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Systematic Review
The authors state:
"This report aims to identify and summarise evidence that addresses the following question: What is the effectiveness and cost-effectiveness of intensive family preservation programmes for families in crisis where there is an imminent risk of children entering care?"
The authors state:
"A literature search identified a range of primary and secondary evidence. In line with our rapid review approach outlined in the protocol, a recent systematic review and meta-analysis that reported on rates of out-of-home placement met our inclusion criteria and was considered the highest priority evidence Bezeczky et al. (2020). In addition, we also included five primary studies conducted in the UK setting that provided additional outcomes on out-of-home placement or other outcomes relating to children, parents, or family functioning (Biehal 2005, Brandon & Connolly 2006, Forrester et al. 2008, Forrester et al. 2016, Thom et al. 2014).
Findings from these studies suggest that IFPP are associated with reductions in out-of-home placement and can keep children within the family unit. Where available, outcomes relating to child well-being and family functioning did not appear to improve on receiving IFPP, but results trended towards benefits and there was no suggestion that staying within the family unit was detrimental to children. Outcomes relating to parents were mixed across studies, but some suggested that IFPP are associated with reduction in distress and substance misuse. However, it should be noted that most available evidence came from non-randomised studies with varying risk of bias, and this adds uncertainty.
Children’s and parent’s perspectives on IFPP and wider involvement with children’s social services were also captured through literature searches on the advice of the HTW Public and Patient Involvement Standing Group"
The authors state:
"Parents and children’s perspectives support the idea that IFPP are beneficial and can help address crises that may risk a child’s entry to care. In published literature relating specifically to IFPP, parents report that the additional support provided by IFPP helped address issues that were driving crises and they valued the additional support, and this was supported by the testimony of a parent who had had contact with IFSS in Wales. However, parents do raise concerns about the coercive nature of IFPP and question why more intensive services could not be provided prior to crises occurring.
However, there are a number of issues regarding available evidence that add uncertainty and should be considered within decision-making. First, evidence predominantly comes from nonrandomised trials and recent RCTs are not available. The studies have varying methods of generating control groups and are likely to introduce biases that reduce their accuracy and precision. Second, there is a high level of variation between details relating to populations, the delivery of IFPP and support provided within usual care. and often incomplete reporting of these details within included studies. Third, much of the evidence is conducted outside of the Welsh setting and from a number of years ago and it is unclear how generalisable this evidence is to the present setting.
A de-novo cost-consequence analysis was undertaken to estimate the associated costs and outcome associated with IFPP compared to no use of the intervention, in families who are at imminent risk of children being taken into out-of-home care. The analysis found that due to a reduction in out-of-home placements in families receiving IFPP (118 fewer compared to those not receiving the intervention), the programme was associated with cost savings of £12,171 per child, in addition to being associated with a reduction in substance misuse in families, and better outcomes for parents. No measure of child welfare was included in the analysis due to a lack of identified evidence"