The Integration of Health and Social Care: The Lessons from Northern Ireland

Mechanisms for the integration of social services with health have come to dominate the debate on providing a more seamless provision of health and social care. Working together at the health and social care interface has been strongly promoted and endorsed in government documents since the late 1990s. Moves towards integration have been treated with suspicion and scepticism in the academic literature, with many authors highlighting the many barriers and challenges presented by this method of working. Yet these proposals do not represent a paradigm shift in culture in all parts of the United Kingdom, as Northern Ireland has had an integrated health and social care system for over thirty years. Based on an empirical study of senior health care professionals in Northern Ireland, this study identifies and discusses the key issues associated with integration. It concludes that the experiences in Northern Ireland have to date been overlooked or misrepresented and could prove extremely valuable in gaining an understanding of the challenges and benefits of integrated arrangements.     

Relating outcomes to objectives in child protection

With the introduction of the Children (Northern Ireland) Order 1995, Health and Social Care Trusts in Northern Ireland have been engaged in a refocusing of children's services, shifting resources and interventions towards supporting families at an earlier stage in order to reduce the likelihood of crisis, breakdown or abuse at a later stage. Alongside this development the Government wishes to see a clearer link between the objectives of the child protection system and the outcomes for children and their families. This paper critiques the current system of performance management in the child protection system. Using data from a study exploring the characteristics and careers of children in the children protection system in Northern Ireland it is argued that the current measurements of performance are too basic and are designed principally to monitor the operation of the system rather than the impact of services and interventions on the lives of children and their families.     

Understanding and negotiating identity: Children from cross-community families in public care in Northern Ireland

In Northern Ireland, most research on the impact upon children of living through the ‘troubles’ and in a divided society has assumed that children are from either the Catholic or Protestant community. There has been very little research with children from cross‐community families who have one parent from a Catholic background and one from a Protestant background. It is known, however, that these children are over‐represented in the public care system in Northern Ireland. The study reported in this paper addresses this gap in knowledge by exploring the experiences and views of children from cross‐community families who are in public care in Northern Ireland. The study has key messages for the development of services for looked after children from cross‐community families, if these are to be delivered in accordance with legislative duties in Northern Ireland and in an anti‐sectarian manner.     

Truth,partial truth,and irreconcilable truths: Reflections on the prospects for truth recovery in Northern Ireland

The issues facing truth recovery work in Northern Ireland arise in the context of a peace process in which there has been no clear winner, where several key issues, such as policing and criminal justice remain unresolved, and where there is a lack of trust between the parties to the conflict. Yet there is a demand for processes that have the potential to uncover the truth about unresolved killings and disappearances. The South African Truth and Reconciliation Commission is often cited in Northern Ireland as a model for truth recovery processes, in spite of its shortcomings and the contextual differences between South Africa and Northern Ireland. While there remains a demand for truth about human rights violations and contested killings, the compromised nature of the Northern Ireland settlement and the culture of silence that prevails within Northern Ireland institutions are obstacles to the progress of truth recovery work there. Nor is Northern Ireland ready for the rewriting of its history, although some argue that truth recovery work could provide an important disincentive to those who would return to violence. The assumption that truth recovery is always a prerequisite for healing is challenged, and painful effects of truth processes in reopening the wounds of the past are pointed out. Yet the role of truth recovery in improving public awareness of the wrongs of the past, and in providing new opportunities for forgiveness and reconciliation is acknowledged. However, truth recovery can inadvertently reinforce a dis‐empowered and unhealthy “victim culture” and may also prejudice future judicial processes. The paper concludes by summarizing the recommendations for truth recovery in Northern Ireland of the Healing Through Remembering Project. They suggest that a range of mechanisms, including some community‐based self‐help processes, are the preferred paths for this work in Northern Ireland.     

