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.


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.


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.”

spare time (2)

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)


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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Young people’s sense of belonging: The importance of ‘family practices’

Feeling of belonging to a family is likely to be very important for the young people in our study at this early adulthood stage of their lives. We will be asking questions in relation to this key issue when we interview them, as recommended in our consultation process with key stakeholders and user groups.

Children’s perceived sense of belonging is shaped by a range of factors, including family practices and the meaning that children attribute to blood and non-blood relationships. Families are enacted (‘done’) through their everyday routines, practices and activities.


In the previous phase of the current study, when the children were aged 9 to 14 years, we asked them what activities they did with their families, and who was part of their family. Children included a range of people in their families, with some even including their pets. The majority included siblings, some of whom they did not always see or did not see as often as they would have liked. Depending on their placement, they included birth family members, adoptive parents and extended family, or foster carers and their extended family. The vast majority felt very close to their families, and identified those who were the most important to them:

“Mum [is the most important to me] because she’s always there for me” (Joseph, living with birth mum)

“Well, I think my sister [is the most important to me], because she always kind of helps me, if I’ve got a bit of a problem, and I don’t want to say it to my mum and dad, then she helps me in that thing, so she does so… Because she’s very good, listening to me, and she can tell sometimes what I’m, if I come home from school she gets, she just turns round and says “well someone’s had a bad day”. (Bronagh, living with birth parents)

“Dad [is the most important to me], because he’s the best. Because he always plays with me and he always plays hurling … and goes horse riding with me.” (Steve, adopted by foster carers)

“My granny and granddad [are the most important to me] … because they took me out of care eleven years ago.” (Eoghan, in kinship care)

“Foster mum and birth mum [are the most important to me] because foster mum looks after me, and other mum is part of my family” (Connor, in foster care)

“Foster mum and foster dad [are the most important to me] because more or less I’ve been here all my life just. Thirteen years.” (Sue, in foster care)

In terms of family practices, the most frequently mentioned activities that the children did with their families were watching TV, going to the play park or playing games/sports, shopping, eating out and travelling (either to other countries or having trips in the country, including caravan holidays or camping). Most children mentioned a wide range of activities, while a few could not think of much they did with their family.

Family activities1

Some children were more likely to mention different type of activities than others. For instance, children living with birth parents appeared less likely to travel or eat out with their families than children in other types of placements, but they were more likely to go to the play park or practice sports than children who were adopted or subject to a residence order. Children in kinship care were the most likely to mention talking as an activity they did with their families. There were also a few gender differences, in that more girls than boys identified shopping and talking as something they did with their families but fewer of them mentioned certain social activities (including going to parties, to church, or to the cinema, and family time).

Family activities2

“My favourite would be travelling. Because it’s fun and there’s more time spent together.” (Danny, adopted by foster carers)

“Playing in the park, I would sometimes go with my sister. … We would either go for a walk or play on the swings and that then. … And if my brother, if my brother’s not off and he would take us over or me over just he would take us. … He would mostly do when he’s off, so he would, yeah, and then the other time …, … when he was actually off working, he would take me for a meal. … Even on his day off, he would rather spent it off with me as well so.” (Bronagh, living with birth parents)

“Well, sometimes me and my brother G would go in his car to the chip shop in Newtonstewart or Plumbridge or somewhere like that and bring it back for us here. … We like sit all and watch television on Saturday nights and things like that and talk about stuff sometimes.” (Martin, in foster care)

“… me and my wee cousins and all when they come down we go to Burger King and all and KFC.  We eat normally but they don’t eat vegetables and stuff.” (Annie, in kinship care)


For this phase of the study, we will be exploring the young people’s sense of belonging to their families. We want to find out who they considered was there for them in the key moments of their lives (to witness/cheer their achievements, or/and to comfort them in difficult times), and to what extent and in what ways they feel part of their families. We aim to compare family practices for young people who have had different long-term placements in early adulthood.  It is often argued that adoption is more likely than other forms of long-term placement to offer a ‘family for life’, a base that the young person can return to throughout life.  So, we will want to compare the length of time that young people remain living within their long-term placements post 18, and also the extent to which young people attend and are invited to important family events after they have left the family home, such as weddings, funerals, birthdays, and Christmas.  Where do they consider ‘home’?  We will also want to look at the issue of young people being included in the parents/carers wills, a very formal recognition of family membership, and whether this differs across the different long-term placement types.


