some themes were marked down for quality where data had primarily come from studies with moderate or high risk of bias. In addition, certain themes were marked down for quality where few studies contributed to a theme, themes had become overly disparate (covering several subthemes), or there were contradictions in the direction of the theme.

The committee valued qualitative evidence that was direct from the population to which the recommendations would apply, that was recent, and particularly that was from the perspective of looked-after children and young people themselves. As such the qualitative evidence collected in this review was generally thought to be high quality since it was all UK-based, studies most commonly reported the perspective of looked after children and young people themselves, and all studies were published after 2010.

The qualitative work commissioned by NICE and performed by the University of Lancashire was considered the highest quality evidence since interview methods were tailored to address the review questions in this guideline, participants recruited into this study were also selected to provide a good cross-section across vulnerable groups of interest, and data was gathered very recently. In addition, this piece of work was rated high quality when assessed using CASP criteria (see evidence table for Larkins 2021, Appendix D).

Benefits and harms

UCLan qualitative work

Qualitative evidence was presented from the University of Lancashire with a particular focus on the barriers and facilitators to placement stability. The committee noted that there was significant overlap between the themes that arose in this review and the review question on positive relationships. The committee reflected that positive relationships were likely the best possible intervention to prevent placement instability. Themes that arose invoked the ideas of building trusting relationships, discussing and negotiating care plans, and consistent care which demonstrates an understanding of trauma. The committee considered an intervention that already exists in practice, that could help to address all of these issues: Life story work. Life story work had the potential to build relationships (one of the common qualitative themes was to do with sharing joint activities “doing things together”), was a trauma-focused technique, and could assist with discussing and negotiating care plans (by outlining felt priorities and experiences). However, life story work was considered neglected or poorly completed in practice. Therefore, the committee set out to establish a standard of life story work. This standard of life story work should be incorporated into a schedule of mandatory training for carers to equip carers for good quality work.

The committee initially discussed what life story work should consist of. The need for this work to take place in the context of a safe relationship was important. The committee recommended that life story work should consist of building a narrative that focuses first on the present (a young person’s identity, strengths, and any significant relationships); before moving onto the past (discussions of reasons for entering care in the first place); and finally turning thoughts to the future (discussions regarding building independence, hopes and dreams, and career plans). The committee then considered methods by which this may be achieved: techniques such as life mapping, use of pictures, art, written narratives, toys/play can be used to approach these discussions which should be compiled in one place (e.g. a ring binder) and built upon during regular life story sessions. As with other recommended interventions, the committee felt the approach should be flexible depending on the needs and response of the looked after person and should be a shared experience, in a setting preferred by the looked after person.

Considering those from subgroups of special interest also, the committee discussed the role that life story work could play in cultivating a positive self-image and identity, i.e. one that embraces the looked after child or young person’s ethnic, cultural or religious differences, as well as sexual identity and disabilities.

The committee also considered the occasions in which life story work may involve more persons present than the practitioner and the looked after person. The example of sibling relationships was raised, and about how at times it may be useful to perform life story work with siblings as a pair (for example, siblings may have had very difference perspectives of previous shared life events that need to be reconciled). The committee recommended that shared life story work should be carefully considered and planned to ensure the sibling relationships were not destabilised in the process. Particularly for complex situations such as these, the committee recommended that life story work should always have social work oversight, despite recognising that the work is not always performed by the social worker themselves.

In addition, the committee considered that the network around looked after children and young people comprised a community that needed to be primed to support ongoing life story work. As such, the idea of life story work and its importance needed to be expressed to the social work team, carers, educational staff, and birth family. This may be important so that broader social networks can be engaged in the work, for example, where sensitive or emotional information has been discussed with the child or young person during life story work, schools may need to be informed to be supportive. Likewise, involving birth families to encourage consistent narratives and reframing of previous events.

Finally, the committee made a recommendation regarding the prioritisation of life story work. As discussed previously, the committee felt that this intervention, despite being recommended, had been neglected in practice. Often only starting late into the care process and being poorly invested in. The reasons for this may be numerous - while there may be lack of professional time to devote to the work, it was possible for other significant adults with fewer time pressures to take on life story work. However, poor training and lack of understanding of the importance of life story work in others who may be expected to carry out the work (for example, foster carers) may obstruct good quality, impactful work. The committee discussed the importance of time for life story work being clearly set aside, with a named professional to ensure it happens, and for it to begin at the earliest opportunity following entry into care.

Qualitative findings from the University of Lancashire were clear about the importance of shared decision making. As part of this, a strong theme that emerged was that needs and priorities of carers are laid out transparently to the looked after person to help them make their own decisions. For example, the committee discussed occasions where an option for a new placement was being “dressed up” as great opportunity, when in reality the young person was being nudged into the placement due to financial pressures for the local authority, or because the foster carer had decided to terminate the placement. Rather, the committee recommended that reasons for placement breakdown should be discussed with emotional support and be built into ongoing life story work with accessible and age-appropriate communication.

Qualitative review work RQ1.2

The committee considered themes arising from the qualitative review of barriers and facilitators for placement stability. A moderate quality themes covered the desire for carers to be treated more like professionals. There was a perceived lack of agency/ and inclusion in input & information sharing as professionals for foster carers. The opposite was valued. As such the committee made a recommendation that carers should be valued as professionals and included as much as possible in multiagency working and decision making since they may have the most intimate knowledge of the looked after person.

Another moderate quality theme was the usefulness of peer support between carers, carers benefitted from the companionship, mutual support and problem-solving, that peer groups provided. Therefore, a recommendation was made that peer group support for carers should be facilitated by local authorities, and be regularly made available and accessible.

One moderate quality theme outlined the problem of resource constraints, stretched services, information gaps, and reactive care. Carers were often unaware of the different services available for support by the local authority, and therefore felt as though certain services had been kept hidden in an attempt to save costs. The committee therefore recommended that carers should be informed and updated about the support services available e.g. given a “menu” of support upfront, and prior to the beginning of placement, as this would enable them to negotiate the support needed for their placement, as well as empower them to act on a more equal footing with professionals.

Lastly, another moderate qualitative theme described how carers and looked after children and young people particularly valued care that was available, accessible, and reliable. As such, carers felt the benefit of knowing that support was available even out of hours for urgent problems, as a kind of “safety net”. The committee therefore recommended that local authorities make available out of hours support in helping carers deal with urgent problems that arise. However, the committee recognised that there was a need for any help sought outside of usual hours to be fed back into the care records so that the whole team could be aware; therefore the committee recommended that carers log any help sought outside of usual operational hours as part of their routine and urgent reports.

Cost effectiveness and resource use

No economic evidence was considered in relation to this review question given its focus on qualitative evidence. Overall, the committee felt that there was insufficient evidence of effectiveness from the quantitative evidence review (review question 1.1) in relation to costs to recommend any specific interventions for placement stability. However, the committee noted that in the short term, placement breakdown leads to increased social care case management work and the need for additional placement arrangements, some of which will be high-cost emergency placements. In addition, placement instability can contribute to further disruption of LACYP’s social and emotional relationships, sense of belonging and educational outcomes, with long-term consequences that were not captured in randomised controlled trials. Therefore, the committee made recommendations based on both the quantitative and qualitative evidence presented and discussed any expected cost impacts using their knowledge of the care system.

The committee discussed the importance of recognising carers as professionals and recommended that they be included in decision making and fully informed of all important information regarding the child they care for. Additionally, the committee recommended that carers be fully informed of any support services available to carers and LACYP within their local authority. It is unlikely that this recommendation will have a substantial resource impact, as its implementation would only require additional content to be communicated to carers.

The committee recommended that out of hours support should be available for carers and LACYP in the case of urgent issues. The committee discussed a range of possible ways in which out of hours support could be provided in order to allow local authorities to use a system that works best for them - both logistically and financially. One option was that out of hours support would consist of an “on-call” social worker. The committee noted that this would require a contract change for social workers, but agreed that it would be feasible to reallocate existing staff time from regular work hours to out-of-hours work. This contract change and reallocation would likely have cost implications but the committee felt that having social worker availability for these emergency situations would allow for serious issues to be addressed, and may avoid significant costs associated with those emergencies (e.g. self-harm, hospitalisation, placement breakdown, justice system costs).

The committee recommended that local authorities should facilitate accessible peer support for carers, for example hosting community groups or online forums. These community groups or forums would likely be peer-led and although there will be some costs to the local authority associated with setting up and monitoring these groups, the costs would be minimal and the benefits of this peer support are likely to outweigh the cost.

UCLan qualitative work

The committee heard qualitative evidence from the University of Lancashire with a focus on barriers and facilitators to placement stability, and made recommendations based on the findings presented. Since these recommendations were made without economic evidence, the committee used their knowledge and expertise to provide input on their expected resource impact.

The committee recommended that priorities and needs should be discussed transparently with the LACYP and that communication should be accessible and age-appropriate. This recommendation is not anticipated to have any resource impact as opportunities for this communication already exist in current practice.

The committee discussed multiple recommendations around life story work, which is mandated by statutory guidance for all LACYP with a plan for adoption and is already current practice, and these recommendations can be integrated into the process to improve how life story work is done. For example, the committee recommended that life story work should be prioritised and start at the earliest opportunity, which would simply require the professional/person conducting this work to initiate it soon after the LACYP enters care. The committee also recommended that life story work should support care placement and emotional stability, which are aspects of life story work that should be best practice and included in any training that the professional/person conducting this work would receive. Another recommendation made was that life story work should be considered when planning contact arrangements, which could easily be integrated into current practice by keeping the child’s social worker informed of any important issues that may affect contact.