Social Work, Sectarianism and Anti-sectarian Practice in Northern Ireland

Correspondence to Dr Jim Campbell, Department of Social Work, The Queen's University of Belfast, 7 Lennoxvale, Belfast BT9 5BY, Northern Ireland. Jim Campbell lectures in the Department of Social Work, The Queen's University of Belfast. His doctoral thesis was on the concept of violence in social and political thought. His current research interests include social policy in Northern Ireland and mental health social work Summary This paper addresses a subject relatively unknown to the Britishand international social work audience—that of trainingfor anti-sectarian practice. In doing so, it points to someof the complex, even dangerous issues raised by such trainingfor social work students and practitioners in Northern Ireland.The paper comments upon the limited but significant ways inwhich social work educators and practitioners have tried tochallenge sectarian discrimination in Northern Ireland, andproposes methods in train ing and research which might facilitatea better understanding of these processes.     

The Development of Intergroup Forgiveness in Northern Ireland

As societies like Northern Ireland, Israel, and South Africa strive to resolve social conflict, there is growing theoretical and empirical interest in the role of intergroup forgiveness. This study examined intergroup forgiveness among 340 young adults in Northern Ireland. A short form of the Enright Forgiveness Inventory explored possible influences on propensity to forgive. All participants were Catholic and female (mean age 17.36 years), and had experienced verbal or physical injury or bereavement due to the Northern Irish political violence. Overall forgiveness levels were low in comparison with previous studies of interpersonal forgiveness but similar to previous studies of intergroup forgiveness in Northern Ireland. The strongest (negative) predictor of forgiveness was the perceived degree of hurt caused by the injury .     

Policy Style and Governing without Consensus: Devolution and Education Policy in Northern Ireland

Devolved government was established in Northern Ireland in 1999 at the same time as Scotland and Wales with a varying range of powers, particularly over the major areas of social policy including education. Devolution in Northern Ireland was set up on the basis of statutory power‐sharing in the core executive with a number of mechanisms to promote involvement by all sections of the community through their political representatives. This marked a departure from the traditional majoritarian and hierarchical model of UK government. The operation of devolved government in Northern Ireland requires a consensus on major policy items requiring legislation. The main aim of the article is to assess whether or not there is a devolved policy style in Northern Ireland and to compare this policy style with the findings of similar analysis in Scotland and Wales. Consideration is then given to the impact of both the distinctive policy processes which reflect the consociational nature of the Good Friday Agreement and wider social, political and administrative factors. Decision‐making on education policy is a totally devolved function and thus serves as an important example of autonomous policy formulation and policy‐making. The three main topics of current policy debate in education are selected for analysis to determine the nature of the decision‐making process and the existence of a distinct devolved policy style.     

Identities in Northern Ireland: A Multidimensional Approach

The conflict in Northern Ireland is often described in terms of a clash of identities, national and religious. This study aimed to determine the relative importance of these identities using a multidimensional approach to examine the identity structures of students (N = 216). Analyses revealed that national and religious identities were accorded low salience and centrality relative to other identities. The study also investigated relations between a variety of identity dimensions derived from two identity traditions, social identity theory and identity theory. The differing patterns of relationships to emerge across groups and across identities suggest that the process of identification in Northern Ireland is a complex one. The implications of these findings for the analysis of the Northern Ireland conflict are discussed.     

Children of the Troubles: The Impact of Political Violence in Northern Ireland

This article explores the effects of political violence on children and young people in Northern Ireland. The article begins with a brief historical account of the Northern Irish conflict and the recently negotiated Belfast Good Friday Agreement of 1998. This account illustrates, as is the case with many conflicts, its basis is religious, national, economic, and political, despite its frequent construction as a battle between Protestant and Roman Catholic. The article goes on to review young peoples' experience of conflict in Northern Ireland and the impact of conflict experiences on three related areas of young people's lives. These include the effects of the conflict on everyday aspects of life, social identity, and mental health .     

Secular Trends in Substance Use: The Conflict and Young People in Northern Ireland

The resolution of political conflict has led some to suggest that Northern Ireland will now face a range of social problems that have been ignored or suppressed by the Troubles. One such area is adolescent drug use. In this article, a review of a range of data sources shows that drug use, with few exceptions, has increased since the emergence of the ongoing peace process. Social and political changes and enhanced paramilitary involvement in the drugs trade appear to have somehow created an environment where drug use has flourished. In reviewing current drug policy and practice, the article highlights the lack of prevention, treatment, and harm reduction services established in Northern Ireland as a cause for concern .     

