Interventions to support readiness for school in looked-after children and young people

Interventions to support readiness for school in looked-after children and young people

Looked-After Children and Young People

Evidence review H

NICE Guideline, No. 205

London: National Institute for Health and Care Excellence (NICE); 2021 Oct.

ISBN-13: 978-1-4731-4291-6

Interventions to support readiness for school for looked-after children and young people

Review questions

a): What is the effectiveness of interventions to support readiness for school?

b): Are interventions to support readiness for school 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 readiness for school?

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. Pre-emptive interventions that support readiness for school prior to a looked-after child’s entry into 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 school readiness might be needed. This review was conducted to consider the effectiveness of this and other readiness for school interventions among looked-after children and young people.

Summary of protocol

PICO table

Table 1

PICO for review on interventions to support readiness for school in looked-after children and young people.

SPIDER table

Table 2

SPIDER table for review on interventions to support care placement stability in looked-after children and young people.

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

The search for this review was part of a broader search for the whole guideline. After removing duplicates, a total of 36,866 studies were identified from the search. After screening these references based on their titles and abstracts, 151 studies were obtained and reviewed against the inclusion criteria as described in the review protocol for interventions to support readiness for school (Appendix A). Overall, 15 studies were included, reporting on nine original studies.

The evidence consisted of nine original randomised controlled trials, no qualitative evidence was identified for this review question. 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 7 different readiness-for-school or developmental catch-up interventions.

Excluded studies

In total, 136 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 evidence

Quantitative evidence

Table

ABC-I: 24 DEF: 28

See Appendix D for full evidence tables

Qualitative evidence

No qualitative evidence was identified for this review question

Summary of the effectiveness evidence

Pre-school

Table 3

Summary GRADE table (Attachment and biobehavioural catch-up for infants (ABC-I) vs Developmental Education for Families (DEF)).

Table 4

Summary GRADE table (Attachment and biobehavioural catch-up for toddlers (ABC-T) vs Developmental Education for Families (DEF)).

Table 5

Summary GRADE table (Attachment and biobehavioural catch-up for infants and toddlers (ABC-I/T) vs Developmental Education for Families (DEF)).

Table 6

Summary GRADE table (Head start programme vs care as usual).

Entering primary school-age education

Table 7

Summary GRADE table (Therapeutic playgroups vs care as usual).

Table 8

Summary GRADE table (Kids in Transition to School (KITS) programme vs care as usual).

Entering secondary school-age education

Table 9

Summary GRADE table (Middle School Success vs care as usual).

See appendix F for full GRADE tables.

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. Of these records, 3,225 were excluded on basis of title and abstract for this review question. One publication was inspected in full and found to be relevant for inclusion. 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.

Summary of included cost effectiveness evidence

Table

Lynch 2017 US

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

The committee were hopeful for results that would define the success of interventions to support readiness for school in terms of clear educational outcomes while the child was at school. For example, the committee were particularly interested in outcomes that would relate to academic success in UK settings e.g. a child’s Key Stage level (the educational knowledge expected of students at various ages in the UK). For developmental outcomes among pre-school children, the committee were interested in “Good Level of Development” or GLD as defined by a child meeting Early Learning Goals, as set out in the Early Years Foundation Stage (EYFS). Other outcomes outlined in the protocol were both important and clearly defined such as homework completion, school attendance, school absence, school exclusion, or school suspension.

Secondary in importance to these outcomes, were behavioural, cognitive, and social outcomes while the child was at school. While these outcomes were important, they may be more difficult to define, and their relationship to academic success one step removed from the more critical outcomes described above. Similarly, measures of a child’s knowledge and beliefs about school may not translate directly into academic success and, regardless, may be better captured by qualitative evidence.

The committee considered the evidence from the 9 included randomised controlled trials. Outcomes reported for preschool interventions captured some developmental outcomes (such as receptive language/vocabulary scores, cognitive flexibility scores, theory of mind scores, attention problems) and some pre-academic outcomes (such as pre-academic skills scores and maths/reading scores). Other reported outcomes related to social and behavioural outcomes (such as child-teacher relationship, behaviour problems, aggressive/hyperactive scores) or more surrogate outcomes such as “positive approach to learning” scores. The committee recognised the validated nature of some of the scores e.g. the Child Behaviour Checklist and did not recognise other scores (such as the Woodcock-Johnson III tests of achievement), however, in all cases, it was unclear how such scores related to true academic or developmental success in this group of children. One test (the theory of mind score) was not considered to have been conducted properly to measure what it was attempting to measure. The committee felt the test described in the paper was more of a test of ability to imitate, rather than a true theory of mind test.

Outcomes reported for children entering primary school were varied including pre-academic measures (such as sound fluency, letter naming, concepts about print, and pre-reading skills), relational outcomes (such as social competence and prosocial skills), behavioural outcomes (such as aggression, internalising, and externalising symptoms), emotional outcomes such as (emotional regulation and understanding) and outcomes relating to confidence such as self-competence. In addition, some outcomes were reported which have relevance to physical health such as “attitudes towards substance use” but also have some relation to behaviour at school. Once again, the committee noted the lack of clear academic outcomes such as appropriate Key Stage level. Presented research frequently use scales designed for research rather than “real-life” measures of academic success which would have more relevance.

No academic outcomes were reported in studies of secondary school-age interventions. Outcomes reported included measures of behavioural problems (such as delinquent behaviour, association with delinquent peers, internalising and externalising problems) social outcomes (such as prosocial behaviour) and substance use outcomes (such as alcohol, tobacco, and marijuana use scores). The committee noted the lack of outcomes relating to educational success for these interventions. The reported outcomes were considered as surrogate, since better behaviour may lead to better educational outcomes, and improved social outcomes may relate to other experiences of relational success in the school setting for looked after children and young people.

The quality of the evidence

The overall quality of all the presented evidence was noted to be very low by the criteria outlined in GRADE. This was for several reasons. Included research studies were all considered at high risk of bias, often due to poor reporting of methods. This meant there was lack of clarity regarding: how randomisation and allocation concealment was performed; whether participants were lost to follow up (and how many); whether there was missing data (and how much); whether a blinding procedure was carried out for assessments; and whether the trial and analysis were performed in accordance with a pre-defined protocol. The lack of certainty regarding a pre-defined protocol was particularly problematic since many studies had measured multiple relevant outcomes at different time points but may have only reported selected (or composite) outcomes at selected time points. In addition, some studies used versions of multivariable modelling in which it was unclear how the variables entered into the model had been selected. In GRADE, all included research studies were considered as having very serious risk of bias. It would be difficult to determine the direction of the bias in all cases, however, if selection of outcomes or analysis has occurred this is often a bias in favour of finding a statistically significant result in favour of the intervention group. Similarly, some of the outcomes measured had very subjective components, if the assessors had prior knowledge of the intervention group this may have led to a bias in the direction of a positive intervention effect (where the intervention is believed to be effective).

The committee also noted the lack of UK evidence. Most included studies were from America which the committee noted had a very different social care system. As a result, studies from outside of the UK were marked down for quality on account of indirectness. The committee considered that they would have difficulty recommending a readiness for school intervention without some experience or evidence that similar interventions had been implemented successfully in the UK population.

Finally, the committee commented on the confidence intervals which were frequently too wide to be able to discern an important effect between study groups. The reasons for this were discussed with the committee which included the sample sizes in the reporting studies, which were generally small, and the measures themselves, which may be considerably variable within the intervention groups meaning that a larger sample size is required to observe a statistically significant difference between comparison groups.

The GRADE rating of all evidence considered was “very low”. Taking this into account the committee considered that it would be inappropriate to make any strong recommendations regarding the use of readiness for school interventions. Rather, the committee would make use of “consider” (weaker strength) recommendations which reflect the uncertainty of the evidence base.

Finally, the committee noted that much of the evidence focussed on looked-after children who were already in the school system and were being prepared to start the school year at the same time as other school children. The committee determined that school-readiness interventions should also apply to children moving from school to school in the middle of a school year or returning to school following extended absence, events that occur more commonly in the looked-after children population. Recommendations were worded to reflect the possibility of these events.

Benefits and harms

Preschool interventions

The committee considered RCT evidence looking at the Attachment and Biobehavioural Catch-up intervention for infants and toddlers (ABC-I/T). It was noted that these were the only interventions that were compared to another active intervention (not counting usual care). ABC-I/T was compared to developmental education for families (DEF). ABC-I/T was distinct from DEF in its focus on promoting sensitive caregiving and use of video feedback. Included studies found that ABC-I was associated with significantly improved receptive language score at three years of age, even after adjusting for baseline differences between comparison groups. Participants receiving ABC-T had improved attention problems and cognitive flexibility at 4 years of age, and improved receptive vocabulary across 3–6 years of age. Participants receiving ABC-I/T were found to have improved theory of mind and cognitive flexibility scores across ages 4–6. For all these results it was not possible to tell if the difference observed between groups was important, since confidence intervals were wide.

The committee discussed the ABC-I/T intervention and its similarity to interventions already recommended in the NICE guidance on attachment disorders (NG26) – in this case the committee considered its use for preschool development. Similarities between ABC-I/T and these recommendations included the focus on teaching nurturing, non-frightening, and sensitive caregiving; the need for parental education and guidance about child development and the impact of trauma, neglect and disrupted attachments; encouraging caregivers to promote child-led play; and the use of a video-feedback programme consisting of 10 sessions over a few months, highlighting parental strengths and areas for improvement. The committee considered the overlap between the population considered in NG26 and those considered in the current guideline. The committee felt that all looked after children and young people were “at risk of” attachment difficulties, and therefore that the evidence-base considered in NG26 was relevant to the current guideline. Therefore, the committee chose to cross-refer to guidance in NG26 to answer the question of what interventions should be considered for pre-school children to assist their development in care.

The committee considered RCT evidence looking at the Head Start programme intervention for 3 to 4-year-olds. In one study, there was no difference between Head Start and usual care observed for maths and reading scores at 5–6 years of age. After adjusting for baseline differences, studies found that being in the Head Start intervention group was associated with greater pre-academic skills, teacher-child relationship, and behaviour problems at 1-year follow up, as well as improved hyperactivity scores at 5–6 years of age. For these results it was not possible to tell whether the differences between groups were important.

