The Experiences of Foster Carers’ Birth Children of Living in Fostering Families: A Qualitative Evidence Synthesis

Figures & data

Table 1. Inclusion and exclusion criteria used to screen studies.

Include	Exclude
Sample
Studies with children and/or adolescents (up to and including age 19) who are the biological/birth children of foster carers	Studies which include the perspectives of others such as foster carers or adult biological children, where the data relating to the sample of interest is not clearly extractable Studies focussed on the experiences of the adoptive children of foster carers
Phenomenon of interest
Qualitative, first-hand accounts of the experiences or perspectives of foster carers’ biological/birth children, of living in fostering families	The experiences of being an adoptive child or a foster child in a fostering family The experiences of a foster family intervention, aimed at altering the fostering experience
Design
Qualitative research methodology (studies that use qualitative methods for data collection and analysis)	Quantitative research methodology only (studies that use only quantitative methods for data collection and analysis)
Evaluation
Experiences, perspectives, views, opinions, beliefs, perceptions, feelings, or understanding	Studies that do not include experiences, perspectives, views, opinions, beliefs, perceptions, feelings, or understandings
Research type
Qualitative Mixed method (where qualitative data is clearly extractable) Empirical research Peer-reviewed, published in the English language	Quantitative Non-empirical research such as opinion pieces, books, book chapters, literature reviews, editorials, and systematic reviews Non-peer reviewed work, including grey literature

Table 2. Characteristics of included studies.

Author(s), year	Country	Study aims/phenomenon of interest	No. of participants (gender)	Age range	Recruitment	Methodology: data collection and analysis
Adams et al., 2018	England, UK	To explore how the birth children of foster carers experience and make sense of the relationship with their parents	N = 8 (4 M/4F)	14–16 yrs	Purposive	Qualitative: Semi-structured interviews; interpretative phenomenological analysis
Höjer, 2007 and Nordenfors, 2016	Sweden	To investigate the experiences of birth children of foster carers, the impact of fostering on their lives, their participation in foster placements and the impact on their relationships and identities	N = 725 (N/a)	4–28 yrs	Purposive	Mixed-methods: Focus groups, discussion groups, questionnaires containing open and closed questions, and interviews; survey answers were analyzed both as written statements and as frequency tables, qualitative data from the groups, interviews and open-ended questionnaire questions were analyzed qualitatively (no further information provided)
Kaplan, 1988	USA	To explore the psychological issues that arise for foster parent’s biological children	N = 15 (11 M/4F)	6–12 yrs	Purposive	Mixed-methods: Semi-structured interviews, mutual story-telling, sentence completion task, kinetic family drawing; descriptive categorization and examination of qualitative data for the psychoanalytic constructs
Martin, 1993	England, UK	To listen to foster carers’ children about their own needs in preparing for the demands of fostering	N = 7 (N/a)	10–15 yrs	Convenience	Qualitative: Discussion groups; analysis not described
Njøs & Seim, 2019	Norway	How biological children perceive their involvement and participation in the foster family and in contact with child protection services	N = 8 (3 M/5F)	11–30 yrs	Convenience	Qualitative: Semi-structured interviews; inductive and content analysis
Ntshongwana & Tanga, 2018	South Africa	The experiences of biological children living in the same households with foster children	N = 30 (9 M/21F)	10–18 yrs	Purposive	Qualitative: Semi-structured interviews; thematic analysis
Raineri et al., 2018	Italy	To explore the experiences of birth sons and daughters of foster parents; to draw on their views to understand how their satisfaction with foster care processes could be improved	N = 15 (7 M/8F)	6–19 yrs	Purposive	Qualitative: Interviews and picture drawing; theme generation guided by semantic analogy
Reed, 1994, 1996–1997	England, UK	The experiences of both birth children and adult carers in foster families looking after children and young people with serious learning disabilities	N = 23 (9 M/14F)	8–19 yrs	Convenience	Qualitative: Discussion groups and interviews; analysis not described
Rees & Pithouse, 2019	England & Wales, UK	To explore birth children’s experiences of supporting the young people placed with them in their foster families and illuminate these “sibling” relationships	N = 9 (N/a)	13 yrs+	Purposive	Qualitative: Semi-structured interviews; thematic analysis
Roche & Noble-Carr, 2017	Australia	The perspectives, needs, and experiences of biological children within Australian Capital Territory	N = 9 (5 M/4F)	8–17 yrs	Purposive	Qualitative: Focus groups; thematic content analysis
Spears & Cross, 2003	England, UK	To explore what birth children thought of issues raised in the literature, how they felt fostering had affected them, what skills they needed, how they had acquired them, how they were supported in their role and potential confusion of roles	N = 20 (4 M/16F)	8–18 yrs	Purposive	Qualitative: Semi-structured interviews; analysis not described
Stoneman & Dallos, 2019	England, UK	To examine birth children’s experiences of having fostering child(ren) in their family and how birth children’s attachment relationships and strategies are impacted by and influence the accounts of their experiences	N = 8 (3 M/5F)	8–18 yrs	Purposive	Qualitative: Semi-structured interviews and “sculpts”; interpretative phenomenological analysis
Sutton & Stack, 2013	Scotland, UK	To access the lived experience of being part of a fostering family and to ask the question: How do biological children of foster-carers adjust and adapt to the fostering experience?	N = 6 (1 M/5F)	12–18 yrs	Convenience	Qualitative: Semi-structured interviews; interpretative phenomenological analysis
Targowska et al., 2016	Australia	To explore the fostering experiences of biological children of foster carers in Western Australia, the levels of information and support required by them, to explore ways of supporting them	N = 14 (N/a)	6–14 yrs	Purposive	Qualitative: Semi-structured interviews and focus groups; coding and theme generation
Twigg, 1994	Canada	To explore the effects of the foster care experience on foster parents’ biological children	N = 8 (3 M/5F)	15 yrs +	Convenience	Qualitative: Unstructured interview; narrative analysis and grounded theory