Intergroup Contact, Forgiveness, and Experience of "The Troubles" in Northern Ireland

Two studies used random sample surveys to test the "contact hypothesis" on intergroup attitudes of Catholics and Protestants in Northern Ireland. In Study 1, archival data from two different surveys in 1989 ( N = 310 Catholics, 422 Protestants) and 1991 ( N = 319 Catholics, 478 Protestants) showed that contact was positively related to attitudes toward denominational mixing. Study 2 ( N = 391 Catholics, 647 Protestants) explored predictors of intergroup forgiveness, and also showed that intergroup contact was positively related to outgroup attitudes, perspective-taking, and trust (even among those who had a worse experience of sectarian conflict). These studies indicate that research in peace psychology can provide a deeper understanding of the conflict in Northern Ireland and, in due course, contribute to its resolution.     

Using critical social theory to develop a conceptual framework for comparative social work

This paper sets out a conceptual framework for comparing and contrasting social work within nation-states and across international boundaries. The framework is "situated" theoretically within a (late)modernist understanding of events within advanced capitalism and draws primarily on Habermas' critical social theory. The authors apply this framework to explicate the development of social work in Northern Ireland, a region in which high levels of political conflict mark it out as a site of local, national and international interest. It is suggested that the ideas developed from the case study have relevance for the social professions in other countries, particularly where social conflict is in evidence.     

Varieties of marketisation in the UK: examining divergence in activation markets between Great Britain and Northern Ireland 2008–2014

This article examines the sub-national diversity in activation quasi-markets in the United Kingdom (UK). Through comparison of four active labour market programmes in Great Britain and Northern Ireland between 2008 and 2014, the article clarifies and maps intra-UK diversity in employment service governance and unpacks the shifting configurations of market structures in each jurisdiction to reveal a temporally and spatially distinct patterning of marketisation. Drawing on Gingrich's approach to analysis and classification of quasi-market variation, the article proposes that between 2008 and 2014, Great Britain rapidly evolved a provider-directed activation market. In contrast, the activation market structure in Northern Ireland, up to late 2014, is better characterised as state directed. A recent reconfiguration of the activation market in Northern Ireland does however indicate some (modified) convergence on Great Britain's approach. One common and consistent feature of the configuration of activation markets in each jurisdiction is the few powers given to direct users of employment services to shape contracted out provision.     

An Empirical Study into the Psychosocial Reactions of Staff Working as Helpers to those Affected in the Aftermath of two Traumatic Incidents

Correspondence to Professor Dorota Iwaniec, Institute of Child Care Research, Queen's University Belfast, 5a Lennoxvale, Belfast BT9 5BY, Northern Ireland, UK. Summary This paper will address the outcome of the first empirical studyon the psychosocial impact on four groups of professional staffinvolved as helpers in the aftermath of two major incidents.The two incidents selected were the Kegworth Air disaster thatoccurred in the East Midlands area of England in 1989 and aterrorist bombing on the Shankill Road Belfast, Northern Ireland(NI) in 1993. The four groups of staff chosen for the research,both in England and Northern Ireland, were social workers, ambulancepersonnel, accident and emergency nurses and clergy. The policyand practice implications of the study were used to developa training programme for those who have to cope with traumain their workplace. The need for such training was based onthe hypothesis that pre-training will help to ameliorate anynegative reactions that may be experienced by the helpers. Theresults from both incidents were compared to highlight the impactof the work on helpers working with victims from a single incidenttrauma and in a situation where there was multiple incidenttraumatization.     

