The Impact of Drugs on Family Well-Being The Impact of Drugs on Family Well-Being

Kieran McKeown and Grace Fitzgerald

Kieran McKeown Limited Social & Economic Research Consultants

SEPTEMBER 2006

BALLYFERMOT STAR Acknowledgements

We acknowledge the contributions James Maguire We received help from a number of of many people to this report. The Project Worker people and organisations in evaluation would not have been accessing those families affected possible without the support of Sandra Roberts by drug use but who are not using management and staff in Administrator Ballyfermot Star. Ballyfermot STAR. Marie Brown Olive Power Housekeeper Ballyfermot Social Intervention The Board of Management Initiative (an initiative of Dublin City Catriona Kearns Council) Patsy Moran / Community Family Support Co-ordinator Chairperson Dr. Eamon Keenan Sheila Ward Consultant Psychiatrist, Ashling Mary Marsh / Community Family Support / Key Worker Centre, Ballyfermot Treasurer Bernie Martin Fr. Seamus Ryan and the Parish Mark Kavanagh / Community Family Support Worker Council, St. Matthew’s Parish Secretary Tracy Smith Sr. Cora Mary Hill / Community Family Support Worker Parish Sister, Cherry Orchard Member Parish Declan Reddy Trish O’ Neill / Community Cocaine Initiative Co-ordinator Sr. Brigid Member The Bungalow Family Resource Collette Newman Centre Patricia Williams / Community Complimentary Therapy Member Co-ordinator Frank Gilligan Coordinator of Ballyfermot Local John Bruckshaw / Dublin Rebecca O’ Reilly Drugs Task Force. City Council Conference Coordinator Member All of the interviews were carried Selene Redmond out by Meg Murphy and we Administrator acknowledge the skills and The Staff Team sensitivity which she brought to Paul O’Toole this work. We also acknowledge Sunniva Finlay Administrator the generosity of all those who Manager shared their experiences with us in Bernie Shortall order to help other families Laura O’Reilly House Keeper affected by drug use. Education Co-ordinator / Depty Manager Finally, we wish to acknowledge A number of former staff the fi nancial support of Dublin City Richard Brennan also contributed to the report, Council which enabled this study Key Work Co-ordinator including to be undertaken.

Perry Walker Bernie McGrane Community Employment Family Support Worker Supervisor / Key Worker Linda Cooney Mary McGarry Assistant Family Support Worker Key Worker Jo O’Sullivan Pat Curren Education Coordinator and Project Worker Manager of CE Programme Contents

Early Development of 5 Well-being Of Service Users Ballyfermot STAR & 5.1 Introduction 27 Report Overview 5.2 Physical Well-Being 27 Patsy Moran 5.3 Emotional Well-Being 28 Ballyfermot STAR Chairperson 5.4 Psychological Well-Being 28 Sunniva Finlay 5.5 Negative Life Events 28 Ballyfermot STAR Manager 4 5.6 Support Networks 30 5.7 Neighbourhood Satisfaction 30 Introduction 7 5.8 Parent-Child Relationship 30 5.9 Relationship with Partner 32 1 Context 5.10 Summary and Conclusion 34 1.1 Introduction 9 1.2 Ballyfermot in Context 9 6 Infl uence of Drug Use on 1.3 Illegal Drug Use in Ballyfermot 10 Family Well-being 1.4 Services of Ballyfermot STAR 10 6.1 Introduction 37 1.4.1 Family Support Programme 10 6.2 Family Well-Being and Type of Drug User 37 1.4.2 Community Employment Programme 6.3 Family Well-Being and Number of for Recovering Drug Users 11 Drug Users 39 1.4.3 Complementary Therapies 11 6.4 Family Well-Being and Imprisonment 40 1.4.4 Drop-in Service 12 6.5 Family Well-Being and 1.4.5 Community Education Programme 12 Deaths from Drugs 40 1.5 Summary and Conclusion 12 6.6 Family Well-Being and Grandparents Acting as Full-time Parents 41 2 Methodology 6.7 Summary and Conclusion 41 2.1 Introduction 13 2.2 Defi nition of Need 13 7 Summary, Conclusions and 2.3 The Questionnaire 13 Implications 2.4 Interviews with Service Users 13 7.1 Introduction 43 2.5 The Analysis 13 7.2 Context 43 2.6 Structure of Report 15 7.3 Methodology 44 7.4 Background Characteristics of 3 Characteristics Of Service Users Service Users 44 3.1 Introduction 17 7.5 Drug-Related Experiences in 3.2 Age and Gender of Service Users 17 Families of Service Users 45 3.3 Parents and Grandparents 17 7.6 Needs of Service Users 45 3.4 Family Type 19 7.6.1 Physical Well-Being 45 3.5 Household Characteristics 19 7.6.2 Emotional and Psychological Well-Being 46 3.6 Housing Status 19 7.6.3 Negative Life Events 46 3.7 Education 19 7.6.4 Support Networks 46 3.8 Employment 20 7.6.5 Relationships with Children 46 3.9 Financial Position 20 7.6.6 Relationships with Partner 46 3.10 Summary and Conclusion 20 7.7 Impact of Drug Use on Families 46 7.8 Implications 47 4 Drug Use in Families of 7.8.1 Recognising the Socio-Economic Service Users Infl uences on Drug Use 47 4.1 Introduction 23 7.8.2 Matching Interventions to the 4.2 Drug Use by Family Members 23 Depth of Needs 47 4.3 Current Drug Status of Family Members 23 7.8.3 Matching Interventions to the 4.4 Family Members Imprisoned Range of Needs 48 for Drug Use 24 7.8.4 Recognising the Diversity of Needs 48 4.5 Family Members Died 7.8.5 Meeting Needs Through from Drug Use 24 Building Strengths 48 4.6 Length of Time Attending 7.8.6 Concluding Comment 49 Ballyfermot STAR 24 4.7 Summary and Conclusion 24 Appendix To Chapter One 51

