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Development of a Psychoeducational Foster Carer Program Using the Medical Research Council (MRC) Framework for Complex Interventions

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Title: Development of a Psychoeducational Foster Carer Program Using the Medical Research Council (MRC) Framework for Complex Interventions
Language: English
Authors: Maria Lotty (ORCID 0000-0002-7809-6458), Eleanor Bantry-White (ORCID 0000-0002-7663-6836), Audrey Dunn-Galvin
Source: Child Care in Practice. 2026 32(1):4-18.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 15
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Psychoeducational Methods, Foster Care, Trauma Informed Approach, Evidence Based Practice, Foreign Countries, Program Design, Program Content
Geographic Terms: Ireland
DOI: 10.1080/13575279.2022.2121683
ISSN: 1357-5279
1476-489X
Abstract: Foster carers require high quality evidence-based psychoeducational programs to support them in the care of children with complex trauma-related difficulties. However, there is a lack of systematic development of such programs which may explain mixed results. This paper presents a detailed account of the development of a complex intervention. This program was developed to address a practice gap of evidenced-based foster care programs in the Irish context. It aims to improve foster carers' capacity to provide children with trauma-informed care and in turn improve emotional and behavioural difficulties. The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used to develop Fostering Connections: The Trauma-informed Foster Care Programme. A prior narrative review of the evidence base of similar programs was combined with a prior qualitative study. A Stakeholder Group provided expert feedback during the development process. The development of a promising psychoeducational programs for foster carers using the MRC framework is described
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1500759
Database: ERIC
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  Value: <anid>AN0191102787;j2301jan.26;2026Jan28.00:55;v2.2.500</anid> <title id="AN0191102787-1">Development of a Psychoeducational Foster Carer Program Using the Medical Research Council (MRC) Framework for Complex Interventions </title> <sbt id="AN0191102787-2">Introduction</sbt> <p>Foster carers require high quality evidence-based psychoeducational programs to support them in the care of children with complex trauma-related difficulties. However, there is a lack of systematic development of such programs which may explain mixed results. This paper presents a detailed account of the development of a complex intervention. This program was developed to address a practice gap of evidenced-based foster care programs in the Irish context. It aims to improve foster carers' capacity to provide children with trauma-informed care and in turn improve emotional and behavioural difficulties. The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used to develop Fostering Connections: The Trauma-informed Foster Care Programme. A prior narrative review of the evidence base of similar programs was combined with a prior qualitative study. A Stakeholder Group provided expert feedback during the development process. The development of a promising psychoeducational programs for foster carers using the MRC framework is described</p> <p>Children who enter foster care often have experienced multiple, chronic, and prolonged experiences of abuse (Greeson et al., [<reflink idref="bib18" id="ref1">18</reflink>]). In Ireland, in 2020, about 5 children per 10,000 population aged 0–17 years were in the care equating to 5818 children, not including children in respite arrangements and separated children seeking asylum (Tusla, [<reflink idref="bib47" id="ref2">47</reflink>]). Eight hundred and thirty-seven of these children were admitted to care in 2020, of these nearly a quarter (24%) were repeated admissions (n = 200) and the remaining children (76%), it was their first-time admission (n = 637) (Tusla, [<reflink idref="bib47" id="ref3">47</reflink>]). The majority (85%) of all children admitted to alternative care were placed in foster care (n = 712). Neglect was the primary reasons for children's first-time admission to care (43%) and the primary reason for being in care (46%). This was followed by child welfare concerns (33%, 38%). Emotional abuse (14%, 8%), physical abuse (8%, 6%), and sexual abuse (2%, 3%) were also indicated (Tusla, [<reflink idref="bib47" id="ref4">47</reflink>]). While fostering can involve high levels of personal satisfaction for foster carers (Gibbs et al., [<reflink idref="bib17" id="ref5">17</reflink>]), it is also often experienced as emotionally and psychologically demanding (Brown & Campbell, [<reflink idref="bib7" id="ref6">7</reflink>]; Whenan et al., [<reflink idref="bib50" id="ref7">50</reflink>]).</p> <p>In Ireland, the supervising agency (Tusla, Child and Family Agency or a private agency) is responsible for the provision of training and support to foster carers. However, with no national training policy in place (IFCA & Tusla, [<reflink idref="bib21" id="ref8">21</reflink>]), training varies from area to area and is dependent on local resources and expertise. Preparation training is widespread and developed within each area, no published data are available. Post-approval training is provided to foster carers after they have completed the assessment process and are registered. Most often, training involves a one-off session and tends to be diverse covering a range of subjects targeting areas such as, internet safety, life story work, cultural awareness, and safe care practices in fostering. There are no data available on Irish single-session training, internationally these type of training have not produced evidence to support improvement in child difficulties (Dorsey et al., [<reflink idref="bib13" id="ref9">13</reflink>]) and are lacking in rigorous evaluation (Festinger & Baker, [<reflink idref="bib15" id="ref10">15</reflink>]). Post-approval training is also provided through multisession programs; however, this differs greatly from area to area. Data are limited, whilst there are some examples of training showing positive effects, but evidence of effectiveness is lacking (Pearce & Gibson, [<reflink idref="bib36" id="ref11">36</reflink>]).