Examining the influence of the European Convention on Human Rights in Northern Ireland courts

This article examines the influence of the European Convention on Human Rights (ECHR) on the legal culture of litigants and judges in Northern Ireland. The results show that there has been a dramatic increase in the number of judicial review cases based upon the ECHR in the years immediately following implementation of the treaty through the Human Rights Act. However, while there has been an increase in the number of ECHR claims by litigants, judges in Northern Ireland have thus far been reluctant to issue declarations of incompatibility pursuant to the Human Rights Act. Furthermore, a multivariate analysis of the likelihood of Northern Irish judges to rule against the government shows that, controlling for other factors, judges are not more willing to rule against the government when the ECHR is invoked. Overall, it appears that the early influence of the ECHR on Northern Irish law has been greatest in the willingness of litigants to bring judicial review cases based upon the treaty—a development that may portend larger changes in UK jurisprudence in the future.     

Child Poverty in Northern Ireland: The Limits of Welfare-to-Work Policies

Levels of child poverty in Northern Ireland are high; 32 per cent of children live in households whose only income derives from benefits, compared with 19 per cent of children in Britain living in families totally dependent on benefits. Unemployment, low pay, a higher cost of living, low levels of public services, including childcare and support services for people with disabilities, slightly larger families and a lack of access by poorer women to the means of limiting their family size, together with even greater levels of inequality than in Britain, all contribute to the high levels of child poverty in Northern Ireland. This paper argues that even the less ambitious child poverty targets announced by the Department of Work and Pensions at the end of 2003 will not be met unless there is a fundamental change in the government's approach. In particular, evidence from Northern Ireland suggests that its insistence on work as the primary—if not only—route out of poverty will not lead to a radical reduction in levels of child poverty.     

Identity Change in Northern Ireland: A Longitudinal Study of Students' Transition to University

This two-wave longitudinal study followed a cohort of young people in Northern Ireland (N = 124) to examine how the transition to university impacts on identity change. Drawing on Stryker's (1968, 1987) identity theory, we examined salience, affective and interactional commitment for five identities: family member, friend, student, national and religious identity. The relative salience of national and religious identities did not change over time, but an absolute increase in the salience of religious identity was indicated at Time 2. Regression analysis provided some support for identity theory but suggested a difference between Catholics and Protestants in relation to religious identity. The implications for the identities of young people in Northern Ireland, and, more generally, for identity theory are discussed .     

Researching in the Victorian censuses: a note on a computerized,annotated bibliography of publications based substantially on the census enumerators' books

The authors describe a project, begun in 1981, to locate, list, and annotate all the published work based substantially on the census enumerators' books for nineteenth-century censuses for England and Wales. The results are currently available in a computerized file, enabling a variety of searches by topic, geographical area, and type of population. Information is provided on using the data and the computerized bibliography. The authors note that, subsequently, data for censuses of Scotland and Ireland have been added.     

Postconflict Reconciliation: Intergroup Forgiveness and Implicit Biases in Northern Ireland

Even after a conflict has formally ended, there is still a need for postconflict reconciliation and the building of mutual forgiveness and trust between communities. This article addresses psychological processes crucial to moving beyond a history of violent sectarian conflict in Northern Ireland. We investigated the predictors of intergroup forgiveness, in terms of intergroup emotions, infrahumanization, empathy, and intergroup contact. Intergroup trust and measures of implicit intergroup bias were also explored in this area of real intergroup conflict. The results are discussed in terms of their implications for postconflict reconciliation in Northern Ireland and other conflict areas.     

Social Work and Social Justice in Northern Ireland: Towards a New Occupational Space

Correspondence to: Dr John Pinkerton, School of Social Work, Queens University Belfast, 7 Lennoxvale, Belfast BT9 5BY, Northern Ireland. E-mail j.pinkerton{at}qub.ac.uk Summary This article considers the concept of social justice by referenceto the experience of social work in Northern Ireland duringthe past forty years of communal, paramilitary and state violence.It notes the contested nature of the concept and its chequeredhistory within the professional ideology of social work generallyand its absence as a significant explanatory and motivationalconcept for social workers in Northern Ireland to date. It arguesthat in the emerging post-conflict situation social work asa profession needs to operationalize a view of social justicethat acknowledges social and cultural diversity in order toredefine the profession itself and direct its relationship toboth the state and civil society.