Exploring health outcomes for children in care &
young carers using HBSC Ireland data:
challenges and opportunities
Kelly, C., Gavin, A., Gajewski, J., Molcho, M. & Nic Gabhainn, S.
Presented by
DR COLETTE KELLY
HEALTH PROMOTION RESEARCH CENTRE
NUI GALWAY
colette.kelly@nuigalway.ie
www.nuigalway.ie/hbsc
Social Care Ireland conference – March 2013
Overview
 Context - Children in care
 Health Behaviour in School-aged Children (HBSC) survey
2010
 State of the Nation’s Children report
 Context – Young Carers
 HBSC 2013 Pilot Study
 HBSC 2014: challenges and opportunities
Background
 Historical perspective of children in care in Ireland
 Policy and Legislation:
 Child Care Act, 1991
 Children Act, 2001
 National Children's Strategy (2000)
 The Health Act, 2007
 Children's First Guidelines (2011)
Context – children in care
 Children in Ireland – 1,148,687 (Census, 2011)
 “Children in care” include children who are in voluntary care and
those who are in care under care orders
 Children in care of HSE – 6,160 (5.4/1,000 children)
 Number increased by 16% from 2007 to 2011
 The majority are in foster families (90.3%)
 Foster care (general): 61.3%
 Foster care (relative): 29.0%
 Residential care: 7.2%
(Census 2011; Review of Adequacy Report, 2011)
Why explore their lives?
 2nd goal of National Children’s Strategy
 “Children’s lives will be better understood; their lives will benefit from evaluation,
research and information on their needs, rights and the effectiveness of services”
 Looked after children frequently present with complex health and
educational needs and often face many obstacles in accessing services
(McNicholas, 2012)
 Meltzer (2003) – 45% of CIC had mental health problems and
experienced significant health and educational inequalities
 Studies of children in care in Ireland –qualitative and thus include
relatively small numbers
Aim
The purpose of this research was to explore the lives of
children living in care in Ireland utilising the Health
Behaviour in School-aged Children (2010) data in relation to
the National Well-being Indicators
Health Behaviour in School-aged Children (HBSC)
 The study aims to gain new insight into, and increase our
understanding of young people’s health and well-being, health
behaviours and their social context
 Collaborative study with WHO European Region – 42
countries in 2010
 The findings are used to inform and influence children’s policy and
practice at national and international levels
 The international target age groups are 11, 13 and 15 years old
Health Behaviour in School-aged Children
Children’s lives
SES:
Gender
Age
Social Class
Ethnicity
Contexts:
Family
School
Peers
Risk behaviours:
Drinking, smoking...
Health enhancing
behaviours:
Physical activity, leisure
activity...
Health
outcomes:
Well being
Life satisfaction
Self rated health
........
HBSC Questionnaire - Topics
ABOUT YOU
ABOUT SCHOOL
EATING AND DIETING
ABOUT YOU AND YOUR FAMILY
YOUR LOCAL AREA
BULLYING
PHYSICAL ACTIVITY
SEXUAL BEHAVIOUR
TOBACCO, ALCOHOL AND DRUGS
VIOLENCE AND INJURIES
LEISURE AND OTHER ACTIVITIES IN YOUR FREE TIME
ABOUT YOU AND YOUR FRIENDS
YOU, YOUR HEALTH AND HOW YOU FEEL
Methods
 Data based on the 2010 survey
 Nationally representative sample of children
aged 10-18years (n=16,060)
 Recruited through schools – questionnaires
completed anonymously in class
 Response rates – schools (67%); pupils (85%)
State of the Nations Children Report (SONC, 2012)
 National set of child well-being indicators
 Children’s relationships
 Children’s outcomes
 social, emotional and behavioural outcomes
 Formal and informal supports
Identifying children in care
Please answer this question for the home where you live all or most of
the time and tick the people who live there.
The response options were:
mother; father; stepmother; stepfather; grandmother;
grandfather; I live in a foster home or children’s home; I live
somewhere else with someone else
Demographic Profile of the Sample
A total of 129 young people self-identified as living in care (60.8% boys; 39.2% girls).
Number of children in care by area
SONC Indicators: Relationships
Indicator
Children in care (%)
SONC (%)
Ease of communication
(mother)
72
79
Ease of communication (father)
65
62
3 or more friends of same
gender
77
89
Have a pet
83
75
Been bullied
46
24
*n.b.: statistical analysis was not carried out to compare the groups
Social, Emotional and Behavioural Outcomes
Indicator
Children in care (%)
SONC (%)
Participate in making school rules
48
32
Smoking – every day
23
5
Been drunk (last 30 days)
37
18
Cannabis use (lifetime)
27
11
Self-reported happiness
80
91
Breakfast 5+ days a week
70
78
*n.b.: statistical analysis was not carried out to compare the groups
Formal and Informal Supports
Indicator
Children in care (%)
SONC (%)
Feel safe in local area
75
91
Good place to spend free time
62
51
* n.b.: statistical analysis was not carried out to compare the groups
Implications
 In general, children in care report experiencing more negative
health and well-being outcomes across most indicators presented.
 Overall, children in care are among the most vulnerable in our
society and we should continue to highlight and address ways to
improve their health and well-being.
 Future work required to better understand the lives of children in
care.
 What can HBSC study offer?
#1-8-7
HBSC Ireland 2014
Opportunities
 Collect nationally representative data
 Range of health and wellbeing outcomes
 Inform policy and practice
 At little extra cost?....
Challenges
 Children in school on day of data collection
 Not capture children in care
 Only quantitative
 Cross-sectional data
HBSC Ireland 2014
 Pilot: To explore the utility and appropriateness of the new
items/questions.
 Questions on Children in Care
 In consultation with Fiona Daly (EPIC)
 Included questions on Young Carers
 In consultation with the Carers Association
 A young carer is a child or young person under the age of 18 carrying out significant caring
tasks and assuming a level of responsibility for another person, which would normally be taken
by an adult
In care - You and your family
 All families are different (for example, not everyone lives with both their
parents, sometimes people live with just one parent, or they have two homes or
live with two families) and we would like to know about yours.
Please answer this question for the home where you live all or most of
the time and tick the people who live there.
 Mother, Father, Stepfather, …..Grandmother…..Uncle.....
 I live in a foster home
 I live in a residential centre
You and your family – Pilot Q
How long have you been living in your current foster
home or residential centre?
 Less than 6 months; More than 6 months; Less than 1 year; 1 – 2 years; 3 – 5 years;
More than 5 years
 How many foster homes or residential centres have you
lived in?
 What age were you when you first went into foster care
or a residential centre?
Context – young carers
 Young carers: 6,449 (5.6/1,000 children) (Census, 2011)
 May not represent the true number
 Respondent was parent/guardian
 Child not represented
 Challenges/barriers to self-identify
 Tasks not clearly defined
 The National Carer’s Strategy (July 2012)
 Under the National Strategy for Research and Data on Children’s
Lives (DCYA, 2011) a detailed analysis of young carers is expected
by the end of 2013.
 To inform future policy as to how best to address the support needs of
young carers.
Context - Young carers
 Study of young carers in Irish Population (Fives, 2010)
 Interviews with young carers and professionals
 Caring before their time: Research and Policy Perspectives on
Young Carers – (Halpenny & Gilligan 2004)
 Review of literature
 HBSC - provides opportunity to collect data on young carers -
risk and protective behaviours, relationships and health
outcomes.
HBSC Pilot study 2012/2013
• Sample size: 233 (Boys: 146 & Girls: 87)
• Age range: 16-19 years
• Schools: 2 county & 3 city schools
• 2 mixed gender (1 DEIS), 1 all boys, 2 all girls school
Pilot study protocol
 Brief introduction: consent, confidentiality, ground
rules.
 Questionnaire distribution (with envelopes)
 At the end of questionnaire students invited to comment
on each section of the questionnaire
Questionnaire design
• Section 1 - demographics
• Section 2 - relationships and sexuality
• Section 3 - substance use
• Section 4 - bullying
• Section 5 - disability and chronic conditions
• Section 6 - you and your family
Children in Care
 Challenge – no child identified as being in care
 Go back to the drawing board to test these questions
 In consultation with children in care?
Identifying Young Carers
Do you provide unpaid personal help for a friend or family
member with a long-term illness, health problem or disability?
Boy % (n)
Girl % (n)
Overall % (n)
Yes
11.7 (16)
10.1 (8)
11.1 (24)
No
88.3 (121)
89.9 (71)
88.9 (192)
Comment: ‘Although I wouldn't mind doing so, no
relatives/friends have any long term illnesses'
Who do young carers care for?
Who do you provide regular unpaid personal help for?
Grandparents
Parents
Autistic brother
Friends
Uncle/Aunt
Others
Nobody
Total
Frequency
13
3
1
2
2
1
211
233
%
5.6
1.3
0.4
0.9
0.9
0.4
90.6
100.0
Initiation of caring
 At what age did you start providing regular unpaid
personal help?
 Mean age 13.2 years (8.5-16.0)
 Comment:
‘When I realized some people are not strong enough to
get through life's challenges alone’
Time spent on caring for others
How many hours per week do you provide regular unpaid
personal help for?
Hours per week
1
1.5
2
3
6.5
10
14
20
168 (24 x 7=168 )
Overall % (n)
6.7 (1)
26.7 (4)
13.3 (2)
20.0 (3)
6.7 (1)
6.7 (1)
6.7 (1)
6.7 (1)
6.7 (1)
Health and wellbeing – young carers
 Life satisfaction - Students were asked to indicate the
step on the ladder at which they would place their
present lives.
 Happiness: In general how do you feel about your life at
present?
 Self-rated health: Would you say your health is...?
Cantril’s Ladder
1.
Here is a picture of a ladder.
The top of the ladder ‘10’ is
the best possible life for you
and the bottom ‘0’ is the
worst possible life for you.
In general, where on the
ladder do you feel you stand
at the moment?
Tick the box next to the
number that best describes
where you stand.






