Understanding out of home care rates in Northern Ireland: a thematic analysis of mixed methods case studies

Claire McCartan, Lisa Bunting & Gavin Davidson

School of Social Sciences, Education & Social Work, Queen’s University Belfast

The research

The concept of health inequalities – unfair and avoidable differences in health across the population, and between different groups within society – is well-established and accepted within public health. However, the idea that similar disparities exist with social care, in particular child welfare, has received much less attention.  The Child Welfare Inequalities project (CWIP: Bywaters et al., 2020) set out to address this gap by examining the relationship between deprivation and child welfare service provision across England, Scotland, Wales and Northern Ireland (NI). We found a strong association between area level deprivation and the chances of a child being placed on a child protection plan or the child protection register, or becoming looked after. Despite having the highest levels of deprivation in the UK, Northern Ireland’s use of out of home care was lower than the other UK nations: 50% lower than England, 75% lower than Wales and 130% lower than Scotland. Why?

As part of the CWIP research, case studies exploring social work practice were conducted in England and Scotland (Mason et al., 2019; Morris et al., 2018). The case studies found similar practice across the two nations, where poverty had become ‘invisible’ even though it contributed to the risk of harm. The findings highlighted the need for new approaches and critical reflection in social work to help engage with, and support, families experiencing poverty and deprivation. 

To try to understand the differences in NI, the same case study approach was used. This involved embedding a researcher within two social work teams in two different Health and Social Care Trusts (HSCTs) in NI, in the most and least deprived electoral ward areas. Mixed methods were used to explore two questions:

1. What is the interplay between decisions to intervene in children’s lives and their social, economic and material circumstances?
2. What are the relative strengths of the variables that influence unequal rates in decisions to intervene? 

Fieldwork was informed by analysis of routinely collected child protection data and involved a range of activities such as practice observations, semi-structured interviews, focus groups using a standardized vignette and mapping of decision-making processes. Data were entered, coded and analysed using a ‘framework’ approach (Ritchie and Spencer, 1994) which produced a table of thematically coded data.  

The findings

Early help systems and structures

The availability of early help was more evident in NI than in England. Devolution has allowed for a divergence from national policy and whole family support approaches have been central to family support and service provision in NI. This has included the development of regional Family Support Hubs with the aim of providing better access to and co-ordination between statutory and community support. Family Support Hubs were reported as effective in providing early and tailored support for families by employing a ‘step up, step down’ approach. Equally, NI’s rich history of community sector activism has not been eroded by austerity in the same way as seen in England and Scotland although social workers voiced concern that this decline was only a matter of time under current financial cutbacks which has led to a reduction and strain in available services. Contrary to English policy, NI has specific anti-poverty strategies that make provision for practical support for families in need (e.g. the 1991 ‘Targeting Social Need’ policy and the subsequent ‘New Targeting Social Need’ policy set out in the terms of the 1998 Belfast ‘Good Friday’ Agreement (https://cain.ulster.ac.uk/issues/policy/tsn/index.html)). The CWIP research has re-informed and reinforced this policy direction and the promotion of anti-poverty social work practice (Morrison et al., 2018). 

Poverty aware practice

Social workers in the study demonstrated relatively high levels of routine poverty awareness. While the implementation of Universal Credit has been delayed in NI, UK welfare reform has begun to impact negatively on families in NI. Social workers in NI demonstrated an understanding of the complex relationship between poverty and family difficulties and many felt able to provide practical support, including the routine use of Article 18 payments to provide assistance and even cash payments. Other common examples of practical support included buying heating oil and travel bursaries to attend meetings. This was in contrast to England and Scotland where special payments were difficult to make, not only because of a lack of funds, but the bureaucracy associated with applying for them.

Poverty aware systems?

Routine assessment forms include questions about benefits and there is a free income maximization service (the Department for Communities, Make the Call) available which assesses entitlement to social support. However this can be seen as an additional task in what is an already lengthy assessment process. Safeguarding children remains the foremost priority during assessment and while poverty may feature, ensuring a child’s safety is the ultimate concern and risk-based decision-making is secondary to anti-poverty practice. 

Community cohesion and social capital

The history of conflict in NI has in some ways also strengthened local communities and social ties. While neighbourhoods can be polarized along sectarian lines, there is evidence that cohesive communities can provide some level of protection for children and families.. Conversely, close communities can also be a source of abuse and risk for children and young people due to paramilitarism which is an area of ongoing concern (Bunting et al., 2020). 

Familial dynamics

Families tend to live in close proximity and are often a source of support for social workers in order to provide protection and are when a family is in crisis. Extended families ability to help was framed in NI as a much more positive assumption compared to England for example. This reliance on kinship care is reflected in national data, with NI having the highest use of kinship care in the UK. 


We need more research of course! Family dynamics, size, and geographical proximity may increase the availability of informal family support in times of difficulty. Less reliance on state support born out of NI’s political history may have contributed to a stronger community support for children and families. The research also suggests that social work practice in NI may have a better understanding of the impact of poverty on families, have more access to practical help and community support and have a more positive narrative about the resources of extended family.  Early help and support such as the Family Support Hubs also seem to make a difference. While deprivation levels are high, inequality is lower – inequity in the distribution of resources is arguably one of the main drivers of poor health, social problems and inequality (Wilkinson and Pickett, 2009).


Bunting, L., McCartan, C., Davidson, G., Grant, A., McBride, O., Mulholland, C., Murphy, J., Schubotz, D., Cameron, J. and Shevlin, M. (2020). The Mental Health of Children and Parents in Northern Ireland: Results of the Youth Wellbeing Prevalence Survey. Belfast: Health and Social Care Board. https://pureadmin.qub.ac.uk/ws/portalfiles/portal/219940525/Youth_Wellbeing_FINAL.pdf

Bywaters, P., Scourfield, J., Jones, C., Sparks, T., Elliott, M., Hooper, J., McCartan, C., Shapira, M., Bunting, L. and Daniel, B. (2020). Child welfare inequalities in the four nations of the UK, Journal of Social Work, 20(2): 193–215. https://doi.org/10.1177/1468017318793479

Mason, W., Morris, K., Webb, C., Daniel, B., Featherstone, B., Bywaters, P., Mirza, N., Hooper, J., Brady, G., Bunting, L. and Scourfield, J. (2019). Toward full integration of quantitative and qualitative methods in case study research: insights from investigating child welfare inequalities. Journal of Mixed Methods Research, 14(2): 164-183. https://doi.org/10.1177/1558689819857972

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Morrison, A., McCartan, C., Davidson, G. and Bunting, L. (2018). Anti-poverty practice framework for social work in Northern Ireland. Belfast: Department of Health. https://www.health-ni.gov.uk/publications/doh-anti-poverty-framework

Ritchie, J. and Spencer, L. (1994). Qualitative data analysis for applied research. In: Bryman, A. and Burgess, R.G., eds. Analysing qualitative data. London: Routledge: 173-194.

Wilkinson, R. G. and Pickett, K. (2009). The Spirit Level. London: Bloomsbury Press.