Bibliography 57 Early Development of Ballyfermot STAR & Report Overview

After the publication of two Ministerial of a statutory and voluntary agency Ballyfermot STAR is a community reports on drug use in 1996 and 1997, showed this level of commitment. response to drug use. It provides non- a number of areas were identifi ed judgemental support, guidance and as having a major heroin problem. It was agreed to call the project education to drug users, their families and Ballyfermot was one of the areas in the Ballyfermot STAR. STAR stands the community, enabling them to cope greater Dublin area that was assessed for Support, Treatment, Aftercare with and overcome the effects of drug use as having a signifi cant drug use and Rehabilitation. In June 1999 in their every day lives. There are currently problem. Ballyfermot Local Drug Task the organisation was registered as 102 families and 160 drug users accessing Force initiated a number of consultation a charity and a company limited by services with Ballyfermot STAR. The meetings in the public library in 1997. guarantee. Ballyfermot STAR received staff team is comprised of nineteen These meetings were to form the basis funding to employ 2 workers and people, with each person performing of the fi rst Ballyfermot Drugs Task Force they were in place in June 1999. a unique and indispensable role. Plan. From these beginnings a number of working groups were established A premises was identifi ed and purchased Ballyfermot STAR delivers a unique care with Drugs Task Force funding in 2000. plan. The method used is based on a ‘Bio- Ballyfermot STAR as an organisation A manager and administrator post was Psycho-Social’ approach. This method grew out of this process. A number of funded by Ballyfermot Drug Task Force enables staff to look at the biological, local people expressed an interest in to assist the development of the project. psychological and social aspects of developing an initiative in response to individuals accessing care. Central to its heroin and its impact on individuals, Additional funding was secured for approach is the individual in question. The families and our community. A number refurbishment and the building was care plan can be summarised as follows: of sub-groups of the Task Force came offi cially opened in April 2002. A special together in January 1998 to look at the drugs Community Employment Scheme An initial assessment is carried out by a way forward in relation to what was was secured and started in April 2002. Care Team Member. The Care Team is seen as a central objective of requiring where all practice issues are dealt with in a premises and then delivering services An application was made under the EOCP the organisation. From this assessment a to drug users and their families. programme to secure funding for a crèche. key worker is assigned, who subsequently develops a care package. This is done Citywide Drug Crisis Campaign facilitated I wish to acknowledge the support of the under the guidance of the individual the group from January 1998 to develop people who have been involved on the in question. Identifi ed are a number its aims and objectives. The group, to Board of Management past and present. of areas in their life they wish to work enable people to see different approaches on. For a drug user these areas may and methods used by various projects I commend the staff past and present include homelessness, relapse into visited a number of drug projects. The for their dedication to the work of the drug use, health and childcare issues, group visited and got support and project, their professionalism and their education and training, or their release encouragement from the following commitment to the poeple of Ballyfermot. from prison, while for a family member, projects and service providers: Aisling key areas include feelings of shame and Clinic, Merchant Quay Project, Saol isolation, or a relationship breakdown. Women’s Project, Soilse, and Caroline Patsy Moran Project in Clondalkin, Clondalkin Addiction Ballyfermot STAR Chairperson A limited counselling service and a Support Project, and JADD in Tallaght, August 2006 complimentary therapy service are also Addiction Response Crumlin and Cairde. provided. These services are delivered alongside key working sessions. Meetings were used to help people clarify Additionally, Ballyfermot STAR facilitates their ideas around addiction and to look a Support Group for family members at what was the best way to develop a – a fathers group, a mothers group, community response. A lot of training a partners group, a siblings group, a and developmental work allowed the bereavement group, and a group for group to be in a position to develop a family members who have had a child project. This process was necessary, murdered. It also operates a wide-range as Ballyfermot unlike other Task Force of tailored accredited courses specifi c areas did not have a drugs community to service user needs. A training and or voluntary project operating in the education programme also features as area. The group, having met fortnightly part of Ballyfermot STAR’s care package. throughout 1998 and met weekly in 1999 For example, a FAS Special Community achieved this. Fourteen people who lived Employment Programme is delivered to in Ballyfermot as well as a representative 25 participants in recovery from drug use.

