Regional variations in care planning

A child in a particular area of Northern Ireland has a bigger chance to be placed for adoption (or to return to their birth parents, or to be fostered by relatives) than a child in another area with similar background and characteristics. That is what we found in previous phases of the Care Pathways and Outcomes study. This is concerning because it shows evidence of a ‘postcode lottery’ in relation to placements. Thus, we then became interested in exploring the reasons behind the regional variations in care planning in Northern Ireland. This is how the Regional Variations study came about.

As part of this study, between January 2015 and May 2016, we conducted focus groups with senior managers in each of the five HSC Trusts in Northern Ireland. They were broken into three different parts: general questions regarding placement policy and practice, a vignette, and a presentation of preliminary findings from a case file review we also conducted as part of the study. We have just published an article in the Journal of Qualitative Social Work on the findings in relation to the general questions part of the focus groups.

In this article, we developed an ecological model of decision-making in care planning based on our findings. The model identifies three levels of factors that might lead to regional differences in care plans, when the characteristics of the individual case or child are similar. The three levels refer to:

  • individual and team factors – including social workers’ individual and team judgements, practice mindsets, and confidence defending their decisions;
  • regional practice factors – including local practices, initiatives, guidelines, projects, structures and resources; and
  • global context factors – including the influence of the Courts, other professionals’ mindsets, and the socio-economic and cultural context in each area, such as poverty, migration, sectarian issues, etc.

We found that decision-making processes in care planning were influenced by a range of factors within these three levels. The findings also suggested that only the policy framework or philosophy in relation to care planning was basically the same across the whole region, but most of the other factors differed to some point in the different HSC Trust areas, particularly in relation to practices, structures, mindsets, socio-economic contexts (rural/urban, migration, poverty, sectarian issues, etc.), and Courts’ influence. For instance, judging by the views expressed by the focus group participants, three of the Trusts had a very clear adoption focus, which was noticeable in their mindsets, practices, structures and initiatives, while that was not there in the other two Trusts.

Children should have the same opportunities and be treated equally, and any postcode lottery regarding their placements is an infringement of their rights. Therefore, we believe clear regional policy and guidelines should be developed and implemented, taking into account the differing socio-economic and cultural characteristics of each area.

To download a copy of the article accepted for publication (not journal edited version), please click the link: Fargas-Malet, M. & McSherry, D. (2018). Regional Variations in Care Planning in Northern Ireland: Proposing an Ecological Model of Decision-Making. Journal of Qualitative Social Work. Early online date 05/11/2018

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Project Update 6: The well-being of care-experienced young adults in Northern Ireland

We have talked to 50 care-experienced young people and/or their parents or carers now. Last week, we presented a taster of what we have found so far in an international conference on family welfare in the beautiful city of Porto (EUSARF 2018). One of our presentations was in the form of a poster, focusing on a range of issues connected to wellbeing, such as mental health, life satisfaction and self-worth. You can find the poster here in this blog post (although it’s a bit too small for all the writing to be read). The full size poster can be downloaded as a pdf here.

We found that young people appeared to be doing reasonably well in terms of general health, with most parents or carers considering the young people to be in a very healthy or healthy overall state of health. However, there were some concerning findings in terms of their mental health. We found that 15 out of 48 young people (31%) had either self-harmed, had suicidal thoughts or/and had attempted suicide. These were spread across all the types of placements: four adopted young people, three who had been/were in long-term foster care, four who had been/were in long-term kinship care, three who had been subject of a Residence Order, and one who had been living with a birth parent. In addition, 18 were suffering or/and had suffered from anxiety or depression (38%). We also found that seven out of 32 who had completed a self-concept scale (22%) had low scores, meaning they were unsure of their own self-worth. We also found that some young people had an apparently low level of life satisfaction, with young people who were/had been in either long-term foster care, or long-term kinship care showing the lowest means, with 5.6 and 6.6 respectively in a scale of 0 to 10 (0 being the lowest).

We found that a range of challenges could tip the balance of wellbeing. These included bullying, bereavement of close relatives and friends, unemployment and family rejection. On the other hand, some factors were having a positive impact, including sense of belonging to a family, becoming a parent, support from friends and family, employment, and therapeutic support. We are going to expand on these different factors in future blog posts, and as more young people and their families take part in the study.

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Project Update 5: Youth’s experiences of (and future expectations of) parenthood

Care-experienced young people are more likely to become parents at an early stage of their lives than children who don’t have any experience of care. Some research has been carried out on care-leavers parenthood experiences, but the subject of adoptee’s experiences of becoming a parent has been identified as a very much under-researched area. However, it is a topic that has started attracting more attention. I recently attended ICAR 4 (International Conference on Adoption Research) in Montreal, and one of the sessions I went to was entirely dedicated to this topic, and led by Professor Elsbeth Neil from the University of East Anglia. She has recently received funding to run a study on the experiences of adoptees who become parents, and adoptive parents who become grandparents. We are looking forward to hear more from this very important study, and in this short blog post, we’d like to share what we have found so far in our study in terms of parenthood experiences, but also future expectations of parenting.

