Peer-reviewed article

Families and Schools Together (FAST) for improving outcomes for children and their families

Jeffrey C. Valentine, Stephen M. Leach, Allison Fowler, Diana Kuo Stojda, Geraldine M. Macdonald · 31 Jul 2019

Abstract

Background Parents and carers have a major influence on children's learning and development from birth, through the school years, and into adulthood. Parental contributions to education include providing a secure environment in which to learn, providing intellectual stimulation, transmitting social norms and values, shaping the child's resilience through fostering literacy and problem‐solving, and encouraging personal and social aspiration. Increasingly, providers of formalised education are recognising the primary role of parents, carers, and the wider family, as well as peers and the environment, in shaping children's education, health, and life experiences. Objectives To assess the effectiveness of the Families and Schools Together (FAST) programme in improving outcomes among children and their families. Search methods Between October 2018 and December 2018, we searched CENTRAL, MEDLINE, Embase, PsycINFO, 11 additional databases, and three trial registers. We handsearched the reference lists of included studies and relevant reports and reviews, contacted the programme developer and independent researchers, and searched relevant websites to identify other eligible studies. Selection criteria We included randomised controlled trials (RCTs) and quasi‐RCTs examining the effects of FAST, relative to waiting list, usual or alternative services, or no intervention, on outcomes for children (aged from birth to completion of compulsory education) and their families. Data collection and analysis At least two review authors independently evaluated the records retrieved from the search for relevance. One review author (JV) extracted data from eligible studies with a second independent review author (AF, DK, or SL). Review authors consulted with one another to resolve disagreements. We used a fixed‐effect model for meta‐analysis. We presented results as standardised mean differences (SMDs) because all outcomes were continuously scaled, and we accompanied these with 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence for each outcome. Main results We identified 10 completed RCTs, most of which were relatively recent (2007 or later) and were conducted with at least some involvement from the intervention developer or the FAST organisation. Nine of the 10 trials were from the USA; the other was from the UK. Children were young (five to nine years old; mean age approximately six years), and therefore, whilst not so named in the reports, evaluations consisted of what is sometimes referred to as 'Kids FAST' and sometimes 'Elementary Level FAST'). Among the USA‐based studies, at least 62% of participants were members of a racial/ethnic minority group (most commonly, African American or Latino). FAST was usually delivered in schools after the school day. Trials lasted about eight weeks and usually examined the effects of FAST relative to no additional intervention. Most studies were funded by agencies in the US federal government. We judged the certainty of evidence in the included studies to be moderate or low for the main review outcomes. Failure to include all families in outcome analyses (attrition) and possible bias in recruitment of families into the trials were the main limitations in the evidence. We included over 9000 children and their families in at least one meta‐analysis. The follow results relate to meta‐analyses of data at long‐term follow‐up. Primary outcomes Four studies (approximately 6276 children) assessed child school performance at long‐term follow‐up. The effect size was very small, and the CI did not include effects that, if real, suggest possibly important positive or negative effects if viewed from an individual perspective (SMD ‐0.02, 95% CI ‐0.11 to 0.08). We assessed the certainty of evidence for this outcome as moderate. No studies assessed child adverse events, parental substance use, or parental stress. Secondary outcomes Parent reports of child internalising behaviour (SMD ‐0.03, 95% CI ‐0.11 to 0.17; 4 RCTs, approximately 908 children; low‐certainty evidence) and family relationships (SMD 0.08, 95% CI ‐0.03 to 0.19; 4 RCTs, approximately 2569 children; moderate‐certainty evidence) also yielded CIs that did not include effects that, if real, suggest possibly important positive or negative effects. The CI for parent reports of child externalising behaviour, however, did include effects that, if real, were possibly large enough to be important (SMD ‐0.19, 95% CI ‐0.32 to ‐0.05; 4 RCTs, approximately 754 children; low‐certainty evidence). Authors' conclusions Given these results, it is hard to support the assertion that assignment to FAST is associated with important positive outcomes for children and their parents.