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Friends, pets, and social workers: who is important in young people’s lives and why

We are social beings, and relationships are crucial. We need other people to help and support us in different ways throughout our lives, from birth to old age: to take care of us and give us affection when we are babies (but also as we grow up into teenagers and adults), to play with when we are children, to talk to about our worries and our joy, to give us a cuddle when we are upset, to take care of us when we are sick, to have fun and laugh with, to work together with, to give us advice, to show us things, etc. We might often take these relationships for granted, or their importance in our lives, but people experiencing a lack of social support and being isolated in their community are particularly vulnerable to mental health difficulties, financial trouble, offending, and alcohol/substance abuse.


Young people leaving care or who have been in care are more likely to have fewer of these supportive relationships, and that has a huge impact on the quality of their lives. For example, a recent review of the literature found that many care leavers felt that they lacked a “safety net” of support, and relationships with at least some professionals were seen as fundamental in guaranteeing that practical needs were met. Sustained social support from family and/or friends (as well as professionals) is one of the most important issues that appear to influence a variety of outcomes for these young people, in terms of employment and careers, offending, risk-taking, living arrangements, subjective wellbeing and mental health, among others. This is why we will be exploring young people’s relationships with a range of people when we interview them.

In the previous phase of the study, when the young people were between 9 and 14, we asked them (outside of their families) who was important to them and who gave them the most support. We had different prompts in a book we had especially created with the help of a young people’s advisory group. Young people identified a range of important people, as well as things, including friends, teachers, doctors, neighbours, pets, TV, games, youth leaders, game coaches, and social workers.

People most important


As children grow into adolescents, they rely less on parents for support, while their relationships with peers become increasingly important when seeking comfort in times of stress. So, as might be expected, apart from their families, the majority of children mentioned their friends (or/and their boyfriend/girlfriend) as important people in their lives. Out of 66 children we conducted semi-structured interviews with, 57 mentioned their friends. Some distinguished between best friends and mates:

“Your best friends, you can tell them like anything, but with your mates, you can’t because they have best mates and they might tell each other” (14-year old girl living with birth father)


The reasons why friends were important to them had to do with their need for communication, companionship, emotional support and play, among others. Here are a few of their responses:

“Because if you lost them, you’d be like… bored, with no friends and… they are into the same stuff as you” (14-year old boy in foster care)

“Because they help me with things. … Well, if there’s something annoying me, I just tell them, or if I’m being bullied I just tell them, or something.” (12-year old girl subject to a residence order)

“Because they know when I am sad and they cheer me up.” (12-year old boy living with birth mum)

“They make me calm like when I’m angry and help me.  They play with me and they’re there for me … Like they would talk to me about, like if they see I’m in a bad mood they would talk to me about all the times that what’s been funny about us and then they make me laugh” (11 year-old girl in foster care)

However, there were nine children who did not mention friends. These were children who were experiencing a lack of meaningful friendships. These children were more likely to display behavioural problems (scoring within abnormal range in the SDQ total score) (7 out of 9). A research study found that adolescents with a secure attachment to their peers are less likely to become depressed and anxious than those who are insecurely attached.



An unexpected finding was the huge importance of pets in the children’s lives. Of the 66 children, 42 said that their pet or pets were important to them. Some even claimed that it was their pet that gave them the most support (apart from their families). These are some of the reasons children gave for the importance of their pets in their lives (which are similar to those given for friends):

“Because when I shout at her, she doesn’t shout back.” (13-year old girl living with birth mum)

“When you’re crying or something, they’d come up and sit beside you and all.” (14-year old adopted girl)

“… every time he sees me, he jumps up … messes around with me” (13-year old boy adopted by previous foster carers)

“… she understands everything … I just tell her stories and she sits there and looks at me as if I have ten heads.  … I talk to her all the time.” (14-year old girl in kinship care)

boy with dog

A recent study on the wellbeing of adolescents with disabilities also found that pets were very much an important part of these young people’s lives, and made them feel happy. There is some research evidence on the health, social and psychological benefits of pet ownership, particularly for children experiencing some difficulties (e.g. bereaved, or seriously ill). Our study appears to support some of these findings.