So far, 47 young people (aged between 18 and 23) and/or their foster/kinship carer/birth/adoptive parent have been recruited into the study. Of them, nine (19%) are parents (3 were in foster care, 2 subject to RO, 2 in kinship foster care, one adopted, and one living with birth parents) and another two girls (one in kinship, and one subject to a RO) reported being pregnant with their first child at the time of the interview. Five of the young parents were girls and four were boys. Their circumstances are quite varied. Only one of them was adopted, and her child was currently being cared for by the child’s adoptive grandparents. Five were living with their children, and the three who were not, visited them regularly except for the adopted seventeen-year old, whose visits to her adoptive home were sporadic and irregular. She became pregnant at 14 years old, and at least two others had been as young as that too. In the case of the other two fathers not living with their child, the child’s mum was the one living with the kid. One young dad had lived with his child and girlfriend but the boy had tragically died when he was two, and at the time they were expecting another baby. Only one of the young parents had two children, the other eight had one.

All the six young parents who we have talked with so far (in the 3 other cases, we only talked with their carers/parents) identified their children as key people in their lives, talked warmly about them, and were overall happy to be a parent. They described becoming a parent as a key positive turning point in their lives.

“When I woke up [after the C section] and they said ‘Look, it’s a boy’, I was like ‘Get him away, I am too sore. Give me medicine’, but yeah, that was the happiest time. Because then I finally found, you finally find what true love is when you have a baby, you know.” (Anna, 20 years old, raised in foster care)

They were all trying to do the best they could for their children. They reported that their families (either being foster, adoptive, birth or kinship) were very supportive and loved their child. Despite that, some also talked about the challenges of being a young parent. For instance, Belinda, who was raised by her grandparents, became pregnant at 14, and had a four-year old daughter. She had moved out of her grandparents with her child, but visited her grandparents every day. She said that she liked being a parent but also talked about it as being demanding for a young person:

“I think with having a wee girl not being able to go out as much with your friends and I do find it difficult to get her minded. …”

Other young people who were not parents themselves talked about their expectations for the future. Most focused on career and job aspirations, but a few also talked about having children in the future. For instance, James, who was living with his foster parents, when asked directly if he could see himself having children, he answered that not at this time, not until he felt ready to look after one:

“I don’t want a child yet, not until I am stable. Because I have always said I don’t want to bring a child into somewhere where I can’t look after it the way no one could look after me. So I want something there for my child, to give it everything that I was never given. I have always said that from day one.”

Janette, who was also raised in foster care, and still visited her foster family every day, said that she had always wished to be a mother someday. However, she had this fear that her parenting would be scrutinised by social services, as she was in care herself:

“I’ve always had that fear because I’ve been in foster care, I’ve always had that fear that my child might be or I might be absolutely tortured by social services, and my boyfriend is going ‘Wise up! You’ll not, they’ll not torture you’.”

This is just a wee summary of what we have found so far, but we are expecting to be able to update that post in a year’s time with a lot more experiences of parenthood for our group of young people. Hopefully, we can then make comparisons with findings from other studies, like the ‘From care, to adoption, to parenting’ study, mentioned at the start of this post.

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Photo credits: Photo 1 by Freestocks on Unsplash; Photo 2 by Katie Emslie on Unsplash

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Project Update 4: The 3 THINGS that are HELPING care-experienced young people COPE with difficult experiences in their lives

Care-experienced young people often have to deal with a range of negative experiences and difficult/challenging emotions, which many of their peers might not have to deal with (e.g. abandonment, rejection, birth family histories of alcohol/drug abuse and domestic violence). In addition, many are dealing with other difficulties that their peers might also be experiencing, such as bereavement, bullying, ill health, financial pressures, or difficulties finding a job.

So far, we have recruited 47 young people into the study (that includes cases where we have only been able to talk with their parent/carer). This post focuses on the 30 cases where we have been able to do a face-to-face interview with the young person. Of these, seven have experienced the bereavement or/and life-threatening illness of a close family member, and eight have told us about their experiences of being bullied. For most of these young people, these experiences have had a big impact on their lives. In a few cases, it has even led to a placement disruption or strained relationships. In the case of bullying, these experiences had a serious impact on the young person’s formal education and school experience, with most of the eight missing/not attending or giving up school altogether. Schools appeared largely unable to deal with this bullying.

For example, Carl was in foster care when his birth brother died at the age of 10. A year later, his foster father died, and shortly after, his birth granny also died. He was very close to all three of them, and they all died in the space of three years. The grief he experienced led to his behaviour becoming more challenging. As he says, he was “really angry”. That led to the eventual breakdown of the placement, although the relationship with his foster mum continued over the years, and he still considers her his mum.

William was bullied when he was in secondary school, and felt the school did nothing about it. Their attitude was that if there was no physical violence it wasn’t happening:

“Leading up to that, I was always bullied. Everybody knew I was adopted. […] And that was a very, very big part of it. […] Physical, verbal, emotional… It was a bit about my height, that type of stuff. Because I was quiet as well … In fact, there was a point where I got bullied to the point where I exploded in second year. And I got into very big trouble and I wasn’t suspended or anything but mum took me out and wanted to self-teach, so that was for a good couple of months, and then I had to go back.”

Maeve, who lived in kinship care (first with granny and then with uncle) was also bullied throughout secondary school, and she also stopped attending school, and got tutored instead:

“For sixth year, I didn’t go to school from October right through the end of the year. I went to school about a handful of times and that was it. […] I would have got bullied for being like… posh. People thought we were quite stuck up because we didn’t speak like… you know, and stuff like that. […] I was going to sports groups like outside Belfast so they didn’t have the accent, and then I was just mingling with other types of people, whereas here it was different.”

We have found that the young people interviewed so far have been able to cope with these difficulties using mainly three particular resources:

NUMBER 1: Long-lasting supportive family relationships or/and friendships

For most young people interviewed, their (foster, adoptive, birth) parents or carers and other family members were very important to them, and they relied on their support when dealing with difficult experiences. Many referred to their friends or girlfriends/boyfriends too. When asked how they coped with difficulties in their lives, they often mentioned talking with specific family members and/or friends.

For instance, Madeleine (20 years old, adopted) talked about the support she received from her adoptive mother while looking for a job:

“… like at the minute the way I’m like looking for a job like they (my adoptive parents)’re so supportive and like my mum comes with me to interviews and stuff just to calm me down you know and things like that there like they do everything for you if you need something they get it for you even if you need the money they give it to you…”

Edgar (20 years old, was in foster care), who was struggling with a range of issues (e.g., drug addiction, mental health, disability), told us that he still relied on his foster dad for practical support (although he had left the foster placement over 7 years previously):

“My dad took me to a hospital appointment this morning sure. […] Down there at f*cking quarter to eight!”

James (21 years old, foster care) suffers from anger issues, and when asked about how he copes, he answered:

“Going out with my mates and having a laugh, or going for a walk, going for something to eat. […] well even if they do [ask you a million questions], we will turn it into a joke and slag each other about it. And that’s not a bad way, I find that a funny way like if my mate started slagging me about it, I would start laughing.”

 

NUMBER 2: Professional help (particularly, the continuous support of one particular practitioner)

Some young people mentioned psychological help, and highlighted the role of particular counsellors and psychiatrists in helping them cope with their mental health difficulties.

For instance, Maeve was first referred to a counsellor after she attempted suicide due to bullying and other difficulties in her life. Even though it took her some time to open up to the counsellor, she eventually did:

“like at the start it wasn’t constant, I seen her for about a year and I didn’t really tell her anything and I didn’t actually like her because she was always so positive all of the time […] But then it got to a point […] I was like ‘look I really don’t know who to talk to’.  I didn’t have all my friends, well I wouldn’t have been this close with them and then it was just like, ‘I need to go back’. So I went back and got on really well with her and chatted away to her. Before that, it would have been my friends, I wouldn’t really talk to my nannie or [my uncle], not that they wouldn’t have helped me but I would just have felt uncomfortable explain myself to them, but I know fine rightly that they would have helped me and been understanding, but just you know when you are a bit embarrassed about sensitive subjects.”

She explained the importance of having her counsellor as a constant in her life, somebody she could rely on in the case she needed it:

“… like my counsellor now, she stops seeing people when they turn 18 but I am 19 and I was just like please… I spoke to my PA and my social worker before I turned 18 and I was like, the thought of… not that I need it, but just the thought of going, if I needed help again, to having to go to someone new, it is just not going to work. It is better to have a constant. It is not that I am completely reliant on her, like I hadn’t seen her all summer until today. Today was the first time I seen her since June”

 

NUMBER 3: Hobbies (and/or keeping busy) and work

Robbie Gilligan’s research has focused extensively in this area, and it has evidenced how a positive experience of ‘work’ can have a transformative effect on care experienced young people.

Killian (living with Residence Order carers) worked as a lifeguard in the leisure centre for about a year, and remembers his first rescue as ‘phenomenal’. His work gives him a ‘buzz’. He works in the ambulance service. He really enjoys it. He has worked since he was 14 (started washing cars as work experience at school, and he was kept after the work experience).

Mary (living with birth dad) also described getting her job as a nurse in the hospital as one of the experiences she felt best about:

“Because I have sort of been, like most of the people I have been brought up around don’t really work, and I don’t want to, that is not my outlook on life, I want to be the complete opposite and work hard. … I feel like, I love nursing, I love looking after people. I just feel that you can’t just be a nurse for the job you have to enjoy it.”

Some young people were particularly involved in certain sports or hobbies, and found that it really helped them in terms of their wellbeing and mental health. Young people referred often to ‘keeping busy’ as a means to cope with the daily stresses and worries in their lives.

When we asked Brandon (22 years old, was in foster care) how he coped with his anxiety, he replied:

“Just trying to get out of the house, just try and keep myself active. Aye, even if it’s on my own. Like when I’m down, I don’t want to be in company, but I like to keep myself entertained. So I will go climb a mountain, or go to the gym, just keep myself active. […] You have to keep your mind occupied and stuff.”

