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NICE Underpinning Review
The authors state:
"This review aims to answer:
3.2a: What is the effectiveness of interventions and approaches to promote physical, mental, and emotional health and wellbeing of looked-after children, young people and care leavers?
3.2b: Are interventions to promote physical, mental, and emotional health and wellbeing acceptable and accessible to looked-after children and young people and their care providers? What are the barriers to, and facilitators for the effectiveness of these
interventions?"
The authors state:
"The committee considered the evidence presented for interventions to promote the physical, mental, and emotional health and wellbeing of looked after children, young people and care leavers. The committee initially considered the evidence presented looking at multidimensional treatment foster care (MTFC). This intervention had one version which was aimed at pre-schoolers (aged 3 – 5 years), and another version which was aimed at adolescents. The committee considered evidence looking at salivary cortisol outcomes for MTFC (Fisher 2007/2011). While cortisol levels usually drop from morning to evening, these studies seemed to show that being in the routine foster care group was associated with a flattening effect in AM-PM cortisol compared to being in the intervention group. This flattening pattern is known to occur in children with early adversity. The committee considered that evidence of change of cortisol patterns could be valuable in the context of other evidence showing the broader effectiveness of MTFC for pre-schoolers, however, on its own it was insufficient to be able to support the use of MTFC for pre-schoolers. For example, there was no clear evidence of the effectiveness of this intervention for other outcomes of interest (e.g. positive relationships and placement stability). It was unclear how a change in diurnal cortisol patterns translates into tangible differences for the looked after child and caregiver. The committee considered two randomised studies looking at the impact of MTFC in an older age group (adolescents). These were in groups with conduct disorders or complex emotional/behavioural disorders. The committee considered that these were in small studies (n=34 to 46) which might account for the lack of significant impact found. The remaining evidence was from a larger randomised controlled trial looking at the use of MTFC in adolescent offenders who had been mandated to MTFC by court order. These studies showed a significant improvement in the MTFC group for depressive symptoms, psychotic symptoms, and drug use. The committee considered that MTFC had been shown to be effective across outcomes spanning a range of review questions (e.g. interventions to improve positive relationships) and that this constituted further supportive evidence of their decision to recommend MTFC for adolescents in the specific sub-population of looked after young people who were persistent offenders. However, the committee considered the possible harms of this intervention would include risk to the treatment foster parents and any existing children in treatment foster homes. Therefore, providers should take care when considering this intervention.
Next the committee considered evidence looking at the impact of Attachment and Biobehavioural Catch-up (ABC) compared to developmental education for families. The committee had considered evidence for this intervention in an earlier review question (interventions for promoting Readiness for School). The evidence presented showed that being in the ABC intervention group was associated with an overall lower level of cortisol (including AM and PM values). In this case, the studies did not consider the diurnal pattern of cortisol between groups. The committee had already recommended the ABC intervention as a result of evidence presented in a previous review question. They considered the cortisol evidence as broadly supportive of their recommendation to cross-refer to recommendations 1.5.1 to 1.5.3 in the Children’s Attachment Guideline.
Similarly, there was some evidence showing an association between the Middle School Success intervention and better substance use outcomes at 3 years follow up; and the Kids in Transition to School intervention and improved self-regulation, positive attitudes towards alcohol, self-competence, and overall level of salivary cortisol. The committee saw this evidence as broadly supportive of recommendations they had made after reviewing evidence in a previous review (interventions to promote readiness for school), to consider the use of transition programmes for supporting looked after children moving between schools.
Therefore, no further recommendations were made."
Please read the full review to access the complete findings