Authors' objectives: This report aims to identify and summarise evidence that addresses the following question: What is the effectiveness and cost-effectiveness of intensive family preservation programmes for families in crisis where there is an imminent risk of children entering care?

Authors' results and conclusions: Evidence on the effectiveness of intensive family preservation programmes (IFPP) is available from a number of studies summarised within a systematic review and meta-analysis and several additional studies conducted in the UK setting. HTW was also able to develop additional evidence on the cost-effectiveness of IFPP through the development of an economic evaluation. The main source of evidence within this review was a systematic review and meta-analysis reporting on rates of out-of-home placement and this was supported by a series of studies which were conducted in the UK and included due to their higher likelihood of generalisability. Findings from these studies suggest that IFPP are associated with reductions in out-of-home placement and can keep children within the family unit. Where available, outcomes relating to child well-being and family functioning did not appear to improve on receiving IFPP, but results trended towards benefits and there was no suggestion that staying within the family unit was detrimental to children. Outcomes relating to parents were mixed across studies, but some suggested that IFPP are associated with reduction in distress and substance misuse. Parents and children’s perspectives support the idea that IFPP are beneficial and can help address crises that may risk a child’s entry to care. In published literature relating specifically to IFPP, parents report that the additional support provided by IFPP helped address issues that were driving crises and they valued the additional support, and this was supported by the testimony of a parent who had had contact with IFPP in Wales. However, parents do raise concerns about the coercive nature of IFPP and question why more intensive services could not be provided prior to crises occurring. However, there are a number of issues regarding available evidence that add uncertainty and should be considered within decision-making. First, evidence predominantly comes from non-randomised trials and recent randomised controlled trials are not available. The studies have varying methods of generating control groups and are likely to introduce biases that reduce their accuracy and precision. Second, there is a high level of variation between details relating to populations, the delivery of IFPP and support provided within usual care. and often incomplete reporting of these details within included studies. Third, much of the evidence is conducted outside of the Welsh setting and from a number of years ago and it is unclear how generalisable this evidence is to the present setting. A de-novo cost-consequence analysis was undertaken to estimate the associated costs and outcome associated with IFPP compared to no use of the intervention, in families who are at imminent risk of children being taken into out-of-home care. The analysis found that due to a reduction in out-of-home placements in families receiving IFPP (118 fewer compared to those not receiving the intervention), the programme was associated with cost savings of £12,171 per child, in addition to being associated with a reduction in substance misuse in families, and better outcomes for parents. No measure of child welfare was included in the analysis due to a lack of identified evidence.

Authors' recommendations: The evidence supports the adoption of IFPP for families in crisis. The use of IFPP reduces the risk of out-of-home child placement. Parent and children’s perspectives support the view that IFPP are beneficial and can address crises that may risk a child needing to enter care. While the evidence leaves some uncertainty about the impact of this on children’s emotional and behavioural wellbeing, there appears to be no evidence of harm. The economic analysis is associated with uncertainty but indicates the potential for cost savings of up to £12,171 per child through the use of IFPP due to the avoidance of out-of-home placements.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Project Status: Completed

Year Published: 2024

URL for published report: https://healthtechnology.wales/reports-guidance/intensive-family-preservation-services-ifps/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk