Randomised control trials for family group conferences are a practical and ethical quagmire

The government money being spent on a What Works Centre programme to evaluate FGCs could be put to more intelligent use, argues Michelle Janas

family
Photo: Rido/Fotolia

by Michelle Janas

A recent article in Community Care highlighted concerns from the social work academic community about a research proposal from the children’s social care What Works Centre.

On offer from the Department for Education (DfE) is a portion of £15million to evaluate the use of family group conferences (FGCs) at the pre-proceedings stage in child protection cases via a randomised control trial (RCT). As a former medical researcher now training to be a social worker, the decision to use an RCT particularly caught my attention.

Until two years ago I was the principal scientist at a multinational biotechnology company that develops and trials the latest cell therapies for hard-to-treat cancers. So, while not a clinical trial expert, I feel somewhat equipped to write about the practicalities and ethics of RCTs, whether they pertain to medicine or social care.

RCTs are an attractive concept for researchers because of their ‘gold-standard’ status for generating empirical evidence. But ethically RCTs are contentious, because by their nature they test a group that has received a treatment or intervention against one for whom it has been deliberately denied. As such, RCTs should be used only under certain circumstances, with rules and checks in place that ensure they are conducted efficaciously.

Family group conferences’ benefits are known

The first premise for conducting an RCT is that there is a professional equipoise – that is, that there is genuine uncertainty about whether a treatment or intervention is beneficial. RCTs are useful when there is a stalemate in the field and they begin with a null hypothesis, in other words the assumption that there will be no difference between the two groups.

With regard to FGCs though, there is already a wealth of research demonstrating their benefit within the context of child safeguarding. In addition, a 2017 DfE report on the use of Daybreak family group conferencing for children on the edge of care conclusively showed an increased proportion of children remaining with their families when FGCs were used.

Interestingly, Daybreak, a charity specialising in providing FGCs, is the identified partner for conducting the proposed RCT – yet the 2017 study recommendations make no mention of such an approach. Rather, they call for an extended follow-up period and strategies for integrating FGCs into local authorities.

There are detractors, perhaps most notably a meta-analysis of 14 non-UK studies which showed no significant reduction in out-of-home placements when FGCs were used. But its relevance to FGC use in the UK has rightly been critiqued by David Wilkins, who pointed out that the spirit in which FCGs are conducted, and the way in which outcomes are measured, will influence any evaluation.

With reference to RCTs specifically, the results of a large US study by Tyler Corwin and others on the effectiveness of FGCs in active child protection cases have just been published. They add to the strong favourable discourse for including FGCs at the pre-proceedings stage. Thus, questions must be asked as to what added value this newly proposed RCT will bring, and whether the What Works Centre is merely repeating and confirming published evidence rather than conducting genuinely novel research.

The ethics of consent and non-treatment controls

RCTs that have a non-treatment (or placebo) group, as for the FCG proposal, bring up a unique ethical dilemma. As with any research study, the explicit consent of all participants is paramount, and thus those families allocated to the control group will (presumably) be aware that they are being denied an FGC.

Although it may be tempting to conceal the existence of the trial to these families, their resulting data cannot be published without their explicit consent (and could otherwise be challenged lawfully). Presumably the What Works Centre’s research partner CASCADE and its approving ethics committee at Cardiff University understand this.

Aside from this practicality, there is something unpalatable about the active withholding of a support option at a time when a family is at risk of losing their child(ren). In the US study mentioned above, the control group was offered a family team meeting instead of an FGC, but they were also able to override the study protocol and ask for an FGC.

A similar issue of contention arises in medicine. For example, when conducting surgical RCTs a placebo group is considered tolerable if the risks are minimal and when the procedure offers some benefit (such as a diagnosis).

However, in cancer therapy, where the stakes are high, RCTs will never include a placebo group where the potential for a life-saving treatment is available. Indeed, a notable 2016 study forcefully asserts that participants can only be assigned to a placebo if they “are not substantially more likely than those in active treatment group(s) to die; suffer irreversible morbidity, disability, or other substantial harms; suffer reversible but serious harm; or suffer severe discomfort”.

One could argue that the removal of a child to state care also risks serious harm, for both the child, parent(s), and extended family.

Randomisation and blinding

The essence of RCTs is that they are designed to minimise bias. This is achieved by randomly assigning individuals to groups (as the name suggests) and by a process of blinding.

