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Interventions to support learning needs for school-aged looked-after children and young people
Evidence review I
NICE Guideline, No. 205
Interventions to support learning needs for school-aged looked-after children and young people
Review question
- a)
What is the effectiveness of interventions to support learning needs by either a learning provider or carer of school-aged looked-after children and young people?
- b)
Are interventions to support learning needs 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 to support learning needs in school-aged looked-after children and young people?
Introduction
Looked-after children are at a greater risk of poor educational outcomes. In 2017, 56.3% of looked-after children had a special educational need, compared with 45.9% of children in need and 14.4% of all children. At key stage 2, 32% of looked-after children and young people reached the expected standard in reading, writing and maths (compared with 61% of those who were not looked after). In 2016, 0.10% of looked-after children were permanently excluded from school, compared to 0.08% of all children. Interventions that support learning needs for looked-after child during preschool, primary, or secondary education could help to improve educational outcomes while the child is at school.
Looked after children and young people are currently entitled to a pupil premium to support their education, however there is uncertainty about which specific educational interventions work. The (2010) NICE guideline for looked-after children and young people did not include recommendations on specific educational interventions. A NICE surveillance review found new evidence that indicated recommendations on interventions to support school learning in looked-after children might be needed.
Summary of protocol
PICO table
SPIDER table
Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. For further details of the methods used see Appendix N. Methods specific to this review question are described in this section and in the review protocol in Appendix A.
The search strategies for this review (and across the entire guideline) are detailed in Appendix B.
Declarations of interest were recorded according to NICE’s 2018 conflicts of interest policy.
Effectiveness evidence
Included studies
After removing duplicates, a total of 36,866 studies were identified from the search. After screening these references based on their titles and abstracts, 110 studies were obtained and reviewed against the inclusion criteria as described in the review protocol for interventions to support leaning in school (Appendix A). Overall, 17 studies, reporting on 16 original studies, were included.
The evidence consisted of 9 randomised controlled trials, 3 non-randomised controlled studies, 2 uncontrolled before-and-after studies, and 2 qualitative studies. See the table below for a summary of included studies. For the full evidence tables please see Appendix D. The full references of included studies are given in the reference section of this chapter. These articles considered 12 different interventions to support learning needs in school-aged looked-after children.
Excluded studies
In total, 93 references were excluded because they did not meet the eligibility criteria. See Appendix J for a list of references for excluded studies, with reasons for exclusion.
Summary of studies included in the effectiveness evidence
Quantitative evidence
Qualitative evidence
See Appendix D for full evidence tables
Summary of the effectiveness evidence
Quantitative evidence
Primary school-age (primarily)
Secondary school-age (primarily)
All school-ages
See appendix F for full GRADE tables.
Qualitative evidence
Economic evidence
Included studies
A systematic review was conducted to cover all questions within this guideline update. The study selection diagram is available in Appendix G. The search returned 3,197 publications since 2000. Additionally, 29 publications were identified through reference tracking. All records were excluded on basis of title and abstract for this review question. An updated search was conducted in November 2020 to identify any newly published papers. The search returned 584 publications. After screening titles and abstracts five publications were considered for full text inspection but did not meet the inclusion criteria and were excluded from the evidence report. Reasons for exclusion are summarised in Appendix J.
Economic model
No economic modelling was undertaken for this review question.
The committee’s discussion of the evidence
Interpreting the evidence
The outcomes that matter most
Initially, the committee considered evidence from the four interventions that were applied to support the learning needs of majority primary school aged children (up to 11 years). Of the outcomes reported, the committee considered objective literacy and numeracy education outcomes, such as word reading, reading age, sentence comprehension, spelling and maths scores to be the most important and useful outcomes for making recommendations. These outcomes were reported across all four interventions: foster-parent and volunteer-delivered tutoring programmes, letterbox, and paired reading. Positive results were reported for tutoring and paired reading.
Furthermore, the committee considered the evidence from five interventions to support learning needs in majority secondary school aged children: Take Charge (individualised coaching and group mentoring), Multidimensional Treatment Foster Care, ESTEP tutoring programme, and animal-assisted psychotherapy. Outcomes that the committee considered to be particularly useful among this evidence included scholastic/language skills score, school attendance, academic grade levels, and reading and maths scores. Engagement in educational planning score was also considered to be relevant to the UK population’s engagement in the personal education plan (PEP) and was reported as positive in a study of Take Charge coaching and mentoring.
Two studies considered interventions that were relevant for looked after children at all ages: Child Advocacy and Evolve Interagency Services. The committee considered some outcomes reported by these studies to be important – for example: passing all courses, and school expulsion by year 1, scholastic or language skills score and poor school attendance. Positive results were found for passing all courses by year 1 in child advocacy, and scholastic and language skills/school attendance for Evolve Interagency Services. The committee noted that in many cases, while the phenomenon that the outcomes were attempting to measure were important, the measures themselves may be subject to bias through self-reporting. In some cases, such as for the outcomes reported in the Child Advocacy study, it was not clear how the outcomes were being defined.
The quality of the evidence
The quality of the evidence was found to be low or very low by the criteria outlined by GRADE. One exception was outcomes reported by the UK-based study of the Letterbox club intervention, a well-designed and well-reported RCT which was judged overall to be of low risk of bias. Otherwise, there was a lack of UK evidence with only 3 of the 14 identified studies conducted in the UK, therefore the committee were careful to take into account the indirectness of these studies to current UK practice.
The committee considered other common reasons why the presented evidence was marked down for quality. For example, studies frequently failed to report how randomisation was performed or if allocation of participants was concealed; it was often unclear how many were lost to follow up or if there was missing data (and for what reason, and whether this varied between comparison groups); studies commonly failed to adequately adjust for differences between comparison groups at baseline for important variables such as behavioural problems, number of placement changes, and special educational needs; studies were frequently unblinded and did not outline a detailed protocol or analysis plan. In addition, for certain studies, outcomes may have been selectively reported (either through selective use of subscales or follow up times).
While most reported evidence used a contemporary control group, two included studies were uncontrolled before and after studies. One considered a paired reading intervention (this study was included since it was UK-based and there was a paucity of UK-based evidence), the other considered the use of an interagency “wrap-around” model of care (this study was included since there was a paucity of evidence considering interventions for looked-after children with psychological or behavioural disorders specifically). The committee considered the problems inherent in this study design. For example, the outcomes of participants in these studies may improve with time regardless of the intervention, or perhaps as a result of other interventions received during the follow up period.
The interpretation of one study was particularly problematic. The committee considered outcomes reported by one randomised trial of the ESTEP tutoring programme for which 38.2% of those assigned to the E-STEP group did not receive E-STEP services and 12.3% of those in the control group did receive ESTEP services. In addition, the study authors noted that approximately equal proportions of ESTEP and control groups received some form of tutoring (58.4% vs 60.8%).
Small sample size was also a problem for many outcomes with included studies frequently unable to differentiate between an observed effect that was non-significant and one which was greater than the pre-defined minimum important difference.
A gap in the evidence base was noted on the use of therapeutic interventions of popular interventions used in current practice such as art therapy, play therapy, occupational therapy, music therapy and psychotherapy. The committee highlighted these interventions as being known to have a positive impact on educational, social and emotional outcomes in broader populations of children. A research recommendation was therefore drafted for interventions to assess the effectiveness of these interventions on improved learning outcomes, school attendance and exclusion to help address this evidence gap. NB: while evidence from two non-randomised controlled trials was presented looking at outcomes for animal-assisted psychotherapy, the outcomes presented from this study focussed on behavioural rather than academic outcomes while at school. The committee considered that evidence for this therapy should be considered again under review questions looking at health and wellbeing for looked after children and young people.
The committee was disappointed by the lack of high-quality evidence, in particular, in secondary school-aged children which meant they were unable to make more positive recommendations for this population group. Instead a recommendation was made advising “When providing interventions to improve education in secondary school-aged looked after children, ensure ongoing evaluation of appropriateness and impact.” The committee noted that the pupil premium is often spent on interventions to improve educational outcomes (for example, tutoring) without enough evidence to say that these interventions are working in looked after children and young people. A practice of regular evaluation of these interventions could help schools select interventions that have been tried and tested over those for which the impact is unclear. This practice would have an additional benefit in increasing the amount of available data which could be used for research.
Benefits and harms
Primary school aged interventions
The committee considered the four interventions tested in majority primary school aged children: foster parent-delivered Teach Your Children Well (tutoring), volunteer-delivered Teach your Children Well (tutoring), the Letterbox club, and a paired reading intervention. It was observed in one randomised controlled trial that foster parent-delivered tutoring was associated with higher maths and sentence comprehension scores postintervention compared to a waitlist intervention. Across two randomised controlled trials volunteer-delivered tutoring was associated with improved word reading, spelling, and maths scores postintervention compared to a wait list intervention. Though very low-quality evidence overall, these were outcomes that the committee considered to be important (see above). In addition, a UK-based before-and-after study showed that a paired reading intervention was associated with a large improvement in reading age (MD 1.00 95%CI 0.24 to 1.76 years) comparing baseline to postintervention results.
The committee noted that the two RCTs considering the volunteer-delivered Teach Your Children Well tutoring programme reported consistently positive results. In one of these studies, there was significant improvements in three out of the four WRAT-4 academic outcome domains. While significant findings were also observed in the foster parent-delivered tutoring, the committee suggested that volunteers may be a more appropriate vehicle for delivering tutoring support to LACYP: it was suggested that volunteers providing tutoring programmes, especially if they are recent graduates, may be more familiar with recent teaching methods for maths and phonics than foster parents; the committee also discussed that looked after children can often benefit from building relationships with volunteers who are investing their own personal time into improving LACYP academic outcomes; finally, foster carers often report that they struggle with providing extra educational support to looked after children as they feel this creates a ‘blurring of boundaries’ between their caring and education role.
The committee also discussed the behaviour management component of the Teach Your Children Well intervention. In terms of future implementation, they highlighted that the points system for rewarding positive behaviour in the foster carer delivered “Teach Your Children Well” tutoring programme may not work for many looked after children and would require tailoring to the individual. The committee discussed points-based systems and the variety of behavioural management reward systems currently in use. It was suggested that many LACYP often need immediate rewarding (or feedback such as praise) for good behaviour rather than a points system. In some cases, children may also benefit from a points system as long as rewards are tangible and material, such as time out to engage in something they enjoy.
Based on the above discussions, the committee decided to recommend tutoring for improving educational outcomes in primary school-aged looked after children. Tutoring could be delivered by foster carers, volunteers, or professional tutors, but the committee considered it was important that tutors were trained (as in the evidence base). In addition, tutoring could take place individually or in small groups.