Table 3. CASP tool quality appraisal.

Study	CASP item
	Clearly stated aims	Qualitative methodology appropriate	Research design appropriate	Recruitment strategy appropriate	Data collection appropriate	Researcher-participants relationship considered	Ethical issues considered	Rigorous data analysis	Clearly stated findings	Valuable research
Adams et al., 2018	✔	✔	✔	✔	✔	–	✔	✔	✔	✔
Höjer, 2007 and Nordenfors, 2016	✔	✔	–	✔	✔	–	–	–	✔	✔
Kaplan, 1988	✔	✔	✔	–	✔	–	–	–	✔	✔
Martin, 1993	✔	✔	–	–	–	–	–	–	✔	✔
Njøs & Seim, 2019	✔	✔	✔	✔	✔	–	✔	✔	✔	✔
Ntshongwana & Tanga, 2018	✔	✔	✔	✔	✔	–	✔	✔	✔	✔
Raineri et al., 2018	✔	✔	✔	✔	✔	–	✔	–	✔	✔
Reed, 1994, 1996–1997	✔	✔	–	–	–	–	–	–	✔	✔
Rees & Pithouse, 2019	✔	✔	✔	✔	✔	–	✔	✔	x	✔
Roche & Noble-Carr, 2017	✔	✔	✔	–	✔	–	✔	✔	✔	✔
Spears & Cross, 2003	✔	✔	✔	✔	✔	–	–	–	✔	✔
Stoneman & Dallos, 2019	✔	✔	✔	✔	✔	✔	✔	✔	✔	✔
Sutton & Stack, 2013	✔	✔	✔	✔	✔	–	✔	✔	✔	✔
Targowska et al., 2016	✔	✔	✔	✔	✔	–	✔	–	✔	✔
Twigg, 1994	✔	✔	✔	✔	✔	–	–	✔	✔	✔

✔ = yes; – = can’t tell; x = no.

Table 4. Summary of qualitative findings.