The committee recommended that training also be provided for the professionals/people conducting life story work (e.g. carers, social workers) where necessary to ensure a consistent approach. This training would not be associated with a resource impact as it could be incorporated into existing training frameworks and draw on materials that are freely available. The committee acknowledged that this may require another area of the existing training frameworks to be altered or removed, however given life story work is mandated by statutory guidance, the committee believed that training for appropriate delivery should be prioritised. Adjustments required to incorporate life story work considerations into existing training frameworks may also incur some administrative costs, but these were thought to be minimal and would be outweighed by the increased benefits achieved from the improved delivery of life story work to all LACYP. The committee also recommended that a social worker should oversee any life story work, even in cases where it is being conducted by another professional. Such an approach is anticipated to have minimal resource implications, as it is already current practice for life story work to be conducted by a social worker or in cases where another professional is leading the work, a social worker would simply need to be informed of the content of the life story work being conducted.

This evidence review supports recommendations 1.3.1 to 1.3.3, 1.3.12, 1.2.18, 1.5.15 to 1.5.25. Other evidence supporting these recommendations can be found in the evidence reviews on the effectiveness of health and social care interventions and approaches to support care placement stability [evidence review A]

Recommendations 1.3.1 to 1.3.3, 1.3.12, 1.2.18, 1.5.15 to 1.5.25

1.3.1.: Involve and value the carer’s input in decision-making in the broader care team, and keep the carers fully informed about a child or young person’s care plan.

1.3.2.: Provide out-of-hours support services for carers to help resolve urgent problems, for example through social workers working ‘on call’, voluntary or independent agency helplines, or carer peer support associations. Ensure that carers log any help sought outside of usual operational hours as part of their routine and urgent reports.

1.3.3.: Facilitate peer support for carers at accessible times and places, including online if people may find it difficult to attend a physical meeting.

1.2.18.: Discuss the priorities and needs, of caregivers sensitively and transparently with the looked-after person in a manner that takes into account the looked after child or young personperson’s developmental age. For example, if placements are at risk of breakdown, social workers should facilitate communication between the carers and the looked-after person (and birth parents if relevant) to try to resolve problems.

1.5.15.: Start life story work as soon as possible after the looked-after child or young person enters care to support care placement and emotional stability, rather than as an intervention to deliver once placements are stable.

1.5.16.: Schedule regular, dedicated times for life story work to help the child or young person make sense of their journey through the care system and beyond, their significant relationships, and their identity.

1.5.17.: Ensure that life story work is done in the setting preferred by the looked-after child or young person, and conducted by a named carer or practitioner with whom they have a continuous and close relationship. This named person may change over the period in care.

1.3.12.

Provide a schedule of mandatory training for all carers. This should cover:

Life story work to promote a positive self-identity, which has a consistent, child-focused, and planned approach (see recommendations 1.5.15 to 1.5.25).

1.5.21.: Ensure that a social worker oversees the life story work if another carer or practitioner is carrying out the work. For example, the social worker may share background information to support the carer or practitioner performing life story work, with the looked-after child or young person’s consent.

1.5.18.

Include the following in life story work:

the present – identity, strengths, and significant relationships
the past – reasons for entering care and for any placement breakdowns, important memories and relationships
the future – building independence, careers, hopes and dreams.

1.5.19.: Take a flexible approach to life story work, and tailor it to the age and needs of the looked-after child or young person. The content could include life mapping, pictures, art, narratives, and toys or play. Compile life story work in 1 place (such as a ring binder) and build on this in each session.

1.5.20.: Ensure that life story work captures and embraces ethnicity, cultural and religious identity, as well as other personal aspects of identity, for example, sexual identity or disabilities.

1.5.22.

Think about and plan how to carry out life story work with sibling groups in a manner appropriate to developmental age. This may include:

preparing siblings for navigating conversations with older siblings or siblings not in care
deciding whether it is appropriate to deliver life story work sessions in a sibling group or individually
determining whether conversations will include sensitive information.

1.5.23.: Ensure the experience and skillset of the practitioner or carer delivering life story work is sufficient to deliver good quality work, particularly in complex situations.

1.5.24.: Explain to the looked-after child or young person’s wider support network that life story work is ongoing, so that they can support it as needed. For example, if sensitive or emotional information has been discussed with the child or young person during life story work, schools may need to be informed.

1.5.25.: Plan regular reviews of how life story work may affect contact arrangements and the person’s relationship with their birth family. Use information from these reviews to adjust the support provided. This could include, for example, involving birth families in life story work to encourage consistencies in narratives explored, and helping the young person with reframing previous relationships.

References – included studies

Qualitative evidence

Alderson H.; Brown R.; Copello A.; Kaner E.; Tober G.; Lingam R.; McGovern R.; The key therapeutic factors needed to deliver behavioural change interventions to decrease risky substance use (drug and alcohol) for looked after children and care leavers: a qualitative exploration with young people, carers and front line workers; BMC medical research methodology; 2019; vol. 19 (no. 1); 38 [PMC free article: PMC6385417] [PubMed: 30791874]
Berridge, David; The education of children in care: Agency and resilience.; Children and Youth Services Review; 2017; vol. 77; 86–93
Brewin, Marnie; Statham, June; Supporting the transition from primary school to secondary school for children who are looked after.; Educational Psychology in Practice; 2011; vol. 27 (no. 4); 365–381
Brown R.; Alderson H.; Kaner E.; McGovern R.; Lingam R.; “There are carers, and then there are carers who actually care”; Conceptualizations of care among looked after children and care leavers, social workers and carers; Child Abuse and Neglect; 2019; vol. 92; 219–229 [PubMed: 31005828]
CHASE Elaine; Agency and silence: young people seeking asylum alone in the UK; British Journal of Social Work; 2010; vol. 40 (no. 7); 2050–2068
Chase, Elaine; Security and subjective wellbeing: the experiences of unaccompanied young people seeking asylum in the UK.; Sociology of health & illness; 2013; vol. 35 (no. 6); 858–72 [PubMed: 23301783]
DIAZ, Clive; PERT, Hayley; THOMAS Nigel, Patrick; Independent reviewing officers’ and social workers’ perceptions of children’s participation in children in care reviews; Journal of Children’s Services; 2019; vol. 14 (no. 3); 162–173
DIAZ, Clive and AYLWARD, Tricia (2019) A study on senior managers’ views of participation in one local authority…a case of wilful blindness?. British Journal of Social Work 49(5): 1333–1349
Dodsworth, Jane; et al; Internet technology: an empowering or alienating tool for communication between foster-carers and social workers?, IN British Journal of Social Work, Vol 43 No 4 Jun 2013; 2013
Evans, Rhiannon; Hallett, Sophie; Rees, Alyson; Roberts, Louise; The acceptability of educational interventions: Qualitative evidence from children and young people in care.; Children and Youth Services Review; 2016; vol. 71; 68–76
Fargas-Malet, Montserrat; McSherry, Dominic; The mental health and help-seeking behavior of children and young people in care in Northern Ireland: Making services accessible and engaging.; British Journal of Social Work; 2018; vol. 48 (no. 3); 578–595 Fargas-Malet, Montserrat; McSherry,
Francis, Yvonne J; Bennion, Kim; Humrich, Sarah; Evaluating the outcomes of a school based Theraplay project for looked after children.; Educational Psychology in Practice; 2017; vol. 33 (no. 3); 308–322
Franklin, Anita; Doyle, Lisa; Still at risk: a review of support for trafficked children; 2013
GASKELL Carolyn; ‘If the social worker had called at least it would show they cared’. Young care leaver’s perspectives on the importance of care; Children and Society; 2010; vol. 24 (no. 2); 136–147
Groark, Claire; Sclare, Irene; Raval, Hitesh; Understanding the experiences and emotional needs of unaccompanied asylum-seeking adolescents in the UK.; Clinical child psychology and psychiatry; 2011; vol. 16 (no. 3); 421–42 [PubMed: 21317184]
Griffiths, Rose; The Letterbox Club: An account of a postal club to raise the achievement of children aged 7 to 13 in foster care.; Children and Youth Services Review; 2012; vol. 34 (no. 6); 1101–1106
Hiller, R.M.; Halligan, S.L.; Meiser-Stedman, R.; Elliott, E.; Rutter-Eley, E.; Supporting the emotional needs of young people in care: A qualitative study of foster carer perspectives; BMJ Open; 2020; vol. 10 (no. 3); e033317 [PMC free article: PMC7066644] [PubMed: 32161157]
HOOLEY Kate; STOKES Laura A.; COMBES Helen; Life story work with looked after and adopted children: how professional training and experience determine perceptions of its value; Adoption and Fostering; 2016; vol. 40 (no. 3); 219–233
KIRTON Derek; THOMAS Cliff; A suitable case? Implementing multidimensional treatment foster care in an English local authority; Adoption and Fostering; 2011; vol. 35 (no. 2); 5–17
Larkins C; Creating our lives: hope and support for children and young people in care - Research for NICE: looked after children and young people’s perspectives on outcomes and interventions (not yet published)
LITTLECHILD Brian; Conflict resolution, restorative justice approaches and bullying in young people’s residential units; Children and Society; 2011; vol. 25 (no. 1); 47–58
MANTOVANI Nadia; THOMAS Hilary; Resilience and survival: black teenage mothers ‘looked after’ by the State tell their stories about their experience of care; Children and Society; 2015; vol. 29 (no. 4); 299–309
Nixon C.; Elliott L.; Henderson M.; Providing sex and relationships education for looked-after children: A qualitative exploration of how personal and institutional factors promote or limit the experience of role ambiguity, conflict and overload among caregivers; BMJ Open; 2019; vol. 9 (no. 4); e025075 [PMC free article: PMC6500194] [PubMed: 30975674]
Ni Raghallaigh, Muireann; Sirriyeh, Ala; The negotiation of culture in foster care placements for separated refugee and asylum seeking young people in Ireland and England.; Childhood: A Global Journal of Child Research; 2015; vol. 22 (no. 2); 263–277
November, Lucy; Sandall, Jane; “she was accused of colluding with the mother”; the training and support needs of parent-and-child foster carers: A qualitative study.; Child & Family Social Work; 2020; no-specified
Oke, Nicholas; Rostill-Brookes, Helen; Larkin, Michael; Against the odds: foster carers’ perceptions of family, commitment and belonging in successful placements.; Clinical child psychology and psychiatry; 2013; vol. 18 (no. 1); 7–24 [PubMed: 22104365]
PEARCE Jenny J.; Working with trafficked children and young people: complexities in practice; British Journal of Social Work; 2011; vol. 41 (no. 8); 1424–1441
Pert, Hayley; Diaz, Clive; Thomas, Nigel; Children’s participation in LAC reviews: A study in one English local authority.; Child & Family Social Work; 2017; vol. 22 (no. suppl2); 1–10
Quarmby, Thomas; Sport and physical activity in the lives of looked-after children: A ‘hidden group’ in research, policy and practice.; Sport, Education and Society; 2014; vol. 19 (no. 7); 944–958
Ridley, Julie; Larkins, Cath; Farrelly, Nicola; Hussein, Shereen; Austerberry, Helen; Manthorpe, Jill; Stanley, Nicky; Investing in the relationship: Practitioners’ relationships with looked-after children and care leavers in Social Work Practices.; Child & Family Social Work; 2016; vol. 21 (no. 1); 55–64
Roesch-Marsh, Autumn; Gillies, Andrew; Green, Dominique; Nurturing the virtuous circle: Looked after children’s participation in reviews, a cyclical and relational process.; Child & Family Social Work; 2017; vol. 22 (no. 2); 904–913
SAMRAI Amandeep; BEINART Helen; HARPER Peter; Exploring foster carer perceptions and experiences of placements and placement support; Adoption and Fostering; 2011; vol. 35 (no. 3); 38–49
Schofield, Gillian; Biggart, Laura; Ward, Emma; Larsson, Birgit; Looked after children and offending: An exploration of risk, resilience and the role of social cognition.; Children and Youth Services Review; 2015; vol. 51; 125–133
SCHOFIELD, Gillian; et al; Providing a secure base for LGBTQ young people in foster care: the role of foster carers; Child and Family Social Work; 2019; vol. 24 (no. 3); 372–381
Sen, Robin; McCormack, Jess; Foster carers’ involvement in contact: Other professionals’ views.; Practice: Social Work in Action; 2011; vol. 23 (no. 5); 279–292
SIDERY Abigail; Fostering unaccompanied asylum seeking young people: the views of foster carers on their training and support needs; Adoption and Fostering; 2019; vol. 43 (no. 1); 6–21
Thomas, Nigel; Percy-Smith, Barry; ‘It’s about changing services and building relationships’: Evaluating the development of children in care councils.; Child & Family Social Work; 2012; vol. 17 (no. 4); 487–496
Thompson, Hayley; McPherson, Susan; Marsland, Louise; ‘Am I damaging my own family?’: Relational changes between foster carers and their birth children.; Clinical child psychology and psychiatry; 2016; vol. 21 (no. 1); 48–65 [PubMed: 25319872]
VALENTINE, Deborah; MACCALLUM, Fiona; KNIBBS, Jacky (2019) When carers end foster placements: exploring foster carers’ experience of adolescent foster placement breakdown. Adoption and Fostering 43(4): 445–460
Wadman R.; Armstrong M.; Clarke D.; Harroe C.; Majumder P.; Sayal K.; Vostanis P.; Townsend E.; Experience of Self-Harm and Its Treatment in Looked-After Young People: An Interpretative Phenomenological Analysis; Archives of suicide research : official journal of the International Academy for Suicide Research; 2018; vol. 22 (no. 3); 365–379 [PubMed: 28786765]
York, W; Jones, J; Addressing the mental health needs of looked after children in foster care: the experiences of foster carers.; Journal of psychiatric and mental health nursing; 2017; vol. 24 (no. 23); 143–153 [PubMed: 28124485]