The committee also considered one UK-based before and after study looking at a paired reading intervention. While very low-quality evidence, the committee were impressed by the large effect size observed in this study (i.e. that participants improved their reading age by a year over 16 weeks). Given the liaison between the school and the carer described in the study, the committee considered that this intervention also had potential for increasing links and engagement between foster carers and schools.
Despite the quality of the evidence for paired reading being very low by the criteria outlined by GRADE, the committee decided that a strong ‘offer’ recommendation was still warranted. This was based on expert consensus. The committee considered paired reading to be a simple, cheap, and already widely used intervention in primary schools (with parents often encouraged to engage in paired reading) in addition this intervention was known to have a good evidence base, and historical use, outside of looked after children. Paired reading was also considered to have a relational aspect, improving quality time spent between carer and child. It was also suggested that older students in primary school (e.g. Year 6) can engage in paired reading with younger students which may also provide an important mentoring role.
Despite being a well-known intervention with evidence from a well conducted high quality trial, the Letterbox club intervention did not report any significant benefit on educational outcomes in looked after children. The trial stated “As a book gifting scheme directed at the child, the intervention does not rely on, expect or demand foster carer involvement and, as such, there is no manual or guidance for carers about how and in what ways they/the child should engage with the parcel.” However, the committee stated that this was not the usual guidance and support provided by Letterbox to foster carers to promote the implementation and use of the intervention. The committee considered that the Letterbox intervention is often used in combination with strategies such as paired reading to promote the use of their parcels. Additional, untested, benefits include the fact that (in the experience of the committee) foster children frequently find it very meaningful to receive mail and a letter addressed to them personally. However, it was conceded that for some children the Letterbox club books were left stacked and unused.
Potential harms of the letterbox intervention were also considered, for example the Letterbox club intervention was noted for being popular amongst LACYP however this intervention could have a negative impact on relationships in the household through disappointment and jealously amongst other (non-looked after) children in a foster home who don’t receive a parcel. The committee reported anecdotal evidence of foster carers contacting Letterbox asking if they can purchase additional Letterbox parcels for other children. The committee agreed to delay judgement on this intervention until qualitative evidence had been considered.
The Letterbox club intervention is a well-known UK intervention targeted at LACYP and the committee noted that the intervention was popular amongst LACYP as it is personalised and attractively presented. The committee noted that the intervention also helped build a sense of identity amongst LACYP. However, this intervention did not report any significant benefit on education outcomes such as reading or recreational reading skills scores.
Secondary school aged interventions
Four interventions aimed at primarily secondary school-aged children, were considered: Take Charge (coaching and mentoring); Multidimensional Treatment Foster Care; ESTEP tutoring; and animal-assisted psychotherapy.
Take Charge was associated with improvements in the (self-reported) number of hours spent doing homework postintervention, a total count of self-reported educational accomplishments at postintervention, and mean youth knowledge and engagement in educational planning (student and parent reported). However, the committee considered these outcomes to be mostly surrogate and unable to show that academic outcomes were improved.
Multidimensional Treatment Foster Care was considered as a highly intensive intervention for LACYP with severe emotional/behavioural disorders and unstable placements. One UK-based randomised trial was not able to differentiate an effect for Multidimensional Treatment Foster Care (MDTFC) on scholastic/language skills or odds of higher school attendance. The USA-based RCT found that MDTFC was associated with improved homework completion score, and school attendance score on follow up. The committee found that the academic outcomes reported by these studies were insufficient to recommend its use on the basis of academic outcomes alone. The committee decided to consider this intervention again for its use in improving the health/wellbeing, relationships, and placement stability of LACYP.
One study found evidence of no meaningful effect of ESTEP tutoring on grade level, academic outcomes, and school behaviour. The committee discounted results reported in the RCT study of the ESTEP tutoring programme due to considerable cross-over between intervention and comparison groups meaning that (by the end of the study) similar proportions of participants in both groups had received some form of tutoring.
Finally, the committee considered results from two non-randomised controlled trials considering the use of animal assisted psychotherapy in youth in residential care with emotional behavioural disorders. This study found improvements in teacher-rated school maladjustment and adaptive skills in the intervention group. Once again, the committee found that the academic outcomes reported by these studies were insufficient to recommend its use on the basis of academic outcomes alone. The committee agreed that it may be a useful intervention in children experiencing trauma and decided to consider this intervention again for its use in improving the health/wellbeing, relationships, and placement stability of LACYP in later evidence reviews. However, the committee were particularly interested in the use of therapeutic strategies to support the education of LACYP with mental health problems or emotional and behavioural disorders. Therefore, a research recommendation was drafted: What is the effectiveness and cost-effectiveness of therapeutic interventions for improving learning outcomes and school attendance and exclusion in educational settings for looked after children? (for example: art therapy, play therapy, occupational therapy, music therapy, psychotherapy, animal-assisted psychotherapy, and therapeutic foster carer training.
In the absence of strong evidence, the committee discussed tutoring amongst LACYP attending secondary school. In current practice a large amount of money is spent on tutoring, however there is a lack of evidence showing effectiveness for this intervention for LACYP. In stead the committee recommended that interventions for improving education in secondary school-aged looked-after young people are regularly evaluated to check they are appropriate for the user and effective.
All ages
The committee considered the findings from the Child Advocate Volunteers intervention which was aimed at both primary and secondary school aged LACYP and showed improvements in passing all courses and reports of poor conduct by 1 year follow up. However, these outcomes were not clearly defined. The committee agreed with the need for child advocacy, however, highlighted a problem in the implementation of this intervention in which there is a high turnover in child advocates. There is often a difficulty in finding advocates to maintain a long-term relationship with LACYP. Training and support would also be needed for advocates. The committee noted that advocacy is supposed to be the role of the independent visitor in UK practice.
Finally, the committee considered evidence from a before and after study considering Evolve Interagency Services, a wrap around model of care for LACYP presenting with psychological and behavioural disorders. This study found improvements in scholastic/language and school attendance when comparing pre and postintervention outcomes. Participants in this study received a range of therapeutic interventions, of different intensity and duration. Therefore, the committee were unable to extrapolate the impact of the wrap-around model of care itself since the study had no contemporary control group.
Cost effectiveness and resource use
There were no published cost-effectiveness analyses addressing this review question and no original economic modelling was undertaken due to the limited amount of effectiveness evidence for key educational outcomes. In discussing the evidence, the committee took into consideration the type of resource use that would be required to deliver each intervention.
Among primary school aged looked after children, the “Teach Your Children Well” tutoring programme and paired-reading interventions were delivered by foster carers and volunteers. In the studies, tutoring was delivered at an intensity of 3 hours per week and paired reading for 20 minutes or more 3 times per week. Overall, these interventions were not expected to be very costly. However, the committee recognised that even interventions that have an apparently low cost (such as those delivered by volunteers) are likely to have hidden costs such as the carer or volunteer time, training, travel and administrative support. The committee commented that some carers may not want to take on the responsibility for tutoring as this can blur the line between the carer and educator roles.
It was highlighted that foster carers would benefit from extra support or training from schools on active reading. Infrastructure may be needed to support this and to train volunteer paired readers. The committee noted the important role that virtual schools play in supporting and training not only teaching staff but also foster carers, and that therefore they may be best placed to deliver training in paired reading to foster parents. Overall, the committee felt that the resource impact of tutoring programmes and paired-reading interventions would be limited and could be funded as part of the pupil premium.
The interventions involving secondary school participants were perceived as being more resource intensive. MTFC in particular was associated with 9-month placements with full-time specialist foster carers and continuous multidisciplinary team support. Take Charge was delivered weekly over 9 months period and required coaches to undergo formal training and be mentored on a weekly basis. Given the available evidence, the committee did not feel these interventions were an effective use of resources to support learning needs in LACYP.
The committee agreed that the resource impact of these recommendations is low. Paired reading is currently offered to all children in primary schools, so no additional resource is required. Individual or small group tutoring has the potential to also have a low resource impact especially if delivered by trained foster carers or trained volunteers. The use of professional tutors may have resource implications, however, these interventions can be prioritised for funding through the Pupil Premium which is part of statutory education funding provision for LACYP.
References – included studies
- Balluerka, Nekane, Muela, Alexander, Amiano, Nora et al. (2015) Promoting psychosocial adaptation of youths in residential care through animal-assisted psychotherapy.. Child abuse & neglect 50: 193–205 [PubMed: 26443670]
- Courtney, Mark E., Zinn, Andrew, Zielewski, Erica H. et al. (2008) Evaluation of the Early Start to Emancipation Preparation Tutoring Program, Los Angeles County, California: Final Report. Administration for Children & Families: 1–129
- Flynn, Robert J, Marquis, Robyn A, Paquet, Marie-Pierre et al. (2012) Effects of individual direct-instruction tutoring on foster children’s academic skills: A randomized trial.. Children and Youth Services Review 34(6): 1183–1189
- Forsman, Hilma; Foster carers’ experiences of a paired reading literacy intervention with looked-after children.; Child & Family Social Work; 2017; vol. 22 (no. 1); 409–418
- Geenen, Sarah, Powers, Laurie E, Powers, Jennifer et al. (2013) Experimental study of a self-determination intervention for youth in foster care.. Career Development and Transition for Exceptional Individuals 36(2): 84–95
- Green, J M, Biehal, N, Roberts, C et al. (2014) Multidimensional Treatment Foster Care for Adolescents in English care: randomised trial and observational cohort evaluation.. The British journal of psychiatry : the journal of mental science 204(3): 214–21 [PubMed: 24357575]
- Griffiths, Rose; The Letterbox Club: An account of a postal club to raise the achievement of children aged 7 to 13 in foster care.; Children and Youth Services Review; 2012; vol. 34 (no. 6); 1101–1106
- Harper, Julie and Schmidt, Fred (2012) Preliminary effects of a group-based tutoring program for children in long-term foster care.. Children and Youth Services Review 34(6): 1176–1182
- Harper, Julie and Schmidt, Fred (2016) Effectiveness of a group-based academic tutoring program for children in foster care: A randomized controlled trial.. Children and Youth Services Review 67: 238–246
- HICKEY Andrea, J. and FLYNN Robert, J. (2020) A randomized evaluation of 15 versus 25 weeks of individual tutoring for children in care. Children and Youth Services Review 109: 104697
- Klag S, Fox T, Martin G, Eadie K, Bergh W, Keegan F, Turner D, Raeburn N. Evolve therapeutic services: A 5-year outcome study of children and young people in out-of-home care with complex and extreme behavioural and mental health problems. Children and Youth Services Review. 2016 Oct 1;69:268–74.
