Reflective Fostering Study

Background

Foster and kinship/connected carers provide care for the most vulnerable children in society. The role is a rewarding one but can be challenging and foster and kinship carers report high levels of stress and burnout. There is a need, therefore, for programmes that support carers’ wellbeing so that fostering agencies can retain their carers and foster/kinship carers can provide the best support for the children they look after. However there is currently a lack of evidence about what types of programmes to support carers are most effective, and little evidence of effectiveness beyond the short-term

Aims

The Reflective Fostering Study aimed to evaluate the effectiveness and cost-effectiveness of the Reflective Fostering Programme for foster or kinship carers of children between the ages of 4 and 13. The Reflective Fostering Programme focuses on the carer-child relationship by increasing carers’ ability to mentalize on behalf of themselves and the children they care for. The Study examined whether offering the Programme alongside usual support provided to foster and kinship carers was more effective than usual support alone in promoting the wellbeing of children in care and the wellbeing of foster/kinship carers at the end of four months and at 12 months.

The study included a process evaluation to look at what usual support looked like, how the Programme was delivered and how carers and facilitators experienced the Programme, and a Health Economic Evaluation assessed the cost-effectiveness of adding the Programme to usual support.

Alongside the main study, there were two additional sub-studies:

the Relationship Stories Study aimed to explore how foster and kinship carers used what they had learned in the study in their interactions with the children they cared for.
the InCLUDE study examined the barriers to diverse and inclusive recruitment in foster care research and aimed to identify ways to overcome these barriers.

Methodology

This was a definitive, superiority, two-armed, parallel, pragmatic Randomised Controlled Trial with an internal pilot study and embedded process evaluation. Foster and kinship carers were allocated to one of two arms of the study – to the intervention arm, where carers were asked to attend the Programme alongside their usual support or to the control arm, where carers continued with usual support alone.

Who took part?

524 foster and kinship carers were recruited via our fostering partners and by direct promotion of the study. We worked with a wide range of Local Authorities and Independent Fostering Agencies in England and Wales.

Findings

The main findings of the Study, including the health economic evaluation, are due to be reported by Autumn 2025.

For findings from the process evaluation, see Publications below.

Research team and funding

Chief Investigator: Prof Nicholas Midgley, UCL

Co-applicants: Dr Karen Irvine, Dr Erika Sims, Prof Sarah Byford, Dr Jamie Murdoch, Prof David Wellsted, Dr Sheila Redfern, Caroline Smith, Prof Lee Shepstone

Members of the research team: Adaku Anyiam-Oswige, Antonella Cirasola, Caroline Cresswell, Rebecca Flanagan, Shayma Izzidien, Thando Katangwe-Chigamba, Alay Rangel, Beth Rider, Po Ruby, Cerys Seeley, Eva Sprecher, Rachael Stemp, Hannah Wright

Study Partners: Anna Freud, Kent County Council, Kings College London, University of East Anglia, University of Hertfordshire

Funding: This study was funded by the National Institute of Health Research (NIHR) Public Health Research (award number MIDGLEY127422).

Publications

Midgley, N., et al. (2021). The Reflective Fostering Programme – improving the wellbeing of children in care through a group intervention for foster carers: study protocol for a randomised controlled trial. Trials. 22, 841 (2021). https://doi.org/10.1186/s13063-021-05739-y

Izzidien, S., Stemp, R., Akram, S. et al. (2024). The lived experience of co-production: Reflective accounts from the InCLUDE project. Res Involv Engagem 10, 104 (2024). https://doi.org/10.1186/s40900-024-00639-2

Katangwe-Chigamba T, Murdoch J, Irvine K, Redfern S, Midgley N. (2025). A qualitative evaluation of the reflective fostering programme – examining foster and kinship carers’ experiences, practical application, and perceived impact. Clinical Child Psychology and Psychiatry. 2025;0(0). https://doi.org/10.1177/13591045251321032

Redfern, S. & Midgley, N. (2024). The Reflective Fostering Programme: A dialogue between clinical practice and research. Journal of Infant, Child and Adolescent Psychotherapy, https://doi.org/10.1080/15289168.2024.2307263

Redfern, S., Pursch, B., Katangwe-Chigama, T., Sopp, R., Irvine, K., Sprecher, E., Schwaiger, T. & Midgley, N. (2023). The Reflective Fostering Programme – considerations for online delivery in response to the COVID pandemic in the UK. Psychology and Psychotherapy: Theory, Research and Practice. http://dx.doi.org/10.1111/papt.12497

Midgley, N., Cirasola, A., Sprecher, E., Redfern, S., Wright, H., Rider, B. & Martin, P. (2023). The Reflective Fostering Programme Fidelity Rating Scale: Development and Inter-Rater Reliability. Journal of Children’s Services. https://doi.org/10.1108/JCS-01-2022-0002