Please note this application is under active development. If you spot any errors or something isn't working, please contact us at evidence.service@wales.nhs.uk.
Systematic Review
The authors state:
"The review sought to answer the following five research questions:
1. What interventions for kinship families improve the outcomes for children in kinship care (e.g. safety, permanence, and wellbeing) and for kinship carers (e.g. wellbeing, confidence in parenting, relationship with child in care)?
2. Are there interventions/programmes that are particularly effective with different groups of carers and children (e.g. disabled or carers or children from minoritised ethnic backgrounds)?
3. Are there common elements shared by effective interventions?
4. What are the enablers and barriers to successful implementation of interventions for kinship carers and children in kinship care in the UK?
5. What are the perspectives of kinship carers and children in kinship care on the acceptability and usefulness of different interventions in the UK?"
The authors state:
"We identified 29 impact evaluations (from 21 studies) that met our inclusion criteria and 6 qualitative studies. Of the impact studies, 67% presented some/moderate or high concerns around risk of bias. Four qualitative studies were assessed as moderate quality, and two as high quality.
Both the qualitative and impact literature emphasised that kinship families have unmet needs and different programmes and services can meet these needs and improve outcomes for children in care and kinship carers. One prevalent approach was to assist carers to navigate services. A meta-analysis for two of the QED studies for these ‘kinship navigator’ programmes showed that they had a small, but statistically significant, impact on the likelihood of children being placed in kinship care (low certainty of evidence). Based on the common effects model, two meta-analyses of RCTs and QEDs studies showed small, but significant effects on the likelihood of placement disruption (medium and low certainty of evidence). Other individual studies found positive effects in kinship navigator in terms of reunification rates, permanency (defined as adoption/guardianship and/or reunification), safety, carer wellbeing, parenting skills, knowledge, use and perceptions of services, and on relationship with the child. Two studies which measured enhanced kinship navigator programmes against standard kinship navigator programmes also found some positive impacts, showing that additional supports can improve outcomes above a heightened ‘business as usual’.
Another set of studies examined direct financial support to kinship carers who enter legal guardianship for the children in their care. The meta-analysis showed small but statistically significant effect of subsidised guardianship on permanence.
Other studies identified through this review and summarised narratively measured the impact of parenting skills programmes, cognitive behavioural therapy, resourcefulness or self-care practices, and peer-to-peer group support. These programmes and interventions again showed a variety of outcomes – there was no significant impact in some domains but significant positive impacts in others.
The qualitative literature from the UK also emphasised the importance of practitioners building relationships with kinship carers, of peer-support, and of being recipient-centred in both the content and the implementation of interventions, including addressing accessibility."
The authors state:
Policy and practice recommendations and next steps:
Based on studies reporting positive findings for ‘kinship navigator’ programmes, this approach holds promise and should be continued to be funded and delivered in areas where it is present, and rolled out and evaluated in areas where assistance to navigate needs is not present (e.g. informal carers). Many papers clearly highlighted core components for navigator or case management services, which is helpful for considering implementation, and programmes should introduce core components if they do not already do so to enhance implementation. It is important to understand how ‘navigation’-type programmes currently operate in the UK and how this evidence maps onto them. Local authorities in England have documented wide variation in the support offered for kinship carers (Smyth et al., 2023). The building of an evidence base about kinship navigation programmes has been possible due to the commitment by the US government to build the evidence base, and we recommend investment by national and local government to build rigorous evidence on what works to improve outcomes for kinship carers in the UK and what adapts from elsewhere to various contexts in the UK. In the US, the federal government created a pot of funding for evidence-based kinship navigation programmes; although the evidence standards have been challenging for evaluations to meet, the evidence and practice have grown and adapted (Rushovich, McKlindon & Vandivere, 2021; Schmidt & Treinen, 2021). This also ensures programmes are based on not just good intentions but on models and approaches that can improve outcome
Research recommendations:
Although the findings for placement in kinship care and placement stability are promising, kinship navigator programmes need further research on caregiver and child wellbeing outcomes to paint a fuller picture of this programme’s effects. Further randomised controlled trials and quasiexperimental design evaluations are also needed for other kinship care interventions such as parenting programmes, peer support groups, financial support, and mentoring for children in kinship care. There are gaps in terms of understanding how best to help children in care improve educational outcomes and health, and long-term follow-up is needed to better detect outcomes that happened with less frequency such as substantiated allegations of abuse and neglect. Literature supporting the efficacy of programmes, policies, and interventions for kinship carers – and the confidence of the review team in individual studies as well as meta-analyses – has been limited due to the challenges in meeting rigorous study design and execution standards for evidence-based programmes. This review did not seek to answer questions about the needs of kinship carers, so future research should continue to examine this topic with both quantitative and qualitative methods and align services with need.