4 A strength-based approach is adopted members. Also, having a drug using agencies. Interagency protocol and and services are orientated to enhance parent or sibling creates the condition referral procedures need to be put in the service user’s self-esteem and in which children are at increased risk place locally in Ballyfermot with all ability to solve their own problems. of exposure to, and use of drugs. service providers. The Equal model Family members are encouraged in Blanchardstown is a very good to examine their own needs rather Families are in need of assistance and example of what can be achieved by than the needs of their child, sibling it is up to policy makers and service agencies working in collaboration or parent, and to see themselves as providers to meet those needs. locally. This will ensure that service individuals outside of drug use. A high users can progress and use other quality service is provided, based on a Problems are frequently more complex agencies as their needs suggest. philosophy of trust and understanding. than the solutions proposed and are beyond the reach of any one agency. The staff team, past and present, and At present, Ballyfermot STAR is in the volunteers in Ballyfermot STAR are the process of developing a Cocaine An integrated approach to drug use completely committed to carrying out the Initiative via the National Drugs Strategy is required, as well as a recognition aims and objectives of the organisation, Emerging Needs Programme. A Child of the enormous strain a drug using and will work with integrity, commitment Care Centre is also underway which is child, parent or sibling can have and professionalism to make this happen. funded through the EOCP programme on a family member and perhaps and the National Development Plan. more importantly on themselves. The Board of Management give Both programmes are unique to their time energy and commitment Ballyfermot STAR and as such must be As such, the key recommendations of to support and direct staff. credited to the innovative and visionary Ballyfermot STAR are as follows: approach taken by the organisation. • Parents who have a history of Sunniva Finlay ‘The Impact of Drugs on Family Well- drug use need additional supports Ballyfermot STAR Manager Being’, produced by Dr. Kieran McKeown with their parenting skills August 2006 was commissioned by Ballyfermot STAR to assess the needs and well- • Both family members and people being of both family members and who use drugs need specifi cally people who use drugs that access designed courses to improve services in Ballyfermot STAR. The confi dence and self esteem study clearly shows that compared to the average Irish family, the well-being • Specifi cally designed interventions of the families that access Ballyfermot are needed to improve physical, STAR is greatly affected by drug use. emotional and psychology well-being.

The report highlights a number of • Key working and case management diffi culties experienced by the service that is now in place in Ballyfermot STAR users of Ballyfermot STAR. needs to be extended to all agencies. This will provide a service conduit, These include: enabling service users to interact with a variety of agencies. Multidisciplinary • 36% of the Family Support group and teams need to be set up to 72% of the Community Employment accommodate this approach. group are prescribed benzodiazepines. This compares to a national average On a positive note, those who of 5%. This raises the question: does participated in the study felt that Ballyfermot require an additional they really liked living in Ballyfermot counselling service to support the and conveyed a strong sense of work of General Practitioners? belonging to their neighbourhood.