Appendices

Appendix E. Forest plots

No forest plots were produced for this review question as meta-analysis was not attempted.

Appendix F. CERQual tables

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Appendix G. Economic evidence study selection

This question was not considered in the review of existing economic studies given its focus on qualitative evidence.

Appendix H. Economic evidence tables

No economic evidence was identified for this review question.

Appendix I. Health economic model

No economic modelling was undertaken for this review question.

Appendix J. Excluded studies

Table

- no methods described - Not a peer-reviewed publication

Appendix K. Research recommendations – full details

Research recommendation

No research recommendations were drafted for this review question

Appendix L. References

Other references

None

Appendix M. Other appendix

No additional information for this review question.

Final

Evidence reviews underpinning recommendations 1.2.23, 1.3.1 to 1.3.4, 1.3.13, 1.5.22 to 1.5.33

These evidence reviews were developed by NICE Guideline Updates Team

Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.

Bookshelf ID: NBK575860PMID: 34941232

Table 1SPIDER table for barriers and facilitators for supporting care placement stability among looked-after children and young people

Type of review	Qualitative evidence synthesis
Sample (S)	Looked after children and young people, wherever they are looked after, from birth until age 18 and their families and carers (including birth parents, connected carers and prospective adoptive parents). Also including: Children and young people living at home with birth parents but under a full or interim local authority care order and are subject to looked-after children and young people processes and statutory duties. Children and young people in a prospective adoptive placement. Looked-after children and young people on remand, detained in secure youth custody and those serving community orders.
Phenomenon of Interest (PI)	Barriers and facilitators for supporting care placement stability, including the statutory support offered for looked after children and young people.
Design (D)	Systematic reviews of included study designs Qualitative studies: including focus groups, unstructured, and semi-structured interview-based studies (mixed-methods studies will also be included provided they contain relevant qualitative data)
Evaluation (E)	Evidence should relate to views concerning barriers and facilitators for placement stability in looked after children and young people, among: Looked after children and young people themselves Carers of looked after children and young people Other support workers providing and accessing support for placement stability With a focus on: Experience of support for placement stability and accessing this support Unintended consequences
Research type	Qualitative or mixed methods where relevant qualitative data is presented
Search date	1990
Exclusion criteria	Countries outside of the UK (unless not enough evidence, then progress to OECD countries) Studies older than the year 2010 (unless not enough evidence, then progress to include studies between 1990 to current) Studies including mixed populations (i.e. looked after and non-looked after children) without reporting results separately for LACYP Mixed-methods studies reporting qualitative data that cannot be distinguished from quantitative data.

Table 2characteristics of studies included in the qualitative synthesis for this review