- Leve, Leslie D and Chamberlain, Patricia (2007) A randomized evaluation of multidimensional treatment foster care: Effects on school attendance and homework completion in juvenile justice girls.. Research on Social Work Practice 17(6): 657–663 [PMC free article: PMC2151756] [PubMed: 18159224]
- Mooney, Jennifer, Winter, Karen, Connolly, Paul et al. (2016) Effects of a book gifting programme on literacy outcomes for foster children: A randomised controlled trial evaluation of the Letterbox Club in Northern Ireland.. Children and Youth Services Review 65: 1–8
- Muela, Alexander, Balluerka, Nekane, Amiano, Nora et al. (2017) Animal-assisted psychotherapy for young people with behavioural problems in residential care.. Clinical psychology & psychotherapy 24(6): o1485–o1494 [PubMed: 28730756]
- OSBORNE Cara; ALFANO Julia; WINN Tanya (2010) Paired reading as a literacy intervention for foster children. Adoption and Fostering 34(4): 17–26
- Waxman, Hersh C, Houston, W Robert, Profilet, Susan M et al. (2009) The long-term effects of the Houston Child Advocates, Inc., program on children and family outcomes.. Child welfare 88(6): 23–46 [PubMed: 20695290]
- Zinn, Andrew and Courtney, Mark E (2014) Context matters: Experimental evaluation of home-based tutoring for youth in foster care.. Children and Youth Services Review 47(part3): 198–204
Effectiveness
Cost effectiveness
No cost-effectiveness evidence was identified for this review question
Appendices
Appendix A. Review protocols
Review protocol for interventions to support learning needs for looked-after children and young people (PDF, 282K)
Appendix B. Literature search strategies
Effectiveness searches (PDF, 257K)
Cost-effectiveness searches (PDF, 381K)
Appendix C. Evidence study selection
Download PDF (137K)
Appendix D. Evidence tables
Effectiveness studies (randomised controlled trials) (PDF, 659K)
Effectiveness studies (non-randomised controlled studies) (PDF, 415K)
Effectiveness studies (uncontrolled studies) (PDF, 285K)
Qualitative studies (PDF, 388K)
Appendix E. Forest plots
No forest plots were produced for this review question as meta-analysis was not attempted.
Appendix G. Economic evidence study selection
Download PDF (142K)
Appendix H. Economic evidence tables
No economic evidence was identified for this review question.
Appendix I. Health economic model
No economic modelling was undertaken for this review question.
Appendix J. Excluded studies
Effectiveness studies
| Study | Code [Reason] |
|---|---|
| (2010) Sharing Data between Child Welfare and Education to Improve Outcomes for Children and Youth in the Foster Care System. Policy Brief. Center for the Future of Teaching and Learning: 1–4 | - Not a peer-reviewed publication |
| Bastiaanssen, Inge L. W, Delsing, Marc J. M. H, Geijsen, Luuk et al. (2014) Observations of group care worker-child interaction in residential youth care: Pedagogical interventions and child behavior.. Child & Youth Care Forum 43(2): 227–241 | - Study does not contain a relevant intervention |
| Bean, Pamela, White, Ladd, Neagle, Lee et al. (2005) Is residential care an effective approach for treating adolescents with co-occurring substance abuse and mental health diagnoses?. Best Practices in Mental Health: An International Journal 1(2): 50–60 | No indication that this population is looked after |
| Berridge, David (2017) The education of children in care: Agency and resilience.. Children and Youth Services Review 77: 86–93 |
To be considered for inclusion under a different review question: - RQ4.4 |
| Brannstrom, Lars; Vinnerljung, Bo; Hjern, Anders (2013) Long-term outcomes of Sweden’s Contact Family Program for children.. Child abuse & neglect 37(6): 404–14 [PubMed: 23490057] | No indication that this population is looked after |
| Clemens, Elysia V, Klopfenstein, Kristin, Lalonde, Trent L et al. (2018) The effects of placement and school stability on academic growth trajectories of students in foster care.. Children and Youth Services Review 87: 86–94 | - Not an investigation of an intervention |
| Crosby, Shantel D, Somers, Cheryl L, Day, Angelique G et al. (2017) Examining school attachment, social support, and trauma symptomatology among court-involved, female students.. Journal of Child and Family Studies 26(9): 2539–2546 | - Not an investigation of an intervention |
| Denecheau B. (2011) Children in residential care and school engagement or school ‘dropout’: What makes the difference in terms of policies and practices in england and france?. Emotional and Behavioural Difficulties 16(3): 277–287 |
-To be considered for inclusion under a different review question: - RQ4.4 |
| Dickinson, Janet and Miller, Mandy (2002) Complex Learning Difficulties and EBD. Emotional and Behavioural Difficulties 7(4): 197–206 | - Intervention description/practice report |
| Durbeej, Natalie and Hellner, Clara (2017) Improving school performance among Swedish foster children: A quasi-experimental study exploring outcomes of the Skolfam model.. Children and Youth Services Review 82: 466–476 |
-Intervention describes the use of an education plan with a multidisciplinary team (covered by statutory care but check with committee) -Not included under this question since uncontrolled before and after study Also, to be considered for inclusion under a different review question: - RQ2.1 - RQ3.2 |
| Dymoke, Sue and Griffiths, Rose (2010) The Letterbox Club: The impact on looked-after children and their carers of a national project aimed at raising achievements in literacy for children aged 7 to 11 in foster care.. Journal of Research in Special Educational Needs 10(1): 52–60 |
-To be considered for inclusion under a different review question: - RQ4.4 |
| Ennis, Robin Parks, Jolivette, Kristine, Boden, Lauren J et al. (2013) STOP and DARE: Self-regulated strategy development for persuasive writing with elementary students with E/BD in a residential facility.. Education & Treatment of Children 36(3): 81–99 | -No indication that this population is looked after |
| Evans, Rhiannon, Brown, Rachel, Rees, Gwyther et al. (2017) Systematic review of educational interventions for looked-after children and young people: Recommendations for intervention development and evaluation.. British Educational Research Journal 43(1): 68–94 [PMC free article: PMC5299458] [PubMed: 28239209] | -Systematic review, checked for relevant citations |
| Feuerstein R., Rand Y., Hoffman M. et al. (2004) Cognitive modifiability in retarded adolescents: Effects of Instrumental Enrichment. Pediatric Rehabilitation 7(1): 20–29 [PubMed: 14744671] |
-Unclear that adolescents are looked after (study refers to their parents and number of children per family - Non-UK setting (Israel) |
| Finn, Jerry and Kerman, Ben (2004) Internet Risks for Foster Families Online.. Journal of Technology in Human Services 22(4): 21–38 |
- Study does not contain a relevant intervention (Ruled out by committee as not being an intervention of interest: providing internet access to foster families) - Non-UK setting |
| Finn, Jerry, Kerman, Ben, LeCornec, Juliette et al. (2005) Reducing the Digital Divide for Children in Foster Care: First-Year Evaluation of the Building Skills-Building Futures Program.. Research on Social Work Practice 15(6): 470–480 |
- Study does not contain a relevant intervention (Ruled out by committee as not being an intervention of interest: providing internet access to foster families) - Non-UK setting |
| FLETCHER-CAMPBELL Felicity (2001) Issues of inclusion. Emotional and Behavioural Difficulties 6(2): 69–89 | - Qualitative study published prior to 2010 (original qualitative data collected and published prior to 2000; also no methods described) |
| Fox, Paul and Avramidis, Elias (2003) An evaluation of an outdoor education programme for students with emotional and behavioural difficulties.. Emotional & Behavioural Difficulties 8(4): 267–283 |
-To be considered for inclusion under a different review question: - RQ4.4 |
| Francis, Yvonne J, Bennion, Kim, Humrich, Sarah et al. (2017) Evaluating the outcomes of a school based Theraplay project for looked after children.. Educational Psychology in Practice 33(3): 308–322 | -To be considered for inclusion under a different review question |
| Gairal-Casado, Regina, Garcia-Yeste, Carme, Novo-Molinero, Maria Teresa et al. (2019) Out of school learning scientific workshops: Stimulating institutionalized Adolescents’ educational aspirations. Children and Youth Services Review 103: 116–126 | - non-UK qualitative study |
| Griffiths, Rose (2012) The Letterbox Club: An account of a postal club to raise the achievement of children aged 7 to 13 in foster care.. Children and Youth Services Review 34(6): 1101–1106 |
- Quantitative data incomplete (no measure of spread or statistical significance of difference) -To be considered for inclusion under a different review question: - RQ4.4 |
| Hooper, S R, Murphy, J, Devaney, A et al. (2000) Ecological outcomes of adolescents in a psychoeducational residential treatment facility.. The American journal of orthopsychiatry 70(4): 491–500 [PubMed: 11086527] | - Unclear that population are LACYP |
| HOPKINS Graham (2003) It all clicks into place. Community Care 61103: 42–43 | - Not a peer-reviewed publication |
| HOPKINS Graham (2003) Small steps, giant leaps. Community Care 131103: 42–43 | - Not a peer-reviewed publication |
| Horwitz, S M; Owens, P; Simms, M D (2000) Specialized assessments for children in foster care.. Pediatrics 106(1pt1): 59–66 [PubMed: 10878150] |
-To be considered for inclusion under a different review question: - RQ3.1 |
| ICF Consulting Services; Arad Research; Cardiff University (2019) Evaluation of the implementation of the Pupil Development Grant for Looked after Children: final report (Welsh Government social research no 1/2019).: 154 |
- Not an intervention of interest (Descriptive study of grant and its spending on various interventions) |
|
ISRCTN19090228 (2017) Confidence in Care Evaluation. Http://www | - RCT protocol |
| JAY Matthew, A. and McGRATH-LONE, Louise (2019) Educational outcomes of children in contact with social care in England: a systematic review. Systematic reviews 8(155) [PMC free article: PMC6599338] [PubMed: 31253197] | - Systematic review |
| Johnson, Sara B; Pryce, Julia M; Martinovich, Zoran (2011) The role of therapeutic mentoring in enhancing outcomes for youth in foster care.. Child welfare 90(5): 51–69 [PubMed: 22533054] | -No outcomes of interest to this review question |
| Kim, Hyoun K and Leve, Leslie D (2011) Substance use and delinquency among middle school girls in foster care: a three-year follow-up of a randomized controlled trial.. Journal of consulting and clinical psychology 79(6): 740–50 [PMC free article: PMC3226884] [PubMed: 22004305] | -No outcomes of interest to this review question |
| LARZELERE Robert E. and et al (2001) Outcomes of residential treatment: a study of the adolescent clients of girls and boys town. Child and Youth Care Forum 30(3): 175–185 | -No outcomes of interest to this review question |
| Larzelere, Robert E, Daly, Daniel L, Davis, Jerry L et al. (2004) Outcome Evaluation of Girls and Boys Town’s Family Home Program.. Education and Treatment of Children 27(2): 130–149 | - Data not reported in an extractable format |
| Lee, Kyunghee (2016) Head Start’s impact on cognitive outcomes for children in foster care.. Child Abuse Review 25(2): 128–141 | -No outcomes of interest to this review question |
| LEWIS Helen (2000) Improving health care and health education: for looked after young people. Childrens Residential Care Unit Newsletter 13: 5–6 | -No outcomes of interest to this review question |
| Liabo, Kristin; Gray, Kerry; Mulcahy, David (2013) A systematic review of interventions to support looked-after children in school, IN Child and Family Social Work, Vol 18 No 3 Aug 2013. | -Systematic review, considered for relevant references |
| Lin, Ching-Hsuan (2014) Evaluating services for kinship care families: A systematic review.. Children and Youth Services Review 36: 32–41 | -Systematic review, considered for relevant references |
| Littlewood, Kerry A, Strozier, Anne L, Whittington, Danielle et al. (2014) Kin as Teachers: An early childhood education and support intervention for kinship families.. Children and Youth Services Review 38: 1–9 |