Social workers

A few talked about their social workers being important to them: 3 out of 10 children in kinship care; and 4 out of 15 children in foster care. These children had been able to form good relationships with their social workers, and talked about them being nice and helping them to deal with different issues.

“Because he helps me, like he tells me stuff … [he deals with] important things like does he need to tell mummy stuff and he would go ring her. … He comes out and visits me to see if I’m okay.” (11-year old girl in foster care)


Some of the children explained how they had different social workers. One boy in foster care described these constant changes as ‘annoying’, and an 11-year old girl in kinship care explained how she did not like that:

“I hate them changing because it’s like if you’re watching TV and you can’t find the remote and you wanted to watch something and change, change, change, change…”

This same girl explained why she did not like some of her social workers:

“She was very nosey, snooping about the room. She said she had to go to the bathroom and she ended up in my room looking at my stuff.”

It is clear that social workers have an important role to play in these children’s lives, so it is important that we examine these relationships, and help better understand the positive ways that social workers respond to the needs of children in care.


Relationships in early adulthood

We don’t know who will be important in the young people’s lives as they enter adulthood. Following advice from our consultation events, we will be asking young people about their relationships with significant others, how significant and constant they have been and why, and what positive/negative impact they have had and continue to have in different aspects of their life.

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RESILIENCE: A blurry concept

Despite experiencing early adversities, some young people in care go on to live happy and ‘successful’ lives. The question many have been trying to understand is what makes some young people do considerably better than others, when they all experienced similarly tough and traumatic upbringings. Some authors have tried to explain these differences with the concept of resilience, which has been widely theorised and investigated in the fields of developmental psychology and psychopathology, with roots in physics and materials science. It is basically the idea of ‘bouncing back from adversity’. This concept has quickly been introduced into our everyday vocabulary, into policy documents and strategies, and even into business jargon. However, what does it really add to our understanding? Why don’t we just focus on how young people cope with adversity, instead? Can resilience be really measured? And if so, how?


A range of authors have tried to operationalise the concept in order to measure it. While at the beginning, some just focused on individual characteristics that resilient individuals appear to have (e.g. self-efficacy, self-esteem, hardiness, locus of control, etc.), many have now included contextual and environmental factors (e.g. attachment, social support, family cohesion, social activities, community safety, etc.) into the picture (i.e. ecological approach). While some have seen it as a fixed personal trait (something people have), others understand it as a state or a process (something people can achieve). While some believe it can be measured directly, others believe it needs to be inferred from individual variations in outcome among those who have experienced major adversities.


Some authors, especially within disability studies, have criticised the concept on different grounds. First, it is not accurately or consistently defined, and may just be a tautology – a concept that predicts itself. There is a clear lack of agreement on what constitutes resilience: is it a trait, a process or an outcome variable? Second, it is inherently prescriptive, thus based on a Western, middle class and ableist notion of health and wellbeing; a culturally-specific idea of what is normal. It presumes how individuals should be functioning, and which outcomes are deemed successful. Third, it is a ‘slippery’ concept, in that it implies the individualistic idea that people can overcome adversity if they try “hard enough”. This is dangerous, as it can compel a neoliberal focus on self-reliant individuals developing their own resilience. In other words, as explained in a recent report, individuals who display positive outcomes in the face of adversity are assessed as coping well and not requiring any support, while not coping is perceived as an individual’s flaw; the solution being transforming the individual instead of tackling existing inequalities.

Nevertheless, some have given further arguments for defending resilience research. One of the arguments for persevering with this line of enquiry is the emphasis on individual agency and control instead of passivity and vulnerability. These authors have also argued that the concept has too much heuristic power to be abandoned. But what does that actually mean? Within social work, some consider it to be a helpful concept/tool in pinpointing the unique strengths of individuals and identifying particularly vulnerable individuals requiring additional support within contexts of adversity, as well as being useful for programme evaluation. Other authors have tried to re-conceptualise the concept in a different way (such as a constructionist approach to resilience) and developed new terms such as ‘cripping resilience’. In this sense, resilience is understood “as a process of a community’s and individual’s becoming, not as an outcome to be achieved or a set of competencies to satisfy.”