The committee reflected that the comparison groups (care as usual) for the Head Start trials were likely to have received some if not many of the same services as the Head Start group. It was felt that Head Start was too broad an intervention, and the evidence of effect too weak, for its recommendation within the current guideline. Head Start encompassed preschool education; medical, dental, and mental health care; nutrition services; and services to help parents foster their child’s development. Therefore, the committee considered it was not possible to isolate the aspect of the intervention that might be important for developmental outcomes in a looked-after child or young person. Finally, the committee noted that several services offered in Head Start were already available for looked-after children in the UK population.

Interventions for entering primary-school education

The committee considered RCT evidence looking at the Kids in Transition to School (KITS) intervention, targeted at children aged 5–6 years old entering kindergarten. After adjustment for differences at baseline, KITS was associated with improved early literacy skills and self-regulatory skills following the intervention. After adjustment for differences at baseline, KITS was associated with improved oppositional and aggressive behaviours. Over 12 months of kindergarten, participants in the KITS intervention group experienced more days free from internalising symptoms. At 9 years of age, children in the KITS group were found to have greater self-competence and fewer positive attitudes towards alcohol, after adjustment for baseline differences this group was also associated with fewer positive attitudes towards antisocial behaviours. For these results it was not possible to tell whether the differences between groups were important.

For the KITS intervention, the committee considered the broad reported improvements across several reported dimensions and the considerably long follow up period. However, it was noted that many differences between intervention groups were only observed after statistical adjustment in a multivariable model. In addition, it was not clear that the effects observed were greater than the minimum important difference. Resource impacts of the KITS intervention are discussed below.

The committee considered RCT evidence looking at therapeutic playgroups used in children in kindergarten entering second grade (7–8 years). At 2 weeks following the intervention foster parent-rated social competence was improved in the intervention group (mean difference 1.53 (0.63 to 2.43). Emotional lability was also improved in the intervention group; however, it was not possible to tell if this was an important difference.

The committee noted that of all the evidence presented, the only reported effect size that was greater than the level of the minimum important difference was that found for foster-parent-rated social competence at 2-week follow-up in looked-after children who had received therapeutic playgroups (compared to care as usual). The committee considered the use of playgroups in children and noted the differences in quality between usual playgroups and guided therapeutic playgroups which included learning opportunities to improve socialisation and the attention of small child-to-staff ratios. However, it was recognised that evidence consisted of a small trial (n=20) and that results at longer-term follow up (1 month) were not able to differentiate an effect. Because of this, and the expense of running therapeutic playgroups, the committee did not recommend them specifically. But they agreed that early-years education should include opportunities to improve socialisation, such as early-years education in playgroups as well as other opportunities to encourage child-led play.

Interventions for entering secondary-school education

The committee considered RCT evidence looking at the Middle School Success (MSS) programme for foster girls entering secondary school education (age 11–12). Compared to care as usual, after adjusting for baseline differences, MSS was found to be associated with improved internalising problems and externalising problems at 6 months follow up. At 12 months follow up, the MSS group was found to have a greater prosocial score. At 3 years follow up, the MSS group was found to have improved substance use scores (including tobacco use and marijuana use scores).

Similarly to results from other readiness for school interventions, the committee observed that improvements were found in the intervention group across several behavioural outcomes. However, effect sizes may be unimportant, and many impacts were only observed after adjustment in multivariable modelling. The committee considered the broadly positive findings with the use of readiness for school interventions. However, the committee did not wish to specifically recommend one model of readiness for school intervention over another.

In terms of harms of the intervention, the committee considered the reviewed interventions were likely to be benign. However, it was raised that, particularly in a child returning to school after prolonged absence, the necessity to cope with the possibility of peers and parents of other children “finding out” about the “looked after” situation of a child could be traumatic, and particularly a risk if the child is receiving special interventions for education. These risks must be balanced with the opportunities for benefit that a child may receive from efforts to support their readiness for school. Other evidence suggested that looked-after children and young people did not necessarily want more professionals or programmes in their lives.

The committee therefore agreed there was a broad benefit of tailored transition support into new school placements. They favoured approaches that would help ease the looked-after person into the new school placement but not single them out, for example, structured visits to the school beforehand, school preparation for the carer, meeting the designated teacher, and handover between designated teachers.

The committee also agreed that transition to a new school placement may need input from professionals beyond those in education and therefore recommended the inclusion of other relevant caring professionals for transition support and decision making (e.g. healthcare).

Cost effectiveness and resource use

The committee was presented with evidence from one published cost-effectiveness study (Lynch 2017) comparing the Kids in Transition to School intervention (KITS) to standard foster care in looked after children entering kindergarten in the US. The study concluded that KITS was more effective than standard foster care at increasing the number of days free from internalising symptoms (IFD) and days free from externalising behaviour (EFD) over a period of 12 months, but KITS was also more costly (ICER: £45 per IFD and £44 per EFD). The committee agreed that the study had limited applicability to the UK context because it was conducted from a US perspective and had a relatively short 1-year time horizon, which may be insufficient to capture the longer-term consequences of the intervention. The committee noted that the study had very serious limitations because it was informed by a single randomised controlled trial of very low quality. The committee also noted that IFD and EFD were not specific measures of readiness for school and that the economic analysis only focussed on these measures even though a number of other potentially more relevant or meaningful outcomes had been captured in the trial.

The committee discussed that KITS was a resource-intensive intervention, delivered over 24 sessions to groups of 12–15 children by a lead teacher and 2 assistant teachers using a manualised set of strategies and 8 caregiver group meetings led by a facilitator and co-facilitator. Given the available evidence, the committee felt that KITS was unlikely to be an effective use of resources.

The committee also considered the potential costs and resources of delivering other interventions for which there was effectiveness evidence but no published economic evidence. There was some evidence that therapeutic playgroups led to an improvement in parent-rated social competence in looked-after children of primary school age. This intervention was delivered in accordance with a curriculum manual in 14 sessions over 7 weeks with a student-to-staff ratio of 3:1. The committee felt therapeutic playgroups would be more affordable than interventions involving multiple 1:1 sessions delivered individually in the home, but noted that the evidence on differences between usual playgroups and guided therapeutic playgroups was from a small trial with no long-term follow up. Therefore, the committee recommended that early-years education including playgroups, and other opportunities to encourage child-led play should be considered to support social competence in LACYP, but did not specifically recommend therapeutic playgroups.

The committee agreed that the resource impact of these recommendations is low. Early years support should be provided as a statutory service, so no additional resource is required. Transition support and services is also currently supported by the Virtual School. Furthermore, these interventions can be funded through the Pupil Premium which is part of statutory education funding provision for LACYP.

Other factors the committee took into account

The committee discussed who should be involved with the care of a looked-after child transitioning between schools. In the absence of evidence, the committee made a consensus recommendation to “consider the use of multidisciplinary specialist support for transition services tailored to the child’s needs.” The committee felt that transition to school should be tailored to the needs of the child, a bespoke model, which is better suited to delivery by a multidisciplinary team (e.g. composed of education specialists, social workers, occupational therapists, and psychologists to intervene as needed).

References – included studies

Effectiveness

Bernard, Kristin; Lee, Amy Hyoeun; Dozier, Mary; Effects of the ABC Intervention on Foster Children’s Receptive Vocabulary: Follow-Up Results From a Randomized Clinical Trial.; Child maltreatment; 2017; vol. 22 (no. 2); 174–179 [PMC free article: PMC5610911] [PubMed: 28152611]
Hu A, Van Ryzin MJ, Schweer-Collins ML, Leve LD. Peer relations and delinquency among girls in foster care following a skill-building preventive intervention. Child maltreatment. 2020 May 14:1077559520923033. [PMC free article: PMC7666035] [PubMed: 32406265]
Kim, Hyoun K; Leve, Leslie D; 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; 2011; vol. 79 (no. 6); 740–50 [PMC free article: PMC3226884] [PubMed: 22004305]
Lee, Kyunghee; Head Start’s impact on cognitive outcomes for children in foster care.; Child Abuse Review; 2016; vol. 25 (no. 2); 128–141
Lee K, Lee JS. Parental Book Reading and Social-Emotional Outcomes for Head Start Children in Foster Care. Social work in public health. 2016 Jul 28;31(5):408–18. [PubMed: 27167763]
Lewis-Morrarty, Erin; Dozier, Mary; Bernard, Kristin; Terracciano, Stephanie M; Moore, Shannon V; Cognitive flexibility and theory of mind outcomes among foster children: preschool follow-up results of a randomized clinical trial.; The Journal of adolescent health : official publication of the Society for Adolescent Medicine; 2012; vol. 51 (no. 2suppl); 17–22 [PMC free article: PMC3407592] [PubMed: 22794528]
Lind, Teresa; Lee Raby, K; Caron, E B; Roben, Caroline K P; Dozier, Mary; Enhancing executive functioning among toddlers in foster care with an attachment-based intervention.; Development and psychopathology; 2017; vol. 29 (no. 2); 575–586 [PMC free article: PMC5650491] [PubMed: 28401847]
Lipscomb, Shannon T, Pratt, Megan E, Schmitt, Sara A et al. (2013) School readiness in children living in non-parental care: Impacts of Head Start.. Journal of Applied Developmental Psychology 34(1): 28–37
Lynch, Frances L; Dickerson, JohnF; Pears, Katherine C; Fisher, Philip A; Cost effectiveness of a school readiness intervention for foster children.; Children and Youth ServicesReview; 2017; vol. 81; 63–71 [PMC free article: PMC5737933] [PubMed: 29276324]
Pears, Katherine C; Fisher, Philip A; Bronz, Kimberly D; An intervention to promote social emotional school readiness in foster children: Preliminary outcomes from a pilot study.; School Psychology Review; 2007; vol. 36 (no. 4); 665–673 [PMC free article: PMC2593470] [PubMed: 19057655]
Pears, Katherine C; Kim, Hyoun K; Fisher, Philip A; Effects of a school readiness intervention for children in foster care on oppositional and aggressive behaviors in kindergarten.; Children and Youth Services Review; 2012; vol. 34 (no. 12); 2361–2366 [PMC free article: PMC3661284] [PubMed: 23710106]
Pears, Katherine C; Fisher, PhilipA; Kim, Hyoun K; Bruce, Jacqueline; Healey, Cynthia V; Yoerger, Karen;Immediate effects of a school readiness intervention for children in fostercare.; Early Education and Development; 2013; vol. 24 (no. 6); 771–791 [PMC free article: PMC3760738] [PubMed: 24015056]
Pears, Katherine C; Kim, Hyoun K;Fisher, Philip A; Decreasing risk factors for later alcohol use andantisocial behaviors in children in foster care by increasing early promotivefactors.; Children and Youth Services Review; 2016; vol. 65; 156–165 [PMC free article: PMC4857707] [PubMed: 27158175]
Raby K.L.; Freedman E.; Yarger H.A.; Lind T.; Dozier M. ; Enhancing the language development of toddlers in foster care by promoting foster parents’ sensitivity: Results from a randomized controlled trial; Developmental science; 2019; vol. 22 (no. 2); e12753 [PMC free article: PMC6716063] [PubMed: 30230658]
Smith, Dana K; Leve, Leslie D; Chamberlain, Patricia (2011) Preventing internalizing and externalizing problems in girls in foster care as they enter middle school: impact of an intervention.. Prevention science : the official journal of the Society for Prevention Research 12(3): 269–77 [PMC free article: PMC3137664] [PubMed: 21475990]

Cost effectiveness

Lynch FL, Dickerson JF, Pears KC et al. (2017) Cost effectiveness of a school readiness intervention for foster children. Children and Youth Services Review 81: 63–71 [PMC free article: PMC5737933] [PubMed: 29276324]

Appendices

Appendix D. Effectiveness evidence

Quantitative studies

Download PDF (609K)

Qualitative studies

No qualitative evidence was identified

Appendix E. Forest plots

No forest plots were produced for this review question as meta-analysis was not possible.