• Also highlighted is the impact a Although Ballyfermot STAR is working drug using relative can have on his/ extensively with both family members her family. Problem drug use creates and drug users at all stages in their enduring stress, anxiety and confl ict recovery and drug use, we need to work that greatly affect the health and well- extremely closely and in collaboration being of the family unit and its individual with all statutory community and voluntary

5

Introduction

It is now increasingly recognised to the inclusion of community family member in the household that drug use affects not just the as a key player in triggering the is using illegal drugs. The concept 1 STAR is an drug user but the whole family emergence of drug use and in of need refers to anyone who acronym for Support, Treatment, Aftercare, 4 including parents, siblings and shaping responses to it . However does not feel healthy or does Rehabilitation. wider kin such as grandparents. this evolution still overlooks the not experience a sense of well- In view of this awareness, there family dimension to drug use being. To be healthy, according 2 Watters and Byrne, 2004:8. is now growing concern about the as exemplifi ed in the current to the World Health Organisation needs of families affected by drug National Drugs Strategy (2001- involves “a complete state of 3 According to the use and the best ways of meeting 2008)5 which lacks a clear vision physical, mental and social well- Commission on the Family (1995-1998): 1 those needs. Ballyfermot STAR of how to address the needs of being and not merely the absence “The experience was one of the fi rst groups in families affected by drug use. of disease or infi rmity ... a resource of family living is Ireland to recognise how drug use Internationally, a recent review of for everyday life, not the objective the single greatest infl uence on an affects entire families and, since the literature on the needs and of living; it is a positive concept individual’s life and its establishment in 1998, has experiences of families affected emphasising social and physical the family unit is a fundamental building been offering supports to parents by drug use identifi ed 104 studies resources as well as physical and block for society” whose children take drugs as well but found that most of these were mental capacity”8. This concept of (Commission on the as supporting drug users who wish not “directly related to the needs health informs the Government’s Family, 1996:13; see also 1998). to make the journey to recovery. of families of drug users or how health strategy and is therefore those needs might best be met”6. important in shaping a policy- 4 This evolution The needs of families affected relevant understanding of need9. is excellently documented by by drug use are not well-known In Ireland, there are signs of Shane Butler and there is a widespread growing awareness that the The report comprises seven (2002) and a similar perception that services are not family dimension to drug use is chapters. In Chapter One we conclusion is reached in the analysis of responding adequately to those receiving more serious attention. set the scene by describing the Barry Cullen (2002). needs. An important conclusion This awareness has been socio-economic characteristics to emerge from a study of family triggered by the emergence of of Ballyfermot, the prevalence of 5 Department of Tourism, Sport and support services published by family support groups to help illegal drug use in the community, Recreation, 2001 the National Advisory Committee cope with the consequences of and the range of services on Drugs (NACD) in November drug use in families, of which offered by Ballyfermot STAR. In 6 Bancroft, Carty, Cunningham-Burley 2004 was that the majority of Ballyfermot STAR is a good Chapter Two, we describe the and Backett- these services “are not aware of example. Some of these groups methodology used to carry out the Milburn, 2002:3 the positive role they could play have formed a network - City Wide study. Chapter Three describes 7 CityWide in responding to and preventing Family Support Network - and the background characteristics Family Support drug, including alcohol, problems”2. have produced a handbook for of service users in Ballyfermot Network, 2004b 7 families affected by drug use . STAR while Chapter Four 8 Quoted in The reality in Ireland, as elsewhere, describes the extent of drug use Department of is that families who experience This study is timely given that experienced by these families. Health, 2001:15 drug-related problems are often Ballyfermot STAR has been in Chapter Five assesses the well- 9 Ibid overlooked by policy-makers, existence for nearly a decade being of service users along a service-providers, community and provides an opportunity to number of dimensions including activists and social researchers. systematically assess the needs physical, psychological, support This is because drug use is often of those who use its services networks, family relationships, seen as a problem which impacts and to refl ect on how all services etc. In Chapter Six we assess on individuals, communities and in the community - and not just the impact of drug use on family society at large - but not families. Ballyfermot STAR - might respond members by analysing variations Despite the acknowledged to those needs. As such, the in well-being according to the importance of families in study adopts a ‘needs-led’ rather intensity of drug use experienced determining well-being3, there than a ‘service-led’ perspective by the family. Finally, in Chapter is a tendency to overlook how by focusing on how services can Seven, we draw together the key drug use by a family member can be developed to meet the needs fi ndings and their implications. impact on other family members. of families affected by drug use.