This is important because, as has been shown in medical trials, a lack of concealment at the time of allocation and/or assessment is known to produce an outcome bias in favour of the intervention. A trial can be single-blind (the participants do not know which group they have been assigned to) or double-blind (neither the participants nor researchers are aware of the allocation).

In the proposed RCT for FGCs, blinding is not practically possible. Although a researcher in an office might randomly assign the families to cohorts, the families will obviously know which group they are in, as will the professionals assessing them. Indeed, this was one of the major limitations of the Corwin study, and arguably negated its objectivity and status as an RCT.

Reporting for an FGC trial will always be subjective, unless one is crudely measuring whether a child remains in their family’s care or not. Even then accidental bias needs to be considered, as the mere act of offering a family an FGC may render them more hopeful, responsive and engaged than those for whom an FGC has been denied (who might in turn become increasingly despondent, especially in the face of pre-proceedings).

RCTs are time and resource intensive

While RCTs might be considered the ultimate in data generation, they are time and resource heavy. The What Works Centre cites a two-year evaluation period for its proposal, yet the protocol and evaluation plan have yet to be published.

For comparison, the study design (including ethics) for the Corwin RCT was approved in 2012, and the results published seven years later. One of the recommendations from the 2017 Daybreak report, which also had a two-year runtime, was for a longer-term follow-up on families, which would be impossible to implement within another two-year restriction.

Further consideration must also be given to the number of families that would need to be recruited for an RCT. The Corwin RCT accepted 544 families onto the study, but only 287 (53%) were included in the final analysis. This was in part due to families in the control group exercising their right to an FGC, thereby excluding themselves from the trial.

While the resulting data was statistically significant (in favour of the inclusion of FGCs), the study limitations, including the inability to conduct a blinded trial and ensure objectivity, led to an authors’ statement that “these results should be interpreted with caution”. Surely the WWC does not seek to do the same.

With that in mind, perhaps it is better to design a trial that is appropriate for the practical and ethical realities of family group conferences and ensure success, rather than retrofitting into an RCT and producing another study full of caveats (a conclusion others have also reached).

A randomised control trial will never improve research rigour if the ethics are compromised and the design is flawed. There are many alternative options that the FGC portion of the £15 million DfE money could support, and I am confident the What Works Centre, academic community and family-advocate groups could work together to design a study that is robust and beneficial for all.

Michelle Janas graduated with a PhD in medicine in 2000 and is currently studying for a social work master’s at Oxford Brookes University.

6 Responses to Randomised control trials for family group conferences are a practical and ethical quagmire

  1. Richard Mc Kenny June 23, 2019 at 7:56 pm #

    Given that this article appears in a popular professional publication which has wide appeal within the profession, but is not subject to peer review, there is a burden on authors to weigh their arguments carefully, to be clear, accurate and represent others fairly. I do not think you do that here. You have made decisions in relation to the evidence you present and the arguments you marshal which are not a matter of the word count, so while you are limited by space considerations that does not explain all of the problems with the article.

    You provide a brief summary of some of the evidence concerning FGCs and point your reader to several resources. Some of these resources are descriptive summaries, some discussions, some reports of particular research efforts. It is important to attend to how you weigh these resources, and how you invite your reader to weigh them.

    Meta-analysis was developed first in the related field of psychotherapy research to help overcome the problems of selective and subjective interpretation of evidence. It is a powerful technique, not without limitations (all research methods have their limitations). Unless you are challenging the conventions of evidence as they exist now (in which case you should write something for a peer-reviewed journal specialising in scientific method), you ought to give most weight to meta-analyses, then single RCTs, then other designs. This is not about the importance of the research findings, but about trying to avoid certain kinds of subject bias: meta-analyses and RCTs often tell us very little, but they are a sound foundation for other research.

    You make a claim that David Wilkins has offered a critique of the meta-analysis you cite. This is not a fair account of his article. The publication of this meta-analysis prompted a debate on twitter and Wilkins offers a description of the debate, a survey of opinions within the field, before making some general comments about research. The effect of your description of Wilkins’s paper as ‘critique’ is to suggest that a well-respected UK researcher has provided grounds for questioning the findings of this meta-analysis in its own terms.

