The Reflective Fostering Study
The Reflective Fostering Study evaluated whether the Reflective Fostering Programme is more effective and cost-effective than the usual support provided for foster and kinship carers.
Background to the study
Foster and kinship (or connected) carers play a crucial role in supporting vulnerable children, many of whom have experienced significant adversity and neglect. While caring can be deeply rewarding, it is also emotionally demanding. Carers often report high levels of stress and burnout, and there is growing concern about increasing numbers leaving caring roles.
There is therefore a clear need for programmes that support carers’ wellbeing, improve retention and promote greater stability for children in care. Such support can also help carers provide the best possible care for the children they look after. However, despite this need, there remains limited evidence about which types of support are most effective.
About the study
The Reflective Fostering Study was a randomised controlled trial (RCT) conducted between 2021 and 2025. Its primary aim was to evaluate whether the Reflective Fostering Programme (RFP) is cost-effective and delivers greater benefits for carers and the children in their care compared with usual support.
The team worked in partnership with a wide range of Local Authorities and Independent Fostering Agencies across England and Wales. In total, 524 foster and kinship carers took part in the study.
The Reflective Fostering Programme
The Reflective Fostering Programme is a 10-week group intervention for foster and kinship carers. It provides psychoeducation and practical tools to help carers build and maintain supportive, reflective relationships with the children in their care.
Aims of the study
Programme impact
To assess the effectiveness and cost-effectiveness of the Reflective Fostering Programme for foster or kinship carers of children aged 4-13.
Mentalizing capacity
To examine whether the programme strengthens carers' capacity to mentalize, supporting more secure and reflective carer-child relationships.
Carer wellbeing
To explore whether the programme reduces levels of stress and burnout among foster and kinship carers.
Child wellbeing and behaviour
To investigate whether the programme improves emotional wellbeing and behaviour for children in care.
Study design and evaluation
Alongside outcome evaluation, the study included:
a process evaluation exploring what usual support looked like, how the programme was delivered, and how carers and facilitators experienced it
a health economic evaluation assessing the cost-effectiveness of adding the programme to usual support.
Alongside the main study, two sub-studies were conducted:
the Relationship Stories Study, which explored how carers applied what they had learned in their every interactions with the children
the InCLUDE study, which examined barriers to diverse and inclusive recruitment in foster care research and identified ways to overcome these barriers.
Study findings
The study found that the Reflective Fostering Programme led to several statistically significant improvements when compared with usual support.
By the end of the study, carers who took part in the programme showed:
improved reflective (mentalizing) capacity
reduced levels of stress and burnout
reduced dysfunction in the carer-child relationship.
Importantly, these positive outcomes were not only evident at the end of the programme but were maintained at the 12-month follow-up, demonstrating the lasting impact of the intervention.
The health economic evaluation showed that the programme was more cost-effective than usual support. This strengthens the case for its implementation by local authorities and fostering agencies, highlighting both its clinical value and economic benefit.
Visit the UCL study page to access the publications.
Funding
The research was funded by the National Institute for Health and Care Research (NIHR). Delivery of the Reflective Fostering Programme was funded by KPMG and Segelman Trust.
