Group support programme helps foster carers avoid burnout

Reflective Fostering Programme supports carers and reduces burnout

A group-based support programme developed by experts from Anna Freud for foster carers significantly improves carer wellbeing, reduces burnout and stress, and strengthens relationships with children in care, while also offering good value for money, a new study has found.

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 this 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 Programme, which was developed by experts at Anna Freud. The programme 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 programme focuses on building carers’ reflective capacity: the ability to think about thoughts, feelings and behaviour in themselves and in the child, particularly in emotionally challenging situations.

This approach is also known as mentalization, a practice pioneered by experts from Anna Freud.

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 Programme, with outcomes assessed at four months and again at 12 months.

The findings show that carers who took part in the programme experienced significant and lasting benefits that were sustained a year after joining the study. Compared with carers receiving usual support, those who attended the programme 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 behavioural difficulties, but it seemed that carers had found ways to manage these situations better.

Lead author Professor Nick Midgley, Director of the Child Attachment and Psychological Therapies Research Unit (ChAPTRe), a collaboration between UCL and Anna Freud, said:

“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.”

Study trial manager Dr Karen Irvine, from the University of Hertfordshire, explained:

“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. Supporting carers to manage these pressures may help carers remain in the role for longer and provide more emotionally available care.

The study also included a detailed economic evaluation. The Reflective Fostering Programme costs were lower than the reduction in overall health and social care costs for carers (and the children in their care) who attended the programme. The analysis found a high probability that the programme 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 programme 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, said:

“The results from this landmark study show how vital it is that foster carers have access to support like the Reflective Fostering Programme, 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 programmes, which often focus on managing children’s behaviour.

“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 programme 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, and took part in the Reflective Fostering Programme in 2023.

Jackie 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. They had so many needs, we were totally overwhelmed and looked for help and training wherever we could.

“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.

“The eldest is now 18 and has moved out to be independent, and the youngest is still living with us. While we still have tricky days, we have so many strategies to support him. He’s in Year 6 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.”

Find out more about the Reflective Fostering Programme and the Reflective Fostering Study.