</p> <p>Similar to international research, most of the multisession training programs in practice are not empirically supported (Chamberlain & Lewis, [<reflink idref="bib8" id="ref12">8</reflink>]; Kinsey & Schlosser, [<reflink idref="bib23" id="ref13">23</reflink>]). The lack of evidence to support effectiveness is often complicated by methodological limitations (Dickes et al., [<reflink idref="bib12" id="ref14">12</reflink>]). A recent meta-analysis parenting programs for foster carers report positive effects for carer outcomes: sensitive parenting, dysfunctional discipline, parenting knowledge and attitudes<emph>,</emph> and parenting stress and for the child outcome: behaviour problems (Schoemaker et al., [<reflink idref="bib41" id="ref15">41</reflink>]). The authors highlight the need for more in-depth research into effective elements of programs. In the UK, the <emph>Hear, Head and Hands</emph> Program based on a social pedagogy approach illuminated the importance of contextual issues in program impact (McDermid et al., [<reflink idref="bib31" id="ref16">31</reflink>]). Similarly, the recent evaluations of the <emph>Fostering Changes Program</emph>, also in the UK, reflect the consideration for intervention that targets the specific needs of the children and contextual issues to support effectiveness (Channon et al., [<reflink idref="bib9" id="ref17">9</reflink>]; Moody et al., [<reflink idref="bib33" id="ref18">33</reflink>]).</p> <p>The need to improve the quality of foster carer support and training has been also highlighted in Ireland (Moran et al., [<reflink idref="bib34" id="ref19">34</reflink>]). Key stakeholders in foster care in Ireland echo the need for improved foster-carer training including foster carers (Devaney et al., [<reflink idref="bib11" id="ref20">11</reflink>]), multidisciplinary practitioners (Lotty, Bantry-White & Duun-Galvin, [<reflink idref="bib28" id="ref21">28</reflink>]) and children and young people with care experience (McEvoy & Smith, [<reflink idref="bib32" id="ref22">32</reflink>]). <emph>Fostering Connections</emph>, a group-based psychoeducational program was developed to address this particular practice gap (Lotty, [<reflink idref="bib26" id="ref23">26</reflink>]).</p> <hd id="AN0191102787-3">Trauma-informed care</hd> <p>Trauma-informed care (TIC) is an approach that aims to provide a more targeted and effective intervention for children and their families who have experienced trauma. The movement towards trauma-informed care in child welfare and protection social work practice is becoming more integrated among the practitioners (Lotty, [<reflink idref="bib26" id="ref24">26</reflink>]). Psychoeducational group-based interventions in foster care are underpinned by strong theoretical orientations (Benesh & Cui, [<reflink idref="bib3" id="ref25">3</reflink>]). Predomiantly, these have been underpinned by social learning theory[<reflink idref="bib1" id="ref26">1</reflink>] (Bandura, [<reflink idref="bib1" id="ref27">1</reflink>]), as well as behavioural management[<reflink idref="bib2" id="ref28">2</reflink>] (Brestan & Eyberg, [<reflink idref="bib6" id="ref29">6</reflink>]) and/or attachment theory[<reflink idref="bib3" id="ref30">3</reflink>] (Bowlby, [<reflink idref="bib5" id="ref31">5</reflink>]). TIC programs for foster carers go beyond psychosocial approaches (cognitive, behavioural, and attachment-based) in social work to a broader biopsychosocial approach (Larkin et al., [<reflink idref="bib24" id="ref32">24</reflink>]). Thus, these programs are also underpinned by the emergent body of knowledge of traumatology which reflects a broad multidisciplinary integrated perspective of from the fields of neurobiology, psychology, sociology, and social work.</p> <p>Complex interventions are described as comprising of various multifaceted components that may act interdependently or independently (Faes, Reelick, Esselink, & Rikkert, [<reflink idref="bib14" id="ref33">14</reflink>]). These interacting components impact the length and complexity of the casual chain form intervention to outcome and the influence of the local context (Bleijenberg et al., [<reflink idref="bib4" id="ref34">4</reflink>]). Foster carer psychoeducational programs involve multicomponents as they seek to improve the diverse needs of children in foster care through their foster carer. Therefore, such programs are complex interventions. The research on foster care is relatively scarce (Kaasbøll et al., [<reflink idref="bib22" id="ref35">22</reflink>]) and existing research efficacy of foster-carer training programs is mixed (Solomon et al., [<reflink idref="bib44" id="ref36">44</reflink>]). In this paper, we provide a detailed account of the systematic development of <emph>Fostering Connections</emph>, a promising program (Lotty, Dunn-Galvin & Bantry-White, [<reflink idref="bib27" id="ref37">27</reflink>]) to contribute to the literature. The first author, at the time of the study, located herself as an "insider" in this research, having a dual role of doctoral researcher and experienced social work practitioner (Lotty, [<reflink idref="bib26" id="ref38">26</reflink>]). First, we describe the MRC framework and then its application to the development of <emph>Fostering Connections</emph>. We also describe the program. The evaluation stage has been completed and is reported elsewhere (Lotty, Bantry-White & Dunn-Galvin, [<reflink idref="bib29" id="ref39">29</reflink>]). The implementation stage of <emph>Fostering Connections</emph> has not been completed.</p> <hd id="AN0191102787-4">Methods</hd> <p>The program was developed using a study design informed by the revised guidelines for developing and evaluating complex interventions of the Medical Research Council (MRC) (Craig et al., [<reflink idref="bib10" id="ref40">10</reflink>]). The MRC framework has four stages; each stage involves key elements that adhere to a number of methodological approaches. The design allows for an iterative approach involved in the development and evaluation of a complex intervention owing to the reciprocal relationship between the stages and between the elements within each stage. Ethical approval was granted by both the Social Research Ethics Committee (Number 2017--004) in University College Cork and by the Tusla Ethics Review Group.