These might sound like obvious things. However, we believe it is useful to highlight their importance in helping young people cope. We want to make policy-makers aware of the ability of these key resources to turn youth’s lives round, so they then focus on developing effective policy and practice strategies to enable care-experienced young people to access these assets. Examples of that would be:

  • helping youngsters maintain positive relationships with caring adults during/after leaving the care system;
  • enabling long-lasting relationships between practitioners and young people; and
  • providing young people with a range of opportunities to access jobs and sporting/artistic regular activities.

Picture and icon credits: 

First photo by Ben White on unsplash.org; Second photo (on number one: relationships) by Bewakoof on unsplash.org; Third photo (on number two: professionals) by Serena Wong on Pixabay; Fourth photo (on number three: sports) by Jeffrey Lin on unsplash.org; and last photo (open door) by Alexander Rumpel on unsplash.org.

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Project Update 3: Birth family contact and searching for young people who entered care at a young age

Contact with the birth family is a very complex issue for children with experience of the care system, as well as for their parents/carers and for Social Services (making decisions about them). There is plenty of research focusing on this topic, but less is known about what happens when they reach adulthood, and how relationships evolve. With the growth of social media, searching becomes easier for young people and relatives, and different issues emerge from that.

Photo by daria nepriakhina on unsplash

As said in the previous post, we are only in the early stages of data collection (having recruited 43 families up to now), but from the data collected so far, we are starting to see patterns emerging, with young people falling into different categories. To date, we have identified the following groups (with some young people falling into more than one category):

Contact 1

The CONTENT group involves regular ongoing contact with specific members of the birth family, which does not involve any major problem for the young person in terms of their feelings of belonging to another alternative family and their identity. Many of the young people in this group would have grown up in kinship care.

For instance, Belinda (20 years old), who was raised by her grandparents and now lived in her own flat with her two-year-old child, was still in touch with her birth dad, and was content with this relationship. She was closer to her grandparents, but was able to visit her dad when she pleased.

“I still see my dad and stuff and obviously his kids, like my brother and two sisters but I would be more close with my nannie and granda. I still would call up and see him the odd time but…”

Contact2

The CURIOUS group refers to feelings of curiosity towards the birth family, which have led the young person to search for a particular birth family member or members (mostly on social media), but has not led to any direct action to make contact with them.

For instance, Julie (21 years old) was adopted at a young age and searched for both her parents on social media:

“I think more whenever it comes to my looks, … I was like ‘I want to find her [my mum] because I want to see do I look like her then, and I think it was more the curiosity of like looking like your family that’s where it came from. Because I like the way [adoptive sisters] can go ‘oh you’ve got mummy’s’ and ‘You’ve got daddy’s’, but it’s like a small thing. But then I was like ‘I wonder where I get mine from’. I don’t think it was about them but I think it was more a selfish thing, where I wanted to know what I look like, why I look like that.”

Anna (19 years old) grew up in foster care, but has a little brother (aged about 15 or 16), who was adopted, and she has searched for him on social media:

“… he has accepted a friend request on Facebook and stuff but I haven’t done anything else, do you know that way. Because I wouldn’t want to put him in a situation if he doesn’t know yet. … like I haven’t texted him or anything, because I would rather wait until he would text me, because I wouldn’t want to lay it on him in case he doesn’t know.”

When asked about the reasons for searching for him, she said:

“just to see what he looked like, and what he was like. Like obviously I could see from Facebook that he had the best of clothes and he has a good life you know that way and he is doing well and he has grew up in a loving home as well.”

Contact3

The NO INTEREST group included young people that have no interest in the birth family at the present time, although there might have been contact whenever they were younger which eventually stopped as they got older.

For instance, Fionn (18 years old), who was adopted at a young age, would have asked questions about his birth family when he was younger. The adoptive parents had letters and photographs of the birth family, and they would have shared them with him. By now, he had reached 18, and the adoptive parents had told him that he could make contact with his birth family if he wanted to, but he did not want to talk about it.

“I have never seen them… I have never really thought about it … knowing about your past and birth parents isn’t important to everyone … I am not sure, for me it may not be important but for someone else, I don’t know. ”

Contact4

The SEARCHED AND FOUND BY RELATIVES group involves birth family members searching for the young person (sometimes through social media) and getting in touch, often causing difficult issues and complex feelings for the young person.

For instance, Nichole (19 years old), who was raised by her foster carers on a Residence Order, felt a lot of anger towards her birth family, and expressed a complexity of feelings. Some of her birth family members had contacted her in a myriad of ways.

“My dad added me in Facebook when I was like 16. And then a few of his sisters added me, and his ma and da added me. … I had a big fight and argument with my dad, I had a lot of anger on him, it actually kind of felt good but there was a lot of anger. … Not really knowing anybody and then getting a lot of messages going ‘oh, we miss you’ and all and then I was thinking ‘you knew where I was and I don’t even know yous’, I was ‘No, I won’t take any of that … It’s really hard to explain, it’s like mixed feelings, you don’t know how you are feeling and then you think about it, and then that’s when you start getting angry, when you think about it.”

Contact5

The MAKING CONTACT IN THE LATE TEENS group included a few cases where the young person made contact with a birth parent (or the other way round: the parent made the contact) as they turned 16, 17 or 18 (without the foster/adoptive family’s knowledge), and in some cases, this led to the young person living with their birth parent for a short period of time.