- No outcome of interest reported [Surrogate outcomes: e.g. parents knowledge of development and home environment] |
| MANNISTO Inka I. and PIRTTIMAA Raija A. (2018) A review of interventions to support the educational attainments of children and adolescents in foster care. Adoption and Fostering 42(3): 266–281 | -Systematic review, considered for relevant references |
| McMillen J.C., Narendorf S.C., Robinson D. et al. (2015) Development and piloting of a treatment foster care program for older youth with psychiatric problems. Child and Adolescent Psychiatry and Mental Health 9(1): 23 [PMC free article: PMC4504401] [PubMed: 26185524] | -No outcomes of interest to this review question |
| Melius, Patience, Swoszowski, Nicole Cain, Siders, Jim et al. (2015) Developing peer led check-in/check-out: A peer-mentoring program for children in residential care.. Residential Treatment for Children & Youth 32(1): 58–79 | -No outcomes of interest to this review question |
| Moffat, Shaye and Vincent, Cynthia (2009) Emergent literacy and childhood literacy-promoting activities for children in the Ontario Child Welfare System.. Vulnerable Children and Youth Studies 4(2): 135–141 | - No outcome of interest reported |
|
NCT00056303 (2003) Mental Health Services for Foster and Adopted Children. Https: | - RCT protocol |
|
NCT00239837 (2005) Prevention Program for Problem Behaviors in Girls in Foster Care. Https: | - RCT protocol |
|
NCT00701194 (2008) Early Intervention Foster Care: a Prevention Trial. Https: | - RCT protocol |
|
NCT00810056 (2008) Fostering Healthy Futures Efficacy Trial for Preadolescent Youth in Foster Care. Https: | - RCT protocol |
|
NCT02037750 (2014) Foster Teens’ Risk During Transition. Https: | - RCT protocol |
|
NCT02113085 (2012) My Life: evaluation of Self-determination Enhancement for Adolescents in Foster Care. Https: | - RCT protocol |
|
NCT02217072 (2014) Educational Support Interventions for Children in Care. Https: | - RCT protocol |
|
NCT04027257 (2019) Sit Together and Read (STAR): a Pilot Study of Children and Their Kinship Caregivers. https: | - RCT trial registry |
| NELSON Justine G.; GIBSON Priscilla A.; BAUER Jean W. (2010) Kinship care and “child-only” welfare grants: low participation despite potential benefits. Journal of Family Social Work 13(1): 3–24 | - Not an investigation of an intervention |
| Nilsen, Wendy (2007) Fostering futures: a preventive intervention program for school-age children in foster care.. Clinical child psychology and psychiatry 12(1): 45–63 [PubMed: 17378079] | -No outcomes of interest to this review question |
| Noam G.G. and Hermann C.A. (2002) Where education and mental health meet: Developmental prevention and early intervention in schools. Development and Psychopathology 14(4): 861–875 [PubMed: 12549707] | - Intervention description/practice report |
| O’Higgins, Aoife; Ott, Eleanor Marie; Shea, Michael William (2018) What is the Impact of Placement Type on Educational and Health Outcomes of Unaccompanied Refugee Minors? A Systematic Review of the Evidence.. Clinical child and family psychology review 21(3): 354–365 [PubMed: 29623526] | -Systematic review, considered for relevant references |
| Osei, Gershon K, Gorey, Kevin M, Hernandez Jozefowicz, Debra M et al. (2016) Delinquency and crime prevention: Overview of research comparing treatment foster care and group care.. Child & Youth Care Forum 45(1): 33–46 | -Systematic review, considered for relevant references |
| Pandya, Samta P (2018) Spirituality for wellbeing of bereaved children in residential care: Insights for spiritually sensitive child-centred social work across country contexts.. Child & Adolescent Social Work Journal 35(2): 181–195 |
- Non-OECD country [Some participants from US and Canada but majority from non-OECD and results not stratified] |
| Panerai, Simonetta, Zingale, Marinella, Trubia, Grazia et al. (2009) Special education versus inclusive education: the role of the TEACCH program.. Journal of autism and developmental disorders 39(6): 874–82 [PubMed: 19205860] |
- Unclear that population are LACYP - Unclear that population are LACYP |
| Parker, Elisabeth (2017) An actor-network theory reading of change for children in public care.. British Educational Research Journal 43(1): 151–167 | -No outcomes of interest to this review question |
| Petit Zeman S (2000) Healing the scars of war. TIMES EDUCATIONAL SUPPLEMENT: 26–27 |
- Not a relevant study design [magazine article] |
| Pratt, Megan E, Lipscomb, Shannon T, Schmitt, Sara A et al. (2015) The effect of head start on parenting outcomes for children living in non-parental care.. Journal of Child and Family Studies 24(10): 2944–2956 | -No outcomes of interest to this review question |
| Preyde, M., Frensch, K., Cameron, G. et al. (2011) Long-Term Outcomes of Children and Youth Accessing Residential or Intensive Home-Based Treatment: Three Year Follow up. Journal of Child and Family Studies 20(5): 660–668 |
- Unclear that population are LACYP [No subgroup analysis for LACYP] |
| Preyde, Michele, Adams, Gerald, Cameron, Gary et al. (2009) Outcomes of Children Participating in Mental Health Residential and Intensive Family Services: Preliminary Findings. Residential Treatment for Children & Youth 26(1): 1–20 |
- Unclear that population are LACYP [No subgroup analysis for children in care] |
| Riitano D. and Pearson A. (2014) The effectiveness of interventions designed to improve academic outcomes in children and adolescents in out-of-home care: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports 12(1): 13–22 | - Not a relevant study design |
| Ringle, Jay L, Thompson, Ronald W, Way, Mona et al. (2015) Reunifying families after an out-of-home residential stay: Evaluation of a blended intervention.. Journal of Child and Family Studies 24(7): 2079–2087 | -No outcomes of interest to this review question |
| Roberts, Jennifer, Winter, Karen, Connolly, Paul et al. (2017) The Letterbox Club book gifting intervention: Findings from a qualitative evaluation accompanying a randomised controlled trial.. Children and Youth Services Review 73: 467–473 | -No outcomes of interest to this review question |
| Rogers, Anita and Henkin, Nancy (2000) School-based interventions for children in kinship care.. Grandparents raising grandchildren: Theoretical, empirical, and clinical perspectives.: 221–238 |
- Data not reported in an extractable format [No evaluation data provided] |
| Sanders, Michael and et al (2020) What works in education for children who have had social workers? Summary report.: 56 | exclude due to mixed population – “children who have had a social worker” |
| Shoham, Edna and Shiloah, Neomi (2001) The project for the education of Israeli children in the kibbutz movement.. Child & Youth Services 22(12): 37–53 | - no methods described |
| Sloan, Frank A, Gifford, Elizabeth J, Eldred, Lindsey M et al. (2013) Do specialty courts achieve better outcomes for children in foster care than general courts?.. Evaluation review 37(1): 3–34 [PubMed: 23737613] | -No outcomes of interest to this review question |
| Soenen, Bram, Goethals, Ilse, Spriet, Eline et al. (2009) Effects of the combination of life space crisis interventions and a level system at the therapeutic treatment centre ‘Heynsdaele’-A special school and home for youth with behavioural and emotional problems.. Therapeutic Communities 30(2): 200–216 | - Unclear that population are LACYP |
| Soenen, Bram, Volckaert, Annelies, D’Oosterlinck, Franky et al. (2014) The implementation of life space crisis intervention in residential care and special education for children and adolescents with EBD: an effect study.. The Psychiatric quarterly 85(3): 267–84 [PubMed: 24570221] |
- Unclear that these were looked after children (focus on emotional and behavioural disorders) - Non-UK, interrupted time series study. -No outcomes of interest to this review question |
| STATHART Chloe (2011) Read all about it. Community Care 130111: 20–21 |
- Not a relevant study design [editorial (not a research paper)] |
| Strozier, Anne L, Elrod, Brent, Beiler, Pam et al. (2004) Developing a network of support for relative caregivers.. Children and Youth Services Review 26(7): 641–656 | -No outcomes of interest to this review question |
| Taussig, Heather N and Culhane, Sara E (2010) Impact of a mentoring and skills group program on mental health outcomes for maltreated children in foster care.. Archives of pediatrics & adolescent medicine 164(8): 739–46 [PMC free article: PMC3009469] [PubMed: 20679165] | -No outcomes of interest to this review question |
| Taussig, Heather N, Culhane, Sara E, Garrido, Edward et al. (2013) Does severity of physical neglect moderate the impact of an efficacious preventive intervention for maltreated children in foster care?.. Child maltreatment 18(1): 56–64 [PMC free article: PMC4312758] [PubMed: 23076837] |
- Data not reported in an extractable format [Analysis to find a moderating effect of a subgroup not listed in the protocol on intervention effects. No raw data presented.] |
| Taussig, Heather N; Culhane, Sara E; Hettleman, Daniel (2007) Fostering healthy futures: an innovative preventive intervention for preadolescent youth in out-of-home care.. Child welfare 86(5): 113–31 [PMC free article: PMC2613856] [PubMed: 18422051] |
- Not a relevant study design [RCT protocol] |
| Taussig, Heather N, Culhane, Sara E, Raviv, Tali et al. (2010) Mentoring Children in Foster Care: Impact on Graduate Student Mentors.. Educational horizons 89(1): 17–32 [PMC free article: PMC4022595] [PubMed: 24839302] |
- No outcome of interest reported [Not foster children related outcomes] |
| Taussig, Heather, Weiler, Lindsey, Rhodes, Tara et al. (2015) Fostering healthy futures for teens: Adaptation of an evidence-based program.. Journal of the Society for Social Work and Research 6(4): 617–642 [PMC free article: PMC4803110] [PubMed: 27019678] |
- No outcome of interest reported [Acceptability outcomes] - Survey extracted views (not true qualitative) |
| TIDEMAN Eva and et al (2011) Improving foster children’s school achievements - promising results from a Swedish intensive study. Adoption and Fostering 35(1): 44–56 |
Excluded under this review question as non-UK uncontrolled before-and-after study and comparative evidence was available -No outcomes of interest to this review question |
| TORDON Rikard; VINNERLJUNG Bo; AXELSSON Ulla (2014) Improving foster children’s school performance: a replication of the Helsingborg study. Adoption and Fostering 38(1): 37–48 | Excluded under this review question as non-UK uncontrolled before-and-after study and comparative evidence was available |
| Tordon, Rikard, Bladh, Marie, Sydsjo, Gunilla et al. (2020) Improved Intelligence, Literacy and Mathematic Skills Following School-Based Intervention for Children in Foster Care. Frontiers in psychology 11: 718 [PMC free article: PMC7194231] [PubMed: 32390912] | - non-UK qualitative before and after study |
| Trout, Alexandra L, Lambert, Matthew C, Epstein, Michael H et al. (2013) Comparison of On the Way Home aftercare supports to traditional care following discharge from a residential setting: a pilot randomized controlled trial.. Child welfare 92(3): 27–45 [PubMed: 24818429] | -No outcomes of interest to this review question |
| Tyler, Patrick M, Thompson, Ronald W, Trout, Alexandra L et al. (2017) Important elements of aftercare services for youth departing group homes.. Journal of Child and Family Studies 26(6): 1603–1613 | - Survey extracted views (not true qualitative study) |
| Tyre, Ashli D (2012) Educational supports for middle school youths involved in the foster care system.. Children & Schools 34(4): 231–238 |
- Non-UK setting -Unclear that all students were looked after at the time of intervention - Excluded under this review question as non-UK uncontrolled before-and-after study and better-quality evidence was available |
| Tyrer, Rebecca A and Fazel, Mina (2014) School and community-based interventions for refugee and asylum seeking children: a systematic review.. PloS one 9(2): e89359 [PMC free article: PMC3933416] [PubMed: 24586715] | -Systematic review, checked for relevant citations |
