Outcomes from attachment-based group interventions for foster carers and adoptive parents: A systematic review

Abstract

Existing research has shown that group work focused on attachment theory may help carers increase their understanding about the needs of children in care and improve skills in managing difficult behaviours. Despite the potential benefits of attachment-based group interventions, there is a lack of adequate evidence to demonstrate their efficacy among carers and children in care. This systematic review aimed to study the carer and child outcomes from attachment-based group interventions for foster carers and adoptive parents. We included published studies in English that looked at carer and/or child outcomes following attachment-based group interventions for carers fostering or having adopted a child less than 18 years of age. An initial search of relevant databases was completed in June 2021, which was followed up by an updated search in November 2023 and two citation searches, one in June 2022 and another in December 2023. Duplicates were screened and following a review of 91 full texts, 28 articles were included. Qualitative and quantitative outcomes were analysed. Following intervention, there was a general trend of improvements in carer understanding, enhanced skills, better carer responsiveness and more satisfied carer–child relationships. Although there seems to be a perceived benefit from carers, no consistent pattern of change was noted in child psychopathology or challenging behaviours.

Plain Language Summary

Children who are fostered or adopted have complex needs relating to their emotions and behaviours. These needs manifest in presentations among this particular group of children in a way that could potentially lead to placement breakdowns that may in the longer term negatively impact their mental health outcomes. Therapies or interventions that aim to increase bonding and security of attachment with their carers (attachment-based interventions) could be a significant part of managing some difficult presentations often seen with these children. However, the existing research in this area is minimal so it is important to explore the available evidence base. Our research synthesised the outcomes from such therapies delivered to groups of foster carers and/or adoptive parents. A systematic search of the existing literature was completed, and 28 published articles were included in our review. We found that from the carers’ perspectives, there were improvements in their understanding of children’s needs, better relationships and an increase in carer skills and confidence following participation in such interventions. However, children’s behaviour and attachment patterns weren’t reflective of this. In general, interventions delivered to groups were reported to enhance support, promote shared learning and were more cost-effective. The review also highlighted the need for further research in this area that specifically targets outcomes among children following group interventions for carers and studies around long-term outcomes for both fostered/adopted children and their carers.