A total of 3–4% of Swedish children are placed at a foster home or institution at some point. Across their lifespan, they run an elevated risk for suicide, psychological problems, substance abuse, criminal behaviour and the need for long-term public assistance.
The systematic review and assessment by SBU examined whether supportive interventions for children and parents in foster homes can minimise the risk.
The results give cause for hope. The studies that were reviewed indicate overall that interventions can improve physical and mental health, as well as social circumstances and quality of life. Placement may need to be changed or discontinued less often as well.
The average, overall effect of the various programmes and supportive interventions that SBU evaluated point in that direction.
But both the interventions and studies differ substantially, and none of the interventions have been analysed by more than a few studies. Thus, current evidence is insufficient to determine what specific interventions or components that are able to help foster children.
Nevertheless, three of the interventions have been studied enough to demonstrate that they are effective in at least one specific respect. The Attachment and Biobehavioural Catch-up programme has proven capable of improving psychological health and reducing stress, etc. The Take Charge special education programme can strengthen autonomy and social circumstances such that children complete training, etc. Incredible Years can bolster the ability of foster parents to perform their tasks and reduce acting-out on the part of children. None of the other 15 interventions were examined for foster children by more than one study.
Potentially harmful or unwanted effects have not been examined in any study.
The SBU project conducted a survey to identify the interventions currently used in Sweden. Questionnaires were sent to a random selection of 106 municipalities, as well as all 38 businesses that provide services on their behalf.
The responses mentioned 30 interventions which concern assessment of the suitability of foster homes and training of foster parents. The effects of these interventions have not been assessed by SBU. Few foster children or families receive support once the arrangement is under way.
SBU also interviewed four organisations that advocate for current or former foster children, their biological parents and foster parents. All four call for additional support. Foster parents want to know more about children’s needs, while biological parents want help so that they can be more involved in their children’s lives.
SBU’s ethical analysis stresses that the public sector has a special duty to promote a child’s best interests once it has assumed custodial responsibility. The lack of scientific evidence for the advantages and disadvantages of various interventions jeopardizes a child’s rights. Another problem is inadequate documentation and follow-up of the interventions that are administered.
SBU concludes that the results of the studies reviewed can be applied to Swedish foster home care. Small Swedish municipalities that adopt new interventions should be aware that maintaining proper skills when only a few children are placed at foster homes may be difficult.
Implementation of a number of the interventions requires systematic approaches. Even if there is scientific evidence for the effects, procedures are needed to methodically adopt, uphold and discontinue foster home interventions. Systematic local monitoring and documentation of both benefits and harmful effects might be the right way to go. Quality registers could ultimately emerge as a result.
SBU further stresses that future research should examine the value of the interventions currently in use, as well as those that may be adopted down the road. [RL]
About the report: Interventions to improve foster children’s mental and physical health – A systematic review and assessment of the economic, social and ethical aspects (2017). Executive summary and conclusions in English