In the previous phases of this study, we did not consider this concept in great depth. In the current phase, we identified it while reviewing the literature, and during our first meetings and contact with advisory group members, resilience was mentioned a few times. However, we are still trying to grasp what it actually means and entails, and we believe we need to be cautious and critical on how to use it. We presume there will be great variability in how young people are doing across different dimensions. However, is it helpful to define a group as resilient and another as not? Should we try to measure resilience a priori or infer it after? Which qualities or outcomes make somebody resilient? Should we try and measure resilience with a quantitative instrument OR introduce the concept through qualitative enquiry, emphasising subjective understandings of resilience, instead? Should we just forget about the concept altogether? This is some of the questions we face. Any reflections are welcome in our comments section of this post.

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Stressing out about foster carer stress

All of us who are parents are familiar with the stresses that can be involved in raising children.  Imagine then how difficult this would be if these ‘normal’ stresses were exacerbated by the impact of early childhood trauma.  That’s the daily parenting scenario that faces many foster and adoptive parents in Northern Ireland, across the UK, and in many other countries across the world.  If parent/carer stress is experienced within the confines of boundaries, without it leading to negative consequences, then it can be a source of stimulation and an opportunity for growth.  In contrast, stressed-out parents who are irritable, uncommunicative, critical and harsh in their parenting style are more likely to cause problematic behaviour in their children, which in turn results in further parental stress, thus creating a vicious circle.


The Care Pathways and Outcomes study is focused on understanding if the experiences of children and parents/carers are different across the various placement types.  Parental/carer stress is seen as central to unravelling some of these differences.  As such, the issue of parenting/carer stress was examined in the previous phase of the study, applying Abidin’s (1995) Parenting Stress Index (PSI/SF).  We found a much higher percentage of foster carers scoring within the abnormal range on the ‘total stress’ component of PSI, compared with adoptive parents.  These findings are both surprising and counter-intuitive.  This is because foster carers are part of a formal care system, with social workers supporting them and the children they are caring for.  This is not the case for adoptive parents and their children, who have no formal access to social service support, yet they appear significantly less stressed.  How can this be?

parent stress re-sized

Several studies have explored stress experienced by foster carers and have found evidence of strain, anxiety and depression related to the stressors of the caregiving role.  Research evidence consistently demonstrates that children in care have higher emotional disturbance than the general population.  Yet, there is an expectation that when children come into care, their new care placement will ‘provide compensatory experiences of care that enable their positive development’.  Given the previous experiences of these children, carers are tasked with providing a substitute nurturing and safe family home for children who typically have medical and health problems, dysfunctional attachments, academic and cognitive problems, and behavioural and psychiatric disorders.  However, the same can also be said for adoptive parents, so why the differences in stress levels?

There is some indication that the lives of foster carers appear more complicated than those of adoptive parents in terms of the logistical pressures of caring.  They are expected to manage a greater degree of relationships with birth family members than adoptive parents, their own family tensions, the risk of placement disruption, the potential for complaints or allegations, and social work involvement.  All of these factors can make fostering a very difficult task.  Furthermore, children tend to be placed earlier in adoption than foster care, so there is a decreased probability that the adopted child will have experienced significant trauma as a result of maltreatment and witnessing the breakup of the family home.


There have been clear indications from this study that the experience of parent and carer stress may be different between foster carers and adoptive parents, and this can impact on placement stability.  It will continue to be important to examine if these differences remain, as the young people progress through the late teenage years and into early adulthood. We will aim to further explore the reasons for these apparent differences, and to examine the impact this may have on placement stability and other outcome measures.

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Childhood adversity and the dilemmas of measurement

There is a growing body of evidence showing the impact of multiple childhood adversities on later outcomes, particularly in relation to mental health. Adverse childhood experiences are described as coming from a situational context, such as living in poverty or growing up in a household with a parent who misuses substances, and as trauma-related incidents, such as experiencing sexual or physical abuse.

eyes child

Most of the young people in the Care Pathways and Outcomes study population (i.e. 374 children who were under 5 years old and in care in Northern Ireland on 31/03/2000) became looked after either due to abuse (29% due to potential abuse and 11% due to actual abuse) or neglect (22% due to potential neglect and 30% due to actual neglect). Their case files were reviewed in 2000, when they were all under the age of five, and it was found that they had experienced a range of childhood adversities:

  • Parent/s’ alcohol abuse (69%)
  • Parent/s’ substance abuse (42%)
  • Parent/s’ mental health problems (61%)
  • Parent/s involved in domestic violence (60%)
  • Been a victim of sexual abuse (4%)
  • Parent/s involved in offending behaviour (44%)
  • Significant bereavements: 5 had lost their mother, 14 had lost their father and 31 had lost siblings.