Study (country)	LACYP population (age)	Setting and context	Methods	Perspectives (n)
Alderson 2019 (UK)	Looked after children who have experienced receiving drug and alcohol treatment interventions and/or LAC accessing other services for support surrounding ‘help seeking’ behaviour. (age 12 to 20 years)	Taking part in an RCT of a behavioural change intervention to reduce risky substance use	Individual 1:1 semi-structured interviews with looked after children focus groups with professional participants. Thematic analysis was used.	Looked after children (19), carers (17), drug and alcohol workers (8), social workers (8)
Berridge 2017 (UK)	Children in care between the end of Key Stage 2 to end of Key Stage 4 (11–16 years of age).	Secondary school in England	Semi-structured interview data was analysed using a thematic approach.	Adolescents (26), social workers (17), Foster carers (17), residential worker (1), Teachers (20)
Brewin 2011 (UK)	Children who are looked after in one borough in Wales, on roll at a school within the local authority and about to make, or have recently made, transition into secondary school (age 9 – 12 years)	Looked after children in a semi-rural borough in Wales	Semi-structured interviews and thematic analysis using “framework analysis”	Child interviews (14), Foster carers (22), Teachers (19) Looked After Children Education Support Officers (3), and a social worker focus group
Brown 2019 (UK)	Looked after children (aged between 12 and 20 years)	Four local authorities in North-East England	Semi-structured interviews, dyad interviews, and focus group interviews. Thematic analysis was used.	Looked after children (19), Carers (17), Social workers (8)
Chase 2010/2013 (UK)	Unaccompanied asylum seekers (aged 9 – 17 years)	Local authorities in London.	In-depth interviews and thematic analysis	Unaccompanied asylum seekers (54)
Diaz 2019a (UK)	Looked after children (ages not reported)	One English local authority	Semi-structured interviews and thematic analysis	Independent Review Officers (8) and Social Workers (11)
Diaz 2019b (UK)	Looked after children (ages not reported)	One English local authority	Semi-structured interviews and thematic analysis	Social worker senior managers (7)
Dodsworth 2013 (UK)	Looked after children in foster care (age not reported)	Three authorities in England: a rural county that includes the county town, a city unitary authority and a London borough	Separate focus group discussions for foster carers and social workers, thematic analysis was used.	Foster carers (27 and social workers (18)
Evans 2016 (UK)	Looked after children and young people or those with prior experience of being in care and education (16 – 27 years old)	Wales. Participants were purposively sampled though The Fostering Network.	Focus groups with semi-structured interviewing and thematic analysis was conducted.	Looked after young people (26)
Fargas-Malet 2018 (UK)	Children and young people in care (age not reported)	Northern Ireland, foster, kinship, and residential care.	Focus group interviews, semi-structured interviews, and thematic analysis.	Carers (foster, kinship and residential) (233); interviews with young people (25); and multidisciplinary focus group interviews with professionals across the HSC Trusts.
Francis 2017 (UK)	Looked after children who would benefit from additional psychological support (5 to 11 years)	Looked after children referred from nine primary schools in an English local authority (Leicester)	Semi-structured interviews and thematic analysis.	Looked after children (20)
Franklin 2013 (UK)	Young people who were trafficked which children and became looked after (age 15 to 23 years)	Voluntary organisations supporting trafficked children	Semi-structured interviews with trafficked children and telephone interviews with stakeholders. Thematic analysis was used.	Looked after children (17), representatives from six local authorities (social care managers and front line social workers) (9), solicitors (welfare and immigration) (2) and voluntary sector staff (front-line workers with direct experience of supporting trafficked/suspected trafficked children) (7)
Gaskell 2010 (UK)	Looked after young people (age not reported)	Inner London Local Authority. All young people were also service users of a London-based children’s charity.	Interviews and thematic analysis	Looked after young people (10)
Griffiths 2012 (UK)	Children in care (aged 7 to 11 years)	Three different UK local authorities. Participants took part in the Letterbox club intervention.	Semi-structured interviews. Unclear how data was analysed.	Children (4) and foster carers (4) for Letterbox Red and Blue in 2009, and with children (6) and their foster carers (6) for Letterbox Green in 2011
Groak 2011 (UK)	Unaccompanied asylum seekers (aged 16 to 18 years)	An inner-city borough in the UK	Semi-structured interviews and Interpretative Phenomenological Analysis (IPA) were used.	Unaccompanied asylum seekers (6)
Hiller 2020 (UK)	Looked after children in foster care (age not reported)	One local authority in England	Convenience sampling was used. Data from focus groups was analysed thematically.	Foster carers (21)
Hooley 2016 (UK)	Looked after children receiving life story interventions (age not reported)	Health and social care agencies with experience of life story work	Q-methodology for ranking qualitative statements and a focus group with thematic analysis.	Clinical psychologists (7), other therapists (2), social work professionals (6), foster carers (11), adoptive parents (5), care leavers (4)
Kirton 2011 (UK)	Looked after children involved with an evaluation of multidimensional treatment foster care (most were aged 13 or older)	Local evaluation of MTFC within one of the pilot local authorities.	Semi-structured interviews. Unclear how data was analysed).	Foster carers (8), children’s social workers (6), supervising social workers (2), individual therapists, birth family therapists, skills workers (3), social work assistants, programme supervisor (1), programme manager (1), members of the management board (4)
Larkins 2021 (UK)*	Looked after children and care leavers (aged 6 to 17)	Three local authorities in the UK.	Creative methods and thematic interview schedules were developed in consultation with a steering group of young researchers who were LAC. All fieldwork activities were audio recorded and transcribed verbatim. A hybrid approach of inductive and deductive thematic analysis with a framework analysis approach was used. Data was listened to, read, looked at and reviewed by multiple researchers, young researchers and GUC members.	Perspectives of looked after children and care leavers (47)
Littlechild 2011 (UK)	Looked after children in residential care (13 to 17 years of age)	Four residential young people’s units in a local authority involved with an evaluation of restorative justice methods	Semi-structured interviews with young people and focus groups with residential care staff	Residential care staff (33), young people in residential care (8)
Mantovani 2015 (UK)	Mothers in care or having left care with black minority ethnicity (aged 16 to 19 years old)	Three London Local Authorities (LAs) selected for their geographical diversity, reported rates of teenage pregnancy and their high concentration of black minority groups.	In-depth unstructured interviews and thematic analysis.	Looked after mothers in care (15)
Nixon 2019 (UK)	Looked after children (age not reported)	Social services, residential children’s homes and foster care. All caregivers were recruited from a large urbanised local authority in Scotland.	Semi-structured interviews with thematic analysis.	Foster and residential care givers (22)
Ni 2015 (UK)	Unaccompanied asylum seekers (13 to 18 years old)	Four Local Authorities in England	Three focus groups with thematic analysis	Foster carers (23), Young people in their care (19), social workers (4) children’s asylum team managers (4)
November 2020 (UK)	Parents in care (age not reported)	Parent-and-child foster placements across England	Semi structured interviews and focus groups. Snowball sampling was used. Thematic analysis was used with multiple analysts.	Parent and child carers (32) Mothers in care (8) Supervising social workers (9)
Oke 2013 (UK)	Adolescents in care stable in a placement despite previous expectations (aged 12 to 17 years old)	One local authority in the UK	Semi-structured interviews with thematic analysis	Foster carers (7)
Pert 2017 (UK)	Looked after children and young people in foster care (aged 8 to 17 years)	One local authority in England	In-depth interviews and thematic analysis	Looked after children and young people (25) foster carers (16)
Pearce 2011 (UK)	Trafficked children and young people (age not reported)	Three research sites in the UK selected to reflect geographical areas with different proximities to international airports	Focus groups and semi-structured interviews with thematic analysis and triangulation with case records.	Social workers (22); Specialist children’s NGO’s and separated children/asylum workers (12); Police, Crown Prosecution Service staff, Youth Offending Team workers and staff from the UK Boarders Agency (11); residential childcare and statutory children’s centre workers (10); health workers (10); and education workers (7).
Quarmby 2014 (UK)	Looked after children in residential care (aged 12 to 17 years)	One residential home in England	A “mosaic approach”: a participatory, multi-method approach whereby young people’s own research artefacts (photographs, maps, drawings, etc.,) were joined to interview responses and observations. Interview questions were developed in collaboration with the participants.	Looked after children in residential care (4)
Roesch-Marsh 2017 (UK)	Looked after children attending reviews in the study period (aged 12 to 18 years old)	Scotland	Mixed methods. Survey questionnaires and “qualitative interviews”. Individual interviews with young people and a focus group with the independent reviewing officers. Thematic analysis was used.	Looked after young people (10) Independent Review Officers (5)
Ridley 2016 (UK)	Looked after children and care leavers (aged 7 to 23 years)	Participants in the pilot evaluation of Independent Social Work Practices (SWPs), England.	Semi-structured interviews with thematic analysis.	Looked after children and care leavers (169)
Samrai 2011 (UK)	Looked after children in foster care (age not reported)	One English local authority (Midlands)	Semi-structured interviews and thematic analysis (using grounded theory)	Foster carers (8)
Sen 2011 (UK)	Looked after children (age not reported)	One large urban Scottish local authority	Semi-structured interviews and focus groups with thematic analysis	Social work professionals (19) reporters to the Children’s Hearing system (3)
Schofield 2015 (UK)	Looked after children in contact with the youth justice system; and looked after children without involvement in the justice system (aged 15 to 17 years)	Four UK local authorities	Semi-structured interviews with thematic analysis	Looked after children offenders (33), looked after children non-offenders (35)
Sidery 2019 (UK)	Unaccompanied asylum seekers (age not reported)	a semi-rural county in the South West of England with a considerably lower level of ethnic diversity than the national average	Semi-structured interviews with thematic analysis.	Foster carers (11)
Thomas 2012 (UK)	Looked after young people involved in Children in Care Councils (age not reported)	Boroughs around the city of London involved with the development of Children in Care Councils	Semi-structured interviews and focus groups. Unclear how data was analysed.	Looked after young people (10), participation workers (4), managers (4) and elected members (3)
Thompson 2016 (UK)	Looked after children and young people at homes with birth children (age not reported)	one UK foster agency only	Semi-structured interviews. Thematic analysis was undertaken using grounded theory.	Foster carers (9)
Valentine 2019 (UK)*	Looked after children in foster care (child’s age at breakdown was 13 - 18)	foster carers from three fostering organisations where the placement had broken down	Semi-structured interviews. Interpretative Phenomenological Analysis (IPA) was used for thematic analysis.	Foster carers (7)
Wadman 2018 (UK)	Young people with experience of living in care who have self-harmed in the previous 6 months (age 11 to 21 years)	Foster homes or residential homes in the East Midlands	Semi-structured interviews. Interpretative Phenomenological Analysis (IPA) was used for thematic analysis.	Looked after young people (16), care leavers (8)
York 2017 (UK)	Looked after children in foster care with mental health difficulties (age not reported)	A single, inner city, local authority in England	Semi-structured interviews and thematic analysis using a grounded approach.	Foster carers (10)

Figure 1Summary of the qualitative themes observed in this review

Table 3Summary of qualitative findings: barriers and facilitators for supporting care placement stability among looked-after children and young people

Themes

illustrative quotes

Studies

CERQual concerns

CERQual explanation

Detrimental and broad impact of placement moves

Detrimental impact of placement moves and history of placement moves on educational, emotional, mental health, and relational stability. Stability may also improve participation in care processes. Placement breakdown can have an emotional toil on carers also.

“So they might, you know, have contact with their brothers or sisters, you know, it is just they get moved around, and when they are moved around they are vulnerable, they are desperate to have friends or they are desperate to have somebody to call their own…… people get attracted to them who are, I would say, not the type of kids I would want my kids to knock around with” FC

“I′d say that the most important thing is to make sure that there is stability in the young person’s life because moving around a lot affects their education… I think there should be something in a young person’s life that stays the same so whether that be the social worker, or the school, or the placement. [Participant M04] Yeah I found obviously moving around schools a lot, because I moved from Wales to England and it was like during that transition of like for a year I was out of education so I was playing a catch-up game, always like right the way up through school until I left, I was always trying to catch up.” LACYP

“I was lucky, I didn’t move that much. It’s the moving that messes kids up. My brothers and sister have been in the same place the whole time. They were even luckier, they got a foster mum who really wanted them, and they’ve stayed.” LACYP

ML: No concerns

C: No concerns

A: No concerns

R: No concerns

Overall:

High

Some studies were marked down for ML primarily for poor or limited reporting of their methods and indirectness. However, theme was reflected in low risk of bias and direct evidence also.