Summarized review finding	GRADE-CERQual assessment of confidence	Explanation of GRADE-CERQual assessment	References
Responsibility and Power in the Fostering Task
Children as carers: The birth children of the foster carers appeared to take an active caring role in the foster family. They took on practical and emotional caring responsibilities through the fostering task toward the foster children. For some children these caring responsibilities extended toward the parents. The caring duties and roles brought both positive gains and feelings and negative feelings. Two studies reported the caretaking responsibilities tended to be in older children of the sample.	High confidence	Moderate concerns No/Very minor concerns No/Very Minor concerns No/Very Minor concerns	Roche & Noble-Carr, 2017; Kaplan, 1988; Nordenfors, 2016; Reed, 1996–1997; Sutton & Stack, 2013; Adams et al., 2018; Ntshongwana & Tanga, 2018; Stoneman & Dallos, 2019; Spears & Cross, 2003; Reed, 1994; Raineri et al., 2018; Targowska et al., 2016;
Inclusion in decision-making and preparation for fostering: Despite the documented responsibilities that many studies reported children gained through fostering, the inclusion of the children by their parents in the preparation and decision-making related to fostering varied. Many reported not being involved in the decision to foster nor the preparation for fostering. Many children advocated for the importance of their inclusion and of being provided with information, and how this would be beneficial to their role. Less commonly reported was children’s satisfaction with their inclusion and involvement and information received.	High confidence	Moderate concerns No/Very minor concerns No/Very minor concerns No/Very minor concerns	Njøs & Seim, 2019; Roche & Noble-Carr, 2017; Martin, 1993; Nordenfors, 2016; Reed, 1996–1997; Ntshongwana & Tanga, 2018; Stoneman & Dallos, 2019; Spears & Cross, 2003; Raineri et al., 2018; Targowska et al., 2016;
Adaptations within the Family System
Disruption to familial balance: Across many studies it appeared that the arrival of a foster child brought a sense of threat to the biological children, their position and role in the family, and increased tension in the home. There was rivalry for parental resources, personal possessions and space, with many experiencing some degree of loss in relation to these. Preferential treatment of the foster child in the family was also reported by some children.	High confidence	Minor concerns No/Very minor concerns No/Very minor concerns No/Very minor concerns	Njøs & Seim, 2019; Roche & Noble-Carr, 2017; Kaplan, 1988; Martin, 1993; Reed, 1996–1997; Sutton & Stack, 2013; Adams et al., 2018; Ntshongwana & Tanga, 2018; Stoneman & Dallos, 2019; Spears & Cross, 2003; Reed, 1994; Rees & Pithouse, 2019; Raineri et al., 2018; Twigg, 1994; Höjer, 2007; Targowska et al., 2016;
Making space for new members: Across several studies, the process and impact of integrating foster children into the family was evident. The presence of the foster children often brought many benefits for the birth children and their families. For some, the new members joining the family led to children feeling more distant from family members.	High confidence	Minor concerns Minor concerns No/Very minor concerns No/Very minor concerns	Njøs & Seim, 2019; Roche & Noble-Carr, 2017; Martin, 1993; Reed, 1996–1997; Sutton & Stack, 2013; Ntshongwana & Tanga, 2018; Stoneman & Dallos, 2019; Spears & Cross, 2003; Reed, 1994; Rees & Pithouse, 2019; Raineri et al., 2018; Twigg, 1994; Höjer, 2007; Targowska et al., 2016;
Grappling with placement endings: When foster children left the family it was often experienced as a loss, with some ways of coping with this documented. The children who left were often psychologically still present in the thoughts and concerns of the birth children. Some had a desire to continue contact with the child who had left. Placements sometimes brought more ambivalent feelings, such as relief and guilt.	Moderate confidence	Minor concerns No/Very Minor concerns Moderate concerns No/Very minor concerns	Njøs & Seim, 2019; Roche & Noble-Carr, 2017; Kaplan, 1988; Reed, 1996–1997; Sutton & Stack, 2013; Ntshongwana & Tanga, 2018; Stoneman & Dallos, 2019; Spears & Cross, 2003; Rees & Pithouse, 2019; Raineri et al., 2018; Targowska et al., 2016;
Buffering against the Challenges of Fostering
Internal coping mechanisms: Several studies detailed the way in which the birth children appeared to cope with the challenges of fostering at an individual level. This included minimization of their emotions, empathically responding to the foster children, and ascertaining positive gains from their caring role and responsibilities.	Moderate confidence	Moderate concerns No/Very minor concerns Minor concerns regarding No/Very Minor concerns	Roche & Noble-Carr, 2017; Kaplan, 1988; Martin, 1993; Sutton & Stack, 2013; Adams et al., 2018; Stoneman & Dallos, 2019; Spears & Cross, 2003; Reed, 1994; Raineri et al., 2018; Höjer, 2007; Targowska et al., 2016;