    You then cite one paper by Conwin and colleagues, reporting an RCT, which examines “caseworkers’ perceptions of families’ levels of social support”. This paper is part of a larger study, which includes reporting of an outcomes evaluation of FGCs provided as part of in-home support, as measured by both re-referral and out-of-home-placement (so moving beyond just looking at outcomes in terms of coming into care, or not):

    https://www.researchgate.net/publication/317141290_Effectiveness_of_family_group_conferencing_in_preventing_repeat_referrals_to_child_protective_services_and_out-of-home_placements

    Corwin and colleagues’ findings from this 2017 paper are in line with the meta-analysis you cite, that FGCs do not lead to better outcomes for families. I want to pay careful attention to how you describe the Corwin paper you cite, and the relevance of the one you do not cite.

    You say that “with reference to RCTs specifically, the results of a large US study by Tyler Corwin and others on the effectiveness of FGCs in active child protection cases have just been published. They add to the strong favourable discourse for including FGCs at the pre-proceedings stage.” Arguably this is misleading. The study you cite reports caseworkers’ perceptions of families’ levels of social support, while your description might be taken to imply that the report concerns outcomes (e.g. ‘effectiveness’, as measured objectively, in contrast to measuring ‘perceptions’). Corwin and colleagues do report on measures of effectiveness, as outcomes, in their 2017 paper, and find that FGCs do not make a significant difference to these. It is legitimate to argue whether out-of-home placement and in-home re-referral rates are the right kinds of measure of effectiveness, but you do not do this. For your description not to be misleading most readers would have to understand that by ‘effectiveness’ you intend to mean just what professionals think and I doubt this is the everyday understanding of this term.

    One could summarise the current evidence in the round as pointing towards the following statement: FGCs are a well-liked intervention, appreciated by families and professionals alike, however there is little evidence that FGCs make a significant difference to the outcomes for children who are at risk of coming into care, or who are in care. As you also point out, much of this research has been conducted outside the UK.

    It is not true to say that in the proposed (WWC) study a non-treatment or placebo group is planned. Treatment as usual in social research is not equivalent to using placebo in medical research contexts.

    Your discussion of the ethical difficulties that arise with TAU is in places misleading, in my view. For example, you state that in the Corwin study “the control group was offered a family team meeting instead of an FGC, but they were also able to override the study protocol and ask for an FGC.” By eliding two points you allow the suggestion that this overriding of the study protocol was by agreement with the researchers, that this somehow addressed some of the legitimate ethical concerns that arise with RCTs in social care contexts. In fact in the 2017 paper Corwin and colleges say that: “Additionally, families randomized into the control group could demand an FGC, overriding the study protocol. While this phenomenon is believed to have been rare and was identified through an anecdotal disclosure in a focus group of CPS workers, it could not easily be confirmed via administrative data and remains a limitation of this study.” In other words, the researchers did not intend this, and only found out it was happening by chance, and are unsure how often it happened.

    I think you are referring to this limitation when you state that: “although a researcher in an office might randomly assign the families to cohorts, the families will obviously know which group they are in, as will the professionals assessing them. Indeed, this was one of the major limitations of the Corwin study, and arguably negated its objectivity and status as an RCT.” It is important to be clear – this is not a problem with the ethics of the design of the study, but with the ethics of the practitioners delivering one of the interventions, some of whom appear to have been unclear, or uncaring, about the potential effects of their actions.

    Corwin and colleagues set out the key elements of a FGC as they see it: “FGC practice is generally distinguished from other meeting types by the utilization of an independent coordinator who: 1) implements the FGC process, including widening the family and community circle to participate in decision making; 2) organizes the family group to lead the development of the initial plan, including the provision of private family time; and 3) engages in follow-up and monitoring activities to support the family’s and agency’s progress toward achieving the agreed upon goals.”

    The TAU group intervention in this study is described as follows: “each control group family was offered ‘business as usual’ services which may or may not have included other meeting types, such as a Family Team Meeting (FTM).” They do not describe what a FTM consists of, saying that various styles of meeting exist in the area where the study took place. It is not immediately obvious that a family offered TAU would feel they were being “denied” a service (although it seems clear from the 2017 paper that some professionals felt this way).

    For TAU to operate as a control, it would seek to avoid the elements I have listed as 1) to 3) immediately above. It is important to note that 1) to 3) are the activities of an independent coordinator, and distinguishing TAU does not require, for example, the absence of the kinds of follow-up set out in 3). It is just that an independent co-ordinator would not do the follow-up in TAU. TAU, as ‘business as usual’ can be an active piece of social work, and not at all like a placebo. It is perhaps because the TAU in these kinds of study is an ethically sound piece of social work, that the effectiveness outcomes are disappointing (from the point of view of advocates of FGCs).