| Van Dam L., Smit D., Wildschut B. et al. (2018) Does Natural Mentoring Matter? A Multilevel Meta-analysis on the Association Between Natural Mentoring and Youth Outcomes. American journal of community psychology 62(12): 203–220 [PMC free article: PMC6174947] [PubMed: 29691865] | - Not an intervention of interest |
| VINNERLJUNG Bo and et al (2014) Paired Reading for foster children: results from a Swedish replication of an English literacy intervention. Adoption and Fostering 38(4): 361–373 |
- Not a relevant study design [Excluded under review question 4.2 since this was a non-UK-based uncontrolled before-and-after study, and comparative evidence was available] |
| WASHINGTON Gregory and et al (2007) African-American boys in relative care and a culturally centered group mentoring approach. Social Work with Groups 30(1): 45–69 | - No outcome of interest reported |
| WEINBERG Lois A.; OSHIRO Michael; SHEA Nancy M. (2014) Education liaisons work to improve educational outcomes of foster youth: A mixed methods case study. Children and Youth Services Review 41: 45–52 |
- Study does not contain a relevant intervention [Excluded under review question 4.2 and 4.4 since educational liaisons are not an intervention of interest - and are statutory in the UK] - Non-UK setting, uncontrolled study |
| Weis, Robert; Wilson, Nicole L; Whitemarsh, Savannah M (2005) Evaluation of a voluntary, military-style residential treatment program for adolescents with academic and conduct problems.. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 34(4): 692–705 [PubMed: 16232066] | looked after children appear to be a subset of this study with no subgroup analysis for this group |
| WEYTS Arabella (2004) The educational achievements of looked after children: do welfare systems make a difference to outcomes?. Adoption and Fostering 28(3): 7–19 |
- Not an intervention of interest [impact of welfare systems and comparison of foster and residential care] |
| Williams, Sarah C, Fanolis, Verba, Schamess, Gerald et al. (2001) Adapting the Pynoos school based group therapy model for use with foster children: Theoretical and process considerations.. Journal of Child & Adolescent Group Therapy 11(23): 57–76 | -No outcomes of interest to this review question |
| Zetlin, Andrea G; Weinberg, Lois A; Kimm, Christina (2005) Helping social workers address the educational needs of foster children.. Child abuse & neglect 29(7): 811–23 [PubMed: 16051354] |
- Not an intervention of interest [Training for social workers and access to an educational liaison - education liaisons are statutory in the UK (e.g. designated teachers and virtual school heads)] - Non-UK setting - Not LACYP specific outcomes |
| Zetlin, Andrea, Weinberg, Lois, Kimm, Christina et al. (2004) Improving Education Outcomes for Children in Foster Care: Intervention by an Education Liaison.. Journal of Education for Students Placed at Risk 9(4): 421–429 |
- Study does not contain a relevant intervention [Advocacy by education liaison from the school system: already a statutory requirement] - Non-UK setting |
Cost-effectiveness studies
| Study | Reason for exclusion |
|---|---|
| Bennett, C.E.; Wood, J.N.; Scribano, P.V. (2020) Health Care Utilization for Children in Foster Care. Academic Pediatrics 20(3): 341–347 [PubMed: 31622784] |
- Exclude - compared LAC with non-LAC - Exclude - non-relevant outcomes |
| DIXON, Jo (2011) How the care system could be improved. Community Care 17211: 16–17 | - Exclude - not an economic evaluation |
| Huefner, Jonathan C, Ringle, Jay L, Thompson, Ronald W et al. (2018) Economic evaluation of residential length of stay and long-term outcomes. Residential Treatment for Children & Youth 35(3): 192–208 | - Exclude - costs not applicable to the UK perspective |
| LOFHOLM Cecilia, Andree; OLSSON Tina, M.; SUNDELL, Knut (2020) Effectiveness and costs of a therapeutic residential care program for adolescents with a serious behavior problem (MultifunC). Short-term results of a non-randomized controlled trial. Residential Treatment for Children and Youth 37(3): 226–243 | - Exclude - population not specific to LACYP |
| Lovett, Nicholas and Xue, Yuhan (2020) Family First or the Kindness of Strangers? Foster Care Placements and Adult Outcomes. Labour Economics 65(0) | - Exclude - not an economic evaluation |
Appendix K. Research recommendations – full details
Research recommendation (PDF, 133K)
Appendix L. References
Other references
None
Appendix M. Other appendix
No additional information for this review question.
Tables
Table 1PICO for review on interventions to support learning needs in looked-after children and young people
| Population |
School-aged looked after children and young people (wherever they are looked after) from birth until age 18. Including:
|
|---|---|
| Intervention |
Interventions and approaches to support learning needs by either a learning provider or carer of looked-after children and young people Example interventions and approaches of interest include:
|
| Comparator | Comparator could include standard care, waiting list, or another active intervention to support learning needs by either a learning provider or carer of school-aged looked-after children and young people. |
| Outcomes |
|
Table 2SPIDER table for review on interventions to support care placement stability in looked-after children and young people
| Sample |
School-aged looked after children and young people (wherever they are looked after) from birth until age 18. Including:
|
|---|---|
| Phenomenon of Interest | Interventions and approaches to support learning needs by either a learning provider or carer of looked-after children and young people |
| Design | Including focus groups and interview-based studies (mixed-methods studies will also be included provided they contain relevant qualitative data). |
| Evaluation | Qualitative evidence related to interventions to support learning needs will be examined. Evidence should relate to the views of looked after children, their carers, and providers, who would deliver eligible interventions, on:
|
| Research type | Qualitative and mixed methods |
| Search date | 1990 |
| Exclusion criteria |
|
Table 3Summary of included quantitative studies
| Study (country – study design) | LACYP population | Intervention | Comparator | Number of patients who completed study | Outcomes reported (follow up f/u) |
|---|---|---|---|---|---|
| Majority primary school participants | |||||
| Flynn 2012 (Canada - RCT) | Foster or kinship care (aged 6-13 years) | Foster parent-delivered Teach Your Children Well tutoring (TYCW) | Wait List (WL) |
TYCW: 30 WL: 34 |
Word reading mean score (post-intervention) Spelling mean score (post-intervention) Maths mean score (post-intervention) Sentence comprehension mean score (post-intervention) Reading composite mean score (post-intervention) |
| Harper 2012 (Canada - RCT) | Foster or kinship care (aged 7-14) | Volunteer tutor-delivered Teach Your Children Well (TYCW) | WL |
TYCW: 30 WL: 35 |
Word reading mean score (post-intervention) Spelling mean score (post-intervention) Maths mean score (post-intervention) Sentence comprehension mean score (post-intervention) |
| Harper 2016 (Canada - RCT) | Foster or Kinship care (aged 6-14) | Volunteer tutor-delivered Teach Your Children Well (TYCW) | WL |
TYCW: 45 WL: 51 |
Word reading mean score (post-intervention) Spelling mean score (post-intervention) Maths mean score (post-intervention) Sentence comprehension mean score (post-intervention) |
| Hickey 2020 (Canada – RCT) | Children in care (age 6 – 18) | 15-week TYCW | 25-week TYCW |
15-week TYCW = 36 25-week TYCW = 36 |
Reading and maths skills score post intervention Oral language score post intervention Parental Support for Learning Scale post intervention Comprehensive Executive Function Inventory postintervention |
| Mooney 2016 (UK - RCT) | Foster care (aged 7-11) | Letterbox Club | WL |
Letterbox: 56 WL: 51 |
Reading accuracy mean score (4-weeks post-intervention) Reading comprehension mean score (4-weeks post-intervention) Reading rate mean score (4-weeks post-intervention) Recreational reading mean score (4-weeks post-intervention) Academic reading mean score (4-weeks post-intervention) Odds of liking school “a lot” (4-weeks post-intervention) Odds of liking reading “a lot” (4-weeks post-intervention) |
| Osbourne 2010 (UK - UBA) | Looked-after children (primary school age) | Paired Reading (PR) | Pre-intervention | PR: 35 | Reading age (pre- vs post-intervention) |
| Majority secondary school participants | |||||
| Geenan 2012 (USA - RCT) | Foster care with SEN (age 14-17) | Take Charge coaching and mentoring (TC) | Usual Care (UC) |
TC: 60 UC: 60 |
Mean number of hours spent doing homework (post-intervention/9-months) Student-, parent-, and teacher-rated mean youth knowledge and engagement in educational planning score (post-intervention/9-month) Student self-attribution of accomplishments score (post-intervention/9-months) |
| Green 2014 (UK - RCT) | Looked-after children in unstable placement (age 10-17) | Multidimensional Treatment Foster Care for adolescents (MTFC) | UC |
MTFC: 20 UC: 14 |
Odds of higher scholastic/language skills at 12 months follow up Odds of higher school attendance score at 12 months follow up |
| Leve 2007 (USA - RCT) | Out of home care referred by juvenile court judges (age 13-17) | Multidimensional Treatment Foster Care | Group Care |
MTFC: 37 GC: 44 |
Mean homework completion score (3-6 months /12 months) Mean school attendance score at 12 months post baseline |
| Zinn 2014/Courtney 2008 (USA – RCT) | Foster Care 1-3 grades behind (age 14 or older) | ESTEP tutoring programme | No ESTEP tutoring |
ESTEP: 212 No ESTEP: 190 |
Mean letter-word identification score (approximately 26 months follow up) Mean calculation score (approximately 26 months follow up) Mean passage comprehension score (approximately 26 months follow up) Mean highest grade level completion (approximately 26 months follow up) Mean grade point average at follow up (approximately 26 months follow up) Achieving high school diploma or general equivalency diploma (approximately 26 months follow up) School behaviour score (approximately 26 months follow up) |
| Balluerka 2015 (Spain - NRCT) | In residential care with MHP and EBD (age 12-17) | Animal-assisted psychotherapy (AAP) | Residential Care as usual (RCAU) |
AAP: 43 RCAU: 24 |
Mean change in self-rated school maladjustment (post-intervention) Mean change in teacher-rated school maladjustment (post-intervention) Mean change in teacher-rated behavioural symptoms (post-intervention) Mean change in teacher-rated adaptive skills (post-intervention) |
| Muela 2017 (Spain - NRCT) | In residential care with MHP and EBD (age 12-17) | Animal-assisted psychotherapy (AAP) | Residential Care as Usual |
AAP: 52 RCAU: 25 |
Mean change in negative attitude towards school score (post-intervention) Mean change in negative attitude towards teachers score (post-intervention) |
| All ages | |||||
| Klag 2010 (Australia - UBA) | In out of home care with severe and/or complex psychological and/or behavioural problems | Evolve Interagency Services (EIS) | Pre- vs Post-intervention | EIS: 255 |
Problems with scholastic or language skill score (pre- vs postintervention) Poor school attendance score (pre- vs postintervention) |
| Waxman 2009 (USA - NRCT) | Children in custody of the Texas Department of Protective and Regulatory Services | Child Advocate Volunteers (CAV) | UC |
CAV: 327 UC: 254 |
Pass all courses (by year 1/year 2) Poor conduct (by year 1/by year 2) Expelled (by year 1/by year2) |
Table 4Summary of included qualitative studies
| Study (country) | Intervention | LACYP population (age) | Setting and context | Type of analysis | Perspectives (n) |
|---|---|---|---|---|---|
| Forsman 2017 (Sweden) | Paired reading | Children in foster care (age not reported) | Paired reading project carried out in seven local authorities in Sweden | Semi-structured interviews covering positive/negative parts of the method, and contextual aspects they considered to be supports or barriers. Additionally, the carers’ expectations of the project and perceptions of how their participation had affected relations within the family, their everyday life and the child’s reading ability. Thematic analysis was used. | Foster carers (13) |