So, we already know something about these young people’s early childhood adversities, but a key question for this phase of the study is: do we need to find out more to understand the impact of these experiences? If we do want to probe this issue further, this raises another series of questions: how can we do that in a sensitive manner? What instrument would be most appropriate? What ethical and safeguarding issues might this raise? And how might these be effectively dealt with?


A range of instruments (self-completion and interview-based) have been used to measure early adversity. One of them has been used in studies conducted in Northern Ireland. However, there are difficulties associated with using this type of instrument, including: the accuracy and stability of retrospective reports. Key questions are: Is accuracy impacted by the passing of time, or the degree of stress and trauma experienced? To what extent are recollections of early childhood affected by the person’s current mental state?  These need to be considered carefully.

As pointed out to us recently during an advisory group meeting, there is also the problem of safeguarding. If a young person discloses abuse in one of these measures, how do we know whether this happened before placement or while they were in the care of their foster/kinship carers or their adoptive parents?  What should researchers do in these circumstances, particularly when such disclosure can only be detected at the stage of quantitative data analysis?  What if the participants are adults? It is challenging for social researchers to analyse quantitative data to assess for clinical need, especially when that is not the reason for which the data is being collected, and when the research team are not practitioners or clinicians, and thus do not have the necessary skills to make specific diagnoses or identify thresholds for statutory intervention.  Another dilemma is whether or not adversity can be counted in an additive way (i.e. one adversity, plus another and so on), or if certain types of adversity need to be weighted differently because of the severity of their impact, and perhaps have multiplicative rather than additive effects. Thus, the question is: are all types of adversity equally bad? Or are there some worse than others? And are some adversities specifically related to certain outcomes?

Child covering face with hands

These are some of the questions that we are grappling with in terms of considering whether and how to identify or measure early adversity in this study population (who will be 18-22 years old when interviewed). This is an important issue for the study, as we want to explore the relationship between early adversity and longer-term outcomes, in addition to placement stability, and the possible mediating effect of placement type.

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Positive family relationships make disabled young people feel good (just as their non-disabled peers)

This is a post by Grace Kelly. Grace is a Research Fellow in the Centre for Evidence and Social Innovation (CESI). 

“Disabled children are over-represented in looked after children populations and it is estimated that between 10 and 25% of looked after children are disabled.”

In a recent study on the emotional well-being needs of adolescent with disabilities, we interviewed 37 young people, and at least three of them were currently adopted or fostered. This is a higher proportion than found in the general population, which is likely a reflection of the sampling method but also because of the higher representation of disabled young people with experience of the care system. This is an account of some of the findings from this study, with inputs from two of the care experienced young people.

There is general consensus that a person’s well-being includes not only their objective circumstances but how they think and feel about their life. This is commonly referred to as subjective well-being (SWB), with the focus more on how people experience their lives – how happy or satisfied they are with their life overall, and with specific aspects of their life. SWB is also interested in negative feelings and understanding why some people experience their life in more positive ways than others. An essential constituent of SWB, which goes beyond life evaluations and emotional feelings, is ‘eudemonic’ or psychological well-being. This is characterised by having a sense of purpose in life, autonomy, aspiration and self-esteem and, importantly, having an equal opportunity to bring this about.