    In relation to how you discuss the difference between treatment and TAU, your argument at this point involves some circularity – you are assuming, without knowing, that FGCs are more effective than TAU. The meta-analysis you cite, as well as the discussions in Corwin et al, and elsewhere, strongly suggests that we do not currently know if FGC is more effective than TAU (it appears not), although, as I have said elsewhere, we might have stronger grounds for claiming that families and professionals like FGCs more than other kinds of meeting currently available to them.

    The rest of your discussion of surgical placebo, while bringing a certain drama to the piece, has nothing to do with a protocol which uses TAU.

    You state that “reporting for an FGC trial will always be subjective, unless one is crudely measuring whether a child remains in their family’s care or not.” The Corwin et al study goes beyond this in-home/out-of-home measure. There are any number of objective measures one could take, in relation to mental health, school attainment, etc. It is worth noticing that this claim (“reporting for an FGC trial will always be subjective”) applies particularly to the recent, 2019, Corwin et al paper that you pray in aid, and not to the 2017 Corwin et al paper, from the same study, that you do not cite.

    You state that “while RCTs might be considered the ultimate in data generation, they are time and resource heavy… the study design (including ethics) for the Corwin RCT was approved in 2012, and the results published seven years later.” Corwin et al (2017) report that “referrals to the study ended firmly on April 30, 2014. Because families were referred to the study on a rolling basis, re-referral and placement outcomes were tracked for families for a period between 14 and 32 months, depending on how early on in the study period a family received a referral to an FGC.” The more significant and interesting data was reported relatively quickly after the follow up period and in the more prestigious journal, Child Abuse and Neglect (https://www.scimagojr.com/journalrank.php?category=3323). You are referring to relatively unimportant data, reported later, and in the less prestigious journal.

    You say that: “further consideration must also be given to the number of families that would need to be recruited for an RCT. The Corwin RCT accepted 544 families onto the study, but only 287 (53%) were included in the final analysis. This was in part due to families in the control group exercising their right to an FGC, thereby excluding themselves from the trial.” The 2017 paper reports that “the final analytical sample contained 503 case records”. Your phrase, “exercising their right”, in the context of this study, is inappropriate. The protocol did not include any such ‘right’ and the research team were unable to determine how many times this happened, and so it appears that these families were not excluded. You do not say that Corwin et al (2017) reported that the “study protocol dictated that all families randomized into the treatment group would be offered an FGC, though many treatment group families (30 percent) did not receive an FGC. Some families actively declined to participate in an FGC, though there were other reasons that an FGC might not have been held as well. The most common reason cited for not holding an FGC was that a family simply changed its mind, followed by a family’s case being closed or transferred; other reasons included a family not being prepared or ready, agency concerns about safety, the inability to locate family members, or a family being unresponsive.” As the study used an intention-to-treat design, these families in the FGC group who did not receive a FGC were included in the data analysis. Even though a lot of families (perhaps 70%) seem to anticipate that engaging in an FGC will be beneficial to them, it is important to note that nearly one third the treatment group in this study do not, that some of these exercise their ‘right’ not to have a FGC, and as a profession we should attend to their needs as well.

    You say that, in relation to the 2019 paper, “while the resulting data was statistically significant (in favour of the inclusion of FGCs), the study limitations, including the inability to conduct a blinded trial and ensure objectivity, led to an authors’ statement that “these results should be interpreted with caution”.” There are a number of reasons why the results should be interpreted with caution, which I have referred to above, but not least amongst these is that the study is reporting professionals’ perceptions, not outcomes. The 2017 paper from the same study, which you do not cite, did not find that FGCs offer families a significant advantage on a number of objective measures. Blinding is not a relevant issue here, except to the extent that some of the practitioners seem not to have understood their responsibilities.

    I whole-heartedly agree with you when you say that “a randomised control trial will never improve research rigour if the ethics are compromised and the design is flawed”. In this case the ethics were compromised by practitioners, not by researchers. From the account given by Corwin et al there was nothing obviously wrong with the design (which as you note had been approved in the usual way).

