20/10 HS&DR Supporting Information - Family Group Conferencing
Closing date: 07 May 2020 (two stage – Stage 1 to Stage 2)
The following is intended to provide further information on the background of this call but does not constitute an exhaustive review of the literature in this area.
Family Group Conferencing – Children services
An FGC is a decision-making meeting in which a child’s wider family network makes a plan about the future arrangements for the child, which will ensure that the child is safe, and their well-being is promoted. FGCs are intended as a respectful and empowering process in which parents, children and members of the wider family are given clear information about the agency’s concerns and are asked to produce a plan addressing those concerns by answering specific questions.
A (2012) literature review  suggested there were several studies on the use of FGC in child welfare. The review highlighted that family members and child welfare professionals generally agree these meetings improve child protection work, however there was limited research to support this finding. There is a need for systematic, long-term qualitative and quantitative studies that investigates the lasting impact of decisions on the lives of the families involved. Morris and Connolly  emphasise that previous studies of FGC have failed to capture the impact of interventions on families as systems, focusing instead on outcomes and the experiences of individual family members. Frost et al.  explored the outcomes and challenges in implementing FGCs. The findings suggested that FGC was a family-centred and strengths-based approach and promoted partnership between family and State which consequently acted as an empowering process. Studies analysed by Frost et al showed mixed results for FGC, with some studies reporting positive and some reporting neutral outcomes. The evidence showed that service users’ evaluation of the process of FGC was overwhelmingly positive. However, there was a need for further longitudinal studies to examine if FGC can affect change and subsequently produce positive outcomes for children .
Dijkstra et al  investigated the effectiveness of FGC in youth care in a meta-analysis including 14 non-UK studies. The analysis found that FGC did not significantly reduce child maltreatment, out of home placements, and involvement in youth care. Retrospective studies included found FGC to be more effective than regular care in reducing the recurrence of maltreatment and decreasing the number and length of out-of-home placements, whereas prospective studies found FGC to be less effective than regular care. The review is limited by the retrospective studies included but highlights the need for robust research on effectiveness of FGC .
The Department for Education has recently announced significant investment in the new programme – Supporting Families; Investing in Practice which includes the roll out and evaluation of Family Drug and Alcohol Courts, Mockingbird Family Model and Family Group Conferencing. As part of this programme, FGCs will be introduced at the point of pre-proceedings in 24 local authorities, with support from Daybreak. Coram, overseen by What Works Centre for Social Care will evaluate FGC in children at the pre-proceeding stage , this work is currently underway. Applicants should ensure that any proposal relating to Coram’s work is complementary and not a duplication.
Family Group Conferencing – Adult and other services
Involving the family in adult healthcare and welfare is a new and emerging practice in the UK. Some examples of FGC in adult services include safeguarding, abuse, neglect, self-neglect, prevention, dementia support and transition from children to adults’ services. Recent policy and legislative changes advocate the use of FGC in adult safeguarding. The Care Act 2014 guidance states that, ‘professionals should work with the adult to establish what being safe means to them’ and ensure that decisions are not routinely made without the agreement of the individual involved . The Making Safeguarding Initiative also identifies the suitability of FGCs in their 2012-13 pilot .
Several smaller-scale evaluations have emerged focusing upon practice in the Netherlands and Norway as well as the UK. Metze et al  found that FGC practice in Netherlands was met with significant resistance from service users in older people’s care for a variety of reasons, such as reluctance to ask for help and a fear of losing autonomy. Metze et al  in a more recent study, found resistance from social workers in implementing FGC in adult services due to lack of experience with FGC. To facilitate social workers the study suggested alterations to the FGC model, for example, by focusing less on family networks and more on reciprocity. Gorska et al  studying a pilot dementia care service in Scotland concluded that whilst FGC was perceived positively by all involved, there were difficulties (informed consent and ability to engage in decision making) with using the approach in people with impaired cognitive ability. However, de Jong et al  supports the use of FGCs in situation where capacity is reduced or impaired. Similarly, Hobbs and Alonzi  emphasise the importance of advocacy in such situations and the ability of FGC coordinators to recognise and understand issues of capacity and communication.