</p> <hd id="AN0191102787-5">Development of fostering connections aligning with the MRC framework</hd> <p>The program emerged from a process that involved a series of non-linear key steps informed by the MRC Framework. These steps were identified in line with the elements of Stage 1 (Development) and Stage 2 (Feasibility and Piloting) of the MRC framework. These steps involved drawing from a prior narrative review (Lotty, [<reflink idref="bib26" id="ref41">26</reflink>]) and a prior qualitative study (Lotty et al., [<reflink idref="bib28" id="ref42">28</reflink>]) at Stage 1 (Development). Stage 2 (Feasibility) involved completing a review of the program by the local Fostering Social Work Team. A mixed-method approach was used to synthesise the findings of the narrative review and qualitative study (Petticrew et al., [<reflink idref="bib37" id="ref43">37</reflink>]). The use of mixed methods was particularly relevant as it strengthened the development and design of the program by ensuring results from the narrative review, which explored quantitative evidence which were extended, and complemented through qualitative findings. The qualitative study provided findings that reflected the local needs of foster carers, practices, and contextual issues specific to the Irish experience of foster care. A Stakeholder Group was also established to provide support to the research process. Multiple stakeholder input is identified as important in the research process of complex interventions (Bleijenberg et al., [<reflink idref="bib4" id="ref44">4</reflink>]), thus we sought the input from the potential providers and recipients of this program. While presented as steps, the process was iterative supported by the input of the Stakeholder Group. The results of each study are summarised separately and then the developmental process is described that synthesised the findings aligning with the MRC framework (Figure 1).</p> <p>Graph: Figure 1. Study's alignment with the medical research council framework. Adapted from "Developing and evaluating complex interventions: the new Medical Research Council guidance," by Craig et al., [<reflink idref="bib10" id="ref45">10</reflink>], BMJ, 337, p. 6. Copyright 2008 by the BMJ Publishing Group Ltd.</p> <hd id="AN0191102787-6">Summary of findings of the prior narrative review</hd> <p>A prior narrative review assessed the existing knowledge of the effects of TIC programs. The review found that TIC programs for foster carers appear to increase foster carers' capacity to provide children with trauma-informed care and reduce child trauma-related difficulties. However, the strength of evidence is limited by the methodological weaknesses of the evaluation studies. TIC programs are disseminated widely in practice but lack rigorous evaluation. The programs identified used a group-based social learning model and drew from a wide theoretical base that integrated research on early life experiences, the neurobiology of stress, attachment theory, trauma research and resilience theories within a systems framework. Three theory-based mediators that illuminated how these programs aim to develop foster carers' capacity to provide trauma-informed care: psychoeducation, reflective engagement, and skills building. Thus, the core components of these programs included a combination of trauma psychoeducation, foster-carer-related factors (self-reflection, awareness, and self-regulation) and positive caregiving strategies that emphasised developing child regulatory and relational skills.</p> <hd id="AN0191102787-7">Summary of findings of the prior qualitative study</hd> <p>A prior qualitative study used focus groups with foster carers (n = 6) and multidisciplinary practitioners and clinicians (n = 21) in foster care to capture the current needs of foster carers and practice climate within foster care services in the south of Ireland (Lotty et al., [<reflink idref="bib28" id="ref46">28</reflink>]). Participants were asked for their views on the most challenging aspects of fostering, what they found supportive, would they support the development of a trauma-informed care program for foster carers, and if so what would they like incorporated into such a program and what factors would support its implementation. In total, the focus groups lasted 3 h and 34mins, with an average time of 54 min per group. About 27,446 words of data were generated. Thematic analysis revealed three themes: The need for trauma-informed care, development of trauma-informed care, and the implementation of trauma-informed care.</p> <hd id="AN0191102787-8">The stakeholder group</hd> <p>A stakeholder group was established to support the research process. The group consisted of key stakeholders in foster care that included professionals from areas of social work (<reflink idref="bib6" id="ref47">6</reflink>), nursing (<reflink idref="bib1" id="ref48">1</reflink>), psychology (<reflink idref="bib4" id="ref49">4</reflink>), workforce learning and development (<reflink idref="bib2" id="ref50">2</reflink>), the Irish Foster Care Association (<reflink idref="bib1" id="ref51">1</reflink>), the foster carer approvals committee (<reflink idref="bib1" id="ref52">1</reflink>), foster carers (<reflink idref="bib5" id="ref53">5</reflink>), a care leaver (<reflink idref="bib1" id="ref54">1</reflink>), academics (<reflink idref="bib3" id="ref55">3</reflink>), child welfare practitioners (<reflink idref="bib2" id="ref56">2</reflink>) and senior managers(<reflink idref="bib1" id="ref57">1</reflink>) creating a multidisciplinary group. Stakeholder Group meetings were convened every 6 months where members provided expert review on the research process. The members were also given the opportunity to provide feedback via email, phone, and one-to-one meetings throughout the course of the project.