10
Best possible
life
9
8
7
6
5

4

3

2

1

0
Worst possible
life
Results: Young Carers
Young Carer
Other children
High life satisfaction
12.5%
17.8%
Happiness
12.5%
35.3%
Excellent health
29.2%
34.4%
Summary
 Many challenges to researching the lives of children in care
and young carers
 On Government agenda – SONC 2012
 Seek opportunities for how such data can be collected
 One avenue is through the HBSC 2014 survey
 Aim – disseminate findings as broadly as possible – to
improve the lives of these children
HBSC Ireland Team Members
 Dr. Saoirse Nic Gabhainn (Principal Investigator)
 Dr. Michal Molcho (Deputy Principal Investigator)
 Dr. Colette Kelly (Senior Researcher/Project Manager)
 Aoife Gavin
 Jakub Gajewski
 Mary Callaghan
 Natasha Clarke
 Honor Young, Lorraine Burke, Kathy Ann Fox
 HBSC 2010 staff
 Larri Walker (Research Assistant)
Acknowledgements
 Children, Parents, Schools
 Professor Candace Currie, International Coordinator, St. Andrews




University
Professor Oddrun Samdal, Data Bank Manager, University of
Bergen
HBSC network of researchers
Department of Health
Department of Children and Youth Affairs
Thank you!
www.nuigalway.ie/hbsc
www.hbsc.org