Several evaluations of pilot adult FGC services show promising results in terms of service-user satisfaction. Hillebregt et al  evaluated the effectiveness of FGC in adult services and included two small scale non-UK studies. The review identified several barriers to the use of FGC including lack of outcome and implementation studies in adult services. The review suggested a need for high-quality studies evaluating the impact of FGC in adult care and welfare, including their families. Moreover, insight into barriers and facilitators influencing FGC will support the understanding of how to empower individuals in need. Meijer et al  concluded that FGC reduced coercion in adult psychiatry, and helped to regain ownership and restored the sense of belongingness. Research into the role of different professionals in the process of FGCs warrants further investigation. The SCIE review (2012) focusing on safeguarding of vulnerable adults, highlighted further development and evaluation of FGC approaches as they offered better outcomes. The review suggested specific implications for practice in the use of FGC in adult safeguarding and these (capacity and communication; power imbalance) should be considered when developing future studies .
Examples of innovative practice in the UK 
Hampshire County Council and Daybreak’s Bluebird project for vulnerable adults – includes referrals from any source, such as direct referrals from older people and their families and covered any type of abuse – including suspected or potential – of people aged 50 years or more. It also included advocacy services for vulnerable adults involved in the FGC process. The service has now been extended to all vulnerable adults who are experiencing – or are at risk of – abuse, and this is being evaluated.
Kent County Council – included children, older people and people with learning disability. However, adult FGC services were closed in 2010.
North Essex Mental Health Partnership NHS Trust – provides FGC services for vulnerable adults in the context of adult mental health care planning and is currently available to everyone on the Care Programme Approach.
One of the experts we consulted has pointed towards FGC being used in prisons in Wales and being accessed through self-referral in Northern Ireland.
1. SCIE. Safeguarding adults: mediation and family group conferences. Literature review. Social Care Institute for Excellence 2012
2. Morris K and Connolly M. Family decision making in child welfare: Challenges in developing a knowledge base for practice. Child Abuse Review 2012; 21 (1): 41-52
3. Frost N, Abram F, Burgess H. Family group conferences: evidence, outcomes and future research. Child and Family Social Work 2014; 19: 501-507.
4. Dikjstra S, Creemers H, Asscher J, et al. The effectiveness of family group conferencing in youth care: A meta-analysis. Child Abuse & Neglect 2016; 62; 100-110.
5. Coram. Coram to evaluate Family Group Conferencing for the What Works Centre. Published August 2019. Accessed online at https://www.coram.org.uk/news/coram-awarded-role-evaluation-partner-what-works-centre-children%E2%80%99s-social-care January 2020.
6. Legislation Government UK. Care Act 2014 (online). Accessed online at http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted December 2019.
7. Local Government. Making Safeguarding Initiative. Accessed online at https://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/making-safeguarding-personal December 2019.
8. Metze N, Kwekkeboom H, and Abma A.” You don’t show everyone your weakness”: Older adults’ views on using Family Group Conferencing to regain control and autonomy’, Journal of Aging Studies 2015; 34: 57–67.
9. Metze R. Family group conferencing for older adults: Social workers’ views. Journal of Social Work 2019; 19 (3); 351-371.
10. Gorska S, Forsyth K, Prior S, et al. Family group conferencing in dementia care: an exploration of opportunities and challenges. International Psychogeriatrics 2016; 28:2, 233-246.
11. De Jong G, Schout G. and Abma T. Prevention of involuntary admission through family group conferencing: A qualitative case study in community mental health nursing’, Journal of Advanced Nursing, 2014; 70(11): 2651–62.
12. Hobbs A. and Alonzi, A. Mediation and family group conferences in adult safeguarding’, Journal of Adult Protection, 2013; 15(2), 69–84.
13. Hillebregt C, Scholten E, Post M, et al. Family group decision-making interventions in adult healthcare and welfare: a systematic literature review of its key elements and effectiveness. BMJ Open 2019;9
14. Meijer E, Schout G, de Jong G. Regaining ownership and restoring belongingness: impact of family group conferences in coercive psychiatry. The Journal of Advanced Nursing 2017; 73 (8), 1862-72.
