Methodological Challenges to the Evaluation of Interventions for Foster/Kinship Carers and Children: A Systematic Review.

Caregivers of children in alternative care face a complex range of challenges that can result in placement disruption and poor long-term outcomes. Interventions designed to help carers meet these challenges report positive outcomes. Nevertheless, several reviewers have reported these positive results may be mitigated by limitations in trial methodology. This review aims to systematically review these methodological challenges and limitations, to provide an analysis of the current state of the evidence base for these interventions. A systematic review was conducted into the methods used to evaluate the effectiveness of psychosocial interventions for foster and kinship carers. Limitations relating to internal validity, external validity and clinical heterogeneity were identified and synthesised. Seventeen studies met inclusion criteria. The quality of methods used in the included studies is mixed, with high and unknown levels of bias in the majority of trials. Heterogeneity in participant characteristics, intervention aims and outcome measures across interventions reflect the diversity of carer and child needs and make it difficult to generalise results or compare and synthesise the efficacy of different interventions. These factors limit the application of trial results to evidence-based clinical practice. The diverse and complex needs of this population present significant challenges to robustly evaluating interventions for foster/kinship families. Participant needs, theoretical approaches, intervention aims and outcome measures need to be better coordinated, both within trials and across the field. Exploratory research should be used to generate focussed and concrete hypotheses that can be robustly tested in high-quality randomised controlled trials. Protocol registration number: CRD 42017048415.