An evaluation of a 10-week Nurturing Attachments group: Exploring quantitative and qualitative outcomes for foster carers and children in care

Abstract

This service evaluation examined a modified, 10-week Nurturing Attachments group provided by an NHS service for children in care. Areas of evaluation included child outcomes, child–carer relationships, foster carers’ self-efficacy and carers’ experiences of the course. The groups ran 12 times, from September 2017 to July 2023. Eighty-two foster carers provided data at week one, 54 at week 10 and 29 at a two-month follow-up, highlighting a high rate of attrition. Carers completed the Strengths and Difficulties Questionnaire, the Child-Parent Relationship Scale and the Brief Parental Self-Efficacy Scale at the three time points and provided qualitative comments. Quantitative data were analysed using repeated-measures analysis of variance tests (ANOVAs) and t-tests; qualitative comments were collated and summarised. From week one to week 10, significant improvements were found for carer self-efficacy (p = .04, Cohen’s d = .40), carer–child closeness (p = .04, Cohen’s d = .30) and child peer problems (p = .03, Cohen’s d = .30). Children’s dependency significantly decreased from week 10 to follow-up (p = .02, np² = .15). Carers also reported an increased understanding of attachment and trauma, and feelings of support from fellow carers. Findings are further discussed in relation to the limitations, previous literature, clinical implications and future research.

Plain language summary

Children who have been placed in care have often experienced multiple early traumas, typically resulting in attachment-related difficulties and other behavioural and emotional challenges. The Nurturing Attachments training group was devised to support carers in caring for these children and coping with this demanding task. This study evaluated the effectiveness of a 10-week version of the group, delivered by an NHS service, and aimed to explore its usefulness for carers and the children in their care. Areas of focus included carers’ confidence in parenting (self-efficacy), the child–carer relationship, child behavioural and emotional difficulties, and carers’ experiences of the course. A total of 82 foster carers provided feedback through questionnaires at the start of the course, 54 at the end and 29 at a two-month follow-up. Additionally, 59 foster carers provided written feedback. Results showed that by the end of the course, there was a significant increase in carers’ confidence and in closeness within the carer–child relationship and a significant decrease in children’s peer difficulties. By follow-up, children were reported as having reduced dependency on their carers. In carers’ feedback of the course, they reported having increased understanding of trauma and attachment and valued the support of fellow carers. These findings suggest the group may be a valuable support for foster carers, though further evaluation is needed to strengthen the evidence base of the Nurturing Attachments group.