Measuring SWB involves asking a person to reflect on their life and put these thoughts into words. This requires a high level of self-awareness and good verbal reasoning, which often puts children and young people with particular impairments at risk of exclusion from research on well-being. Too often we don’t hear from these young people themselves. But one group of young people from the Barnardo’s Advocacy Group 6th Sense in Northern Ireland addressed this gap by initiating this research study. The result was the report ‘Improving the Well-being of Disabled Young People’.

disabled people report

Through conversations with these adolescents, it becomes clear that the things which promote good SWB differs little from that of their non-disabled peers – positive family relationships, good friendships, social interaction and participation. Overall, good family relationships emerged as one of the most important factors which impacted on how SWB was experienced, for all those taking part.  When Susan* was asked what made her feel happy or feel good about herself, she explained it in terms of being cared for and loved:

My mummy – my other mummy, cause I was adopted – she didn’t really look after me properly. She says it was because she couldn’t look after me properly, but I know it was because she told the social worker lies…so then my granda took over and looked after me. That made me feel happy. Then when my granda was old and couldn’t look after me, my other family, my new family foster cared me. Then they said they wanted to adopt me and that was my happiest moment.

For Clare*, who is a carer for her adoptive mother, her own happiness was bound closely to her mother’s well-being as she explains ‘when mum’s not sore, I’m happy’. Clare said she felt ‘really guilty’ when her mum was not well. Her mother’s health affected Clare’s friendships as she often cancelled outings to care for mum. Her friends were not always understanding, but joining a young carers group provided a chance for Clare to meet other young people in her position. Thus, underlining the importance of facilities which promote, and develop, social interaction.

happy young people-821624_1920

Young people who were most happy with their lives and exhibited good psychological well-being were those who had positive social relations with others, who had a sense of self-determination, a belief in themselves and who believed that opportunities existed for them to realise their potential and continue to develop as a person. Participants who exhibited low well-being and poor psychological health were noticeable due to the lack of references to most of these core dimensions.

If we are serious about improving the well-being of all young adults with a disability, society needs to ensure that the opportunities for living a happy and fulfilling life are available to them, and the conditions which deplete their well-being are addressed.

The report by Dr Grace Kelly, Dr Berni Kelly and Professor Geraldine Macdonald was funded by the Northern Ireland Public Health Agency, Research and Development.

* Names are pseudonyms

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Health and wellbeing of care experienced young people – a crucial concern of this study

“Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” (World Health Organization)

Social inequality is associated with poor health for certain vulnerable social groups. Children in care are one of such social groups, as they usually come from families experiencing social disadvantage and deprivation; and most have experienced abuse and neglect.  With such adverse early experiences, it is no surprise that they appear more likely to suffer from poor health, especially poor mental health, than their peers.  It is also no surprise that these same problems are common amongst children who have been adopted from care.

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Health and wellbeing has been a component of the Care Pathways and Outcomes study since its inception.  This key topic will be examined on some depth within the current phase of the study.  It was raised as critical in the majority of our consultation events (recently held regarding the new phase of the study with key stakeholder groups across Northern Ireland).  Key issues raised were:

  • alcohol and drug abuse/addictions;
  • basic general health (particularly in relation to missing screening opportunities when they first entered care);
  • sexual and reproductive health; and
  • mental health and mental health services (particularly access to services, assessment and diagnosis – are they being properly assessed at the right time?, transition from CAMHS to adult services, the effects of labelling people, violent tendencies, anger issues, etc.)


In the previous phase of this longitudinal study, we found that 23 of the 72 children (aged between 9 and 14) (32%) that took part in that phase displayed behavioural problems (scoring within the abnormal range in the Strengths and Difficulties Questionnaire (SDQ) total difficulties score). Nine of these children had been specifically diagnosed with ADHD and were taking medication for the condition: five had been adopted; two were in foster care; one was in kinship foster care; and one was living with birth parents.  There were also nine diagnoses of Foetal Alcohol Syndrome, and five of these were adopted children.


However, despite these and other health issues, the children themselves, irrespective of who they were living with, tended to view their health in a positive light, with only one child who was living with her birth parents describing her health as bad.

In another recent study, namely ‘Mind Your Health’, for a sample of 204 children in care over the age of three, we found that 40% were within the abnormal range for behavioural problems (again using the SDQ).  This is similar to findings across the UK.  This suggests that despite their challenging early start in life, 60% of these children appeared to be within the normal range in terms of behaviour.  The children also had a range of health conditions, and these are displayed below.


In this phase of the study, we will hope to find out:

  • how the health profiles of these young people have evolved since they entered care;
  • what services have been provided to deal with the young people’s health needs and how effective they are/have been;
  • whether placement type, and placement stability or breakdown have affected the young people’s health needs and their access to the appropriate services; and
  • what worked and what needs to improve in this area.
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