| Griffiths 2012 (UK) | Letterbox | Children in foster care (aged 7 to 11) | Three different UK local authorities | Semi-structured interviews covering participants’ views about each aspect of the Letterbox Club in greater detail, including whether the children continued to use any of the items they had received. Unclear how thematic analysis was performed. | Foster carers (9) |
Table 5Summary GRADE table (Foster-parent delivered tutoring (Teach Your Children Well) (FP-TYCW) vs Wait List (WL))
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effect |
|---|---|---|---|---|
| Word reading mean score post-intervention (assessed using the Wide Range Achievement Test Fourth Edition (WRAT-4)) | 77 | MD 2.54 (−1.22 to 6.30) | Very Low | Could not differentiate |
| Spelling mean score post-intervention (assessed using the WRAT-4) | 77 | MD −1.2 (−8.26 to 5.86) | Very Low | Could not differentiate |
| Maths mean score post-intervention (assessed using the WRAT-4) | 77 | MD 5.8 (1.58 to 10.02) | Very Low | Effect favours intervention group but may be less than the MID |
| Sentence comprehension mean score post-intervention (assessed using the WRAT-4) | 77 | MD 4.53 (0.41 to 8.65) | Very Low | Effect favours intervention group but may be less than the MID |
| Reading composite mean score post-intervention (assessed using the WRAT-4) | 77 | MD 3.79 (−0.60 to 8.18) | Very Low | Could not differentiate |
Table 6Summary GRADE table (Volunteer-delivered tutoring (Teach Your Children Well) (V-TYCW) vs Wait List (WL))
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Word reading mean score post-intervention (assessed using the WRAT-4) | 68 | MD 4.45 (1.75 to 7.15) | Very Low | Effect favours intervention group but may be less than the MID |
| Spelling mean score post-intervention (assessed using the WRAT-4) | 68 | MD 7.89 (2.71 to 13.07) | Very Low | Effect favours intervention group but may be less than the MID |
| Maths mean score post-intervention (assessed using the WRAT-4) | 68 | MD 3.2 (p value=ns) | Very Low | Could not differentiate |
| Sentence comprehension mean score post-intervention (assessed using the WRAT-4) | 68 | MD 0.86 (p value= ns) | Very Low | Could not differentiate |
| Word reading mean score post-intervention (assessed using the WRAT-4) | 101 | 4.64 (2.01 to 7.27) | Very Low | Effect favours intervention group but may be less than the MID |
| Spelling mean score post-intervention (assessed using the WRAT-4) | 101 | 3.19 (0.55 to 5.83) | Very Low | Effect favours intervention group but may be less than the MID |
| Maths mean score post-intervention (assessed using the WRAT-4) | 101 | 3.84 (0.15 to 7.53) | Very Low | Effect favours intervention group but may be less than the MID |
| Sentence comprehension mean score post-intervention (assessed using the WRAT-4) | 101 | 1.70 (p value= ns) | Very Low | Could not differentiate |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 7Summary GRADE table (25-week Volunteer-delivered tutoring (Teach Your Children Well) (V-TYCW) vs 15-week Volunteer-delivered tutoring (Teach Your Children Well) (V-TYCW)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effect |
|---|---|---|---|---|
| Math Fluency score at postintervention: assessed using the Woodcock-Johnson-Third Edition (WJ-III) | 83 | Beta coefficient – 3.94 (p=0.07) | Very Low | Could not differentiate effect |
| Applied problems score at postintervention: assessed using the Woodcock-Johnson-Third Edition (WJ-III) | 83 | Beta coefficient – 3.07 (p=0.07) | Very Low | Could not differentiate effect |
Table 8Summary GRADE table (Letterbox club vs Wait List)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Reading accuracy mean score 4-weeks post-intervention (assessed using the Neale Analysis of Reading Ability) | 116 | MD 1.00 (−4.57 to 6.57) | High | No meaningful difference |
| Reading comprehension mean score 4-weeks post-intervention (assessed using the Neale Analysis of Reading Ability) | 116 | MD −0.49 (−6.44 to 5.46) | High | No meaningful difference |
| Reading rate mean score 4-weeks post-intervention (assessed using the Neale Analysis of Reading Ability) | 116 | MD −3.15 (−8.74 to 2.44) | Moderate | Could not differentiate |
| Recreational reading mean score 4-weeks post-intervention (assessed using the Elementary Reading Enjoyment Scale (known as the ‘Garfield Test’)) | 116 | MD −0.81 (−3.47 to 1.87) | Moderate | Could not differentiate |
| Academic reading mean score 4-weeks post-intervention (assessed using the Elementary Reading Enjoyment Scale (known as the ‘Garfield Test’)) | 116 | MD −0.67 (−3.32 to 1.98) | High | No meaningful difference |
| Odds of liking school “a lot” 4-weeks post-intervention (children were asked “Do you like school?” with the option of reply “not really”, “a little” or “a lot”) | 116 | OR 0.68 (0.31 to 1.47) | Low | Could not differentiate |
| Like reading “a lot” 4-weeks post-intervention (children were asked “Do you like reading?” with the option of reply “not really”, “a little” or “a lot”) | 116 | OR 0.93 (0.43 to 2.01) | Low | Could not differentiate |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 9Summary GRADE table (Paired-reading intervention pre- vs post-intervention)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Reading age pre- vs post-intervention (assessed using the Salford test) | 35 | MD 1.00 (0.24 to 1.76) years | Very Low | Effect favours intervention group but may be less than the MID |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 10Summary GRADE table (Take Charge intervention (coaching and mentoring) vs Usual Care)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Mean number of hours spent doing homework post-intervention: assessed by self-report | 87 | MD 0.51 (0.08 to 0.94) hours | Very Low | Effect favours intervention group but may be less than the MID |
| Mean number of hours spent doing homework at 9-month follow up: assessed by self-report | 87 | MD 0.14 (−0.24 to 0.52) hours | Very Low | Could not differentiate |
| Mean youth knowledge and engagement in educational planning score post-intervention: assessed using the student version of the Educational Planning Assessment | 87 | MD 2.45 (0.98 to 3.92) | Very Low | Effect favours intervention group |
| Mean youth knowledge and engagement in educational planning score post-intervention: assessed using the parent version of the Educational Planning Assessment | 87 | MD 2.81 (−0.94 to 6.56) | Very Low | Could not differentiate |
| Mean youth knowledge and engagement in educational planning score post-intervention: assessed using the teacher version of the Educational Planning Assessment | 87 | MD 2.51 (−0.35 to 5.37) | Very Low | Could not differentiate |
| Mean youth knowledge and engagement in educational planning score at 9-month follow up: assessed using the student version of the Educational Planning Assessment | 87 | MD 2.68 (−0.23 to 5.59) | Very Low | Could not differentiate |
| Mean youth knowledge and engagement in educational planning score at 9-month follow up: assessed using the parent versions of the Educational Planning Assessment | 87 | MD 3.22 (0.32 to 6.12) | Very Low | Effect favours intervention group but may be less than the MID |
| Mean youth knowledge and engagement in educational planning score at 9-month follow up: assessed using the teacher versions of the Educational Planning Assessment | 87 | MD 2.77 (−0.23 to 5.77) | Very Low | Could not differentiate |
| Student self-attribution of accomplishments score post-intervention: youth were asked to list all their educational accomplishments for the past 6 months and a total count was gathered at each time point. | 87 | MD 0.80 (0.33 to 1.27) | Very Low | Effect favours intervention group but may be less than the MID |
| Student self-attribution of accomplishments score at 9-months follow up: youth were asked to list all their educational accomplishments for the past 6 months and a total count was gathered at each time point. | 87 | MD 0.24 (−0.22 to 0.70) | Very Low | Could not differentiate |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 11Summary GRADE table (Multidimensional treatment foster care for adolescents (MTFC-A) vs Usual Care)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Odds of higher scholastic/language skills at 12 months follow up: assessed by a domain of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) | 34 | OR 0.6 (0.15 to 2.4) | Low | Could not differentiate |
| Odds of higher school attendance score at 12 months follow up: assessed by a domain of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) | 34 | OR 2.5 (0.48 to 13.1) | Low | Could not differentiate |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 12Summary GRADE table (Multidimensional treatment foster care for adolescents (MTFC-A) vs Group Care Care)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Mean homework completion score at 3-6 months post-intervention: composite score using the number of days in the last week that the girls spent at least 30 min/day on homework; and whether or not the girls did homework that day. | 81 | MD 0.64 (0.16 to 1.12) | Very Low | Effect favours intervention group but may be less than the MID |
| Mean homework completion score at 12 months post-intervention: composite score using caregiver and girl report of the number of days in the last week that the girls spent at least 30 min/day on homework; and whether or not the girls did homework that day. | 81 | MD 1.44 (0.59 to 2.29) | Very Low | Effect favours intervention group but may be less than the MID |
| Mean school attendance score at 12 months post baseline: composite score using caregivers and girls reports of how often the girls attended school. | 81 | MD 0.61 (0.15 to 1.07) | Very Low | Effect favours intervention group but may be less than the MID |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 13Summary GRADE table (ESTEP tutoring programme vs No ESTEP tutoring)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Mean letter-word identification score at approximately 26 months follow up: assessed by Woodcock–Johnson Tests of Achievement III. | 529 | MD 2.10 (−2.25 to 6.45) | Very low | No meaningful effect |
| Mean calculation score at approximately 26 months follow up: assessed by Woodcock–Johnson Tests of Achievement III | 529 | MD −0.30 (−4.22 to 3.62) | Very low | No meaningful effect |
| Mean passage comprehension score at approximately 26 months follow up: assessed by Woodcock–Johnson Tests of Achievement III | 529 | MD −0.20 (−4.33 to 3.93) | Very low | No meaningful effect |
| Mean highest grade level completion at approximately 26 months follow up: self-report | 529 | MD 0.00 (−0.19 to 0.19) | Very low | No meaningful effect |
| Mean grade point average at follow up at approximately 26 months follow up: Participants reported their school grades they had received across four core subjects during their previous full semester of school. Responses were scored based on a standard 4-point scale, and an overall GPA was computed by taking the average of these. | 529 | MD 0.00 (−0.18 to 0.18) | Very low | No meaningful effect |
| School behaviour score: youths were asked to indicate how often they had had “trouble” completing five tasks during their last full semester of school attendance. School behaviour was then operationalised or defined as the mean of these five items. | 529 | MD −0.02 (−0.25 to 0.21) | Very low | No meaningful effect |
| Achieving high school diploma or general equivalency diploma at approximately 26 months follow up: self-report | 529 | OR 0.79 (0.41 to 1.52) | Very low | Could not differentiate |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 14Summary GRADE table (Animal-assisted psychotherapy vs residential care as usual)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Mean change in self-rated school maladjustment (pre- vs post-intervention): measured as part of the Spanish version of the Behavior Assessment System for Children. | 67 | MD −0.63 (−5.48 to 4.22) | Very low | Could not differentiate |
| Mean change in teacher-rated school maladjustment (pre- vs post-intervention): measured as part of the Spanish version of the Behavior Assessment System for Children.1 | 67 | MD −3.19 (−6.93 to 0.55) | Very low | Could not differentiate |
| Mean change in teacher-rated behavioural symptoms (pre- vs post-intervention): measured as part of the Spanish version of the Behavior Assessment System for Children.1 | 67 | MD −1.39 (−5.92 to 3.14) | Very low | Could not differentiate |