For instance, Aaron (21 years old), who has severe behavioural and mental health difficulties, went to live with his birth father when he was 18, but came back to live with his adoptive family after a couple of weeks. His birth father had started suggesting to him to go back to live with him when he was 16 years old, as his adoptive mother explained:

“When he was between 16 and 18, dad started to be in touch all the time, wanting him to come and live there. … He lived in [town] with his new wife. Although we have always had contact, and it has always been fine. Suddenly, when Aaron turned 16, Aaron started getting Facebook messages ‘Come and live with me’. At that time, Aaron was taking legal high drugs. And whenever we were trying to put consequences, Aaron would come in and say ‘My daddy said everybody does it, I can come down and live with him’. So we contacted Social Services, and a girl came down and spoke to Aaron, and Aaron said ‘I don’t want to go and live with him. He’s putting a lot of pressure on me’. So they went down and spoke to dad. They had told us they could put in place something with the police to stop him annoying Aaron but after they spoke to dad, they said ‘Oh dad said that’s fine, he’ll leave it’, but he didn’t. He did it sneakily, he was contacting him at night time through Facebook, through Messenger, he was phoning him… it sort of made it more sneaky…. So that went on for two years. For some reason, dad thought that when he was 16, he could leave.”

So, eventually, at 18, Aaron did go to live with his birth father, after arguing with the adoptive parents over drugs. He kept in contact with the adoptive family, and after about two weeks, he wanted to come home back to them. His birth father had sold all of his Christmas presents for money, and he also stole all of his money that his birth relatives had put for him in the Christmas cards. For those two weeks, Aaron and his dad abused alcohol regularly.

 “I have stayed with him a couple of weeks but every time he was going ‘Aaron come on we will go down to the bar’ ‘Aaron give us twenty quid and I will go up and get us a round’ and he was going up and he was going up and getting a round and setting it on the table and the next thing, I give him twenty quid, where is the change?”

Similarly, William (22 years old) went to live with his birth family just before his 18th birthday for six months. In his case, he went to live with his birth mother at the same time as his older brother, but remained in close contact with the adoptive family.

“Curiosity mainly drove it. Just to see … what it was like. … It just happened. I can’t even describe how it happened because it happened so quickly. And I’ve put it … to the back of my head really. … [My birth mum] had repeat alcohol abuse. She said she was clean for so many years, but she was still going back to it. I didn’t know about this, but she had a younger son, who was 14, 15 at the time. … We got on at the start. But the way I see it is that he was putting on an act and then he started to show his true colours and then it was just worse, worse, worse. … [My return] happened quite abruptly. I was always told the door was open when I want. It kind of happened like that really, like a click of a finger. I had to call the police to get myself removed. It was that bad. One day, I was like physically being kicked out of the house for turning around and saying ‘there’s a social worker here, can you come back to the house?’ … And there was social workers for the younger brother involved then. So they’d arrived, she was nowhere to be found… I rang, she said ‘right, leave it. Just tell her to go away’. She couldn’t go away. I rang again and she goes ‘blip, blip, blip’, and I goes ‘right, get back here now’, and she came back and all hell broke loose basically.”

These are the main diverse contact and searching experiences we have come across within the study to date. Each category is representative of at least four of the young people we have interviewed so far. We will update this blog post later on in the study.

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Picture and icon credits: Icons in the pictures made by Freepik from www.flaticon.com

First photo of postboxes by Daria Nepriakhina on unsplash.org; Content group photo by Ben White on unsplash.org; Curious group photo by Bing Han on unsplash.org; No interest photo by Jesse Schoff on unsplash.org; Searched and found photo by Joseph Rosales on unsplash.org; Making contact in the late teens group photo by Freestocks.org on unsplash.org.

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Project Update 2: Placement disruptions are often not the end of the relationship

This post is a quick update of an aspect that appears to be coming through from our fieldwork so far. We are only at the early stages, and going back to the families that took part in the previous phase of the study, which was focused on long-term placements.

UPDATE 2.RESIZED

We have visited 42 families so far. The young person and the parent/carer took part in 29 cases, and in the rest, it was only the parent/carer who completed the survey. Of these 42 families, nine had suffered a placement breakdown or disruption, and in one case, the relationship collapsed after the young person (who was adopted) turned 18, and the young person left as a result of that. Of the nine placements that had disrupted, four were long-term foster care and three were kinship placements. The rest were one adopted and one living with birth parents. In two other adoptive placements, the young people went to live with the birth family for a short time when they were 17/18 but moved back to the adoptive family immediately after. However, what we found interesting was that in seven of the nine disruptions/breakdown cases, the relationships continued, despite (in most cases) the young person not living in the family home for several years.

MOVING

Much of the research in placement breakdowns in foster care and adoption disruptions has focused on risk and protective factors and on how to prevent breakdown and disruption. However, there is a gap in the literature in terms of what happens after a breakdown or disruption of a long-term placement occurs. Does the relationship with the young person come to an abrupt close, or does it go on? If it does go on, how does it continue?