Appendix F. GRADE tables

Quantitative evidence

Download PDF (461K)

Qualitative evidence

No qualitative evidence regarding interventions of interest were identified

Appendix G. Economic evidence study selection

Download PDF (156K)

Appendix H. Economic evidence tables

Download PDF (244K)

Appendix I. Health economic model

No economic modelling was undertaken for this review question.

Appendix J. Excluded studies

Effectiveness studies

Table

- Non-OECD country - Book

Cost-effectiveness studies

Table

- Exclude - compared LAC with non-LAC - Exclude - non-relevant outcomes

Appendix K. Research recommendations – full details

Research recommendation

No research recommendations were drafted for this review

Appendix L. References

Other references

Achenbach TM (1991) Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Burlington, University of Vermont
Pears KC, Fisher PA, Bruce J et al. (2010) Early elementary school adjustment of maltreated children in foster care: The roles of inhibitory control and caregiver involvement. Child Development 81(5):1550–1564 [PMC free article: PMC2941223] [PubMed: 20840240]
Pears KC, Fisher PA, Kim HK (2013) Immediate effects of a school readiness intervention for children in foster care. Early Education and Development 24(6):771–791 [PMC free article: PMC3760738] [PubMed: 24015056]
Pears KC, Kim HK, Fisher PA (2012) Effects of a school readiness intervention for children in foster care on oppositional and aggressive behavior in kindergarten. Children and Youth Services Review 34(12):2361–2366 [PMC free article: PMC3661284] [PubMed: 23710106]

Appendix M. Other appendix

No additional information for this review question.

Final

Evidence reviews underpinning recommendations 1.2.28 and 1.6.1 to 1.6.3

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.

Bookshelf ID: NBK575880PMID: 34941229

Table 1PICO for review on interventions to support readiness for school in looked-after children and young people

Population	Looked after children and young people (wherever they are looked after) from birth until age 18. Including: Children and young people who are looked after on a planned, temporary basis for short breaks or respite care purposes, only if the Children Act 1989 (section 20) applies and the child or young person is temporarily classed as looked after. Children and young people living at home with birth parents but under a full or interim local authority care order and are subject to looked-after children and young people processes and statutory duties. Children and young people in a prospective adoptive placement. Children and young people preparing to leave care. Looked-after children and young people on remand, detained in secure youth custody and those serving community orders.
Intervention	Health and social care interventions and approaches to support readiness for school in looked-after children and young people, prior to, or during entry into pre-school, primary school, or secondary school education. Example interventions and approaches of interest include: Interventions to promote readiness for pre-school (early years) education (including interventions delivered in the home/nursery setting by education specialists) Interventions to promote readiness for primary school Interventions to promote readiness for secondary school Interventions to promote positive relationships (as relates to their impact on educational outcomes) Transition programmes Teacher-delivered and carer-delivered interventions School-based and home-based interventions Tutoring programmes Coaching and mentoring Other pedagogical interventions (e.g. ready for school packages, such as “Letterbox”)
Comparator	Comparator could include standard care, waiting list, or another approach to support readiness for school in looked-after children, young people
Outcomes	Preschool developmental progress (e.g. achieving age-appropriate “good level of development” (GLD)) Educational outcomes (academic skills; academic achievement; grade achievement; homework completion; school attendance) Adverse events (school absence, school exclusion or suspension) Behavioural, cognitive, and social functioning at school Knowledge and beliefs about school and education

Table 2SPIDER table for review on interventions to support care placement stability in looked-after children and young people

Sample	Looked after children and young people (wherever they are looked after) from birth until age 18.
Phenomenon of Interest	Health and social care interventions and approaches to support readiness for school in looked-after children and young people, prior to, or during entry into pre-school, primary school, or secondary school education.
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 readiness for school will be examined. Evidence should relate to the views of looked after children, their carers, and providers who would deliver eligible interventions on: The accessibility and acceptability of the intervention, including information about the source and type of intervention used. Barriers to and facilitators for intervention effectiveness in supporting readiness for school.
Research type	Qualitative and mixed methods
Search date	1990
Exclusion criteria	Mixed-methods studies reporting qualitative data that cannot be distinguished from quantitative data. Countries outside of the UK (unless evidence concerns an intervention which has been shown to be effective in reviewed quantitative evidence) Studies older than the year 2010 (unless not enough evidence, then progress to include studies between 1990 to current)

Study (country)	LACYP population	Intervention	Comparator	Number of patients who completed study	Outcomes reported (follow up f/u)
Preschool interventions
Bernard 2017 (USA)	Children in foster care (infant aged)	Attachment and biobehavioural catch up for infants (ABC-I)	Developmental Education for Families (DEF)	ABC-I: 24 DEF: 28	Receptive language score (at 3 years of age)
Lind 2017 (USA)	Children living in foster care (age at intervention approximately 2.5 years)	Attachment and biobehavioural catch up for toddlers (ABC-T)	DEF	ABC-T: 63 DEF: 58	Attention problems score (approximately 2 year f/u) Cognitive flexibility (approximately 2-year f/u)
Lipscomb 2013 (USA)	Children living with non-biological parents or in kinship care (aged 3–4 years)	Head Start (HS) programme	CAU	HS: 154 CAU: 99	Pre-academic skills (1-year follow up) externalising behavior problems (1-year follow up) Teacherchild relationship (1-year follow up)
Raby 2019 (USA)	Children living in foster care (age 2 – 3 years)	ABC-T	DEF	ABC-T: 45 DEF: 43	Receptive vocabulary (composite score over 2 years follow up)
Lewis-Morrarty 2012 (USA)¹	Children living in foster care (intervention delivered prior to age 20 months)	Attachment and biobehavioural catch up for infants and toddlers (ABC-I/T)	DEF	ABC-I: 17 DEF: 20	Cognitive flexibility (at 4–6 years) Theory of mind (at 4–6 years)
Lee 2016a, Lee 2016b, (USA)	Children living with non-biological parents or in kinship care (aged 3–4 years)	HS	CAU	HS: 97 CAU: 65	Maths score (at age 5 – 6) Reading score (at age 5 – 6)
Entering primary school-age education
Pears 2007 (USA)	Children living in foster care entering second grade (age 7–8) from kindergarten	Therapeutic playgroups (TP)	CAU	TP: 10 CAU: 10	Foster parent rated social competence and behavioural functioning (2 week f/u) Foster parent rated emotional regulation and lability (2-week f/u) Assessor-rated emotional lability (2-week f/u) Teacher-rated emotional regulation and lability score (f/u 1 month following the start of school)
Pears 2012 (USA) Pears (2013) Pears (2016) Lynch (2017)	Children living in foster care entering kindergarten (age 5–6)	Kids in Transition to School (KITS) programme	CAU	KITS: 102 CAU: 90	Initial sound fluency; Letter naming fluency; Concepts about print; Caregiver rating of pre-reading skills; preschool PIPPS score, CBCL social competence; Emotional understanding; inhibitory control; behavioural regulation; emotional regulation (end of summer prior to kindergarten, following intervention) Teacher-reported aggressive behaviour; Teacher-reported delinquent behaviour; Teacher-reported oppositional behaviour (measured end of kindergarten year) Days free from internalising symptoms; days free from externalising symptoms (over 12 months of kindergarten) Positive attitudes towards alcohol; positive attitudes towards antisocial behaviours; involvement with deviant peers; self-competence (measured third grade – 9 years old)
Entering secondary school-age education
Kim 2011, Smith 2011, (USA)	Girls in foster care, in final year of elementary school (mean age approximately 11.5 years)	Middle School Success (MSS)	Care as usual (CAU)	MSS: 48 CAU: 52	Internalising and externalising symptoms score (24-month f/u) Prosocial behaviour score (12-month f/u) Delinquent behaviour (36 months) Association with delinquent peers (36 months) Substance use (36 months)

1: Part of a three-armed trial including a non-foster community comparison group

Table 3Summary GRADE table (Attachment and biobehavioural catch-up for infants (ABC-I) vs Developmental Education for Families (DEF))

Outcome	Sample size	Effect size (95% CI)	Quality	Interpretation of effect^a
Receptive language score at 3 years of age (Peabody Picture Vocabulary Test)	52	MD 9.97 (1.58 to 18.36)	Very Low	Effect favours intervention group, but it may be less than the MID
Association between being in the intervention group and receptive language score at 3 years of age (Peabody Picture Vocabulary Test)	52	β 9.39 (0.82 to 17.96)	Very low	Intervention was associated with a more favourable outcome

(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 4Summary GRADE table (Attachment and biobehavioural catch-up for toddlers (ABC-T) vs Developmental Education for Families (DEF))

Outcome	Sample size	Effect size (95% CI)	Quality	Interpretation of effect^a
Attention problems score at approx. 2 years follow up (Attention Problems Scale in the preschool Child Behaviour Checklist)	111	MD −0.90 (−1.66 to −0.14)	Very Low	Effect favours intervention group, but it may be less than the MID
Cognitive flexibility score at approx. 2 years follow up (Dimensional Change Card Sort task for pre-schoolers)	111	MD 5.13 (0.51 to 9.75)	Very Low	Effect favours intervention group, but it may be less than the MID
Receptive vocabulary assessed at approx. 36, 48, and 60 months of age for a composite score (Peabody Picture Vocabulary Test (PPVT third edition).	88	MD 7.10 (0.32 to 13.88)	Very Low	Effect favours intervention group, but it 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 5Summary GRADE table (Attachment and biobehavioural catch-up for infants and toddlers (ABC-I/T) vs Developmental Education for Families (DEF))