| Mean change in teacher-rated adaptive skills (pre- vs post-intervention): measured as part of the adaptive skills | 67 | MD 5.88 (1.61 to 10.15) | Very low | Effect favours intervention group but may be less than the MID |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 15Summary GRADE table (Animal-assisted psychotherapy vs residential care as usual)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Mean change in self-rated school maladjustment (pre- vs post-intervention): measured as part of the Spanish version of the Behavior Assessment System for Children. | 87 | MD −0.03 (−4.28 to 4.22) | Very low | No meaningful effect |
| Mean change in teacher-rated school maladjustment (pre- vs post-intervention): measured as part of the Spanish version of the Behavior Assessment System for Children.1 composite of the Teacher Rating Scale.1 | 87 | MD −2.69 (−4.73 to −0.65) | Very low | Effect favours intervention group but may be less than the MID |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 16Summary GRADE table (Evolve Interagency Services, pre- vs post-intervention)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Problems with scholastic or language skills score: assessed using subscale of the Health of the Nations Outcome Scale for Children and Adolescents) | 255 | MD −0.64 (−0.87 to −0.41) | Very low | Effect favours intervention group but may be less than the MID |
| Poor school attendance score: assessed using subscale of the Health of the Nations Outcome Scale for Children and Adolescents | 249 | MD −0.54 (−0.29 to −0.79) | Very low | Effect favours intervention group but may be less than the MID |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 17Summary GRADE table (Child advocate volunteers vs care as usual)
| Outcome | Sample size | Effect size (95% CI) | Quality | Interpretation of effecta |
|---|---|---|---|---|
| Pass all courses by year 1 | 581 | OR 3.05 (2.09 to 4.45) | Very low | Effect favours intervention group |
| Poor conduct by year 1 | 581 | OR 0.35 (0.25 to 0.49) | Very low | Effect favours intervention group |
| Expelled by year 1 | 581 | OR 0.51 (0.25 to 1.06) | Very low | Could not differentiate |
| Pass all courses by year 2 | 581 | OR 1.55 (0.97 to 2.48) | Very low | Could not differentiate |
| Poor conduct by year 2 | 581 | OR 0.84 (0.60 to 1.18) | Very low | Could not differentiate |
| Expelled by year 2 | 581 | OR 0.92 (0.55 to 1.53) | Very low | Could not differentiate |
- (a)
No meaningful difference: crosses line of no effect but not line of MID; Could not differentiate: crosses line of no effect and line of MID; May favour: confidence intervals do not cross line of no effect but cross MID; Favours: confidence intervals do not cross line of no effect or MID
Table 18Summary CERQual table (Experience of foster carers regarding paired reading)
| Themes | illustrative quotes | Studies | CERQual concerns | CERQual explanation |
|---|---|---|---|---|
|
Getting carers involved in the intervention, a question of attitude? One rationale for using paired reading with children in out-of-home care is that the method actively involves foster parents in the reading process. As indicated by the case descriptions, carers embraced this task differently. Some carers talked about reading in general as something important. Children in their care were encouraged to read and they had a positive attitude towards the project. Carers, like Linda, were already actively involved in the education of the children in their care. They expressed an awareness of foster children’s academic vulnerability and tried to prevent school failure. Such attitudes were linked to carers committing to the programme and following through – despite experiencing problems. Previous studies indicate that low expectations and lack of support from key adults are two main reasons for foster children’s educational underperformance. | “These children should have the same opportunities to succeed in school as other children have. We should have the same expectations on them. They are able and we should not pity them or think any less of them, but this might not come natural for everyone. I think that a project like this could be helpful in that respect.” Carer |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Being a part of the project meant that carers could become aware of the importance of foster children’s school performance Knowing that good literacy skills are crucial for managing school became a motivational factor to get engaged. Carers, who had not previously been involved in their child’s education and reading, were provided with a tool to become active supporters. When practicing paired reading, carers would learn more about their children’s needs. Receiving feedback on the literacy tests the children did as a part of the pre/post-evaluation had a similar effect. As in the case of foster mother Julia, further insights about the children’s abilities and needs could enhance the engagement. Some had continued to use paired reading or wanted to try it with other children. |
“I guess you could say that we were aware of him having problems in school, and we were happy that we had been chosen to be a part of the project. Without it we would probably not have sat down to read with him.” Carer |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Intervention provided an opportunity to spend more time with the child Another reason for carers to get involved was linked to seeing an opportunity to spend more time with the child, as in the case of foster mother Anita. For these carers the intervention meant that they could spend ‘quality time’ together. This relational aspect seemed to be a motivational factor for carers in all participant groups. According to some carers, the intervention had improved their relations with the child. | No supportive quotes reported |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Barriers to engagement with the intervention There were examples of carers who had a more or less explicitly negative attitude towards the intervention. As with the case of foster father Martin (Insufficient reading), this could be due to not experiencing that the child was in need of any reading training. Additionally, some carers felt as if the intervention went beyond their area of responsibility. Although participation was said to be voluntarily, one carer even felt as if she was forced. She talked about the intervention in negative terms, and felt a big relief when it ended. It is possible that a negative attitude could come from carers’ own school experiences and reading habits. Not all carers seemed to regard reading as something important. This could potentially make it more difficult to get involved. Either way, a negative attitude was clearly associated with reduced programme compliance, compared with those who saw relational benefits or talked about the importance of reading or succeeding in school. | “I feel like we already have a pretty, ehm, foster children have a lot to deal with and then this becomes another liability for us … Perhaps it could be something that they can do in school or something that the libraries could take responsibility for.” Foster Carer |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Integrating the reading training in the everyday life – the need for motivation and prioritization The carers who participated in the project took on the task of reading with their foster children on a regular weekly basis. Although the majority complied with the programme, the interviews showed that it could be difficult to integrate the reading training in the everyday life. The key to success seemed to be working with the child’s motivation and prioritizing the reading sessions. Some carers meant that having many children to care for made it difficult to find the time. Others had the same situation but managed anyway, as in the case of foster mother Julia (Sufficient reading). Carers who were used to reading with or helping children with homework were more successful in finding the time. For them, engaging in this intervention was not radically different from what they already did in their daily life with the children. Moreover, their positive attitude towards the project made them prioritize the reading. |
“We already have a tight schedule and since we’re so many, there are so many things that need to work out. Our everyday life is planned in detail with meals, dropping off and picking the children up, school work and so on.” Carer “Other activities were more appealing. You have to motivate them, but it’s not always that easy. They did not want to read, and you can’t force them into doing this.” Carer |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Overcoming reluctance and persistence Some children were reluctant to read, and the carer above makes a point about motivating the children. A period of 16 weeks was described as long, and it turned out to be difficult to keep up the motivation throughout the whole project. Some carers thought that it could have been easier motivating the children had the intervention lasted a shorter time. Others meant that children do not have to enjoy it at all times. When it comes to homework or attending school, children will sometimes resist, and the same goes for paired reading. The responsibility to making it work lies on the carers. | “It’s on us as adults to make sure that this goes well … I think that it’s beneficial if the adult is positive, because your attitude will be reflected on the children. Perseverance does it! I think that it’s on us to communicate this to the children.” Carer |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Use of rewards to motivate, but better motivation was using books that children were excited to read At times, giving stickers or using bribes could be facilitating. As in the case of foster mother Linda and her boy Yusef, children could be motivated to read more when they themselves noticed progress. However, the actual key in motivating the child and making the intervention work seemed to be making the reading session into an enjoyable activity. If the children got to read books or other reading material that excited them, it could be something to long for: Carers like Julia would try to make the reading sessions cosy. Having the one to one time could be important for both children and carers. |
“It was not like they thought it was bothersome to read – quite the opposite! They longed for it. They chose their own books, books they found exciting, so they wanted to know how the plot would unfold.” Carers “He thought that this way of reading was so nice and wanted me to read with him at all times. I think that it was special for him to get close to me, to spend time with me and to get my full attention.” Carers |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Challenge of choosing appropriate reading material Choosing appropriate reading material could be rather challenging. As in the case of foster father Martin, choosing wrong books made it difficult to motivate the child. Another carer who had experienced difficulties motivating her children explained that the releasing point for them was when they dropped the books and instead read the IKEA catalogue. | No supportive quotes reported |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Flexible approach needed Making the reading training enjoyable also involved being sensitive to the child and adapt a flexible approach when delivering the intervention. If a child at one time did not want to read the full 20 min, carers could make them read less and try to catch up at another time. Having a rigid approach made it even more difficult to motivate children who were not used to read in their everyday life. At times of carer/child conflicts, a flexible approach could also involve having someone else reading with the child. Having more than one person reading with the child could make both siblings and the extended family involved in a positive way. | “She was the one doing all the reading. We just followed along and only intervened if it was ‘going to pot’. You have to adapt to her conditions and the situation we had with her otherwise she gets annoyed and the reading will fail.” Carer |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Practicing the paired reading method - a great or disturbing way of reading? According to interviewees’ responses, this was a new and unfamiliar way of reading. Some were enthusiastic about the method, thinking it was great, and noticing its positive effect on their child’s reading. In contrast, others found it disturbing. In the weekly monitoring sheets, reading aloud together and/or correcting the child were described as frustrating factors that affected the reading in a negative sense. During the interviews, this sentiment was echoed repeatedly. | “I think that reading aloud together, it was not okay. It ruins the concentration, so I can understand that she didn’t like it either … She got really irritated when I corrected her. The first couple of times it was okay, but when I continued she said ‘Stop it! You’re spoiling my reading’.” Carer |
