Trauma informed care (TIC) is a whole system organisational change process which emerged from the seminal Adverse Childhood Experiences (ACE) study, establishing a strong graded relationship between the number of childhood adversities experienced and a range of negative outcomes across multiple domains over the life course. To date, there has been no systematic review of organisation-wide implementation initiatives in the child welfare system. As part of a wider cross-system rapid evidence review of the trauma-informed implementation literature using systematic search, screening and review procedures, twenty-one papers reporting on trauma-informed implementation in the child welfare system at state/regional and organisational/agency levels were identified. This paper presents a narrative synthesis of the various implementation strategies and components used across child welfare initiatives, with associated evidence of effectiveness. Training was the TIC implementation component most frequently evaluated with all studies reporting positive impact on staff knowledge, skills and/or confidence. The development of trauma-informed screening processes, and evidence-based treatments/trauma focused services, where evaluated, all produced positive results. Whilst weaknesses in study design often limited generalisability, there was preliminary evidence for the efficacy of trauma-informed approaches in improving the mental and emotional well-being of children served by community-based child welfare services, as well as their potential for reducing caregiver stress and improving placement stability.

The trend towards more open adoption presents adopters with unique parenting challenges associated with satisfying the child's curiosity about their origins and maintaining relationships with birth family through contact. This article by Mandi MacDonald and Dominic McSherry focuses on the experiences of 20 sets of adoptive parents who were interviewed as part of the Northern Ireland Care Pathways and Outcomes Study. Interviews were analysed following the principles of Interpretative Phenomenological Analysis (IPA). The article explores adoptive parents' experience of talking to their child about adoption and of post-adoption contact with members of the birth family. Adopters discussed adoption sensitively with their child but were concerned that difficult and complex family histories would present a risk to the child's self-esteem and emotional well-being. All forms of contact proved emotionally and practically burdensome; however, adopters were committed to making it work for the child's benefit and were open to increased contact should the child wish it in the future. There was little relationship with birth family outside of formal contact. The study reveals the need for a mechanism to facilitate communication with birth families if adopters are to be able to respond to the child's changing need for contact and information.

Background: The impact of informal caregiving is increasingly recognised as an important but often particularly neglected area of research in low and middle income countries. It is important to understand not only the effect of care on patient outcomes, but also the impact of caring on caregivers’ health and wellbeing. Methods: Guided by the Arksey and O’Malley (Res Methodol 8:19–32, 2005) framework, this scoping review sought to collate and chart existing research on the needs, burdens and challenges experienced by caregivers in Uganda. Results: The results of this review indicate that research focusing on the needs of caregivers for individuals with communicable disease, particularly HIV, has been well developed in Uganda, however, there is a lack of research on caregiving related to non-communicable diseases. Research has been dominated by small qualitative studies that are informative for understanding roles, burdens and contextually-specific aspects of care, but there is a need for larger studies that develop and test interventions designed to support the needs of caregivers. Conclusions: Recurrent themes identified within this review, such as challenges in providing physical support and accessing treatment services, financial costs of care, psychological and mental health impacts and the experience of stigma, should help to inform well targeted and contextually-appropriate future research and interventions.

This paper considers how Family Support is conceptualised in the European context with respect to its primary beneficiaries. The central question considers the focus of concern in a child welfare system and what it means when Family Support is focused on children, on parents, or involves the family unit as a whole. Informed by a body of relevant literature reviewed as part of a wider project, Family Support is seen as more often conceptualised as being targeted toward parents as the primary service user, and to a lesser extent described as being tailored toward children or whole families. This approach to Family Support provision is somewhat at odds with a systemic understanding of families, which is foundational to much social care and child welfare work, and which takes account of the multi-layered relationships between individuals within families, and between individuals, families and their social world. Applying an ecological systems perspective, this paper critically discusses the consequences for the involved stakeholders and the implementation of services at different system levels when support and interventions are targeted at the child, the parents or at the family as a whole.