</p> <hd id="AN0191102787-9">Development stage of fostering connections</hd> <p>The developmental stage involved the three elements identified by the MRC Framework of (<reflink idref="bib1" id="ref58">1</reflink>) Identifying existing evidence, (<reflink idref="bib2" id="ref59">2</reflink>) Identify and develop theory and (<reflink idref="bib3" id="ref60">3</reflink>) Modelling processes and outcomes. Bleijenberg et al.'s ([<reflink idref="bib4" id="ref61">4</reflink>]) contribution to enriching the development phase of the MRC Framework guided the delineation of description and presentation of the research process.</p> <hd id="AN0191102787-10">The elements of the development stage</hd> <p></p> <hd id="AN0191102787-11">Problem identification and definition</hd> <p>Drawing on the findings of the qualitative study the target problem was identified as a gap in foster-carer training to adequately equip and prepare foster carers to care for their role of caring for children with trauma-related difficulties.</p> <hd id="AN0191102787-12">Identifying existing evidence</hd> <p>Drawing on the results from the prior narrative review information on the theoretical base, the program core components and outcomes measured to evaluate these programs was identified.</p> <hd id="AN0191102787-13">Identify and develop theory</hd> <p>This stage identified and developed the theory that underpinned the program. The narrative review findings above were supplemented by primary research from the qualitative study in providing contextual data relevant to the Irish experience. This process involved: determining the needs of the target group (foster carers) and examination of the current practices and context in which foster carers operate (the child welfare system) as set out next.</p> <hd id="AN0191102787-14">Determine needs</hd> <p>The qualitative study highlighted specific areas of challenge as: child trauma-related behaviours, exposure to secondary trauma, relationships with birth families, access arrangements and relationships with social workers. The qualitative study illuminated perceptions and preferences of program content, design, and how to support implementation. These findings indicated that a group work experiential-based program format would be acceptable to foster carers, the tools being discussion, case studies relevant to their experience and videos, These identified needs informed the development of a program.</p> <hd id="AN0191102787-15">Examine current practices and context</hd> <p>The need for more collaborative working practices with foster carers was highlighted in the qualitative study (Lotty et al., [<reflink idref="bib28" id="ref62">28</reflink>]). Findings also suggested participants were highly motivated to support the implementation of a TIC program, suggesting the development of a TIC program was timely, relevant, and acceptable to the main stakeholders in foster care.</p> <p>The integration process and making sense of data were also assisted feedback from the stakeholder group. Key themes that emerged from the narrative review informed the core components of the program (Lotty, [<reflink idref="bib26" id="ref63">26</reflink>]). These were integrated with context-rich findings from the focus groups that informed the determined needs of foster carers and current local practices. The program emphasises a parallel understanding that focuses on the experiences of children in foster care and the experiences of foster caring within the context of a foster care system.</p> <p>Five areas were identified that the program sought to target. These were:</p> <p></p> <ulist> <item> increasing foster carers' understanding of the impact of trauma on children;</item> <p></p> <item> increasing foster carers' understanding of the impact of caring for children who have experienced trauma on the caregivers;</item> <p></p> <item> developing foster carers' skills that address trauma impact through remedial relationships, particularly developing skills that support children with emotional and behavioural difficulties;</item> <p></p> <item> developing foster carers' skills that support them managing relationships with birth families and manage access arrangements and</item> <p></p> <item> developing foster carers' skills in developing collaborative working relationships with social workers.</item> <p></p> <item> From these five identified targets of intervention, a theoretical framework was developed. This was summarised into six core principles. Principle 1 was informed by the effectiveness of existing programs identified in the narrative review child development and foster caring. Principles 2, 3 and 4 were informed from the theoretical base of TIC which delineated the core components of TIC (child felt safety, carer-child relationships, and child coping skills). Principles 5 and 6 were informed by the specific needs of foster carers in the Irish foster care system: foster carers to build resiliency to combat the complex and stressful nature of their role, including self-care skills and having a positive outlook, managing relationships with birth families and social workers. Consideration was given to the interrelatedness of these components and how they related to projected outcomes. These six core principles were reviewed by the Stakeholder Group and subsequently refined. Minor changes were made to wording and an overarching principle (Child in Mind) was inserted to make the goal of the program more explicit (Table 1).</item> </ulist> <p>Table 1. The principles of fostering connections.</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Name of Principle</td><td>Description of Principle</td></tr></thead><tbody><tr><td>Overarching Principle: Child in Mind</td><td>The children's needs are at the heart of this program. Trauma-informed foster carers are equipped with a foster caring approach to care for children who have experienced trauma. This foster caring approach promotes placement stability which in turn supports better outcomes for children.</td></tr><tr><td>Principle 1: Trauma in Mind</td><td>Trauma-informed foster care requires foster carers to develop an understanding and awareness (a mindset) of the impact of trauma on children and also of the impact of caring for children who have experienced trauma on themselves as caregivers.