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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The digital media and young people’s social relationships

Digital technologies have changed the ways in which we relate to each other, work and play, and might have even altered who we are.  These changes are happening rapidly. The online and offline world are starting to feel interconnected, especially for children and young people, who have grown up surrounded by these technologies. The Northern Ireland Child Care Research Forum dedicated their conference this year to this topic. Important issues covered included online safety, abuse and bullying, and the advantages and risks to using digital technologies. This made me reflect what these technologies mean for the young people in this study, who either have spent their childhoods in foster or kinship care, have been adopted from care, have been cared mostly by their birth parents, or have been in and out of care. There are different topic areas that can be considered here: one is about the effects of social media on looked after children and young people’s contact with their birth families; another linked to this would be the effects of social media on adopted young people’s searching (for their birth families); and the last one is about the general use by these children and young people of digital technologies in terms of forming and maintaining relationships with others, as well as the related risks of bullying, grooming and sexual exploitation, and fraud.

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In this post, I am going to focus on children’s general use of digital technologies (especially in terms of their relationships), and present some findings from the previous phase of the study. According to a recent study, care experienced children and young people use digital media, just in the same way as their peer group, in order to maintain/develop their offline relationships, and enlarge social networks and social support. Although the majority of those interviewed had received some form of online verbal abuse from other young people they knew, these experiences were not more negative than wider peer experience, and “the underlying issues of friendship, chat, group membership and group exclusion appear similar to those which marked relationships in a pre-digital age.”

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In 2009, we asked children aged 9 to 14 (who were in care at a young age, and were then either fostered, living with birth family, adopted or subject to a residence order) to tell us about the activities they did in their spare time. Digital media featured heavily in their answers, particularly social media and texting. Some also mentioned MSN, email, Skype; and a huge proportion spent a lot of their spare time gaming. Some children were particularly addicted to this type of activities, while others found social media either “boring” (and “not that fun”), or even dangerous, with a few explaining the dangers and risks involved:

 “Not that (Bebo), Social Services don’t let me. Yeah, because they think it’s dangerous. They don’t let, like they put like a wee protection thing in our computer and you’re not allowed to go in… Just in case somebody gets on to Bebo or something and finds out where you live and that.”  (11-year-old girl in foster care)

“I’m getting one (Bebo page), but no, I have one. Someone hacked it. Someone had my password and logged into it…” (12-year-old boy living with birth mum)

A few explained they were not “allowed”, but one child adopted by foster carers admitted to be using it nevertheless. Others, while being aware of the risks, they took measures to be able to use it regardless of those.

“… but mine (my Bebo page) is private, because it’s only for my cousins and stuff… My close friends, yeah.” (12-year-old in kinship care)

The children who were going often on to social media (in particular Bebo, only one child had Facebook instead of Bebo) explained what they found good about it, i.e. staying in touch with their friends.

“See I can, like at the summer and all we don’t get to see them [school mates], you can talk over and all on it.” (11-year-old boy subject to a Residence Order)

Because all my friends are on it, and I have friends… whenever I used to go to my primary school, but they go to a school that is far, so I talk to them on it.” (13-year-old girl living with birth dad)

The children mostly texted their friends, and sometimes their carers and families too, but not as much.

“I text my friends all the time … I say ‘what’s the craic?’ and then they text me back ‘nothing, how’s the craic with you?’” (12-year-old adopted girl)

“I text every day. I love texting. … Because I just text my friends and… I just like texting. There’s nothing else to do” (13-year-old girl living with birth dad)

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Obviously, digital technologies have moved on quite significantly since 2009, with the rise of the smart phones and the tablets, bringing social media, internet access and gaming at our finger tips on a non-stop basis. So, these tendencies we saw in 2009 have probably intensified and been altered as the children grew into young adults. How have they been using digital media since then? What do they find are the risks and the benefits of social media, in their experience? It will be interesting to find out when we interview them again.

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