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Signs of Safety: Findings from a mixed-methods systematic review focussed on reducing the need for children to be in care


• To consider whether, how, for whom and under what conditions Signs of Safety works to safely reduce the number of children entering and re-entering care, and/or to increase the number of children re-unified with their family.


• A mixed-methods approach is used: a quantitative assessment (using traditional systematic review methods) of whether Signs of Safety works to reduce the number of children in care is combined with an exploration of the mechanisms associated with effective delivery, and the contexts under which those mechanisms may operate (a realist synthesis).

• The review uses the EMMIE framework, which considers Effect; Mechanisms; Moderators; Implementation; and Economics.


• Effect – There is little to no evidence to suggest that Signs of Safety is effective at reducing the need for children to be in care. This reflects a limited evidence base, with few studies and none of a high quality for drawing conclusions about the impact of Signs of Safety on this outcome. Lack of evidence is not the same as evidence that Signs of Safety does not work to reduce care. Nor does it establish that Signs of Safety does not have other possible positive outcomes.

• Mechanisms – Evidence suggests that Signs of Safety can lead to positive engagement with parents, children, wider family and external agencies. The most commonly assumed mechanism through which Signs of Safety improves child safety is the development of shared understanding of and responsibility for minimising risk to children, primarily through the development and use of safety plans and safety networks. A programme theory drawn from the literature outlines the mechanisms that enable and follow from this main mechanism to improve child safety.

• Moderators – Key moderators of the development of a shared understanding of and responsibility for improving child safety relate to the contexts that enable relationship building and collaboration between children, parents, and social worker. A key moderator emerging from the review is that parents need to trust and collaborate with social workers if they are to develop a sense of shared responsibility for minimising risks to children.

• Implementation – Signs of Safety recognises the importance of whole organisation change to create a culture that supports social workers to practice with families. The review identifies key barriers and enablers of implementation. There is huge variation in how Signs of Safety is implemented and limited specification of how it is possible to be sure high quality Signs of Safety is being delivered. In part as a result of this, it is not possible to identify from the research evidenced examples of successful and sustainable implementation.

• Economics – The review found no evidence of sufficient quality to analyse for cost effectiveness.

The realist synthesis of mechanisms, moderators and implementation in the literature enabled the development of a programme theory outlining the central features of Signs of Safety when delivered well. Specific gaps were identified in the literature and therefore in the programme theory in relation to how Signs of Safety proposes to work, for instance how to mobilise the wider family.

We use the programme theory to develop practice-focussed summaries that are intended to help those involved in policy, practice or research to think about how to monitor the quality of Signs of Safety; specific behaviours in parents, children, families, and other workers that suggest whether Signs of Safety is ‘working’ and suggestions for how to troubleshoot when expected behaviour change is not observed.