Peer support for carers

Carers benefitted from mutual support and problem-solving among peer groups. And from engaging wider social networks e.g. family. Use of internet systems could help connect social workers and broader foster parent groups. Specialist peer support groups could be particularly useful for carers in specialist placements (e.g. unaccompanied asylum seekers and parent-and-child placements)

“We deal with it pretty well, but I think with this wee core group of carers that we’ve got there’s always an opportunity for learning… ‘I’ve tried to get this boy to do his bloody homework and he just will not do it’ and somebody will say ‘try this’ and you find that it works. That’s where our support is… from other carers in our group. We bounce off each other” FC

“My support network is my friends who are foster carers, not necessarily in this borough (area). They can be a good source of help and more information like if you’re in a crisis or not sure what to do. Your ordinary friends who don’t do what you do have no idea, they wouldn’t relate. (Anna) There is the group and some of us have already made friends any way so we can just call each other and that is very good. My cousin, she is also a foster carer and so we’re also there for each other” FC

Medforth 2019

ML: No concerns

C: Minor

A: No concerns

R: No concerns

Overall:

Moderate

Some studies were marked down for ML primarily for poor or limited reporting of their methods. However, theme was reflected in low risk of bias evidence also. There was minor cases of incoherence or contradiction across studies contributing to this theme.

Resource constraints, high case load, lack of funding led to stretched services, information gaps, and reactive not responsive care (“fire-fighting”).

Resource constraints, high case load, lack of funding led to stretched services, information gaps, and reactive not responsive care (“fire-fighting”). Lower caseloads led to more direct care. Foster carers reported having to fight for resources e.g. an allocated social worker, respite care, or other placement support services. Carers felt that they were not informed of all services available upfront for support. Voluntary organisations were turned to too fill in the gaps left in statutory care.

“‘Young people are not properly protected because of social workers’ high case loads. Social workers don’t have time to do their job properly” SW

“We no longer work as a social worker, we work as an admin officer” SW

“But I think the difficulty, [is] we are “statutories” [statutory organisation employees], I think people and voluntary organisations who don’t have the same kind of “stat limits” can give that more consistent care and support to a teenager [which] is really important. Because as much as we want to, we can’t do it.” SW

“… other agencies often use us as their extra resource … they will recognise the young people in care have gone missing and will let us know and we then spend all our time running around looking for things that we shouldn’t be doing really.” Voluntary sector worker with trafficked children

ML: No concerns

C: Minor

A: No concerns

R: No concerns

Overall:

Moderate

Some studies were marked down for ML primarily for poor or limited reporting of their methods. However, theme was reflected in low risk of bias evidence also. There was some incoherence across studies contributing to this theme e.g. resource constraints were felt to be a problem across the board, however, this manifested in a variety of ways described by included studies. Also studies often did not link these problems directly to placement stability.

Foster carers treated as professionals

Lack of agency/ input/ inclusion/ information sharing as professionals for foster carers. The opposite was valued. For example, the sharing of background information and details about the child and their history.

“As a foster carer you have this child 24 hours a day – you know the child – they [social worker] come and see them once every six weeks. […] They don’t really know that child but they’re not prepared to listen to what the carers have to say. (Josie) We’re everything to that child: we’re a mother, we’re a father, you know, we could be a nurse when they’re not well, you’re there looking after them, you know, you can also be a therapist to them but you’re also punch bag….and everything else, more than just a social worker, so you’d think they would listen. (Michelle)"

“We spoke to the carer and found out a whole load of other details and said, ‘No, we’re not taking her,’ but if I hadn’t have spoken to the carer, we would have taken her and we would have had problems … there’s just no point them coming to placements that just, it’s just setting the child and you up to fail."

“For me most foster-carers are hands on people. It’s not (about) tweeting. I think the difficulty with the NVQ etc. is that a lot of people who come into fostering want to look after children, funnily enough. Sometimes they’re not academic, they don’t want to go down that route; they just want to look after these children. Standards are crucial, but we need more foster-carers. I think we’re going to have an even smaller pot of people prepared to become foster-carers. There are people who the thought of doing any sort of paperwork at all is going to put them off."

ML: No concerns

C: Minor

A: No concerns

R: No concerns

Overall:

Low

Some studies were marked down for ML primarily for poor or limited reporting of their methods. However, theme was reflected in low risk of bias evidence also. There was some incoherence across studies contributing to this theme. Studies touched on different aspects e.g. social workers taking advice from carers, informing, and including them. Involvement in transition planning. Additionally, some contradictory views e.g. about losing more foster carers who simply want to “care for children” and don’t want more paperwork. And concerns about taking on roles such as sexual health education. Four studies (fewer than half) reported partially indirect evidence.

Availability, accessibility, and reliability of support valued by carers.

Availability and reliability of support. Foster carer’s valued accessibility of their link workers, particularly where the matter is urgent. Out of hours availability (safety net) was appreciated and planned respite care (structured pattern of breaks). Calls and text were preferred to email for access. Proactive allocated social workers were appreciated (ones which planned ahead and took initiative with regular contact – “staying in touch”). Absence and delay of action interpreted as lack of care, e.g. delay waiting for mental health services/ interventions which may impact placement stability. Flexibility of work, reduced case load, and administrative support could help practitioners be available as and when needed.

“There’s nothing more reassuring … that you can ring someone up and actually hear that person on the end of the phone, it’s not some call centre or someone you’ve never met before.” FC

“I felt they were pushing me back. If, I don’t call, she doesn’t know how I am, she doesn’t know how I feel, she doesn’t know how my son is. She doesn’t seem to care about us. It’s like she has completely forgotten us” LACYP

“Like you say, ‘Well, we could take this child but we’ll need this help,’ and you have the initial review meeting and things are promised, and then none of it happens, so the child’s got expectations and you’ve got expectations and it doesn’t happen.” FC

“He didn’t sort of stay in touch as much as the other social workers that we’ve had, and I was sort of having to sort of phone him to chase him for things.” FC

“"I tried to get help on several occasions, but at the time she didn’t have a social worker, and the principal social worker kept saying, ‘Oh it’s no good, she hasn’t got a social worker, we’ll sort it out, and then you’ll get some help,’ and this went on for three months.” FC

ML: No concerns

C: Minor

A: No concerns

R: No concerns

Overall:

Low

Some studies were marked down for ML primarily for poor or limited reporting of their methods. However, theme was reflected in low risk of bias evidence also. There was some incoherence across studies contributing to this theme: While the direction of this theme was consistent between studies (accessible and proactive care, with few delays was good). The specifics of how this could be delivered varied between studies. Three studies (less than half) reported partially indirect evidence.

LACYP wished to be included in, listened to, and supported in decision making processes (shared decision making).

LACYP wished to be included in, listened to, and supported in decision making processes (shared decision making). Failing to do so had implications for placement stability. Unsuccessful attempts to influence events resulted in apathy and disengagement from care processes. For example, review meetings were aided by good preparation, direct questions, space in the meeting to check understanding and for the LACYP to be heard, and agency with decisions such as location and time of review meetings. At a higher level, children in care councils were used to influence policy, structural change, and recruitment. However, failure to recruit hard to reach groups and financial concerns were a barrier to these. Children with a lack of agency may try to control their environments by other means e.g. behavioural problems.

“[about review meetings] They are helpful in a way because you can put your point across about anything you might want to change. If you didn’t have them then you wouldn’t know who to see or what to do and nothing would be changed. (Young woman aged 16)"

“What’s the point? Nothing ever changes so there is no point. (Young woman aged 16)"

“If participation, planning and listening to the child’s views are integral to their experience of services, then the review is only one part of that, it’s not going to shift all that, so it has got to fit into the culture” Review Officer

“‘We secured funding from the mayor. Originally, he said no but we turned around and went to him and said we’re your corporate kids, would you deprive your child from using your living room? So why are you depriving us? So we sort of put it to him like that and he couldn’t say no after that’. (Young person)"

Larkins 2021

ML: No concerns

C: Minor

A: No concerns

R: No concerns

Overall:

Low

Some studies were marked down for ML primarily for poor or limited reporting of their methods. However, theme was reflected in low risk of bias evidence also. There was some incoherence across studies contributing to this theme: The variety of ways LACYP may be assisted in shared decision making made the theme less coherent. Agency was broadly seen as a good thing although with some push back that a looked after child may not always know what is in their own best interest. The relevance of this theme to placement stability is indirect.

Bespoke care tailored to the specific needs of the child.

Bespoke care tailored to the specific needs of the child. For example, the usefulness of good placement matching with carers based on personality (“clicking”) or culture/language in the case of UAS (although this was not always necessary, particularly when carers made an effort to bridge the cultural gap). Meeting the carer before moving in was helpful. Participants felt the approach of one intervention or type of care for all was not appropriate – e.g. accessible options for those with learning disabilities. Inclusion in decision making was useful to support this.

“It is very difficult when they first come in because you don’t know them and they don’t know you / the whole house not just the child. It’s the foster carer as well / it’s a whole different routine because we don’t know the person and they don’t know us. But the click thing is a special liking for them I think, taking to them as soon as they come in [pause] like the one we’re thinking about today. Umm I love Sim to bits and he drives me crackers.” FC

“I think it was all right because she [my foster carer], she’s Nigerian and I’m Nigerian as well … we kind of have the same values and norms so.” LACYP

“… they don’t take enough time and effort to actually see what’s wrong, they don’t get to know, they assume too much sometimes I think, maybe that’s just personal experience but they assume like she or he is the same as him, so we’ll keep them that way, nobody is the same … I think they need to try and meet the individual needs of the young people.” LACYP

ML: No concerns

C: Minor

A: No concerns

R: Minor concerns

Overall:

Low

Some studies were marked down for ML primarily for poor or limited reporting of their methods. However, theme was reflected in low risk of bias evidence also. There was some incoherence across studies contributing to this theme: The principle of bespoke care was consistently stressed, however, the need to “match” carers by similar characteristics was not always considered necessary. Five studies (more than a half) reported partially indirect evidence (e.g. recruitment likely occurred prior to 2010)

Multiagency working and better information sharing

Importance of better multiagency working and information sharing. For example: proper incorporation of advocacy services into review meetings, sharing of information between social workers and IROs to aid preparation for review meetings, shared information between social workers and link workers. For groups where specialist knowledge was needed, the need for a worker or team with specialist knowledge to contact was suggested (e.g. unaccompanied asylum seekers). However, inappropriate use of voluntary services was a fear.