</td></tr><tr><td>Principle 2: Safety in Mind</td><td>The foundational skill of the foster carer in trauma-informed foster care is supporting children in foster care to develop a feeling of safety.</td></tr><tr><td>Principle 3: Relationships in Mind</td><td>The second trauma-informed foster care skills area for foster carers is developing safe relationships with children in foster care.</td></tr><tr><td>Principle 4: Coping in Mind</td><td>The third trauma-informed foster care skills area for foster carers in supporting children in foster care to develop coping skills.</td></tr><tr><td>Principle 5: Resilience in Mind</td><td>The fourth trauma-informed foster care skills area for foster carers is developing fostering resilience. Fostering resilience is rooted in the foster carer's empathetic capacity and capacity to remain hopeful about the child's future.</td></tr><tr><td>Principle 6: Teamwork in Mind</td><td>Trauma-informed foster care requires foster carers to be effective members of the team that supports the child in order to promote positive outcomes for the child.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0191102787-16">Modelling process and outcomes</hd> <p>Based on the theoretical framework developed to support the program a proposed hypothesised causal pathway. It is presented here in a linear fashion, the hypothesised causal pathway was developed in a recursive process with the key principles of the program.</p> <p>Trauma-informed foster care recognises that the foster carer is best placed to provide children with the greatest possible remedial impact as they are in the role of the child's primary caregiver. Thus, the focus of this program was on improving the caregiving capacity of the foster carer. Foster carer variables were identified as carers feeling ill-equipped to care for traumatised children owing to gaps in trauma knowledge and skills. Child variables identified were developmental trauma (experienced before coming into care) and system stressors- (such as separation from family and moves in foster care) related difficulties.</p> <p>The theoretical basis for the program was delineated by key program mediators and a hypothesised casual pathway. Three program theory-based mediators that aim to develop trauma-informed foster carers were identified as psychoeducation, a reflective engagement and building a trauma-informed skillset. First, it was hypothesised through psychoeducation that carers will increase their knowledge and understanding of trauma impact on children and the impact of caring for children with complex needs on themselves. Second, it was hypothesised that foster carers will engage in a reflective process that will enhance and develop their reflective capacity (Fonagy & Bateman, [<reflink idref="bib16" id="ref64">16</reflink>]), increasing their awareness of their own needs and of the children they care for and thus, be more able to develop a trauma-informed mindset. Third, it was hypothesised that foster carers who undergo the program will develop a trauma-informed skillset that specifically targets the impact of developmental trauma on children.</p> <p>It is hypothesised that through these three mediators foster carers will increase their knowledge of trauma-informed fostering, tolerance of child misbehaviour and fostering efficiency. Trauma-informed foster care promotes the carers' desire to develop ways to respond more effectively to children is likely to reduce negative caregiving strategies arising from reacting to stress (Vanderfaeillie et al., [<reflink idref="bib48" id="ref65">48</reflink>]). It is also likely to reduce negative perceptions of the children (Muller et al., [<reflink idref="bib35" id="ref66">35</reflink>]) leading to greater tolerance of challenging child's behaviours and confidence in the fostering role. It is hypothesised that the program will also lead to secondary outcomes of improved child's emotional and behavioural difficulties (Figure 2).</p> <p>Graph: Figure 2. Program hypothesised causal pathway.</p> <hd id="AN0191102787-17">Program design and content</hd> <p>Six principles were identified to support the development of an applied program consisting of six sessions. The principles provided six clear domains; each session's learning objectives was structured around a domain. In each session, attention was given to ensure the identified program mediators were facilitated. Thus, in each session, there was an emphasis on increasing understanding (psychoeducation), engagement in a reflective process (reflective engagement) and skills development (building a skillset). The targeted domains were interlinked and thus, the program by design, incorporated a level of repetition across the sessions to reinforce learning.</p> <p>In each session, the content was selected and developed to reflect the targeted domain. This was informed by the findings of the narrative review and focus groups. Particular emphasis was given to using material that reflected the Irish context such as in case studies and quotes from foster carers. Some content was drawn from the RPC (Grillo & Lott, [<reflink idref="bib19" id="ref67">19</reflink>]) and a number of other attributed sources (Hughes & Golding, [<reflink idref="bib20" id="ref68">20</reflink>]; Rock et al., [<reflink idref="bib40" id="ref69">40</reflink>]; Siegel, [<reflink idref="bib42" id="ref70">42</reflink>]; Siegel & Bryson, [<reflink idref="bib43" id="ref71">43</reflink>]; Tronick & Beeghly, [<reflink idref="bib46" id="ref72">46</reflink>]). Further to this, additional content was developed through the course of this study based on practitioners' and foster carers' knowledge and experiences that aimed to root this program within the Irish experience (Table 2).</p> <p>Table 2. Description of program content.