We were somewhat surprised at the ability of foster parents to maintain the relationship with the young people they cared for, but it should not be entirely surprising that after 10 or more years, young people and carers cannot just make feelings of love and belonging disappear. This has been discussed in the media when talking about contact between children and foster carers. Edgar (not his real name) left at 13 years of age, as his extremely problematic behaviour was endangering the whole family. However, his foster parents stayed in touch with him as he moved to various residential care homes, ended up in hospital, and recently moved into rented accommodation. His foster father visits him regularly, and Edgar, now aged 21, calls him every night. Similarly, Carl’s (not his real name) long-term foster placement also broke down when he was 13, and went to live with his birth family, then moved into residential homes, and is now living with his partner and own child. He visits the foster mother, is present in family events, and they keep in touch on the phone. He still calls her mum.

jesus-rodriguez-332039-unsplash

We all know that adolescence is a time full of difficulties, and placements, even long-term ones, are more likely to disrupt at that stage. However, we should not assume that because young people leave the family home, this would mean their feelings of belonging to that family cease to exist, and that their bond will be lost forever. We have witnessed the emotional bond that long-term placements can foster, which can be extremely powerful, given the huge difficulties they have to overcome.

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Project Update 1: The long-term stability of placements for young people who enter care at a young age

Stability is defined as the strength to stand or endure.  As such, it is crucial for young people’s wellbeing and their ability to maintain supportive and caring relationships. We have been tracking the placements of our study population (n=374) since 2000, when they were all under the age of five and in care in Northern Ireland.

stability2

In this blog post, we focus on the stability of the placements that the young people had on 31st March 2007, and whether they were still living there on 31st March 2016 (aged 16 to 21), or at least had remained there until they were 18 years of age. We particularly looked at whether or not young people remained living continuously with the same parents and carers (not just in the same type of placement).

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We found high levels of stability for these young people, as illustrated by the infographic.  Clearly, adoption and Residence Order placements provided the highest levels of stability through to 18.  The adoption figures may need to be treated with some caution as not all adoptive families are traceable by social services, and it may be the case that some disruptions have occurred that have not been accounted for.  However, a rate of 4% would be consistent with Northern Ireland government statistics.  The rate of stability for return home placements is also very high.  In these circumstances, by stability we mean that the young person did not re-enter the care system.

Rates of stability in foster care and kinship foster care were lower than the other three placement types, but these can be considered as still quite high and are at odds with the notion that foster care is not well placed to provide stability through to 18 for children in the care system.  Our findings show that this is clearly not the case.  Furthermore, foster placements require statutory leaving care planning by social services with the young person, and these can at times create an inexorable momentum towards care exit.  Additionally, evidence is emerging from the study that even where foster and kinship foster care placements have disrupted during the teenage years for young people, the relationships with the carers are often maintained, i.e. the ‘family’ remains intact.  The point is that physical endings, i.e. where you live, do not always result in relational endings, i.e. who you consider to be your mum, dad, son, daughter, brother, sister, etc.  This notion of relationship permanence in the context of placement instability will be further discussed in a future blog post.

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The mental health of young people in care: Barriers to help-seeking and how to make services more engaging

This post focuses on the mental health of looked after children and young people (LACYP) in Northern Ireland, as this is a very important aspect of our study. We have started fieldwork recently, and we’ve already encountered a few young people who are struggling with mental health difficulties. Our article on the mental health and help-seeking behaviour of young people in care in Northern Ireland has also been recently published online, and I would like to take this opportunity to summarise the main key findings.

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The article is based on the findings of a previous study which examined the physical and mental health of looked after children and young people in Northern Ireland, namely the Mind Your Health Study. In the study, we found that many children had mental health issues, particularly older teens and those in residential care. In addition, many young people found it hard to seek help for their mental health difficulties, and engage with services. You can see some of our findings in the infographic below.

Mental health

The study used a variety of methods, including:

  • Focus groups with senior social work managers in each of the five HSC Trusts;
  • Telephone interviews with the carers of 233 LACYP (gathering quantitative data but also qualitative data for 120 of them);
  • Semi-structured interviews with 25 looked after young people; and
  • Four multi-disciplinary focus groups with professionals.

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From the analysis of the data collected through these methods, we identified a range of barriers to help-seeking:

  • Young people’s feelings of embarrassment, stigma, guilt and fear of opening up;
  • Social workers and other professionals not being able to spend enough time with the young people to make them feel comfortable enough to build long-lasting positive strong relationships; and
  • Difficulties accessing the services:
    • Timing issues, e.g. long waiting lists, difficulties in getting a referral due to staff turnover or extremely limited criteria needed for referral;
    • Regional issues, in terms of a lack of local services being available in rural areas, thus the requirement to travel long distances, etc.;
    • Difficulties in providing young people with the most suitable service, due to the challenges in accurately assessing their mental and emotional wellbeing, and gaps in service provision;
    • Lack of information provided regarding the services available and where to ask for help.