Outcome	Sample size	Effect size (95% CI)	Quality	Interpretation of effect^a
Theory of mind score at 4–6 years of age (penny hiding game task)	37	MD 1.96 (0.84 to 3.08)	Very Low	Effect favours intervention group, but it may be less than the MID
Cognitive flexibility score at 4–6 years of age (Dimensional Change Card Sort task)	37	MD 2.60 (1.01 to 4.19)	Very Low	Effect favours intervention group, but it 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 6Summary GRADE table (Head start programme vs care as usual)

Outcome	Sample size	Effect size (95% CI)	Quality	Interpretation of effect^a
Association between being in the intervention group and assessor-rated pre-academic skills composite score at 1 year (Woodcock-Johnson III subscales)	253	β 0.16 (0.02 to 0.30)	Very Low	Intervention was associated with a more favourable outcome
Association between being in the intervention group and teacher-rated teacher-child relationship at 1 year (student-teacher relationship scale)	253	β 0.30 (0.12 to 0.48)	Very Low	Intervention was associated with a more favourable outcome
Association between being in the intervention group and teacher/caregiver-reported behaviour problems at 1 year (Achenback Child Behaviour Checklist)	253	β −0.18 (−0.36 to 0.00)	Very Low	Intervention was associated with a more favourable outcome
Maths score at 5–6 years of age: assessed by the Woodcock-Johnson III Tests of Achievement, Math Reasoning (for girls)	162	MD 4.40 (3.48 to 5.32)	Very Low	Effect favours intervention group
Maths score at 5–6 years of age: assessed by the Woodcock-Johnson III Tests of Achievement, Math Reasoning (for boys)	162	MD −8.40 (−9.23 to −7.57)	Very Low	Effect favours control group
Reading score at 4–6 years of age: assessed by the Woodcock-Johnson III Tests of Achievement, Oral Comprehension (for girls)	162	MD 4.80 (4.18 to 5.42)	Very Low	Effect favours intervention group
Reading score at 4–6 years of age: assessed by the Woodcock-Johnson III Tests of Achievement, Oral Comprehension (for boys)	162	MD −3.20 (−3.95 to −2.45)	Very Low	Effect favours control group
Association between being in the intervention group and child-teacher relationship at 5 – 6 years of age (modified Robert Pianta scale)	162	β −0.30 (−1.01 to 0.41)	Very Low	No association was observed between intervention and outcome
Association between being in the intervention group and caregiver-rated positive approach to learning at 5 – 6 years of age (Achenbach /Edelbrock/Howell score)	162	β 0.11 (−0.01 to 0.23)	Very Low	No association was observed between intervention and outcome
Association between being in the intervention group and teacher-rated aggressive score at 5 – 6 years of age (Adjustment Scales for Preschool Intervention)	162	β −1.57 (−1.41 to 4.55)	Very Low	No association was observed between intervention and outcome
Association between being in the intervention group and teacher-rated hyperactive score at 5 – 6 years of age (Adjustment Scales for Preschool Intervention)	162	β −3.28 (−6.26 to −0.30)	Very Low	Intervention was associated with a more favourable outcome

(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 (Therapeutic playgroups vs care as usual)

Outcome	Sample size	Effect size (95% CI)	Quality	Interpretation of effect^a
Change in foster parent-rated social competence at 2 weeks follow up (Child Behavior Checklist)	20	MD 1.53 (0.63 to 2.43)	Very Low	Effect favours intervention group
Change in foster parent-rated externalising behaviours at 2 weeks follow up (Child Behavior Checklist)	20	MD −2.20 (−5.59 to 1.19)	Very Low	Could not differentiate
Foster parent-rated internalising behaviours at 2 weeks follow up (Child Behavior Checklist)	20	MD 1.30 (−2.52 to 5.12)	Very Low	Could not differentiate
Teacher-rated social problems at 1 month following the start of school (Teacher Report Form)	20	MD 0.00 (−2.72 to 2.72)	Very Low	Could not differentiate
Teacher-rated externalising behaviours at 1 month following the start of school (Teacher Report Form)	20	MD 0.90 (−7.12 to 8.92)	Very Low	Could not differentiate
Teacher-rated internalising behaviours at 1 month following the start of school (Teacher Report Form)	20	MD 0.10 (−6.71 to 6.91)	Very Low	Could not differentiate
Foster parent-rated emotional regulation at 2 weeks follow up (Emotion Regulation Checklist)	20	MD −0.03 (−0.20 to 0.14)	Very Low	Could not differentiate
Foster parent-rated emotional lability at 2 weeks follow up (Emotion Regulation Checklist)	20	MD −0.14 (−0.34 to 0.06)	Very Low	Could not differentiate
Assessor-rated emotional lability at 2 weeks follow up (Emotion Regulation Checklist)	20	MD −0.41 (−0.65 to −0.17)	Very Low	Effect favours intervention group, but it may be less than the MID
Teacher-rated emotional regulation at 1 month following the start of school (Emotion Regulation Checklist)	20	MD −0.18 (−0.69 to 0.33)	Very Low	Could not differentiate
Teacher-rated emotional lability at 1 month following the start of school (Emotion Regulation Checklist)	20	MD 0.22 (−0.26 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 8Summary GRADE table (Kids in Transition to School (KITS) programme vs care as usual)

Outcome	Sample size	Effect size (95% CI)	Quality	Interpretation of effect^a
Initial sound fluency score following intervention before school (subtest of the Dynamic Indicators of Basic Early Literacy Skills)	192	MD 0.81 (−1.22 to 2.84)	Very Low	No meaningful difference
Letter naming fluency following intervention before school (subtest of the Dynamic Indicators of Basic Early Literacy Skills)	192	MD 0.23 (−2.81 to 3.27)	Very Low	No meaningful difference
Concepts about print score following intervention before school (Concepts About Print test)	192	MD 0.65 (−0.37 to 1.67)	Very Low	No meaningful difference
Caregiver rating of pre-reading skills following intervention before school (recognition letters of the alphabet and write first name)	192	MD −0.13 (−0.37 to 0.11)	Very Low	No meaningful difference
Association between being in the intervention group and early literacy skills following intervention before starting school (composite of indicators of early literacy skills, above)	192	β 0.10 P<0.05	Very Low	Intervention was associated with a more favourable outcome
Prosocial skills score following intervention before school (Preschool Penn Interactive Peer Play Scale score)	192	MD −0.05 (−0.17 to 0.07)	Very Low	No meaningful difference
Social competence score following intervention before school (Child Behaviour Checklist)	192	MD −0.10 (−0.67 to 0.47)	Very Low	No meaningful difference
Emotional understanding score following intervention before school (matching vignettes to correct emotional state)	192	MD −0.21 (−1.01 to 0.59)	Very Low	No meaningful difference
Association between being in the intervention group and prosocial skills following intervention before starting school (composite of indicators of prosocial skills, above)	192	β 0.4 P>0.05	Very Low	No association was observed between intervention and outcome
Inhibitory control score following intervention before school (composite score: Inhibitory Control subscale; the Attentional Focusing subscale (of the Children’s Behavior Questionnaire); the Inhibit subscale from the Brief Rating Inventory of Executive Function–Preschool Version; and two computer-administered tasks)	192	MD 0.03 (−0.18 to 0.24)	Very Low	No meaningful difference
Behavioural regulation score following intervention before school (composite score: the Activity Level subscale and Impulsivity subscale (of the Childrens Behaviour Questionnaire); the Externalizing subscale (of the Child Behaviour Checklist); the Lability subscale of the Emotion Regulation Checklist)	192	MD 0.14 (−0.11 to 0.39)	Very Low	No meaningful difference
Emotional regulation score following intervention before school (Composite score: the anger subscale and the reactivity/soothability subscale of the Children’s Behaviour Questionnaire; the Emotion Regulation scale of the Emotion Regulation Checklist; and the Emotion Control subscale of the BRIEF–P)	192	MD 0.00 (−0.22 to 0.22)	Very Low	No meaningful difference
Association between being in the intervention group and self-regulatory skills following intervention before starting school (assessed by composite of indicators of self-regulation, above)	192	β 0.11 P<0.05	Very Low	Intervention was associated with a more favourable outcome
Teacher-reported aggressive behaviour at the end of kindergarten year (the aggressive behavior subscales of the Teacher Report Form)	192	MD −1.84 (−4.81 to 1.13)	Very Low	No meaningful difference
Teacher-reported delinquent behaviour at the end of kindergarten year (the delinquent behavior subscales of the Teacher Report Form)	192	MD −0.58 (−1.21 to 0.05)	Very Low	No meaningful difference
Teacher-reported oppositional behaviour at the end of kindergarten year (the oppositional subscale of the Conners’ Teacher Ratings Scales-Revised: Short version)	192	MD −0.81 (−1.78 to 0.16)	Very Low	No meaningful difference
Days free from internalising symptoms over 12 months of kindergarten (symptom reports from caregivers on the Child Behavior Checklist)	192	MD 26.00 (0.05 to 51.95)	Very Low	Effect favours intervention group, but it may be less than the MID
Days free from externalising problems over 12 months of kindergarten (symptom reports from caregivers on the Child Behavior Checklist)	192	MD 26.60 (−2.76 to 55.96)	Very Low	Could not differentiate
Association between being in the intervention group and child oppositional and aggressive behaviours at the end of kindergarten year (composite of indicators of oppositional and aggressive behaviours, above)	192	β −0.17 P<0.05	Very Low	Intervention was associated with a more favourable outcome
Positive attitudes towards alcohol at 9 years of age (questions adapted from the Monitoring the Future National Survey Questionnaire)	192	MD −0.30 (−0.50 to −0.10)	Very Low	Effect favours intervention group, but it may be less than the MID
Positive attitudes towards antisocial behaviours at 9 years of age (based on two questions - “What are some of the things you think teenagers do for fun with their friends?” and “What are some of the things you think teenagers do when their moms or dads are not there?”)	192	MD −0.09 (−0.27 to 0.09)	Very Low	Could not differentiate
Involvement with deviant peers at 9 years of age (based on responses to questions about whether “none”, “some”, or “all” of their friends were involved in five rule-breaking or deviant behaviors)	192	MD −0.19 (−0.44 to 0.06)	Very Low	No meaningful difference
Self-competence at 9 years of age (six questions on the Global Self-Worth Scale of the Self-Perception Profile for Children)	192	MD 1.91 (0.82 to 3.00)	Very Low	Effect favours intervention group, but it may be less than the MID
Association between being in the intervention group and positive attitudes towards alcohol at 9 years of age (questions adapted from the Monitoring the Future National Survey Questionnaire)	192	β −0.34 P<0.05	Very Low	Intervention was associated with a more favourable outcome
Association between being in the intervention group and positive attitudes towards antisocial behaviour at 9 years of age (based on two questions - “What are some of the things you think teenagers do for fun with their friends?” and “What are some of the things you think teenagers do when their moms or dads are not there?”)	192	β −0.11 P<0.05	Very Low	Intervention was associated with a more favourable outcome
Association between being in the intervention group and self-competence at 9 years of age (six questions on the Global Self-Worth Scale of the Self-Perception Profile for Children)	192	β 1.95 P<0.01	Very Low	Intervention was associated with a more favourable outcome