The protective power of attuned parenting: Parents had a key role in helping buffer the impact of the challenges of fostering on the birth children. Feeling valued and cared for in their relationship with their parents was important in helping the biological children cope with the demands brought by fostering. Being able to openly communicate difficulties with parents was important, and sometimes helped the birth children feel like part of a team. Specific examples of practical support were also documented. One example of when such support was provided but not in an attuned way was also documented.	Moderate confidence	Minor concerns Minor concerns Moderate concerns Minor concerns	Martin, 1993; Sutton & Stack, 2013; Adams et al., 2018; Ntshongwana & Tanga, 2018; Stoneman & Dallos, 2019; Spears & Cross, 2003; Reed, 1994; Raineri et al., 2018; Twigg, 1994;
Shaped by the Realities of Fostering
Loss of innocence: The experience of living in a fostering family often exposed children to knowledge about the adversities faced by foster children and their biological families, gaining awareness of family breakdowns, abuse, neglect, and violence. In some cases, awareness of such knowledge seemed to prompt worry for the children. Children were also exposed to challenging behaviors that foster children displayed, such as aggression, stealing, and destruction of possessions, sometimes struggling to make sense of these. The knowledge of the foster children’s life history and experiences sometimes helped them understand the reality of their challenging behaviors.	Moderate confidence	Moderate concerns Very minor concerns Minor concerns No/Very minor concerns	Roche & Noble-Carr, 2017; Kaplan, 1988; Martin, 1993; Sutton & Stack, 2013; Stoneman & Dallos, 2019; Spears & Cross, 2003; Reed, 1994; Raineri et al., 2018; Höjer, 2007; Targowska et al., 2016;
Personal growth and development: It was evident in several studies that exposure to the life adversities inherent to fostering brought growth and personal development to biological children. This related to their worldview and values in life, as well as personal characteristics such as altruism and empathy. This was largely viewed positively, occasional negative consequences of this were captured by one study.	Moderate confidence	Minor concerns Minor concerns Moderate concerns No/Very minor concerns	Roche & Noble-Carr, 2017; Martin, 1993; Nordenfors, 2016; Sutton & Stack, 2013; Ntshongwana & Tanga, 2018; Stoneman & Dallos, 2019; Spears & Cross, 2003; Rees & Pithouse, 2019; Raineri et al., 2018; Targowska et al., 2016;
Collaborating with Others Beyond the Family
The importance of recognition and inclusion by the system: Birth children often felt they were not taken into consideration by the social work systems and agencies implementing fostering. Many called for systems to provide them with more information and include them in the preparation for fostering and in some cases include them in the support offered to the families. Some of the children in one study didn’t appear concerned with their level of involvement with fostering professionals and didn’t want any greater support from them.	Low confidence	Serious concerns Minor concerns Moderate concerns Minor concerns regarding relevance	Roche & Noble-Carr, 2017; Martin, 1993; Reed, 1996–1997; Ntshongwana & Tanga, 2018; Spears & Cross, 2003; Raineri et al., 2018;
The impact and influence of peers: For many children, integrating the fostering task with peers was difficult, while for others, this happened more easily. Some children reported on experiences of peer support groups, which were overall perceived as beneficial.	Low confidence	Serious concerns No/Very concerns Moderate concerns No/Very minor concerns	Roche & Noble-Carr, 2017; Martin, 1993; Reed, 1996–1997; Spears & Cross, 2003; Reed, 1994; Raineri et al., 2018; Targowska et al., 2016;
Negotiating interactions with the birth families: Three studies reported on biological children’s experiences with foster children’s birth families, with the complexity of these relationships seemingly apparent to the children. Some struggled to know how to regard them, others had learned to be tactful and understanding. Some advocated for good relationships between the foster families and foster children’s birth families.	Low confidence	Serious concerns No/Very concerns Serious concerns Minor concerns	Martin, 1993; Raineri et al., 2018; Höjer, 2007;

1 = Concerns regarding methodological limitations, 2 = concerns regarding coherence, 3 = concerns regarding adequacy, 4 = concerns regarding relevance.

Figure A1. Prisma flow chart illustrating selection of studies (Page et al., 2021).

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