</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Session</td><td>Learning Objectives</td><td>Content</td></tr></thead><tbody><tr><td>Trauma in Mind</td><td>Understand the impact of trauma</td><td>Program rationale/structure</td></tr><tr><td /><td>Recognise the child's trauma history, trauma responses, and the child's strengths</td><td>Developmental trauma Resilience</td></tr><tr><td /><td>Understand the importance of connections when children come into care</td><td>Separation and loss</td></tr><tr><td /><td>Understand the concept of the "Invisible Suitcase"</td><td>Trauma impact on core beliefs</td></tr><tr><td>Safety in Mind</td><td>Understand and recognise trauma triggers</td><td>Neurobiology of stress</td></tr><tr><td /><td>Understand and promote the feeling of safety in the child</td><td>De-escalation strategies</td></tr><tr><td /><td>Understand the dangers of burn-out</td><td>"Felt safety" through caregiving Vicarious trauma</td></tr><tr><td /><td>Strategies for self-care</td><td>Self- care</td></tr><tr><td>Relationships in Mind</td><td>Understand trauma impact on child development</td><td>Child development</td></tr><tr><td /><td>Understand basic concepts of attachment</td><td>Attachment theory Developmental trauma</td></tr><tr><td /><td>Develop skills that promote child emotional and social development</td><td>Trauma-informed fostering</td></tr><tr><td>Coping in Mind</td><td>Understand how to help children develop coping skills</td><td>Developmental trauma recovery</td></tr><tr><td /><td>Develop connecting skills with children through play</td><td>Stages of play in child development/ Non-directive play</td></tr><tr><td /><td>Develop skills in helping the child to manage behaviours</td><td>Trauma-informed approaches to behaviour</td></tr><tr><td>Resilience in Mind</td><td>Understand and develop Reflective Fostering skills/ Fostering Resilience</td><td>Reflective fostering</td></tr><tr><td /><td>Understand and develop resilience in children in foster care</td><td>Foster carer resilience</td></tr><tr><td /><td>Understand the importance of Fostering relationships with birth families</td><td>Child resilience</td></tr><tr><td /><td>Develop strategies that support safe and positive access for the child</td><td>Impact of having a "dual identity"</td></tr><tr><td /><td /><td>Foster carers' role in contact with birth families</td></tr><tr><td /><td /><td>Safe access</td></tr><tr><td>Teamwork in Mind</td><td>Understand the foster carers' role in the team around the child</td><td>Collaborative practice</td></tr><tr><td /><td>Identify learnings from the training</td><td>Program review</td></tr><tr><td /><td>Understand the importance of hope</td><td>Hope in fostering</td></tr><tr><td /><td>Introduction to the PACE</td><td>PACE model</td></tr></tbody></table> </ephtml> </p> <hd id="AN0191102787-18">Feasibility stage</hd> <p></p> <hd id="AN0191102787-19">The elements of the feasibility stage.</hd> <p>In this study our main goal of stage 2 was to test the feasibility of the program and the evaluation measures for an effectiveness evaluation study (Lotty et al., [<reflink idref="bib27" id="ref73">27</reflink>]). The program was not piloted to foster carers.</p> <hd id="AN0191102787-20">Testing feasibility of the program</hd> <p>The local Fostering Team (n = 26) was invited to review an initial draft of the program that was developed to test for feasibility. Eighteen practitioners and supervisors attended the review. In 2015, the Resource Parents Curriculum (RPC) was piloted to foster carers by two of the practitioners who participated in the program review. The program presented included significantly adapted material from the RPC and new material. These practitioners' input was particularly useful as they were informed by their experiences of facilitating the RPC (Lotty, [<reflink idref="bib26" id="ref74">26</reflink>]). The review found that the program content, design, and learning methods were highly acceptable and considered feasible by the Fostering Team. The changes that were recommended were: further consideration to program title that reflected a hopeful message; session on exploration of foster carer history to be scheduled after session 4; message of self-care to be linked into each session; session on "play" to be scheduled after child development section in session 4 and the final session should focus on a hopeful message. These recommendations were incorporated into a finalised version of the program and a Facilitator's Guide, slides for each session, a Toolkit and Homework Copybook were produced.</p> <hd id="AN0191102787-21">Testing evaluation measures</hd> <p>The standardised measures for the effectiveness study chosen were informed by the narrative review. The measures were piloted to a group of foster carers (n = 3) and refined/adjusted accordingly. These carers worked with the research team only and were not participants in the evaluation study. Changes were made to Americanised language to denote an Irish context. Estimating recruitment, retention and sample size based on prior research where attrition rates of 29% in the intervention group and 14% in the control group were reported (Purvis et al., [<reflink idref="bib38" id="ref75">38</reflink>]).</p> <hd id="AN0191102787-22">Discussion</hd> <p>The MRC framework supported us to systematically develop an evidenced-based program. In the case of <emph>Fostering Connections</emph>, it has successfully guided us through a complex study design that was underpinned by a mixed-methods approach.</p> <p>The MRC framework supported a complex mixed-methods study design. The MRC framework recommends both quantitative and qualitative approaches to be taken in the program development stage advocating that "where possible, evidence should be combined from different sources that do not share the same weakness" (Craig et al., [<reflink idref="bib10" id="ref76">10</reflink>], p. 3). This design helped navigate and draw from a number of sources, quantitative evidence from the narrative review, contextual data, expert multiple stakeholder views, to develop a theory-based program that reflected local context. We believe that combining these findings strengthened the program development. The delineated theoretical basis for the program supported the evaluation stage of the MRC that produced an effectiveness study (Lotty et al., [<reflink idref="bib27" id="ref77">27</reflink>]) and process evaluation (Lotty et al., [<reflink idref="bib28" id="ref78">28</reflink>]).