Group intervention reduces burnout among foster carers

The findings come as the UK has a rising number of children in care, alongside ongoing challenges in recruiting and retaining carers. With the UK government pledging last week to create up to 10,000 new foster care places, the findings provide timely evidence for local authorities, fostering agencies and policymakers seeking effective, evidence-based ways to support and retain carers.

The study evaluated the Reflective Fostering program, developed by experts at Anna Freud, a mental health charity for children and young people. The program is a 10-week group intervention designed to help carers better understand their own emotions and those of the children they care for, and to build stronger relationships.

With weekly three-hour sessions led by two trained facilitators - typically a foster or kinship carer and a social worker - the program focuses on building carers' reflective capacity: the ability to think about thoughts, feelings and behavior in themselves and in the child, particularly in emotionally challenging situations.

For the study, published in the peer-reviewed journal Adoption & Fostering and funded by the National Institute for Health and Care Research, researchers conducted a randomised-controlled trial involving 524 foster carers and kinship carers (family or friends caring for a child when their parents are unable to do so) caring for children aged between four and 13.

Participants were randomly assigned to receive either usual fostering support alone (typically mandatory training and support from an assigned social worker) or usual support plus the Reflective Fostering program, with outcomes assessed at four months and again at 12 months.

The findings show that carers who took part in the program experienced significant and lasting benefits that were sustained a year after joining the study. Compared with carers receiving usual support, those who attended the program showed improved reflective capacity, reduced parental stress, lower levels of burnout and secondary traumatic stress, and improved quality of relationships with the children in their care.

The children in their care continued to show quite high levels of emotional and behavioral difficulties, but it seemed that carers had found ways to manage these situations better.

Children in foster care have some of the poorest outcomes in terms of mental health of all children in the UK, and have often experienced significant trauma. Foster carers play a crucial role in the lives of these children.

What this study shows is that when carers are given structured time and space to reflect on their own experiences and on the child's inner world, it can make a meaningful difference to their wellbeing and to the relationship they build with the child."

Professor Nick Midgley, Lead Author, UCL Psychology & Language Sciences

Dr Karen Irvine (University of Hertfordshire), the trial manager on the study, said: "While we did not find additional improvements in children's mental health outcomes within the timeframe of this trial, the gains we saw for carers are important in their own right. Improving carers' reflective capacity and reducing burnout may be a necessary foundation for longer-term benefits for children."

Foster carers in the study entered with high levels of stress, burnout and secondary traumatic stress, reflecting the growing pressures facing the fostering workforce nationally, the researchers found. Supporting carers to manage these pressures may help carers remain in the role for longer and provide more emotionally available care, they say.

The study also included a detailed economic evaluation. The Reflective Fostering program costs were lower than the reduction in overall health and social care costs for carers (and the children in their care) who attended the program. The analysis found a high probability that the program is cost-effective compared to usual support alone.

Professor Midgley added: "At a time when fostering services are under enormous strain, it's vital to invest in approaches that support carers themselves. This program offers a relatively low-cost way of improving carer wellbeing, which is essential for the sustainability of the care system."

Professor Eamon McCrory, CEO of Anna Freud and professor at UCL, said: "The results from this landmark study show how vital it is that foster carers have access to support like the Reflective Fostering program, which was developed by experts from Anna Freud. We knew that the needs of foster carers - who are at high-risk of stress and burn-out - weren't always being met by other programs, which often focus on managing children's behavior.

"By giving carers the tools to reflect on their own thoughts and feelings, along with how to understand what's happening in the child's mind, they're better equipped to look after themselves and the young person for the long-term.

"The skills taught through the program support the important relationship between children in care and their new caregiver. When this connection is strong, trusting and stable, it helps to build a brighter future for children who often have experience of really traumatic events."

Jackie Tripp, 64, from Leicestershire, became a kinship carer in 2020 to two of her step-grandchildren alongside her husband Keith. She took part in the Reflective Fostering program in 2023.

She said: "I can honestly say by the time I was offered the course, I was at my lowest ebb. The boys - who were five and 12 at the time - had been through the trauma of being taken away from their mum, followed by the grief of losing her. More than anything, they wanted to be at home - even though it wasn't safe - and had no choice in the matter.

"It was the first course I'd been on that focused on how the foster carer themselves could look after their own wellbeing. All of the courses to date had been about the child and, while that's really important, if the foster carer isn't in a good place, the care is going to be even harder. It became such a benefit and gave us so many tools to help us help ourselves, it utterly revolutionised how we care for the boys.

"While we still have tricky days, we have so many strategies to support him. He's in Year Six now and doing really well, academically and socially. We're now thinking about mainstream fostering as we've learnt so much and have more room, time and emotional strength to give."