    Of most concern to me is that the debate about research involving vulnerable families is conducted in the interests of those vulnerable families. This requires both sides of the debate to engage each other respectfully and using the best arguments. These requirements overlap considerably: respectful engagement is achieved via good arguments that acknowledge the case of made by the other and attend carefully to the current evidence base. In my view there is currently no strong moral obligation or imperative on the proponents of RCTs for FGCs to engage with their opponents, because the ‘other side’ have not put presented their case sufficiently well.

    • Michelle Janas June 27, 2019 at 1:44 pm #

      Thank you for your comments. This has clearly generated debate here and on Twitter. I would strongly defend the article as being, in a short-opinion piece, a reasonable and defensible exploration of a critique of the unthinking use of RCTs.

      I will not address each of your points in turn, but rather state that they are all debatable and I disagree with many of them. I shall leave it for others to read through the evidence and form their own opinions.

    • Robin Sen June 27, 2019 at 4:29 pm #

      Richard,

      You mention the need to be clear and fair. I think it would have been transparent for you to clearly state that you have an affiliation to the What Works Centre for Children’s Social Care (who are planning to conduct the RCT) within your comment so readers are aware: https://whatworks-csc.org.uk/person/richard-mckenny/

      Writing a comment that is almost twice the length of the original article is quite an astonishing response, coming on top of your Twitter request to Michelle to withdraw this article. You clearly feel strongly on the matter, and understand the peer review process. So why do you not instead author an article on the topic yourself, and subject your own views to the scrutiny that comes with this?

  2. Paul Montgomery June 25, 2019 at 1:17 pm #

    This article is helpful in opening up the discourse in this area which is good to see. However, there are some important errors that need correction.

    RCTs have achieved their high status in the evidentiary pyramid since they are the only design to effectively consider causality. Further, there is not yet sufficient evidence, particularly objective evidence of effect. While uncertainty exists, a trial is justified.

    The situation is that currently, high quality evidence is limited, but positive which is encouraging, particularly on ‘soft’ outcomes such as acceptability etc. However, top of the research agenda, as with all attempts to intervene (interfere) with people’s lives, is to ensure that we first do no harm. Currently, there is no good evidence ensuring that FGCs are, at a minimum, not harmful. This is concerning as it may well be that putting groups of people linked to a core of family dysfunction may have negative consequences. We should remember studies like the famous Cambridge-Somerville randomised trial which showed not only that this social work intervention did not work, but that for some, it lead to higher mortality, criminality and illness (hard outcomes) than for the boys in the control group who did not receive it. https://www.childtrends.org/programs/cambridge-somerville-youth-study Only a randomised trial can establish causal links and hence their importance in making policy decisions.

    The points made about blinding and allocation concealment are red herrings. It is, for example, possible to blind the assessors of the data to achieve a reduction in bias. What I think is more important here is to consider the options of the comparison group. If they are to be given ‘business as usual’ this would surely address many of the ethical concerns voiced here. Other strategies can also be deployed to ensure that the results produced are meaningful.

    Having said that, I would call for consideration of important aspects of future trials. While it is accepted that a rights-based approach is important, we need to balance this with understanding properly what works for whom and under what circumstances. This requires better stakeholder engagement in the approach that will lead to sensitive ethical research to improve the lives of children and families.

    Paul Montgomery, Professor of Social Intervention, University of Birmingham

    • Michelle Janas June 27, 2019 at 1:28 pm #

      Hi Paul,
      Thanks for your comments.

      I disagree that my opinion regarding the importance of blinding and allocation concealment are red herrings. To take an example from the medical field, in a trial to test a vaccine for malaria blinding would not be considered ethical (as malaria is a potentially fatal disease). Instead, what often happens in that whole communities are offered the vaccine and the disease rate/severity are compared to other communities that haven’t received the vaccine. The main point here is that these are not called, nor considered to be, randomised controlled trials. As I stated in the article, RCTs have very strict criteria.

      So, whilst I have found that the social sciences are keen to embrace the tools used in experimental medicine, the expected rigour does not always follow. The danger of this is producing data that is full of caveats, difficult to interpret and contributes little to the field.

      As you point out, consultation with the stakeholders is vital to ensure that an appropriate method is designed that is practically feasible as well as ethical.