</p> <p>The feasibility stages of the MRC also helped us develop an acceptable program to providers and recipients. By seeking foster carers' views on the design and content of the program, we hoped to contribute to the program acceptability (Marcellus, [<reflink idref="bib30" id="ref79">30</reflink>]; Spielfogel et al., [<reflink idref="bib45" id="ref80">45</reflink>]). The developed program emphasises translating complex concepts in an accessible way and comprehendible way so that foster carer can apply them to practical everyday situations. Thus, images, accessible language, repetition, role-play, relatable case studies and practicing skills were used to address this and further reinforced through the Toolkit and Homework Copybook. The program design sought to reflected atmosphere of psychological safety to promote an effective learning owing to the strong emotional content. Strategies used included following a similar format in each session, regular check-in with participants' level of emotional stress and facilitator preparation of ground rules, structure (timing, breaks), course content, cumulative exposure to material, types of exercises, debriefing plan, how the session is ended and evaluation process.</p> <p>The group work process was also an important factor in this program emphasising reflective-experiential learning & Leszcz, 2005). Experiential, self-reflective exercises and discussion were used to promote reflective engagement at an emotional level to facilitate learning (Leamnson, [<reflink idref="bib25" id="ref81">25</reflink>]). Foster carers thus were encouraged to share their experience to promote peer learning. Facilitators were also encouraged to guide foster carers through the dimensions of reflection in the experiential exercises and discussion.</p> <p>Whilst the MRC framework provided us with a guide to navigate the process, the reciprocity between stages and within stages was central to the process. We were also aware that consideration of contextual issues in program design is important to the success of programs (Wells et al., [<reflink idref="bib49" id="ref82">49</reflink>]). This is particularly relevant to the field of foster care as most foster-care research is based in the U.S.A. In Ireland, the foster care system operates a care policy of long-term care when children cannot be reunified with their birth family unlike the U.S.A. (Barber & Delfabbro, [<reflink idref="bib2" id="ref83">2</reflink>]). Ensuring that the program reflected the Irish experience supported program relevance and acceptability.</p> <p>This research has some limitations. The qualitative study involved a small sample within a limited timeframe. Thus, the findings of this study make generalisability to a larger population of foster carers and practitioners may not be possible. The research also was limited as it did not include children's views. This is a consideration for future research. There also was a risk of research allegiance bias owing to the "insider" position of the first author. To minimise this risk strategies of transparency and reflexivity were employed that have been highlighted elsewhere (Ritchie et al., [<reflink idref="bib39" id="ref84">39</reflink>]). While research allegiance is associated with unintentionally reduced researcher objectivity in intervention research; the research also indicates some possible benefits (Yoder et al., [<reflink idref="bib51" id="ref85">51</reflink>]). Yoder et al. ([<reflink idref="bib51" id="ref86">51</reflink>]) suggested that research allegiance may reflect a higher level of expertise in delivering intervention. This may have been the case in this study, as the "insider" researcher brought an in-depth level of insider knowledge to the program.</p> <p>To conclude, we have developed a psychoeducational program for foster carers using the MRC framework. 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A., van Duin, D., & Cuijpers, P. (2019). Researcher allegiance in research on psychosocial interventions: Meta-research study protocol and pilot study. BMJ Open, 9 (2), e024622. https://doi.org/10.1136/bmjopen-2018-024622</bibtext> </blist> </ref> <aug> <p>By Maria Lotty; Eleanor Bantry-White and Audrey Dunn-Galvin</p> <p>Reported by Author; Author; Author</p> <p></p> <p>Maria Lotty Maria Lotty , PhD is the Senior Coordinator for Health and Social Care and a lecturer at the Centre for Adult Continuing Education, University College Cork. Her research interests are in therapeutic interventions for children and families in social work contexts, programme development and evaluation with a focus on continuous professional development for practitioners across the health, social care and education sectors. Her teaching primarily support professionals to practice trauma-informed care.</p> <p>Eleanor Bantry-White Eleanor Bantry White , PhD, is the Director, Master of Social Work & Postgraduate Diploma in Social Work Studies and the Director, PhD (Arts) Social Work at University College Cork. Her research interests focus on interventions to support healthy ageing and well-being in later life and her teaching primarily supports social work practice in health care settings.</p> <p>Audrey Dunn-Galvin Audrey Dunn Galvin , PhD, is Co-Director of the Early Years & Childhood Studies and lectures in the School of Applied Psychology, University College Cork. Her interests lie in the psychology of chronic disease, and she has been published widely in medical journals</p> </aug> <nolink nlid="nl1" bibid="bib18" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib47" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib17" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib50" firstref="ref7"></nolink> <nolink nlid="nl5" bibid="bib21" firstref="ref8"></nolink> <nolink nlid="nl6" bibid="bib13" firstref="ref9"></nolink> <nolink nlid="nl7" bibid="bib15" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib36" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib23" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib12" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib41" firstref="ref15"></nolink> <nolink