(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 (Middle School Success vs care as usual)

Outcome	Sample size	Effect size (95% CI)	Quality	Interpretation of effect^a
Association between being in the intervention group and foster parent and girl reported internalising problems at 6 months (Parent Daily Report Checklist)	100	β −0.28 P<0.01	Very Low	Intervention was associated with a more favourable outcome
Association between being in the intervention group and foster parent and girl reported externalising problems at 6 months (Parent Daily Report Checklist)	100	β −0.21 P<0.01	Very Low	Intervention was associated with a more favourable outcome
Association between being in the intervention group and foster parent and girl reported prosocial behaviour at 6 months (Parent Daily Report Checklist)	100	β 0.15 P>0.05	Very Low	No association was observed between intervention and outcome
Prosocial behaviour score at 12 months follow up (subscale from Parent Daily Report Checklist)	100	MD 0.06 (0.01 to 0.11)	Very Low	Effect favours intervention group, but it may be less than the MID
Association with delinquent peers score at 12 months follow up (modified version of the general delinquency scale from the Self-Report Delinquency Scale)	100	Beta −0.21, SE 0.09, P<0.05	Very Low	Effect favours intervention group, but it may be less than the MID
Caregiver-reported Internalising/externalising symptoms score at 2 years follow up (Achenbach System of Empirically Based Assessment)	100	MD 0.27 (−3.03 to 3.57)	Very Low	No meaningful difference
Delinquent behaviour score at 3 years follow up (Self-Report Delinquency Scale)	100	MD −0.65 (−1.43 to 0.13)	Very Low	Could not differentiate
Association with delinquent peers score at 3 years follow up (modified version of the general delinquency scale from the Self-Report Delinquency Scale)	100	MD −0.34 (−0.71 to 0.03)	Very Low	Could not differentiate
Composite substance use score at 3 years follow up (girls were asked how many times in the past year they had (a) smoked cigarettes or chewed tobacco, (b) drank alcohol (beer, wine, or hard liquor), and (c) used marijuana).	100	MD −0.74 (−1.33 to −0.15)	Very Low	Effect favours intervention group, but it may be less than the MID
Tobacco use score at 3 years follow up (see above)	100	MD −0.87 (−1.69 to −0.05)	Very Low	Effect favours intervention group, but it may be less than the MID
Alcohol use score at 3 years follow up (see above)	100	MD −0.31 (−0.78 to 0.16)	Very Low	Could not differentiate
Marijuana use score at 3 years follow up (see above)	100	MD −1.04 (−1.74 to −0.34)	Very Low	Effect favours intervention group, but it 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

Study

Comparators

Costs

Effects

ICER

Uncertainty

Applicability

Limitations

Lynch 2017

192 children in pre-schooler age (kinship and non-kinship)

Cost-effectiveness analysis

Kids in transition to school (KITS) intervention

$6,422 (£4,523)

IFD: 310.5

EFD: 218.6

$64/IFD (£45/IFD)

$63/EFD (£44/EFD)

At a threshold of $100 (£70) willingness to pay KITS was cost-effective 78.7% of times (IFD) and 75.3% for EFD

Partially applicable

Very serious limitations

Standard foster care

$4,746 (£3,343)

IFD: 284.5

EFD: 192.0

: EFD, externalising free days; ICER, incremental cost-effectiveness ratio; IFD, internalising free days