The participants in the study offered a range of suggestions to improve service provision and help engage young people, which included:

  • To make services more engaging, by:
    • Providing more outreach mental health support, and more local drop-in centres;
    • Making services more locally accessible, as well as more flexible and ‘less formal’; and
    • Supporting more consistency, in terms of having a long-lasting relationship with one professional;
  • To facilitate and promote more communication between health professionals and all of the agencies responsible for the child/young person, so young people did not have to retell their problems over and over;
  • To set up a multidisciplinary mental health team (OT specialist, clinical psychologists, specialist nurse, etc.);
  • To provide young people and their carers/parents with more and better information on the services available and where to seek help;
  • To extend the upper age limit of CAMHS to twenty-one (and possibly older); and
  • To enable professionals to take the time to develop positive trusting relationships with the young people.

Source: Fargas-Malet, M., & McSherry, D. (2017). The mental health and help-seeking behaviour of children and young people in care in Northern Ireland: Making services accessible and engaging. British Journal of Social Work. doi: 10.1093/bjsw/bcx062

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Kinship care: Messages from research and practice on the struggle and tribulations of older carers

After attending an ARK workshop held in Queen’s University Belfast on the 7th June entitled ‘Exploring inequalities in caring: grandparents’ experiences of kinship care from multiple perspectives’, I would like to reflect on the main messages I believe came out from the different presentations, and link them to our research.

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There has been considerable changes in the type of care placements that children and young people enter when they become looked after in the last 20 years. Speakers in the event highlighted the increase of kinship care (i.e. care placements with family members or a family friend) in Northern Ireland, with 42% of all fostered children being looked after by kin in 2016, and the Western HSC Trust having the highest proportion (50%). Many of these carers are grandparents, which was the focus of the workshop. This increase in kinship care was attributed to the legislative framework set in the Children (NI) Order 1995, which states that children should be first placed with family, but was also suggested that a lack of foster placements could have had an influence.

Some of the other main messages that were repeated throughout the presentations were:

  • The suddenness and lack of preparation for the placement, combined with the kinship carers’ sense of obligation to care for their relatives’ children;
  • The lack of information and advice received, in terms of the decisions made affecting their families (including legal status, etc.), and the supports and resources they are entitled to;
  • The links between poverty and kinship care – thus, kinship carers’ difficulties in managing finances, given the fact that the majority are in low-income families;
  • The different experiences in forming relationships with social services;
  • The complex nature of contact, and how the placement might disrupt previous relationships with family members;
  • The education of the children as being one of the biggest concerns for kinship carers; and
  • High levels of stress and health-related concerns.

These messages came through also in some of our past research, but I’m going to focus on just four of them in this post.

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Not a choice

Reporting on a study on kinship carers in Northern Ireland, Mandi MacDonald explained how kinship carers stated that they had to make a quick decision at the start of the placement, which was based on a sense of obligation to care for their extended families. They highlighted the lack of preparation for the placement.

This type of statements are reflected in our previous findings from the Care Pathways and Outcomes Study. For instance, Nathan’s grandmother (not real name) described the way in which her grandson and his sister were initially placed with her, and how she was told there was no other option:

“The children were dumped on us … That’s honestly, I’m telling you nothing but the truth… and the social worker says you have to take them, didn’t ask will you take them… just take them.”

 

Lack of information and advice

This message came through very clearly from the research reported in the workshop, as well as from those in practice and from a kinship carer herself who presented at the event. For instance, Anna Tarrant, talking about her research with grandparents who were kinship carers in a city in England, highlighted a lack of transparency on the decisions that social services made in relation to these families, and about their legal rights, etc. Similarly, Mandi Macdonald stressed a clear need for information, advice and support. Michelle O’Neill, from Kinship Care NI, did also encounter in her practice that older kinship carers were often unaware of what they were entitled to, and about the legal situations, etc, as they had never dealt with social services before, and it was all new to them.

This type of messages were also apparent in the previous phase of this study and particularly in the Mind Your Health study (on the physical and mental health of LAC in NI). In this study, kinship carers explained how they received no medical information on the children at the start of the placement. Although some claimed that they already knew most medical information about the child, others believed that more information at the beginning of the placement would have been useful to them, especially regarding their past background, and others had to request information, such as the name of the child’s GP or whether immunisations were up to date or not:

“One day we got a phone call and two hours later, Matthew (not real name) arrived… I would like to have known a bit more about the past … obviously, the social workers have been on mum’s case for years. Obviously Matthew has been under the spotlight – they know a certain amount of what has been going on. But my husband and I have never been told – has Matthew been mentally or physically abused? It’s a bit tricky for us to understand all this but obviously when Matthew was placed with us, they never said about medical conditions, or that the home life was pretty bad, or Matthew’s needs or this or that. There was nothing.”

“Shortly after Sarah (not real name) had come to me, that’s when she took that sore throat and chest infection, within a week or two, I just more or less had to find out who Sarah’s GP was to make the appointment to take her to it.”

In terms of services, we found that kinship carers were often unaware of the types of supports they could avail of, especially those who were new to fostering. They also often felt that there were not enough supports for them.

“I don’t think there is enough support for kinship carers. I don’t think they should have to take the rubbish from parents or grandparents or their solicitors or anything else, because at the end of the day, we didn’t ask to be put in this place, social services came to me asking me ‘Would I take the kids on?’”