nlid="nl12" bibid="bib31" firstref="ref16"></nolink> <nolink nlid="nl13" bibid="bib33" firstref="ref18"></nolink> <nolink nlid="nl14" bibid="bib34" firstref="ref19"></nolink> <nolink nlid="nl15" bibid="bib11" firstref="ref20"></nolink> <nolink nlid="nl16" bibid="bib28" firstref="ref21"></nolink> <nolink nlid="nl17" bibid="bib32" firstref="ref22"></nolink> <nolink nlid="nl18" bibid="bib26" firstref="ref23"></nolink> <nolink nlid="nl19" bibid="bib24" firstref="ref32"></nolink> <nolink nlid="nl20" bibid="bib14" firstref="ref33"></nolink> <nolink nlid="nl21" bibid="bib22" firstref="ref35"></nolink> <nolink nlid="nl22" bibid="bib44" firstref="ref36"></nolink> <nolink nlid="nl23" bibid="bib27" firstref="ref37"></nolink> <nolink nlid="nl24" bibid="bib29" firstref="ref39"></nolink> <nolink nlid="nl25" bibid="bib10" firstref="ref40"></nolink> <nolink nlid="nl26" bibid="bib37" firstref="ref43"></nolink> <nolink nlid="nl27" bibid="bib16" firstref="ref64"></nolink> <nolink nlid="nl28" bibid="bib48" firstref="ref65"></nolink> <nolink nlid="nl29" bibid="bib35" firstref="ref66"></nolink> <nolink nlid="nl30" bibid="bib19" firstref="ref67"></nolink> <nolink nlid="nl31" bibid="bib20" firstref="ref68"></nolink> <nolink nlid="nl32" bibid="bib40" firstref="ref69"></nolink> <nolink nlid="nl33" bibid="bib42" firstref="ref70"></nolink> <nolink nlid="nl34" bibid="bib43" firstref="ref71"></nolink> <nolink nlid="nl35" bibid="bib46" firstref="ref72"></nolink> <nolink nlid="nl36" bibid="bib38" firstref="ref75"></nolink> <nolink nlid="nl37" bibid="bib30" firstref="ref79"></nolink> <nolink nlid="nl38" bibid="bib45" firstref="ref80"></nolink> <nolink nlid="nl39" bibid="bib25" firstref="ref81"></nolink> <nolink nlid="nl40" bibid="bib49" firstref="ref82"></nolink> <nolink nlid="nl41" bibid="bib39" firstref="ref84"></nolink> <nolink nlid="nl42" bibid="bib51" firstref="ref85"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Development of a Psychoeducational Foster Carer Program Using the Medical Research Council (MRC) Framework for Complex Interventions
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Maria+Lotty%22">Maria Lotty</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-7809-6458">0000-0002-7809-6458</externalLink>)<br /><searchLink fieldCode="AR" term="%22Eleanor+Bantry-White%22">Eleanor Bantry-White</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-7663-6836">0000-0002-7663-6836</externalLink>)<br /><searchLink fieldCode="AR" term="%22Audrey+Dunn-Galvin%22">Audrey Dunn-Galvin</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Child+Care+in+Practice%22"><i>Child Care in Practice</i></searchLink>. 2026 32(1):4-18.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
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  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Psychoeducational+Methods%22">Psychoeducational Methods</searchLink><br /><searchLink fieldCode="DE" term="%22Foster+Care%22">Foster Care</searchLink><br /><searchLink fieldCode="DE" term="%22Trauma+Informed+Approach%22">Trauma Informed Approach</searchLink><br /><searchLink fieldCode="DE" term="%22Evidence+Based+Practice%22">Evidence Based Practice</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Design%22">Program Design</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Content%22">Program Content</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Ireland%22">Ireland</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/13575279.2022.2121683
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1357-5279<br />1476-489X
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Foster carers require high quality evidence-based psychoeducational programs to support them in the care of children with complex trauma-related difficulties. However, there is a lack of systematic development of such programs which may explain mixed results. This paper presents a detailed account of the development of a complex intervention. This program was developed to address a practice gap of evidenced-based foster care programs in the Irish context. It aims to improve foster carers' capacity to provide children with trauma-informed care and in turn improve emotional and behavioural difficulties. The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used to develop Fostering Connections: The Trauma-informed Foster Care Programme. A prior narrative review of the evidence base of similar programs was combined with a prior qualitative study. A Stakeholder Group provided expert feedback during the development process. The development of a promising psychoeducational programs for foster carers using the MRC framework is described
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  Label: Entry Date
  Group: Date
  Data: 2026
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  Data: EJ1500759
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1500759
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        Value: 10.1080/13575279.2022.2121683
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      – Text: English
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      Pagination:
        PageCount: 15
        StartPage: 4
    Subjects:
      – SubjectFull: Psychoeducational Methods
        Type: general
      – SubjectFull: Foster Care
        Type: general
      – SubjectFull: Trauma Informed Approach
        Type: general
      – SubjectFull: Evidence Based Practice
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Program Design
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      – SubjectFull: Program Content
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      – SubjectFull: Ireland
        Type: general
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      – TitleFull: Development of a Psychoeducational Foster Carer Program Using the Medical Research Council (MRC) Framework for Complex Interventions
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            NameFull: Maria Lotty
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            NameFull: Eleanor Bantry-White
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              Y: 2026
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