Study	Reason for exclusion
(2008) The effects of early social-emotional and relationship experience on the development of young orphanage children: XI. Intervention effects on caregiver-child interactions (infant affect manual, attachment variables).. Monographs of the Society for Research in Child Development 73(3): 187–223 [PMC free article: PMC2702123] [PubMed: 19121007]	- Non-OECD country
(2008) The effects of early social-emotional and relationship experience on the development of young orphanage children: X. Effects of the interventions on caregiver-child Interactions during free play (PCERA).. Monographs of the Society for Research in Child Development 73(3): 167–186 [PMC free article: PMC2702123] [PubMed: 19121007]	- Non-OECD country
(2008) The effects of early social-emotional and relationship experience on the development of young orphanage children: IX. The effects of the intervention on children’s general behavioral development (Battelle Developmental Inventory).. Monographs of the Society for Research in Child Development 73(3): 142–166 [PMC free article: PMC2702123] [PubMed: 19121007]	- Non-OECD country
(2008) The effects of early social-emotional and relationship experience on the development of young orphanage children: VIII. Intervention effects on physical growth.. Monographs of the Society for Research in Child Development 73(3): 124–141 [PMC free article: PMC2702123] [PubMed: 19121007]	- Non-OECD country
(2008) The effects of early social-emotional and relationship experience on the development of young orphanage children: VII. Orphanage staff attitudes, perceptions, and feelings.. Monographs of the Society for Research in Child Development 73(3): 108–123 [PMC free article: PMC2702123] [PubMed: 19121007]	- Non-OECD country
(2008) The effects of early social-emotional and relationship experience on the development of young orphanage children: VI. Caregiver behavior on the wards (home inventory).. Monographs of the Society for Research in Child Development 73(3): 95–107 [PMC free article: PMC2702123] [PubMed: 19121007]	- Non-OECD country
(2008) The effects of early social-emotional and relationship experience on the development of young orphanage children. V. Evidence that the interventions were implemented as planned.. Monographs of the Society for Research in Child Development 73(3): 84–94 [PMC free article: PMC2702123] [PubMed: 19121007]	- Non-OECD country
Bailey C., Klas A., Cox R. et al. (2019) Systematic review of organisation-wide, trauma-informed care models in out-of-home care (OoHC) settings. Health & social care in the community 27(3): e10–e22 [PubMed: 30033666]	- Systematic review, considered for relevant references
Bakermans-Kranenburg, Marian J, van IJzendoorn, Marinus H, Juffer, Femmie et al. (2008) Earlier is better: A meta-analysis of 70 years of intervention improving cognitive development in institutionalized children.. Monographs of the Society for Research in Child Development 73(3): 279–293 [PubMed: 19121021]	- Meta analysis based on studies from earlier than 1990, or from non-OECD countries
Bernard K.; Hostinar C.E.; Dozier M. (2015) Intervention effects on diurnal cortisol rhythms of Child Protective Services-referred infants in early childhood preschool follow-up results of a randomized clinical trial. JAMA Pediatrics 169(2): 112–119 [PMC free article: PMC4470904] [PubMed: 25436448]	- Unclear that LACYP were included (an intervention to help divert children away from entering foster care)
Berument S.K. (2013) Environmental enrichment and caregiver training to support the development of birth to 6-year-olds in Turkish orphanages. Infant Mental Health Journal 34(3): 189–201	- Quasi-experimental study, excluded as sufficient RCT evidence was identified
Bick J. and Dozier M. (2013) The effectiveness of an attachment-based intervention in promoting foster mothers’ sensitivity toward foster infants. Infant Mental Health Journal 34(2): 95–103 [PMC free article: PMC3756602] [PubMed: 23997377]	- To be considered under a different review question (RQ2.1)
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]	- Does not include LACYP population
Bronz, Kimberly Dawn (2004) Effects of a therapeutic playgroup intervention on the social competence and executive functioning of young children in foster care.. Dissertation Abstracts International Section A: Humanities and Social Sciences 65(6a): 2082	- Dissertation abstract
Bruce, Jacqueline, McDermott, Jennifer Martin, Fisher, Philip A et al. (2009) Using behavioral and electrophysiological measures to assess the effects of a preventive intervention: a preliminary study with preschool-aged foster children.. Prevention science : the official journal of the Society for Prevention Research 10(2): 129–40 [PMC free article: PMC2670355] [PubMed: 19030992]	- No outcomes of interest
Bruce, J., Pears, K.C., McDermott, J.M. et al. (2020) Effects of a school readiness intervention on electrophysiological indices of external response monitoring in children in foster care. Development and psychopathology: 1–11 [PMC free article: PMC7710616] [PubMed: 32489170]	- no outcomes of interest
Bruhn, Christina M, Duval, Denise, Louderman, Richard et al. (2008) Centralized assessment of early developmental delays in children in foster care: A program that works.. Children and Youth Services Review 30(5): 536–545	- To be considered under a different review question (RQ3.1)
Burry, Caroline L and Noble, Lynne S (2001) The STAFF Project: Support and Training for Adoptive and Foster Families of infants with prenatal substance exposure.. Journal of Social Work Practice in the Addictions 1(4): 71–82	- No outcome of interest reported
Byrne, Nicole (2017) Systematic review of speech and language therapy outcomes for children who are in Out of Home Care (OOHC).. Speech, Language and Hearing 20(1): 57–61	- Systematic review considered for relevant references
Bywater, Tracey Jane, Hutchings, Judith Mary, Gridley, Nicole et al. (2011) Incredible years parent training support for nursery staff working within a disadvantaged flying start area in Wales: A feasibility study.. Child Care in Practice 17(3): 285–302	- Does not include LACYP population
Catay Z. and Kologlugil D. (2017) IMPACT OF A SUPPORT GROUP FOR THE CAREGIVERS AT AN ORPHANAGE IN TURKEY. Infant Mental Health Journal 38(2): 289–305 [PubMed: 28236315]	- Quasi-experimental study, excluded as sufficient RCT evidence was identified
Chamberlain, Patricia (2003) An application of multidimensional treatment foster care for early intervention.. Treating chronic juvenile offenders: Advances made through the Oregon multidimensional treatment foster care model.: 129–140	- Review article
Chernego, Daria I, McCall, Robert B, Wanless, Shannon B et al. (2018) The effect of a social-emotional intervention on the development of preterm infants in institutions.. Infants & Young Children 31(1): 37–52 [PMC free article: PMC5793907] [PubMed: 29398781]	- Non-OECD country
Chinitz, Susan, Guzman, Hazel, Amstutz, Ellen et al. (2017) Improving outcomes for babies and toddlers in child welfare: A model for infant mental health intervention and collaboration.. Child abuse & neglect 70: 190–198 [PubMed: 28622589]	- To be considered under a different review question (RQ2.1, RQ1.1, RQ3.2)
COHON Donald J. and et al (2001) Specialized foster care for medically complex drug-exposed HIV positive infants: the Baby Moms Program. Children and Youth Services Review 23(11): 831–863	- Intervention description/practice report and data not reported in an extractable format
Cole S.A. (2005) Infants in foster care: Relational and environmental factors affecting attachment. Journal of Reproductive and Infant Psychology 23(1): 43–61	- Study does not consider a relevant intervention
Craven, Patricia Ann and Lee, Robert E (2006) Therapeutic Interventions for Foster Children: A Systematic Research Synthesis.. Research on Social Work Practice 16(3): 287–304	- Systematic review considered for relevant references
Crockenberg, Susan C (2008) How valid are the results of the St. Petersburg-USA Orphanage Intervention Study and what do they mean for the world’s children?. Monographs of the Society for Research in Child Development 73(3): 263–270 [PubMed: 19121019]	- Non-OECD country - Book
Debnath, Ranjan, Tang, Alva, Zeanah, Charles H et al. (2019) The Long-term effects of institutional rearing, foster care intervention and disruptions in care on brain electrical activity in adolescence.. Developmental science: e12872 [PMC free article: PMC6884653] [PubMed: 31148302]	- Non-OECD country
Dozier M., Higley E., Albus K.E. et al. (2002) Intervening with foster infants’ caregivers: Targeting three critical needs. Infant Mental Health Journal 23(5): 541–554	- Intervention description/practice report
Dozier M. and Sepulveda S. (2004) Foster mother state of mind and treatment use: Different challenges for different people. Infant Mental Health Journal 25(4): 368–378	- Case study - Intervention description/practice report
Dozier, Mary; Bick, Johanna; Bernard, Kristin (2011) Intervening With Foster Parents to Enhance Biobehavioral Outcomes Among Infants and Toddlers.. Zero to three 31(3): 17–22 [PMC free article: PMC3517191] [PubMed: 23226918]	- Case study - Review article - Intervention description/practice report
Dozier, Mary, Lindhiem, Oliver, Ackerman, John P et al. (2005) Attachment and Biobehavioral Catch-Up: An Intervention Targeting Empirically Identified Needs of Foster Infants.. Enhancing early attachments: Theory, research, intervention, and policy.: 178–194	- Not a relevant study design
Dozier, Mary, Peloso, Elizabeth, Lewis, Erin et al. (2008) Effects of an attachment-based intervention on the cortisol production of infants and toddlers in foster care.. Development and psychopathology 20(3): 845–59 [PMC free article: PMC3258505] [PubMed: 18606034]	- To be considered under a different review question (RQ2.1, RQ3.2)
Dozier, Mary, Peloso, Elizabeth, Lindhiem, Oliver et al. (2006) Developing Evidence-Based Interventions for Foster Children: An Example of a Randomized Clinical Trial with Infants and Toddlers.. Journal of Social Issues 62(4): 767–785	- To be considered under a different review question (RQ2.1, RQ3.2)
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 considered for relevant references
Fisher, P A, Gunnar, M R, Chamberlain, P et al. (2000) Preventive intervention for maltreated preschool children: impact on children’s behavior, neuroendocrine activity, and foster parent functioning.. Journal of the American Academy of Child and Adolescent Psychiatry 39(11): 1356–64 [PubMed: 11068890]	- To be considered under a different review question (RQ2.1, RQ3.2)
Fisher, Philip A; Burraston, Bert; Pears, Katherine (2005) The early intervention foster care program: permanent placement outcomes from a randomized trial.. Child maltreatment 10(1): 61–71 [PubMed: 15611327]	- To be considered under a different review question (RQ1.1)
Fisher, Philip A and Chamberlain, Patricia (2000) Multidimensional treatment foster care: A program for intensive parenting, family support, and skill building.. Journal of Emotional and Behavioral Disorders 8(3): 155–164	- Review article
Fisher, Philip A and Chamberlain, Patricia (2001) Multidimensional treatment foster care: A program for intensive parenting, family support, and skill building.. Making schools safer and violence free: Critical issues, solutions, and recommended practices.: 140–149	- Duplicate reference
Fisher, Philip A, Gunnar, Megan R, Dozier, Mary et al. (2006) Effects of therapeutic interventions for foster children on behavioral problems, caregiver attachment, and stress regulatory neural systems.. Annals of the New York Academy of Sciences 1094: 215–25 [PubMed: 17347353]	- Review article
Fisher, Philip A and Kim, Hyoun K (2007) Intervention effects on foster preschoolers’ attachment-related behaviors from a randomized trial.. Prevention science : the official journal of the Society for Prevention Research 8(2): 161–70 [PMC free article: PMC2533809] [PubMed: 17340186]	- To be considered under a different review question (RQ2.1)
Fisher, Philip A, Kim, Hyoun K, Pears, Katherine C et al. (2009) Effects of multidimensional treatment foster care for preschoolers (MTFC-P) on reducing permanent placement failures among children with placement instability.. Children and Youth Services Review 31(5): 541–546 [PMC free article: PMC2678807] [PubMed: 19430545]	- To be considered under a different review question (RQ1.1)
Fisher, Philip A and Stoolmiller, Mike (2008) Intervention effects on foster parent stress: associations with child cortisol levels.. Development and psychopathology 20(3): 1003–21 [PMC free article: PMC3668550] [PubMed: 18606041]	- No outcomes of interest
Fisher, Philip A, Stoolmiller, Mike, Gunnar, Megan R et al. (2007) Effects of a therapeutic intervention for foster preschoolers on diurnal cortisol activity.. Psychoneuroendocrinology 32(810): 892–905 [PMC free article: PMC2174427] [PubMed: 17656028]	- To be considered under a different review question (RQ3.2)
Fisher, Philip A, Stoolmiller, Mike, Mannering, Anne M et al. (2011) Foster placement disruptions associated with problem behavior: mitigating a threshold effect.. Journal of consulting and clinical psychology 79(4): 481–7 [PMC free article: PMC3334279] [PubMed: 21787051]	- To be considered under a different review question (RQ1.1, RQ 2.1)
Frame, L; Berrick, J D; Brodowski, M L (2000) Understanding reentry to out-of-home care for reunified infants.. Child welfare 79(4): 339–69 [PubMed: 10925764]	- Not an intervention of interest - Not a relevant study design
Gamache, Susan, Mirabell, Dianne, Avery, Lisa et al. (2006) Early childhood developmental and nutritional training for foster parents.. Child & Adolescent Social Work Journal 23(56): 501–511	- No outcome of interest reported
Graham, Alice M, Pears, Katherine C, Kim, Hyoun K et al. (2018) Effects of a school readiness intervention on hypothalamus-pituitary-adrenal axis functioning and school adjustment for children in foster care.. Development and psychopathology 30(2): 651–664 [PMC free article: PMC5857473] [PubMed: 28918760]	- To be considered under a different review question (RQ3.2)
Graham, Alice M, Yockelson, Melissa, Kim, Hyoun K et al. (2012) Effects of maltreatment and early intervention on diurnal cortisol slope across the start of school: A pilot study.. Child Abuse & Neglect 36(9): 666–670 [PMC free article: PMC3445788] [PubMed: 22964372]	- To be considered under a different review question (RQ3.2)
Harvey, Aminifu R; Loughney, Georgette K; Moore, Janae (2002) A model program for African American children in the foster care system.. Journal of health & social policy 16(12): 195–206 [PubMed: 12809388]	- No outcome of interest reported - Intervention description/practice report
Hawk B.N., Mccall R.B., Groark C.J. et al. (2018) CAREGIVER SENSITIVITY AND CONSISTENCY AND CHILDREN’S PRIOR FAMILY EXPERIENCE AS CONTEXTS FOR EARLY DEVELOPMENT WITHIN INSTITUTIONS. Infant Mental Health Journal 39(4): 432–448 [PMC free article: PMC6092938] [PubMed: 29953627]	- Non-OECD country
Heller S.S.; Smyke A.T.; Boris N.W. (2002) Very young foster children and foster families: Clinical challenges and interventions. Infant Mental Health Journal 23(5): 555–575	- Intervention description/practice report
Hermenau, Katharin, Goessmann, Katharina, Rygaard, Niels Peter et al. (2017) Fostering Child Development by Improving Care Quality: A Systematic Review of the Effectiveness of Structural Interventions and Caregiver Trainings in Institutional Care.. Trauma, violence & abuse 18(5): 544–561 [PubMed: 27075337]	- Systematic review considered for relevant references
Hillen T., Gafson L., Drage L. et al. (2012) Assessing the prevalence of mental health disorders and mental health needs among preschool children in care in England. Infant Mental Health Journal 33(4): 411–420 [PubMed: 28520175]	- Study does not contain a relevant intervention
Hindman, Annemarie H and Morrison, Frederick J (2011) Family involvement and educator outreach in Head Start.. The Elementary School Journal 111(3): 359–386	- Comparator in study does not match that specified in protocol
Hobbie, C; Braddock, M; Henry, J (2000) Medical assessment of children going into emergency out-of-home placement.. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners 14(4): 172–9 [PubMed: 10900414]	- Intervention description/practice report
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 under a different review question (RQ3.2)
Howell K.H., Miller L.E., Lilly M.M. et al. (2013) Fostering social competence in preschool children exposed to intimate partner violence: Evaluating the preschool kids’ club intervention. Journal of Aggression, Maltreatment and Trauma 22(4): 425–445	- Does not include LACYP population
Humphreys K.L., Miron D., McLaughlin K.A. et al. (2018) Foster care promotes adaptive functioning in early adolescence among children who experienced severe, early deprivation. Journal of child psychology and psychiatry, and allied disciplines 59(7): 811–821 [PMC free article: PMC6214343] [PubMed: 29389015]	- Non-OECD country
Humphreys, Cathy and Kiraly, Meredith (2011) High-frequency family contact: A road to nowhere for infants.. Child & Family Social Work 16(1): 1–11	- To be considered under a different review question (RQ5.1, RQ5.2)
IRCT2016040621090N2 (2016) The effect of developmental stimulation program on developmental criterion in children 1–3 years old of foster care. Http://www.who.int/trialsearch/trial2.aspx?Trialid=irct2016040621090n2	- Non-OECD country
Jankowski, Kathryn F, Bruce, Jacqueline, Beauchamp, Kathryn G et al. (2017) Preliminary evidence of the impact of early childhood maltreatment and a preventive intervention on neural patterns of response inhibition in early adolescence.. Developmental science 20(4) [PMC free article: PMC5055407] [PubMed: 27061609]	- To be considered under a different review question (RQ2.1)
Jonkman C.S., Bolle E.A., Lindeboom R. et al. (2012) Multidimensional treatment foster care for preschoolers: Early findings of an implementation in the Netherlands. Child and Adolescent Psychiatry and Mental Health 6: 38 [PMC free article: PMC3539875] [PubMed: 23216971]	- To be considered under a different review question (RQ2.1)