“We’re all very clear about what we’re working towards and it helps in not splitting that group around the child."

“She [advocate] came, talked to the children and I thought great, that’s done but then she didn’t come to the review so I thought well where are the children’s views? We’ve lost them. She [IRO] said nothing.” FC

ML: No concerns

C: Minor

A: No concerns

R: No concerns

Overall:

Moderate

Some studies were marked down for ML primarily for poor or limited reporting of their methods. However, theme was reflected in low risk of bias evidence also. There was some incoherence across studies contributing to this theme: Most studies reported the benefits of increased multiagency working and information sharing, however, an example of the inappropriate use of voluntary services to fill in the gaps left by deficient social services was raised.

The needs of asylum-seeking children were felt to be considerably different to those of other looked after children.

Upon arrival UAS experienced a series of bewildering and destabilising systems of surveillance and control. For many, learning English was a starting point to order, routine and security which enabled more control e.g. solicitors, healthcare, education. For carers, bridging the communication barrier was important. Other areas of need included – cultural needs (religion and food); needs related to adjusting to life in England (e.g. learning to use a new currency and engaging in the English education system); advocacy needs often related to accessing services; needs pertaining to the asylum seeking process, (including recovery from trauma, emotional support and practical assistance to attend appointment). The needs of asylum seeking children were felt to be considerably different to those of other looked after children so carers felt the need for training (which could be as little as one day). Information was also lacking, even from social workers who had little expertise themselves. There was a need for an information network for fostering UAS.

“Well, I’ll tell you the very first thing, when Adeel 1 came, we had no idea [what to expect]. This was our first asylum seeker. I looked up [online] about the unaccompanied children … it was a lot of research in a very short time. So, I don’t think I really had any expectations…. I had no idea. [After being given a few hours’ notice that an unaccompanied young person was coming into placement with her]” FC

“We don’t know what they’ve been through, we don’t know what their background is or their family or anything, do we. So we do take a big risk in taking them.” FC

“It was the unknown of having a refugee. Yeah. Definitely. And that is fear of the unknown, isn’t it? Luckily, he was such a presentable young man, everyone who met him … Interviewer: Was won over? Cath: Completely! I mean he’s extremely good looking, with a wonderful smile and very, very polite. So yeah, they were won over by him. Straight away."

“Talk to other foster carers … That’s easier said than done. You know we’ve only been in the area at that point just about a year. Fostering about six months at that point. We don’t have a network."

“Food, culture, language, you have no training whatsoever. These children are brought to you. The social worker comes back in a week, ‘Are they OK?’ or maybe phones, ‘How are they?’ Comes back in a week to see how they are, then they have a review within a couple of weeks. You have nothing. A lot of carers say we’ve just literally had the children placed here and we don’t know what to do next."

“I think we need training of what looking after an asylum seeker incurs, you know, the court process, the travelling, food, where they pray, Ramadan."

Chase 2010

Chase 2013

Sidery 2019

ML: Minor

C: Moderate

A: Minor

R: Minor

Overall:

Very Low

Studies were marked down for ML primarily for poor or limited reporting of their methods. Studies touched on many aspects of caring for unaccompanied asylum seekers. However, it was consistent that unaccompanied asylum seekers were found to be a very distinctive group for whom training and information was needed both for carers and support workers. Only three studies contributed to this theme. Two studies (over one half) reported partially indirect evidence (e.g. recruitment likely occurred prior to 2010)

Information gap is detrimental to care participation

Information gap between LACYP and carers lead to apathy, e.g. with looked after children review meetings. Knowledge of the reason for reviews, decisions made, and the roles of the professionals involved was useful for participation.

Regarding review meetings: “They are to check up on me. (Young woman aged 14) I think it’s to do with school. (Boy aged 8) They are to see how things are going. (Boy aged 10)”

“It’s pretty like scary to obviously go [to a review for the first time] … like they are questioning you about your life and how it’s going and all that stuff…I think I first went when I was about 5 and for a 5-year old to have to explain what’s going on…you don’t know how to…so it’s kinda scary.” LACYP

“When there were big words then I switched off cos I don’t like big words, it makes me feel like, like I don’t understand so I just switch off until they ask me and then I just say yes… “

Pert 2017

Roesch-Marsh 2017

Larkins 2021*

ML: No concerns

C: No concerns

A: Moderate

R: No concerns

Overall:

Low

Only three studies contributed to this theme.

Preference for residential care in some cases.

Preference for residential care in some cases. “Everyone has something in common.” This was a concept which linked to looked after children’s preferences being taken into account (shared decision making) when planning placements.

“I didn’t like foster care. I just didn’t like the feeling of being in someone else’s family, in someone else’s home, you get me? In a children’s home everyone has something in common and it’s like ‘oh why are you here then, what’s your story’ you know."

“At least in a foster family I felt loved man, in the children’s home I felt hated by all the staff, it was just their job, they didn’t care.… It was stupid though, he [pointing to a friend also taking part in the interview] just wanted to be in a children’s home and they kept putting him in foster care. I wanted to be in foster care and they kept putting me in a children’s home!"

Gaskell 2010

Schofield 2015

ML: Serious

C: Minor

A: Moderate

R: Minor concerns

Overall:

Very Low

Both studies were high risk for bias, this was largely because of poor description of methods, recruitment, and data analysis. One study merely touched on the positive outcomes occurring as a result of residential care. Only two studies contributed to this outcome.

Usefulness of respite support for carers.

Support offered by the link worker, as well as financial and practical support from social services, was seen as essential. Although respite was also deemed important, not all participants had access to this.

“"Support, the basic support is from the link worker – or supervising social worker they call them now – and we’ve been very fortunate over the years because our support workers have always been brilliant.” FC

Kirton 2011

Samrai 2011

ML: Minor

C: No concerns

A: Moderate

R: Minor

Overall:

Very Low

Both studies were either high or moderate risk of bias, this was largely because of poor description of methods, recruitment, and data analysis. Only two studies contributed to this theme. One of these studies (half) came from partially indirect evidence

The primacy of the natural family for carers, despite the desire to treat foster child “as one of own” – implications for placement matching

The primacy of the natural family for carers, despite the desire to treat foster child “as one of own”. Benefit of careful matching of existing birth children to foster placement (e.g. older/younger child). Shared decision making that includes the birth child. Rivalry for attention between foster child and birth child, and need for different parenting techniques, deteriorating relationship between carer and birth children - a source of feeling overwhelmed. Implications for placement stability. Positive changes could also occur for existing family relationships as a result of fostering.

“I think if you go for the same age group and age range I think you could have a lot of problems as a foster carer … cos your children might be doing something with that foster child. So I think it’s important that you keep that age gap. (Sharon, ln. 491–495) Looking back that was difficult because they were the same age … they fought like cat and dog. (Katrina, ln. 630–632)"

“I think if you’ve got kids in the foster family you should try and keep the kids you’re fostering … lower in age. (Stuart, has older birth children, ln. 305–307)"

“We didn’t want to take another ‘child’ [referring to younger foster children] we didn’t want to add to the stress because we’ve got all our three kids in the same school and we didn’t want to have a child where … she’s running around elsewhere going to another school. (Carl, ln. 350–353)"

“Your children, in your decision to become a foster carer, have to be involved in it. And if your child has any doubts don’t do it. (Sharon, whose birth child was older, ln. 461–463) Our way of dealing with it is basically explaining to the children rather than just sweeping it under the carpet and … not getting them involved in what’s going on because of course they’re young children. (Petula, ln. 139–142)"

“As soon as that young girl [foster child] sat and wanted to cuddle at night I instantly saw [birth child’s] face and I knew, no we can’t do this … Instantly I knew [birth child] didn’t like it…. I knew he was fazed by how close that young girl wanted to be to his mum (Sharon, ln. 337–354)”

“My kids aren’t going to come second you know they have to come first and [foster child] has to come second it’s as simple as that, because if they don’t agree with that well then I’ll end the placement. (Katrina, ln. 367–369) I’m always asking [birth child] if she’s okay … it’s your family and you want to know that your children are okay. (Carl, ln. 228–233)"

Samrai 2011

Thompson 2016

ML: No concerns

C: No concerns

A: Moderate

R: No concerns

Overall:

Low

Only two studies contributed to this theme.

Unique stresses for carers in parent-and-child placements

Most of these stresses were associated with the tension inherent in the role, between nurturing a vulnerable mother and contributing to the assessment which decides whether she will leave with her child. Every carer and social worker cited times when, either implicitly or explicitly, the outcome of assessments had been decided by the LA before placing the mother-and-child, with the placement merely satisfying court proceedings. The desire to advocate for a mother whom the carer felt needed additional time and therapeutic input to develop “good enough parenting” skills was a huge source of stress, and the feelings of powerlessness that accompanied this were problematic. For other carers, very deep issues were raised by their involvement with such troubled families; one couple talked about their 18-year-old son having a breakdown a year after a baby left the family for adoption. Another older carer talked about the pain she experienced when a baby moved on to adoption at 4 months. Aspects of training for this role that carers would have welcomed included: How to manage endings—when a baby is removed; Sharing logs with mothers in a positive way; Working with mothers with learning disabilities and autism.