Relevant NIHR studies
HS&DR 08/1718/145 - Health, medicines and self-care choices made by children, young people and their families: information to support decision making. CI – Anne Williams Published 2011
RfPB PB-PG-1014-35062 - Family based support to build capability and resilience in family carers of adults with learning disabilities and challenging behaviours: collaborative research. CI – Tina Cook; Completed 2019
Other relevant studies
On-going – Primary studies
ID – NTR4320
Title – Family Group Conferencing in youth care: effectiveness and characteristics of the decision making model and implementation of the Family Group (FG) plans. Start date 01/01/2014; End date 30/11/2015 https://www.trialregister.nl/trial/4161
ID – NTR4303
Title – The effectiveness of Family Group Conferencing in the Netherlands, implementation and effectiveness: the role of family managers, method characteristics and family factors. Start date 14/01/2014; End date 30/11/2015 https://www.trialregister.nl/trial/4150
On-going – Non-primary studies
Chantal H, Eline S, Marcel P, et al. Barriers and facilitators implementing FGDM in clinical adult health care/welfare, a systematic literature review. PROSPERO 2018 CRD42018096809 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018096809
Ulugbek N, Zoe B, Catherine F, et al. Impact of shared decision-making family meetings on children’s out-of-home care, family empowerment and satisfaction: a systematic review and meta-analysis. PROSPERO 2019 CRD42019138011 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019138011
Natalie B, Anthony H, Stuart E, et al. Family meetings in pediatric palliative care: a systematic review of structure, process and outcomes. PROSPERO 2019 CRD42019138938 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019138938
Judy D, Jared R, Mary A. et al. Among family members of patients in an intensive care unit, does family-centered care improve family psychological symptoms, quality of life or dying, and satisfaction with care: a systematic review. PROSPERO 2015 CRD42015023445 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015023445
- Barnsdale L and Walker M. Examining the use and impact of family group conferencing. Social Work Research Centre. Scottish Executive 2007
- Brand S, Morgan F, Stabler L, et al. Mapping the evidence about what works to safely reduce the number of children and young people in statutory care: a systematic scoping review. London: What Works Centre for Children’s Social Care 2018.
- Mason P, Ferguson H, Morris K et al. Leeds Family Valued – Evaluation Report. Children’s Social Care Innovation Programme Evaluation Report 43. Department for Education 2017
- Munro E, Meetoo V, Quy K, et al. Daybreak Family. Group Conferencing: children on the edge of care. Children’s Social Care Innovation Programme Evaluation Report 54. Department for Education 2017
- Rodger, J, Woolger A, Cutmore M, et al. Creating strong communities in North East Lincolnshire. Children’s Social Care Innovation Programme Evaluation Report 34. Department for Education 2017.
- Brongers K, Cornelius B, Roelofs P, et al. Feasibility of family group conference to promote return-to-work of persons receiving work disability benefit. Disability and Rehabilitation 2019
- Cahill P, Lobb E, Sanderson C, et al. What is the evidence for conducting palliative care family meetings? A systematic review. Palliative Medicine 2017; 31 (3) 197-211
- De Jong G and Schout G. Evaluating Family Group Conferencing: Towards a meaningful research methodology. Child Abuse & Neglect 2018; 85: 164-171
- Dijkstra S, Creemers H, van Steensel F, et al. Cost-effectiveness of Family Group Conferencing in child welfare: a controlled study. BMC Public Health 2018; 18: 848
- Fox D. Family Group Conferencing and evidence-based practice: what works? Research, Policy and Planning 2008; 26 (3), 157-67.
- Hillebregt C, Scholten E, Ketelaar M, et al. Effects of family group conferences among high-risk patients of chronic disability and their significant others: study protocol for a multicentre controlled trial. BMJ Open 2018;8
- Hollingshead D, Corwin T, Maher E, et al. Effectiveness of family group conferencing in preventing repeat referrals to child protective services and out-of-home placements. Child & Abuse 2017; 69: 285-294
- Mitchell M. Reimagining child welfare outcomes: Learning from family group conferencing. Child & Family Social Work 2019; 1-10.
- Onrust S, Romijn G, de Beer Y. Family group conferences within the integrated care system for young people with ID: a controlled study of effects and costs. BMC Health Services Research 2015; 15: 392
- Sen R, Morris K, Burford G, et al. ‘When you're sitting in the room with two people one of whom… has bashed the hell out of the other’: Possibilities and challenges in the use of FGCs and restorative approaches following domestic violence. Children and Youth Services Review 2018 88; 441-449
- Schout G, van Dijk M, Meijer E, et al. The use of family group conferences in mental health: Barriers for implementation. Journal for Social Work; 2017 17(1); 52-70
Coram. Coram to evaluate Family Group Conferencing for the What Works Centre. Accessed online January 2020
Daybreak. Family Group Conferences. Accessed online December 2019
Department for Education. £15 million investment to help keep families safely together. May 2019. Accessed online December 2019
Early Intervention Foundation. Family Group Conferencing, Camden. Accessed online December 2019.
What Works for Children’s Social Care. Family Group Conferences – what does the evidence say? Accessed online December 2019