Jonkman, Caroline S, Schuengel, Carlo, Lindeboom, Robert et al. (2013) The effectiveness of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) for young children with severe behavioral disturbances: study protocol for a randomized controlled trial.. Trials 14: 197 [PMC free article: PMC3708828] [PubMed: 23826798]	- RCT protocol
Jonkman, Caroline S, Schuengel, Carlo, Oosterman, Mirjam et al. (2017) Effects of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) for young foster children with severe behavioral disturbances.. Journal of Child and Family Studies 26(5): 1491–1503 [PMC free article: PMC5387023] [PubMed: 28458502]	- To be considered under a different review question (RQ2.1, RQ3.2)
Kang, Hyunah, Chung, Ick-Joong, Chun, JongSerl et al. (2014) The outcomes of foster care in South Korea ten years after its foundation: A comparison with institutional care.. Children and Youth Services Review 39: 135–143	- Not an intervention of interest
Kemmis-Riggs, Jacqueline; Dickes, Adam; McAloon, John (2018) Program Components of Psychosocial Interventions in Foster and Kinship Care: A Systematic Review.. Clinical child and family psychology review 21(1): 13–40 [PubMed: 29159486]	- Systematic review considered for relevant references
KENRICK Jenny (2010) Concurrent planning (2) ‘the rollercoaster of uncertainty’. Adoption and Fostering 34(2): 38–48	- To be considered under a different review question (RQ5.2)
KENRICK Jenny (2009) Concurrent planning: a retrospective study of the continuities and discontinuities of care, and their impact on the development of infants and young children placed for adoption by the Coram Concurrent Planning Project. Adoption and Fostering 33(4): 5–18	- To be considered under a different review question (RQ5.2)
Kim, Tae Im; Shin, Yeong Hee; White-Traut, Rosemary C; Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants.; Research in nursing & health; 2003; vol. 26 (no. 6); 424–33 [PubMed: 14689459]	- To be considered under a different review question (RQ3.2)
Kim, Hyoun K, Pears, Katherine C, Leve, Leslie D et al. (2013) Intervention effects on health-risking sexual behavior among girls in foster care: The role of placement disruption and tobacco and marijuana use.. Journal of Child & Adolescent Substance Abuse 22(5): 370–387 [PMC free article: PMC3772734] [PubMed: 24043921]	- To be considered under a different review question (RQ1.1, RQ3.2)
Klag, Stefanie, Fox, Tara, Martin, Graham et al. (2016) 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 69: 268–274	- To be considered under a different review question (RQ2.1, RQ3.2, RQ4.2)
KLEIN Sacha M.; FALCONER Mary Kay; BENSON Stephanie M. (2016) Early care and education for children in the child welfare system: evaluations of two training programs. Journal of Public Child Welfare 10(2): 152–175	- No outcome of interest reported
Klein, Sacha, Fries, Lauren, Emmons, Mary M et al. (2017) Early care and education arrangements and young children’s risk of foster placement: Findings from a National Child Welfare Sample.. Children and Youth Services Review 83: 168–178	- To be considered under a different review question (RQ5.1)
Lakes, Kimberley D, Vargas, Danyel, Riggs, Matt et al. (2011) Parenting intervention to reduce attention and behavior difficulties in preschoolers: A CUIDAR evaluation study.. Journal of Child and Family Studies 20(5): 648–659 [PMC free article: PMC3189410] [PubMed: 22003279]	- Does not include LACYP population
Laurent, Heidemarie K, Gilliam, Kathryn S, Bruce, Jacqueline et al. (2014) HPA stability for children in foster care: mental health implications and moderation by early intervention.. Developmental psychobiology 56(6): 1406–15 [PMC free article: PMC4415368] [PubMed: 24889670]	- To be considered under a different review question (RQ3.2)
Lecannelier, Felipe, Silva, Jaime R, Hoffmann, Marianela et al. (2014) Effects of an intervention to promote socioemotional development in terms of attachment security: a study in early institutionalization in Chile.. Infant mental health journal 35(2): 151–9 [PubMed: 25798521]	- Quasi-experimental study, excluded as sufficient RCT evidence was identified
Lederman C. and Osofsky J.D. (2008) A judicial-mental health partnership to heal young children in juvenile court. Infant Mental Health Journal 29(1): 36–47 [PubMed: 28636241]	- Intervention description/practice report - Case study
Lee R.E. and Stacks A.M. (2004) In whose arms? Using relational therapy in supervised family visitation with very young children in foster care. Journal of Family Psychotherapy 15(4): 1–14	- Case study - Intervention description/practice report
Lee, K. (2020) Long-term Head Start Impact on developmental outcomes for children in foster care. Child Abuse and Neglect 101: 104329 [PubMed: 31935533]	Committee had previously stated they were not interested in this intervention since it offered services on offer in the UK already
Levy, Terry M and Orlans, Michael (2003) Creating and Repairing Attachments in Biological, Foster, and Adoptive Families.. Attachment processes in couple and family therapy.: 165–190	- Book - Review article
Lynch, Frances L, Dickerson, John F, Saldana, Lisa et al. (2014) Incremental net benefit of early intervention for preschool-aged children with emotional and behavioral problems in foster care.. Children and Youth Services Review 36: 213–219 [PMC free article: PMC5663296] [PubMed: 29097828]	- To be considered under a different review question (RQ1.1)
Manheimer, Lauren (2000) Child Life in a nonhospital setting: A play group for substance abusers and their drug-exposed infants and toddlers.. Protecting the emotional development of the ill child: The essence of the child life profession.: 173–189	- Intervention description/practice report
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
Marcellus, Lenora (2004) Developmental evaluation of the Safe Babies project: application of the COECA model.. Issues in comprehensive pediatric nursing 27(2): 107–19 [PubMed: 15204652]	- Intervention description/practice report
McBeath, Bowen, Kothari, Brianne H, Blakeslee, Jennifer et al. (2014) Intervening to improve outcomes for siblings in foster care: Conceptual, substantive, and methodological dimensions of a prevention science framework.. Children and Youth Services Review 39: 1–10 [PMC free article: PMC3951129] [PubMed: 24634558]	- To be considered under a different review question (RQ2.1)
McCrae, Julie S, Brown, Samantha M, Yang, Jessica et al. (2016) Enhancing early childhood outcomes: Connecting child welfare and Head Start.. Early Child Development and Care 186(7): 1110–1125	- To be considered under a different review question (RQ4.4)
McWey, Lenore M and Mullis, Ann K (2004) Improving the lives of children in foster care: The impact of supervised visitation.. Family Relations: An Interdisciplinary Journal of Applied Family Studies 53(3): 293–300	- To be considered under a different review question (RQ2.1, RQ5.1)
Merritt D.H. and Klein S. (2015) Do early care and education services improve language development for maltreated children? Evidence from a national child welfare sample. Child Abuse and Neglect 39: 185–196 [PubMed: 25459989]	- Unclear if includes LACYP population
Milburn, Nicole L; Lynch, Marell; Jackson, Jennifer (2008) Early identification of mental health needs for children in care: a therapeutic assessment programme for statutory clients of child protection.. Clinical child psychology and psychiatry 13(1): 31–47 [PubMed: 18411864]	- To be considered under a different review question (RQ3.1)
Mitchell, Elissa Thomann (2011) The child resiliency program at Hope Meadows.. Journal of Intergenerational Relationships 9(4): 452–457	- Intervention description/practice report
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
Munthe-Kaas, Heather Menzies, Hammerstrom, Karianne Thune, Kurtze, Nanna et al. (2013) No title provided. [PubMed: 29319978]	- Data not reported in an extractable format - Full text paper not available - Study not reported in English
NCT00056303 (2003) Mental Health Services for Foster and Adopted Children. Https://clinicaltrials.gov/show/nct00056303	- RCT protocol
NCT00339365 (2006) Promoting Infant Mental Health in Foster Care. Https://clinicaltrials.gov/show/nct00339365	- RCT protocol
NCT00688129 (2008) KITS: school Readiness in Foster Care Efficacy Trial. Https://clinicaltrials.gov/show/nct00688129	- RCT protocol
NCT00701194 (2008) Early Intervention Foster Care: a Prevention Trial. Https://clinicaltrials.gov/show/nct00701194	- RCT protocol
NCT01261806 (2010) Mental Health Services for Toddlers in Foster Care. Https://clinicaltrials.gov/show/nct01261806	- RCT protocol
NCT01726361 (2012) Multidimensional Treatment Foster Care for Adolescents. Https://clinicaltrials.gov/show/nct01726361	- RCT protocol
NEWMAN Tony and MCDANIEL Benny (2005) Getting research into practice: healing damaged attachment processes in infancy. Child Care in Practice 11(1): 81–90	- Intervention description/practice report - Review article
NTR3899 (2013) Positive parenting in foster care. Http://www.who.int/trialsearch/trial2.aspx?Trialid=ntr3899	- RCT protocol
Osofsky, Joy D; Stepka, Phillip T; King, Lucy S (2017) Attachment and biobehavioral catch-up intervention.. Treating infants and young children impacted by trauma: Interventions that promote healthy development.: 61–74	- Book
Oxford, Monica L, Marcenko, Maureen, Fleming, Charles B et al. (2016) Promoting birth parents’ relationships with their toddlers upon reunification: Results from Promoting First Relationships home visiting program.. Children and Youth Services Review 61: 109–116 [PMC free article: PMC4746016] [PubMed: 26869740]	- To be considered under a different review question (RQ2.1, RQ5.1)
PANTIN Sarah and FLYNN Robert (2007) Training and experience: keys to enhancing the utility for foster parents of the Assessment and Action Record from Looking After Children. Adoption and Fostering 31(4): 62–69	- No outcome of interest reported
Pasalich, Dave S, Fleming, Charles B, Oxford, Monica L et al. (2016) Can Parenting Intervention Prevent Cascading Effects From Placement Instability to Insecure Attachment to Externalizing Problems in Maltreated Toddlers?.. Child maltreatment 21(3): 175–85 [PMC free article: PMC5131711] [PubMed: 27381935]	- To be considered under a different review question (RQ1.1, RQ2.1)
Perry, Deborah F, Dunne, M. Clare, McFadden, LaTanya et al. (2008) Reducing the risk for preschool expulsion: Mental health consultation for young children with challenging behaviors.. Journal of Child and Family Studies 17(1): 44–54	- Does not study LACYP population
Pine, Barbara A and Spath, Robin (2009) Permanent families for adolescents: Applying lessons learned from a family reunification demonstration program.. Achieving permanence for older children and youth in foster care.: 223–243	- To be considered under a different review question (RQ1.1, RQ5.1)
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 reported (receipt of services and parenting outcomes)
Pritchett, Rachel, Fitzpatrick, Bridie, Watson, Nicholas et al. (2013) A feasibility randomised controlled trial of the New Orleans intervention for infant mental health: a study protocol.. TheScientificWorldJournal 2013: 838042 [PMC free article: PMC3655679] [PubMed: 24023537]	- RCT protocol
Purewal Boparai S.K., Au V., Koita K. et al. (2018) Ameliorating the biological impacts of childhood adversity: A review of intervention programs. Child Abuse and Neglect 81: 82–105 [PubMed: 29727766]	- Systematic review considered for relevant references
Raman, S, Ruston, S, Irwin, S et al. (2017) Taking culture seriously: Can we improve the developmental health and well-being of Australian Aboriginal children in out-of-home care?.. Child: care, health and development 43(6): 899–905 [PubMed: 28736897]	- To be considered under a different review question (RQ3.3, RQ4.4)
Rodrigo, Maria Jose, Correa, Ana Delia, Maiquez, Maria Luisa et al. (2006) Family preservation services on the Canary Islands: Predictors of the efficacy of a parenting program for families at risk of social exclusion.. European Psychologist 11(1): 57–70	- No outcome of interest reported
RUFF Saralyn C.; AGUILAR Rosana M.; CLAUSEN June Madsen (2016) An exploratory study of mental health interventions with infants and young children in foster care. Journal of Family Social Work 19(3): 184–198	- Quasi-experimental study, excluded as sufficient RCT evidence was identified
Ryan, Joseph P, Choi, Sam, Hong, Jun Sung et al. (2008) Recovery coaches and substance exposed births: an experiment in child welfare.. Child abuse & neglect 32(11): 1072–9 [PubMed: 19036450]	- No outcome of interest reported - Does not study LACYP population
Rygaard N.P. (2010) Designing the fair start project - a free e-learning and organizational development program for orphanages and foster families in quality care giving. Clinical Neuropsychiatry 7(6): 181–187	- No outcome of interest reported - Intervention description/practice report
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”
Schlosser, Ralf W, Walker, Elizabeth, Sigafoos, Jeff et al. (2006) Increasing Opportunities for Requesting in Children with Developmental Disabilities Residing in Group Homes through Pyramidal Training.. Education and Training in Developmental Disabilities 41(3): 244–252	- No outcome of interest reported - Data not reported in an extractable format
Sharieff, G Q; Hostetter, S; Silva, P D (2001) Foster parents of medically fragile children can improve their BLS scores: results of a demonstration project.. Pediatric emergency care 17(2): 93–5 [PubMed: 11334101]	- No outcome of interest reported
Slopen N., Tang A., Nelson C.A. et al. (2019) The consequences of foster care versus institutional care in early childhood on adolescent cardiometabolic and immune markers: Results from a randomized controlled trial. Psychosomatic medicine [PMC free article: PMC6544473] [PubMed: 31008902]	- Non-OECD country
Smith, Shelia M, Simon, Joan, Bramlett, Ronald K et al. (2009) Effects of positive peer reporting (PPR) on social acceptance and negative behaviors among peer-rejected preschool children.. Journal of Applied School Psychology 25(4): 323–341	- Unclear that LACYP are included
SPIEKER Susan J. and et al (2012) Promoting first relationships: randomized trial of a relationship-based intervention for toddlers in child welfare. Child Maltreatment 17(4): 271–286 [PMC free article: PMC3552521] [PubMed: 22949743]	- To be considered under a different review question (RQ2.1)
Spieker, Susan J, Oxford, Monica L, Fleming, Charles B et al. (2014) Permanency outcomes for toddlers in child welfare two years after a randomized trial of a parenting intervention.. Children and Youth Services Review 44: 201–206 [PMC free article: PMC4128499] [PubMed: 25125769]	- To be considered under a different review question (RQ1.1, RQ5.1)
Stacks, Ann M, Beeghly, Marjorie, Partridge, Ty et al. (2011) Effects of placement type on the language developmental trajectories of maltreated children from infancy to early childhood.. Child maltreatment 16(4): 287–99 [PubMed: 22146859]	- Not an intervention of interest
Sturgess, Wendy and Selwyn, Julie (2007) Supporting the placements of children adopted out of care.. Clinical child psychology and psychiatry 12(1): 13–28 [PubMed: 17375807]	- Qualitative study, published prior to 2010
Taneja V., Aggarwal R., Beri R.S. et al. (2005) Not by bread alone project: A 2-year follow-up report. Child: Care, Health and Development 31(6): 703–706 [PubMed: 16207228]	- Non-OECD country
Underdown A., Barlow J., Chung V. et al. (2006) Massage intervention for promoting mental and physical health in infants aged under six months. Cochrane Database of Systematic Reviews: cd005038 [PubMed: 17054233]	- Systematic review considered for relevant references
Van Andel, Hans, Post, Wendy, Jansen, Lucres et al. (2016) Optimizing foster family placement for infants and toddlers: A randomized controlled trial on the effect of the foster family intervention.. The American journal of orthopsychiatry 86(3): 332–44 [PubMed: 27196390]	- To be considered under a different review question (RQ2.1, RQ3.2)
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
Van Horn, Patricia, Gray, Lili, Pettinelli, Beth et al. (2011) Child-parent psychotherapy with traumatized young children in kinship care: Adaptation of an evidence-based intervention.. Clinical work with traumatized young children.: 55–74	- Book
Whitemore, Erin, Ford, Monica, Sack, William H et al. (2003) Effectiveness of Day Treatment with Proctor Care for Young Children: A Four-Year Follow-Up.. Journal of Community Psychology 31(5): 459–468	- Studied population and results not separated for LACYP
WISE Sarah (2002) An evaluation of a trial of looking after children in the state of Victoria, Australia. Children and Society 17(1): 3–17	- Quasi-experimental study, excluded as sufficient RCT evidence was identified -Not an intervention of interest
Worsham, Nancy L, Kretchmar-Hendricks, Molly D, Swenson, Natalia et al. (2009) At-risk mothers’ parenting capacity: an epistemological analysis of change through intensive intervention.. Clinical child psychology and psychiatry 14(1): 25–41 [PubMed: 19103703]	- To be considered under a different review question (RQ5.2)
Wright, Barry, Hackney, Lisa, Hughes, Ellen et al. (2017) Decreasing rates of disorganised attachment in infants and young children, who are at risk of developing, or who already have disorganised attachment. A systematic review and meta-analysis of early parenting interventions.. PloS one 12(7): e0180858 [PMC free article: PMC5510823] [PubMed: 28708838]	- Systematic review considered for relevant references
Zeanah, C H, Larrieu, J A, Heller, S S et al. (2001) Evaluation of a preventive intervention for maltreated infants and toddlers in foster care.. Journal of the American Academy of Child and Adolescent Psychiatry 40(2): 214–21 [PubMed: 11211370]	- To be considered under a different review question (RQ5.1, RQ3.2, RQ1.1)
Zeanah, Charles H and Smyke, Anna T (2005) Building Attachment Relationships Following Maltreatment and Severe Deprivation.. Enhancing early attachments: Theory, research, intervention, and policy.: 195–216	- Book