“I had a very disturbed mum when she first arrived, and for the first three days couldn’t go into the kitchen to make the bottles, cos she was just so overwhelmed … there was a massive history of DV, so she didn’t want to go into the kitchen if K (carer’s husband) was in there. And that was really difficult to overcome. I had to work really hard with her initially, and all you’ve got is a social worker coming and saying “So, you’re refusing to feed the baby.” You just think “Back off!” And a few days later, this same social worker just said “Tell me when. Tell me when to pull the plug, and she’s out!” And that was his exact words. And I said “No, no, give us some time, we’re working on it.” And do you know, she went on to do 7 months and went home with the baby. But they were prepared to write her off.” (Foster Carer, Female, 60s).

“Very very different, very specialist … sometimes they will say “we don’t want you doing this for the mum. They are to do it themselves and you are to record everything” … I think that’s quite off-putting for someone who’s nurturing by nature.” (Foster Carer, Female, 40s)

“We’ve had times when our carers have been accused of “colluding with the mother!” Such negative language—what does that even mean? Aren’t we all colluding with the mother?” (Social Worker, CEO of an IFP).

1 November 2020

ML: No concerns

C: No concerns

A: Serious

R: No concerns

Overall:

Very Low

Only one study contributed to this theme.

Study	Reason for exclusion
AFFRONTI Melissa; RITTNE Barbara; SEMANCHIN Annette M. (2015) Functional adaptation to foster care: foster care alumni speak out. Journal of Public Child Welfare 9(1): 1–21	- non-UK study
AHMED Kamran (2015) In their own words: abused children’s perceptions of care provided by their birth parents and foster carers. Adoption and Fostering 39(1): 21–37	- No qualitative data relevant to this review question
Augsberger, Astraea (2014) Strategies for engaging foster care youth in permanency planning family team conferences. Children and Youth Services Review 43: 51–57	- Included under another review question (RQ5.1)
Bailey J.R.; Gross A.M.; Cotton C.R. (2011) Challenges associated with establishing a token economy in a residential care facility. Clinical Case Studies 10(4): 278–290	- case study
BAER, Lauren and DIEHL David, K. (2019) Foster care for teenagers: motivators, barriers, and strategies to overcome barriers. Children and Youth Services Review 103: 264–277	- non-UK qualitative study
Beal, Sarah J, Wingrove, Twila, Nause, Katie et al (2019) The Role of Shared Decision-Making in Shaping Intent to Access Services for Adolescents in Protective Custody. Child care in practice : Northern Ireland journal of multi-disciplinary child care practice 25(1): 64–78 [PMC free article: PMC6532998] [PubMed: 31130815]	- Survey extracted views (not true qualitative)
Biehal, Nina, Ellison, Sarah, Sinclair, Ian et al (2011) Intensive fostering: An independent evaluation of MTFC in an English setting. Children and Youth Services Review 33(10): 2043–2049	- non-qualitative study
Boel-Studt, Shamra M and Landsman, Miriam J (2017) Mixed methods study of the effectiveness of intensive family finding services with youth in congregate care. Journal of Public Child Welfare 11(2): 190–210	- non-UK study
BRADY Bernadine and et al (2019) The participation of children and young people in care: insights from an analysis of national inspection reports in the Republic of Ireland. Child Care in Practice 25(1): 22–36	- non-UK study
BROWN Jason (2010) Fostering children with disabilities. Social Work Now: the Practice Journal of Child, Youth and Family youthandfamily: 29–35	- non-UK study
Chamberlain, Patricia, Feldman, Sara Wolf, Wulczyn, Fred et al (2016) Implementation and evaluation of linked parenting models in a large urban child welfare system. Child abuse & neglect 53: 27–39 [PMC free article: PMC4818186] [PubMed: 26602831]	- non-UK study
Chambers, Ruth M, Crutchfield, Rashida M, Willis, Tasha Y et al (2018) “It’s just not right to move a kid that many times:” A qualitative study of how foster care alumni perceive placement moves. Children and Youth Services Review 86: 76–83	- non-UK study
Children’s Commissioner for, England (2020) Pass the parcel: children posted around the care system.: 23	- no methods described - Not a peer-reviewed publication
Conradi, Lisa, Agosti, Jen, Tullberg, Erika et al (2011) Promising practices and strategies for using trauma-informed child welfare practice to improve foster care placement stability: a breakthrough series collaborative. Child welfare 90(6): 207–25 [PubMed: 22533050]	- non-UK study
Cooley, Morgan E, Thompson, Heather M, Wojciak, Armeda Stevenson et al (2017) Risk, resilience, and complexity: Experiences of foster parents. Children and Youth Services Review 76: 35–41	- non-UK study
COOLEY Morgan, E. and et al (2019) A systematic review of foster parent preservice training. Children and Youth Services Review 107: 104552	- systematic review
Crampton, David S, Usher, Charles L, Wildfire, Judith B et al (2011) Does community and family engagement enhance permanency for children in foster care? Findings from an evaluation of the family-to-family initiative. Child welfare 90(4): 61–77 [PubMed: 22413380]	- non-qualitative - non-UK study
CREA Thomas M. and et al (2018) Unaccompanied immigrant children in long term foster care: identifying needs and best practices from a child welfare perspective. Children and Youth Services Review 92: 56–64	- non-UK study
Dallos, Rudi; Morgan-West, Kate; Denman, Katie (2015) Changes in attachment representations for young people in long-term therapeutic foster care. Clinical child psychology and psychiatry 20(4): 657–76 [PubMed: 25062686]	- case study, not true qualitative
Denlinger, Melissa and Dorius, Cassandra (2018) Communication patterns between foster parents and case managers. Children and Youth Services Review 89: 329–339	- non-UK qualitative study
DEVANEY, Carmel; McGREGOR, Caroline; MORAN, Lisa (2019) Outcomes for permanence and stability for children in care in Ireland: implications for practice. British Journal of Social Work 49(3): 633–652	- non-UK qualitative study
DIXON Jo (2011) How the care system could be improved. Community Care 17211: 16–17	- not a peer-reviewed publication
Dodsworth, Jane and et al (2013) Internet technology: an empowering or alienating tool for communication between foster-carers and social workers?, IN British Journal of Social Work, Vol 43 No 4 Jun 2013.	- Duplicate reference
FERGEUS, Josh and et al (2019) The needs of carers: applying a hierarchy of needs to a foster and kinship care context. Adoption and Fostering 43(2): 155–168	- non-UK qualitative study
Flores, Jerry, Hawes, Janelle, Westbrooks, Angela et al (2018) Crossover youth and gender: What are the challenges of girls involved in both the foster care and juvenile justice systems?. Children and Youth Services Review 91: 149–155	- non-UK qualitative study
Frederico, Margarita, Long, Maureen, McNamara, Patricia et al (2017) Improving outcomes for children in out-of-home care: The role of therapeutic foster care. Child & Family Social Work 22(2): 1064–1074	- non-UK study
Garcia Quiroga, Manuela and Hamilton-Giachritsis, Catherine (2017) “Getting involved”: A thematic analysis of caregivers’ perspectives in Chilean residential children’s homes. Journal of Social and Personal Relationships 34(3): 356–375	- non-UK study
Geiger, Jennifer M, Piel, Megan Hayes, Julien-Chinn, Francie J et al (2017) Improving relationships in child welfare practice: Perspectives of foster care providers. Child & Adolescent Social Work Journal 34(1): 23–33	- non-UK study
Gerstenzang, Sarah and Freundlich, Madelyn (2005) A Critical Assessment of Concurrent Planning in New York State. Adoption Quarterly 8(4): 1–22	- non-UK study
GILL, Amy and et al (2020) Practitioner and foster carer perceptions of the support needs of young parents in and exiting out-of-home care: a systematic review. Children and Youth Services Review 108: 104512	- systematic review
Green, Yolanda R and Gray, Michael (2013) Lessons learned from the Kinship Education and Support Program (KEPS): Developing effective support groups for formal kinship caregivers. Social Work with Groups: A Journal of Community and Clinical Practice 36(1): 27–42	- non-UK study
Hanberger, Anders, Wimelius, Malin E, Ghazinour, Mehdi et al (2016) Local service-delivery networks for unaccompanied children in Sweden: Evaluating their effectiveness. Journal of Social Service Research 42(5): 675–688	- non-UK study
Hayes, Megan J, Geiger, Jennifer M, Lietz, Cynthia A et al (2015) Navigating a complicated system of care: Foster parent satisfaction with behavioral and medical health services. Child & Adolescent Social Work Journal 32(6): 493–505	- non-UK study
HERBERT Martin and WOOKEY Jenny (2007) The Child Wise Programme: a course to enhance the self-confidence and behaviour management skills of foster carers with challenging children. Adoption and Fostering 31(4): 27–37	- study published earlier then 2010
Herz, Marcus and Lalander, Philip (2017) Being alone or becoming lonely? The complexity of portraying ‘unaccompanied children’ as being alone in Sweden. Journal of Youth Studies 20(8): 1062–1076	- non-UK study
HOLEN Frank, van and et al (2019) Characteristics of successful foster families according to Flemish foster care workers. Children and Youth Services Review 107: 104519	- Survey extracted views
IRIZARRY Carol; MILLER Keith; BOWDEN Margaret (2016) Kinship care: child safety or easy option? staff and carers’ perspectives. Journal of Family Social Work 19(3): 199–219	- non-UK study
Kalverboer, Margrite, Zijlstra, Elianne, van Os, Carla et al (2017) Unaccompanied minors in the Netherlands and the care facility in which they flourish best. Child & Family Social Work 22(2): 587–596	- non-UK study
KIRALY, Meredith (2019) Nonfamilial kinship carers - who are they and what support do they need to nurture children?. Child and Family Social Work 24(4): 449–457	- non-UK qualitative study
Leathers S.J., Spielfogel J.E., Geiger J. et al (2019) Placement disruption in foster care: Children’s behavior, foster parent support, and parenting experiences. Child Abuse and Neglect 91: 147–159 [PubMed: 30889437]	- non-UK study - survey extracted views
Leinonen, Emilia (2020) Time to care? Temporal variations of agency of the Finnish adult foster carers. Journal of aging studies 52: 100830 [PubMed: 32178800]	- Unclear that population are LACYP Adult foster care
Madden, Elissa E, Chanmugam, Amy, McRoy, Ruth G et al (2016) The impact of formal and informal respite care on foster, adoptive, and kinship parents caring for children involved in the child welfare system. Child & Adolescent Social Work Journal 33(6): 523–534	- Survey extracted views (not true qualitative) - Non-UK setting
MADIGAN Sarah; PATON Kate; MACKETT Naomi (2017) The Springfield Project service: evaluation of a Solihull Approach course for foster carers. Adoption and Fostering 41(3): 254–267	- survey extracted views, not true qualitative
McCormick, Adam, Schmidt, Kathryn, Terrazas, Samuel et al (2017) LGBTQ youth in the child welfare system: An overview of research, practice, and policy. Journal of Public Child Welfare 11(1): 27–39	- review [checked for references]
McGILL Lynda and et al (2018) Social workers’ experiences of using the narrative model to talk to children about why they are in care and other sensitive issues. Adoption and Fostering 42(1): 49–57	- survey extracted views, not true qualitative
McKeough, A, Bear, K, Jones, C et al (2017) Foster carer stress and satisfaction: An investigation of organisational, psychological and placement factors. Children and Youth Services Review 76: 10–19	- non-UK study - survey extracted views, not true qualitative
McLean, Sara (2015) Managing behaviour in child residential group care: Unique tensions. Child & Family Social Work 20(3): 344–353	- non-UK study
McLean, Sara (2012) Barriers to collaboration on behalf of children with challenging behaviours: A large qualitative study of five constituent groups. Child & Family Social Work 17(4): 478–486	- non-UK study
MELLON Maggie (2010) Is intensive fostering more effective than custody?. Community Care 211010: 32–33	- no methods, unclear if true qualitative
Moore, Tim, McArthur, Morag, Death, Jodi et al (2017) Young people’s views on safety and preventing abuse and harm in residential care: “It’s got to be better than home”. Children and Youth Services Review 81: 212–219	- non-UK study
MOUNTZ, Sarah and CAPOUS-DESYLLAS, Moshoula (2020) Exploring the families of origin of LGBTQ former foster youth and their trajectories throughout care. Children and Youth Services Review 109: 104622	- non-UK qualitative study
NASH Jordanna J. and FLYNN Robert J. (2016) Foster and adoptive parent training: a process and outcome investigation of the preservice PRIDE program. Children and Youth Services Review 67: 142–151	- non-UK setting - No outcome of interest reported
Ohene, Serena K and Garcia, Antonio (2020) Narratives of women’s retrospective experiences of teen pregnancy, motherhood, and school engagement while placed in foster care. Children and Youth Services Review 108	- non-UK qualitative study
O’Toole Thommessen, Sara Amalie, Corcoran, Paula, Todd, Brenda K et al (2017) Voices rarely heard: Personal construct assessments of sub-Saharan unaccompanied asylum-seeking and refugee youth in England. Children and Youth Services Review 81: 293–300	- No qualitative data of relevance to this review question
OCTOMAN Olivia (2014) Challenging behaviour in foster care: what supports do foster carers want?. Adoption and Fostering 38(2): 149–158	- Survey extracted views (not true qualitative) - Non-UK setting
Park, Megan; Nesom, Suzanna; Hodges, Helen (2020) What do children and young people looked after and their families think about care?.: 43	- non-systematic review
Rock, Stephen, Michelson, Daniel, Thomson, Stacey et al (2015) Understanding foster placement instability for looked after children: A systematic review and narrative synthesis of quantitative and qualitative evidence. British Journal of Social Work 45(1): 177–203	- Systematic review [checked for relevant references]
Roth, Benjamin J and Grace, Breanne L (2015) Falling through the cracks: The paradox of post-release services for unaccompanied child migrants. Children and Youth Services Review 58: 244–252	- non-UK study
Sasaki, Ginga and Noro, Fumiyuki (2017) Promoting verbal reports and action plans by staff during monthly meetings in a Japanese residential home. Behavioral Interventions 32(4): 445–452	- Non-UK setting [Japanese residential home] - Not an intervention of interest [interventions to improve and manage behaviour reporting and action plans, focused on behaviour] - No outcome of interest reported [no data or qualitative data reported, outcomes were in graphs from which it was not possible to extract meaningful information]
Selwyn, Julie, Saunders, Hilary, Farmer, Elaine et al (2010) The views of children and young people on being cared for by an independent foster-care provider. British Journal of Social Work 40(3): 696–713	- questionnaire-based study (not true qualitative)
Serbati, Sara and Gioga, Gianmaria (2017) Building a successful care path in residential care: Findings from qualitative research with young people and professionals in Italy. Child Care in Practice 23(1): 34–48	- non-UK study
Severinsson, Susanne and Markstrom, Ann-Marie (2015) Resistance as a means of creating accountability in child welfare institutions. Child & Family Social Work 20(1): 1–9	- non-UK study
Shea, Sarah E (2015) Finding parallels: The experiences of clinical social workers providing attachment-based treatment to children in foster care. Clinical Social Work Journal 43(1): 62–76	- non-UK study
SIRRIYEH Ala (2010) Support for migrant children. Community Care 1710: 22–23	- no methods, unclear if true qualitative
Simmonds, John and Harwin, Judith (2020) Special guardianship: a review of the evidence (summary report).: 21	- non-systematic review
Skoog, Viktoria, Khoo, Evelyn, Nygren, Lennart et al (2015) Disconnection and dislocation: Relationships and belonging in unstable foster and institutional care. British Journal of Social Work 45(6): 1888–1904	- non-UK study
Soldevila, Anna, Peregrino, Antonio, Oriol, Xavier et al (2013) Evaluation of residential care from the perspective of older adolescents in care. The need for a new construct: Optimum professional proximity. Child & Family Social Work 18(3): 285–293	- non-UK study
Steels, Stephanie and Simpson, Harriet (2017) Perceptions of children in residential care homes: A critical review of the literature. British Journal of Social Work 47(6): 1704–1722	- Systematic review [checked for relevant references]
Tao, Karen W, Ward, Kristin J, O’Brien, Kirk et al (2013) Improving permanency: Caseworker perspectives of older youth in another planned permanent living arrangement. Child & Adolescent Social Work Journal 30(3): 217–235	- non-UK study
Thoburn, June (2016) Residential care as a permanence option for young people needing longer-term care. Children and Youth Services Review 69: 19–28	- case study, qualitative data reported elsewhere
Thompson, Heather M, Wojciak, Armeda Stevenson, Cooley, Morgan E et al (2017) Through their lens: Case managers’ experiences of the child welfare system. Qualitative Social Work: Research and Practice 16(3): 411–429	- non-UK study
TONHEIM Milfrid and IVERSEN Anette Christine (2019) “We felt completely left to ourselves.” Foster parents’ views on placement disruption. Child and Family Social Work 24(1): 90–97	- non-UK study
WADE, Jim (2019) Supporting unaccompanied asylum-seeking young people: the experience of foster care. Child and Family Social Work 24(3): 383–390	- it was not possible to distinguish data derived from literature review, survey, or thematic analysis in the mixed methods paper.
Wigley, Veronica, Preston-Shoot, Michael, McMurray, Isabella et al (2012) Researching young people’s outcomes in children’s services: Findings from a longitudinal study. Journal of Social Work 12(6): 573–594	- unclear population are looked after children
ZEIJLMANS, Kirti and et al (2019) Participation of children, birth parents and foster carers in the matching decision. paternalism or partnership?. Child Abuse Review 28(2): 139–151	- non-UK qualitative study
ZUCHOWSKI, Ines and et al (2019) Convenient yet neglected: the role of grandparent kinship carers. British Journal of Social Work 49(3): 615–632	- non-UK qualitative study