  3. Lisa Merkel-Holguin July 5, 2019 at 8:24 pm #

    As one of the authors of the Corwin et al (2019) article and of the Hollinshead et al (2017) article, I think it is important to note that much scholarship has emerged from this one random control trial on FGCs (2011-2015). I will summarize these findings below and conclude with a few additional thoughts:

    Outcomes: The randomized control trial study examined whether a referral to a family group conference (FGC) was associated with re-referrals, substantiated re-referrals, or out-of-home placements among child welfare-involved families receiving in-home services. We found no significant associations between treatment and control group assignment and the three outcomes for the sample as a whole. However, some unique differences based on family characteristics, race/ethnicity, and types of service referrals were found. I think what is important to note here is how to interpret this result. The US federal government wanted to study the impact of FGC on families/children who had child welfare involvement but whose children were not placed in foster care. We anticipated the above noted result because placements are a low-frequency event for children/families receiving in-home services. In the United States, child welfare agencies typically implement numerous family meeting models (most which have minimal preparation, little to no family circle widening, and are facilitated within a 2 hour time frame). FGCs are not a predominant model. And so the question that this study illuminated is for families receiving in-home child welfare services (family preservation services), can you get the same outcomes by implementing a less intense “family meeting” model? Or, should FGC be preserved for children who have been placed in out-of-home care or are likely to be placed outside their family? FGC is far more resource intensive than the other models.

    Rates of referral: A sub-study examined data found substantial variation in caseworkers’ rates of referrals to Family Group Conferences (FGC). The results indicate that time in current position and perceptions of supervisor competence and leadership support were significantly associated with a worker’s propensity to refer to FGC.

    Workers’ perceptions of FGC effectiveness: Another sub-study found that worker attitudes about FGC effectiveness are a product of attitudes towards families, type of work responsibility, and the perception of resources or services in the external environment.

    Social Support: Families in the treatment group and those that received a family meeting were significantly more likely to have their caseworkers report greater improvements in their social support. Caseworkers’ perceptions of improvement in social support were also significantly associated with the number of children listed on the case record and the county from which families were referred. Yes, it is a caseworker’s perception of improvement in social support (and not the families). If we believe that caseworkers have relationships and knowledge about families to make the decision to close out child welfare involvement, then their opinion around social support would be formulated by that relationship. I’m unsure of how many FGC studies have tried to unpack (statistically) the differences in social support. In my opinion, this is an incredibly useful finding as it provides partial confirmation of one of theories behind the FGC. That is, if you widen a family’s network and position them as decision makers, will your grow their social support network.

    Children’s participation: Descriptive data from a small sample of child and young people participating in FGCs suggest differences in their perspectives regarding family empowerment, transparency and inclusion in decision making, when compared to the perspectives of other family members and professionals for whom data are available. Children and young people had lower levels of agreement about their FGC experiences in these areas.

    Implementation: Any study will need to measure fidelity. Was the FGC implemented as intended? What are your core program components (widening the family circle, preparing them, private family time, agency deference to the plan generated by the family, agency/family resources provided)? We have found this is a challenge but necessary to understand what was implemented. Finding and partnering with an authority implementing FGCs is also a critical decision–one that likely impacts the results. At what stage of implementation is the authority with their FGC practice? How well-established or installed is the FGC in the agency/community? How skilled or experienced are the Coordinators in their roles? How open and receptive are the referring workers to being led by the family, or do they provide lip service of agreement, but work behind the scenes to maintain all control? What services do families receive if they participate in FGCs vs. not? Really, the list goes on, but the point is that there are so many contextual factors within child welfare and community services, that putting your eggs in the RCT basket is a risky proposition and perhaps not what is most needed to understand how this decision-making model impacts children/families/agencies/communities.

    In the United States, our US government–rightly or wrongly–is privileging RCTs to develop evidence for all child welfare interventions. Let us remember that the FGC was developed from a rights-based framework….that families should be the nexus for decision making, that families are the system to care for and nurture their own, that families, rather than agencies/authorities, are best positioned with their knowledge and expertise to make these decisions, that it is the responsibility of the authority to widen the family circle and involve them in decision-making, and that it is the responsibility of the local authority to resource plans that emerge from the FGCs.

    It is an approach that deconstructs the patriarchy and oppressive tendencies of child welfare systems. It clearly challenges the orthodoxy, and attempts to create a family-centered, if not, family-driven system. Privileging the voices of children and families who experience child welfare systems in developing the FGC research agenda, given the rights-based genesis, is in my opinion one of the most significant research contributions going forward. I wonder what opinions they would have about this debate and how to measure the effectiveness of FGC?