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Financial difficulties

As Anna Tarrant explained, the links between poverty and kinship care have been clearly exposed. Kinship carers are more likely than other foster carers to experience financial hardship, live in overcrowded conditions, as well as experience ill health and depression. Her research and that of Mandi MacDonald and others found that many were having to leave work to care for these children, which deepened their financial hardship. Even, in Northern Ireland at present, where kinship carers receive the same allowances as foster carers, it appears that over a third find their financial situation a struggle at times, and many were concerned about the future in terms of their finances. Mandi and colleagues also found that only 25% were in employment, and only 15% were working full-time. Michelle O’Neill identified poverty and unemployment, and inadequate housing as two of the issues facing kinship carers.

In the previous phase of the study, kinship carers referred to inadequate financial support they were receiving. For instance, Eoghan’s (not real name) grandmother explained how she had stopped asking Social Services for help because of being repeatedly denied of adequate financial support to care for her grandson, while caring for her other (at the time, young) children. She described Social Services as “using” her, and contrasted the lack of support received to that given to the foster carer who had briefly looked after her grandson.

We also found that kinship carers who took on a residence order found themselves in an even worse financial situation, and some complained about being denied funding and other resources from core Social Services budgets, which were routinely provided to fostered children. For instance, Luke’s (not real name) grandmother had had to ask for extra help that year for the first time since assuming care of her four grandchildren, including money for school uniforms as well as school trips. Roisin, Caoimghin and Greg’s (not real names) grandfather was receiving no financial allowances. He contrasted the lack of support from Social Services he was receiving at the time to the much welcomed support he had received before the granting of the residence order (e.g. respite care, equipment, household appliances) to help with his three grandchildren’s care. He explained he had not fully appreciated that all the support would come to an end with the granting of the residence order, but believed he had had little choice but to seek this. The lack of financial support was preventing him from being able to provide for his grandchildren optimally.

 

Complex nature of contact

Kathleen Toner, the Director of the Fostering Network in Northern Ireland, highlighted the complex nature of contact within kinship placements, as carers have to deal with challenging relationships with family members. Similarly, Michelle O’Neill identified changes in relationships with family members as one of the issues facing older kinship carers.

In the previous phase of the Care Pathways study, some kinship carers reported tensions in the relationship with the birth parents. Contact tended to be more frequent in kinship placements, and also more informal, which could sometimes be problematic. In the Mind Your Health study, there was also an older sibling who was a kinship carer of an eleven year old, who found it difficult to get the birth mother to listen to him, in particular in relation to healthy eating for the child:

“Sometimes, if Mary (not real name) is spending time with my mum, she would maybe take her to the shop and offer to buy like a chippie or make something that’s really not what Mary’s meant to be eating. I have had to have discussions with social services and I’ve spoken about it in the last meeting and I’ve spoke to her about it and sometimes she doesn’t want to listen to me so social services will tell her.”

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To finish off this summary of messages, it is important to recognise (as it was done in the workshop in the 7th June) the marvelous important work that these carers do, and of their tenacity to do it. As despite the many difficulties, they do not appear to ever give up on the children. However, there is a clear need for a higher level of support to be provided to these families.

Another blog post regarding this seminar by Dr Gemma Carney and Dr Paula Devine was published in QPol

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Poverty and social deprivation in the Care Pathways and Outcomes Study

Poverty and social deprivation is an issue that we have not really dealt with in our study in the past. However, it is a very relevant issue that we are becoming more interested in. Some of our recent interest has been sparked by research that colleagues in our School of Social Sciences, Education and Social Work have been involved in together with other colleagues in England, Wales and Scotland. We are hoping to soon host a blog post in relation to their findings.

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Thus, we have been going back to the original data that was collected back in 2000 for the full population that we have in our study (n=374), in order to establish what type of economic and social neighbourhood background they came from originally. These were the children who were in public care in Northern Ireland under 5 years old on the 31st March 2000. In order to determine the level of social deprivation of the area/neighbourhood the children came from, we used the NINIS (Northern Ireland Neighbourhood Information Service) website, which includes information on the Northern Ireland Multiple Depression Measure (NIMDM) 2010. The Northern Ireland Multiple Deprivation Measure (NIMDM) 2010 provides information on seven types of deprivation and an overall measure of multiple deprivation for small areas. We introduced the postcodes of the addresses where the child had been living prior to becoming looked after or that of their birth parent/s’ address (if child was taken at birth or had been living in an assessment centre) into this website to identify the children’s Output Areas (OA). Output Areas (OA) are ordered from most deprived to least deprived on each type of deprivation and then assigned a rank. The most deprived Output Area is ranked 1, and as there are 5,022 Output Areas, the least deprived Output Area has a rank of 5,022. We found postcodes for 353 of the 374 children. We only recorded the overall measure of multiple deprivation. We then divided them into five percentiles, 1 being the least deprived area and 5 the most deprived. The infographic in this LINK summarises what we found. It also includes information on other socio-economic variables that were recorded in 2000. You can also see it in the figures below

Deprivation infographic

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