Parental follow-up in family welfare services after child removal: a scoping review
The purpose of this scoping review was to map and present the research on the effects of- and experiences with parental follow-up after child removal within services that correspond to the Norwegian Family Welfare Services.
Having children placed in public care (child removal) is tough on any family. The relation between the child protective services and parents often grows difficult. To ensure the best follow-up of parents after child removal, it may therefore be useful for the family welfare services to offer parents support and counselling. The purpose of this scoping review was to map and present the research on the effects of- and experiences with parental follow-up after child removal within services that correspond to the Norwegian Family Welfare Services. We conducted extensive searches in both scientific databases and grey literature sources. We identified 17 unique studies described in 20 publications, including a total of 18 parental follow-up services.
One study examined the effect of a parental follow-up service. It found that, among parents who participated in a group-based behavioral training program, there were more positive placement outcomes (the child was reunified or remained at home), compared to parents in the control group.
The findings across the studies that investigated parents' and staff's experiences with parental follow-up services, were:
- The parents were generally satisfied with the service they attended, irrespective of whether the service was flexible, semi-structured or structured.
- Many parents said they needed assistance from a support agency at an early stage in the child removal process.
- Many parents felt that the service provider should be independent of the child welfare services, bound by confidentiality and without documentation- or reporting requirements.
- Many parents believed that receiving and giving support and meeting parents in the same situation, was one of the most important aspects about the service.
- Parents who received follow-up services seemed to experience an improvement in their cooperation with the child protective services.
- Most of the parents had a great need for support for a long time after the child had been removed from the home.
Having children placed in public care (child removal) is a serious event in any family. After removal of the child, the relation between the child protective services and the parents is often characterized by high level of mistrust and conflict. To ensure the best possible follow-up of parents after child removal, it may therefore be useful for the family welfare services to offer parents support and counselling.
Currently, no solid review exists of research on services provided by the family welfare services for parents after child removal. Therefore, there is a need for a systematic review of both national and international research on this topic, which is relevant for the Norwegian Family Welfare Services.
The purpose of this scoping review is to map and describe the research on the effects of and experiences with parental follow-up services in the family welfare services, or in services/settings that correspond to the Norwegian Family Welfare Services, after child removal has taken place.
We performed a scoping review in accordance with methods described in the Norwegian Institute of Public Health's methods handbook for systematic reviews and in a peer-reviewed protocol. To identify relevant studies, a librarian searched nine international literature databases, such as MEDLINE, Social Services Abstracts, and PsycINFO, in April 2022. We also performed an extensive search of grey literature to find studies that were not indexed in databases and checked reference lists of the included studies.
We included all empirical studies that aimed to investigate either the effects of or experiences with parental follow-up services after child removal. We were interested in all services that are provided with the intent to assist, guide or otherwise help parents who have children placed outside the home. All services had to be provided in a setting corresponding to the Norwegian Family Welfare Services. Relevant populations were parents and/or employees who provided the services. We set no limitations regarding the outcomes. Two researchers independently screened relevant studies in full text. One researcher assessed the included studies’ risk of bias using appropriate checklists and extracted data and results from the included studies. Another researcher checked the accuracy and completeness of the work. We did not assess the certainty in the findings. Lastly, we classified and synthesized the data and provided narrative descriptions of results in text and created tables where relevant.
We included 17 studies, presented in 20 publications. They were published between 2005-2022, with the majority being published in the last five years. The studies presented 18 unique services and about 600 parents and an unknown number of employees in a family welfare setting. The majority of the included studies were from Scandinavia.
Almost all the studies had a qualitative study design. We identified only one quantitative study that addressed the question about the effects of parental follow-up services, while the remaining 19 publications investigated parents' and group leaders’ experiences with parental follow-up. The studies’ methodological quality was generally good: 13 out of 19 studies had small or small/moderate methodological limitations. Our categorization according how the services were organized showed that there were three categories: flexible services, semi-structured services, and structured services.
Effects of parental follow-up services
We included one study that assessed a structured, group-based follow-up program for parents after child removal. Parents in the control group did not receive any follow-up program. The outcome was the child's placement status, 6 months after parents in the intervention group participated in the program. The study found that, among parents in the intervention group, there were more positive placement outcomes (the child reunified or remained at home), compared to the control group. We assessed the study had a high/unclear risk of bias.
Experiences with parental follow-up services
Flexible services: We included seven flexible services (described in 11 publications). The services were given as individual follow-up services or as an open, non-binding group service. The overall results showed that the parents valued having someone to talk to and to share experiences with other parents. It was important for the parents to have a service that was independent of the child protection services, where they could discuss topics that they feared otherwise would be evaluated negatively and used against them later by the child protection services. In the three studies that investigated having a professional support person assigned to the parents, all parents had a appreciated the service. In most cases, the support person helped to improve cooperation between parents and the social services.
Semi-structured services: We included six semi-structured services (described in four publications). Compared to flexible services, semi-structured services had a somewhat more fixed structure, organization, or purpose. Compared to structured services, they had somewhat greater flexibility with regard to attendance requirements, frequency, and duration. The overall results showed that the services provided the parents opportunities to share feelings of grief and worries without guilt, which eased their everyday life as a parent at a distance. Additionally, by participating in the group services, many parents increased their social network, which contributed to more social support. Several studies highlighted that it was difficult to reach parents in the target group, to inform them about the group service. As a result, there was poor recruitment of parents who could benefit from the service.
Structured services: We included four structured services (described in seven publications). These services had a fixed program, were group-based and the majority of the groups were closed. The overall results showed that the majority of parents felt that the services had a positive impact on various aspects of their parenting skills, and on how they experienced and coped with the situation. They expressed that meeting other parents who were in the same situation and exchanging experiences was important. The parents felt that the group provided a safe community for them, which facilitated change and progress. Group leaders emphasized that closed groups created a safe atmosphere and made it easier for the parents to share information about their situation. In several of the studies, the parents highlighted the group leaders as important both in terms of their professional expertise and willingness to share.
Discussion and conclusion
To our knowledge, this is the first scoping review to synthesize both national and international research, on the effects of- and experiences with parental follow-up services after child removal. However, this scoping review can only provide a general picture of parents' and staff's experiences with parental follow-up services. And it can to a small extent answer the question about the effect of parental follow-up services, because we identified only one experimental study, and it had high/unclear risk of bias.
Overall, the parents appeared to be satisfied with the services they attended. Furthermore, there seemed to be no differences in parents' satisfaction according to how the service was organized, as long as it aimed to offer parents emotional support, counselling, information about parents' rights and the process and working methods of the child protection services, as well as increase cooperation skills, and as long as it was offered by a service provider that was independent of the child protection services. It seems as if parents who attended parental follow-up services experienced an improvement when it comes to collaboration with the child protection services.
The study population in this scoping review appear to be a somewhat singular group of parents and therefore to a small extent reflect all parents who have experienced removal of a child. Consequently, we cannot draw conclusions about parents who refrain from participating in follow-up services or those who drop out. Our findings show that parents who have experienced removal of a child is a group who express a need for tailored support and counseling, both in the short and long term after child removal.