1 |
ML: Minor C: Minor A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. Some contradiction as to whether the paired reading method was helpful or detrimental in every case. |
|
Temporary difficulties For some the difficulties were temporary. Once they got a hold of it, carers could see benefits with this particular way of reading. As mentioned before, sitting next to each other and having the full focus on the child’s reading could lead to new insights about their abilities and needs. Carers also experienced how paired reading, in particular reading aloud together, enabled them to model competent reading. | “It was a bit tricky at first because you’re not used to reading like this. But it was fun once you got a hold of it and it brought a sense of togetherness. I could actually notice a difference in his reading. He adapted to my reading speed, learned that you should make a pause at punctuation, and heard how words that he didn’t know were pronounced.” Carer |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Dealing with persistent problems. Carers had different approaches in trying to handle this. Some were inflexible in their approach and practiced the method in a manual-based way, which made the reading problematic. Insisting on reading in a way that did not suit the child would make the reading training less enjoyable and often lead to conflicts. As in the case of foster mother Anita (Dropout), this could ultimately lead to a dropout. With help from the special education pedagogue, foster mother Linda (Sufficient, but problematic reading), on the other hand, adapted the method to the child’s preferences, and thus made the reading training more enjoyable. Having a flexible approach and adapting the day-to-day delivery of the intervention was in some cases essential in order for the reading training to work at all. | No supporting quotes were reported |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
|
Encouraging Independent reading, following not leading According to the carers, some children wanted to read alone all the time. For others it could take weeks before the child became confident enough to take on the independent reading. This could be frustrating. One carer told how she was advised not to push the child despite this. She let the child be in charge of the reading and afterwards she thought that this was a key factor for the improved self-confidence that she later on noticed in the boy’s reading. One can assume that some children might need encouragement to read by themselves. Either way, judging from the carers’ experiences, it looks as if it is better to adopt a strategy of following and not leading the child. | No supporting quotes were reported |
1 |
ML: Minor C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was not UK-based. Study was moderate risk of bias. No apparent validation of methods. |
Table 19Summary CERQual table (Experience of looked after children and foster carers regarding the Letterbox intervention)
| Themes | illustrative quotes | Studies* | CERQual concerns | CERQual explanation |
|---|---|---|---|---|
|
Encouragement to learn: Many carers and children did feel that receiving the materials had provided important additional support and encouragement to learn. |
“Mr Quinn [my teacher] done a test on us today and I got twenty out of twenty on it. Because I answered all twentyof them right, because I’ve been playing the maths games and it’s helped me with my adding up”. Looked after person “The parcels have played a big part in Hamza becoming more enthusiastic about reading. Even made him keen to bring home school books”. Carer |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
|
Receiving personalised packages created the sense of being important and that someone was interested in them Children clearly felt they could make decisions themselves about what to do with the materials, and were usually keen to share them: The bright envelope was important to many: “Brandon watches the post and can immediately identify ‘his’ package.” Many children told authors they kept each envelope, “because it has my name on”. |
“It may not seem a lot, but when you’ve not had much attention in your life, it is.” Carer “Jake felt rather special as he loved the postman delivering the parcel for himself each month. He enjoyed getting everyone together and playing with his games and reading his books” Carers |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
|
Enthusiasm maintained for the parcels Children who had been in Letterbox Club before were still very enthusiastic when they were members again. One carer said that her foster daughter had had the Red parcels eighteen months before, and when her first Green parcel came she “just ripped it straight open. Excited and straight into it!”. |
“It’s a great thing and it makes you feel a bit happier … To get the parcels, it’ll take a lot of money to put together for people, but it makes people happy” Looked after person |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
|
Source of continuity: The fact that the parcels followed placements was important The fact that the parcel is delivered to the child’s home address was particularly important to children who had moved recently or frequently. One boy (aged 9) in the earlier pilot had expressed this very poignantly: “So somebody knows where I live?” |
“The Letterbox Club was the continuity, something that stayed the same when she moved from A to B. She’d had so many ups and downs and I think something like that, that stays the same, is quite important to children and it was very important to Kelly.” Foster mother “They love just getting the parcels and that was important to them, especially when they hadn’t been here very long, it was like ‘somebody from the outside knows I’m here’.” Foster Carer |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
|
Useful for under resourced foster homes Some foster homes had comparatively few books suitable for the children they cared for, so the Letterbox Club parcels were a valuable resource. | No supportive quotes were reported. |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
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Something to call their own: Even where foster families were already well-provided, many carers commented that a critical element in gaining children’s interest was that the Letterbox books were their own. |
“We’ve got a cupboard absolutely full of books, but he never paid them any attention at all, so it was nice that these came just for him.” Carer “The books she has received we’ve often got already, being a ‘bookish’ house, but none the less she enjoys the parcels and it gets her to read old favourites again” Carer |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
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The element of surprise Children liked the element of surprise, not knowing what books they might get, and carers, too, commented that this broadened the range of books their children used. Many foster carers said that they looked forward to the parcels arriving as much as the children. |
“Everything in the parcels was excellent, but the Diary of a Killer Cat was superb and the CD is used in the car all the time – I love it, too!! Hope we can have more parcels one day.” Foster Carer |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
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Relationship building aspect of Letterbox: Children enjoyed Where’s Wally? (published as Where’s Waldo? in North America) for its social qualities – one carer of a girl aged 8 wrote, “We all had a go at Where’s Wally? – even the teenagers wanted to have a go.” There were many reports of children reading to each other, and asking others (both adults and children) to read to them. For example, Kyle, aged 12, told us he read excerpts from the Guinness Book of World Records to his younger brother: “I’d show him stuff that was a bit weird and stuff. Like the dog with the longest tongue”. The majority of carers (over 80%) indicated that the parcels had helped them do more with the child. Many foster carers commented on the value of the materials in helping them make better attachments with their children. The carer of Marley, aged 10, wrote, “Found it a great way to bond with my daughter”, and the carer of Danny, aged 9, said, “He has had fun, and we have spent a lot of time together because of Letterbox Club.” |
“He is still a reluctant reader, but the books give us an opportunity to spend time together” Foster carer “It’s nice to have something to do with Jamie, where he doesn’t feel I’m forcing my attentions on him. He finds it very hard to be close to anyone, but he’s been keen to be read to and to play the games he’s made. It’s made me feel more comfortable with him” Foster Carer |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
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New ways of reading (audio): At least one parcel in each age range included a story on CD with its accompanying book. Many carers commented that they had not previously thought of using audio stories with their foster child, but said they were often used at bedtime or on car journeys. | “He’s of an age where he wouldn’t appreciate a bedtime story from me, but he listened to the CD at bedtime” Foster Carer |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
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Variety in the packages was helpful Foster carers commented favourably on every genre of books in the parcels. Non-fiction was similarly praised by foster carers: “I’ve learnt such a lot”. Classic books, where many foster carers would already know the story, were welcomed: for example, when Danny, aged 10, received The Silver Sword, he said, “my [foster] dad knows this story, he read it when he was at school”. | “Poetry, I’d never have thought of that, but it’s great!” Foster carer |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
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Encouraging education in a non-threatening way Providing educational support in a nonthreatening and enjoyable way could contribute to improving the stability of foster care placements. Certainly, the parcels raised the profile of educational activity amongst children and adults in many of the participating families, and for some children it seemed to have begun a ‘virtuous circle’ of improved engagement at school and improved feelings of well-being in the child, with consequent feelings of relief and positive engagement for the foster carer. | “When you come home [from school], you’re not expected to read or write, are you! Cause it’s sort of your spare time. But because I got the Letterbox Club, I did sometimes read or write at home, and it helped me at school because I was prepared to do it at school.” Looked after person |
1 |
ML: Moderate C: No concerns A: Serious R: No concerns Overall: Very Low | Only one study contributed to this theme. Study was UK-based however, it was likely that qualitative data was collected prior to 2010. Study was high risk of bias. It was unclear how participants were selected. Unclear interview methods or how thematic analysis was performed. No apparent validation of findings. |
Final
Evidence reviews underpinning recommendations 1.6.16 to 1.6.17
These evidence reviews were developed by NICE Guideline Updates Team
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.