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

Interventions to support readiness for school in looked-after children and young people

Interventions to support readiness for school for looked-after children and young people

Review questions

Introduction

Summary of protocol

PICO table

SPIDER table

Methods and process

Effectiveness evidence

Included studies

Excluded studies

Summary of studies included in the evidence

Quantitative evidence

Qualitative evidence

Summary of the effectiveness evidence

Pre-school

Entering primary school-age education

Entering secondary school-age education

Economic evidence

Included studies

Summary of included cost effectiveness evidence

Economic model

The committee’s discussion of the evidence

Interpreting the evidence

The outcomes that matter most

The quality of the evidence

Benefits and harms

Preschool interventions

Interventions for entering primary-school education

Interventions for entering secondary-school education

Cost effectiveness and resource use

Other factors the committee took into account

References – included studies

Effectiveness

Cost effectiveness

Appendices

Appendix A. Review protocols

Appendix B. Literature search strategies

Appendix C. Effectiveness evidence study selection

Appendix D. Effectiveness evidence

Quantitative studies

Qualitative studies

Appendix E. Forest plots

Appendix F. GRADE tables

Quantitative evidence

Qualitative evidence

Appendix G. Economic evidence study selection

Appendix H. Economic evidence tables

Appendix I. Health economic model

Appendix J. Excluded studies

Effectiveness studies

Cost-effectiveness studies

Appendix K. Research recommendations – full details

Research recommendation

Appendix L. References

Other references

Appendix M. Other appendix

Table 1PICO for review on interventions to support readiness for school in looked-after children and young people

Table 2SPIDER table for review on interventions to support care placement stability in looked-after children and young people

Table 3Summary GRADE table (Attachment and biobehavioural catch-up for infants (ABC-I) vs Developmental Education for Families (DEF))

Table 4Summary GRADE table (Attachment and biobehavioural catch-up for toddlers (ABC-T) vs Developmental Education for Families (DEF))

Table 5Summary GRADE table (Attachment and biobehavioural catch-up for infants and toddlers (ABC-I/T) vs Developmental Education for Families (DEF))

Table 6Summary GRADE table (Head start programme vs care as usual)

Table 7Summary GRADE table (Therapeutic playgroups vs care as usual)

Table 8Summary GRADE table (Kids in Transition to School (KITS) programme vs care as usual)

Table 9Summary GRADE table (Middle School Success vs care as usual)