Barriers and facilitators for supporting care placement stability among looked-after children and young people

Barriers and facilitators for supporting care placement stability among looked-after children and young people

Review question

Introduction

SPIDER table

Table 1

Methods and process

Qualitative evidence

Included studies

Excluded studies

Summary of studies included in the qualitative synthesis

Table 2

Summary of the qualitative findings included in the evidence review

Figure 1

Table 3

Economic evidence

Included studies

Economic model

The committee’s discussion of the evidence

Interpreting the evidence

The outcomes that matter most

The quality of the evidence

Benefits and harms

UCLan qualitative work

Qualitative review work RQ1.2

Cost effectiveness and resource use

UCLan qualitative work

Recommendations 1.3.1 to 1.3.3, 1.3.12, 1.2.18, 1.5.15 to 1.5.25

References – included studies

Qualitative evidence

Appendices

Appendix A. Review protocols

Appendix B. Literature search strategies

Appendix C. Qualitative evidence study selection

Appendix D. Qualitative evidence

Appendix E. Forest plots

Appendix F. CERQual tables

Appendix G. Economic evidence study selection

Appendix H. Economic evidence tables

Appendix I. Health economic model

Appendix J. Excluded studies

Table

Appendix K. Research recommendations – full details

Research recommendation

Appendix L. References

Other references

Appendix M. Other appendix

Table 1SPIDER table for barriers and facilitators for supporting care placement stability among looked-after children and young people

Table 2characteristics of studies included in the qualitative synthesis for this review

Figure 1Summary of the qualitative themes observed in this review

Table 3Summary of qualitative findings: barriers and facilitators for supporting care placement stability among looked-after children and young people