The evolution of public policy and The main purpose of the study services on drugs over the past therefore is to assess the needs of 20 years in Ireland has shifted families who are affected by drug gradually from an exclusive use. As we use the term, a family focus on individual drug users is affected by drug use where one

7

1 Context

1.1 Introduction Realt Nua which are located The decline in overall deprivation in Park West Industrial Estate. scores is related to the signifi cant 10 STAR is an Ballyfermot STAR10 was set up in In 2004, funding was obtained decline in unemployment over this acronym for Support, Treatment, Aftercare, from the Equal Opportunities period. Like Dublin and Ireland, 1998. It emerged from a process of Rehabilitation. consultation initiated the previous Childcare Programme (2000- Ballyfermot experienced a halving year by Ballyfermot Drugs Task 2006) to build a 30-place childcare in the unemployment rate between 11 Data for this section was supplied Force to fi nd out how drug users facility - with additional capacity 1991 and 2002 for both men by Trutz Haase, and their families could be helped for 10 out-of-school places. (from 40% to 19%) and women Social and Economic through support, treatment, (from 33% to 15%) (Table A1.3). Consultant; see Appendix One at the aftercare and rehabilitation. From In this chapter we describe the Nevertheless the unemployment end of this report; this, a core group of 10-15 people broader socio-economic context rate in 2002 for men and women in see also Haase and from the community was formed of Ballyfermot (Section 1.2) and Ballyfermot was still considerably Pratschke, 2005. to formulate a response to the the prevalence of drug use in higher than the corresponding growing drug problem in the area. the community (Section 1.3). rates in Dublin (9% for men and The group participated in a training Against this background, we 8% for women) and Ireland (9% for programme on drug issues run by summarise the main services and men and 8% for women). In other Crosscare and visited a range of activities of Ballyfermot STAR words, Ballyfermot experienced drug projects throughout Dublin. In (Section 1.3) and conclude with an absolute improvement in light of this, it was decided to set a brief summary (Section 1.4). unemployment rates over the up STAR as a community response past decade but its relative to the problems created by drugs position remains unchanged. in the Ballyfermot area. The basic 1.2 Ballyfermot in Context aim was, and remains, to support Ballyfermot is relatively unique drug users and their families as Ballyfermot consists of seven by comparison with Dublin and well as provide information and electoral divisions (EDs), this Ireland in that nearly four out of ten education on drug issues to the being the catchment area for households with a child under 15 wider community. The overall both Ballyfermot Partnership and years (38%) is headed by a lone ethos of the project is to help Ballyfermot Drug Task Force. parent (Table A1.4). This is double people cope with, and overcome, The area is sometimes referred the rate for Dublin (21%) and more their problems by building on to by its postal address, ‘Dublin than double the rate for Ireland strengths and reducing the 10’. In 2002, all seven EDs were (17%). Indeed more than half of all tendency to identify with addiction. amongst the 5 per cent most households in one ED (53%) are In other words, the project aims disadvantaged EDs throughout headed by a lone parent. This may to address the needs of the the country11. The population of be the result of more young women whole person and not just the Ballyfermot in 2002 was just over in the area becoming single problems arising from drug use. 20,000. Unlike the rest of Dublin or parents, a higher rate of separation Ireland, its population has declined / divorce, or the outcome of public In 1999, the project established continuously since 1986, mainly housing policy which concentrates itself as a company limited by as a result of an ageing population lone parents in areas such guarantee and registered as in some EDs (Table A1.1). as Ballyfermot - or perhaps a a charity. In the same year it combination of all three factors. received funding from Ballyfermot The decade between 1991 and Drugs Task Force to employ a 2002 is notable in Ireland for The social class characteristics family support worker and an the decline in deprivation and of Ballyfermot are highly skewed education worker; by 2004, the the growth in prosperity which towards the two poorest classes, staff team had grown to 12 people. was experienced throughout namely those designated as semi- In February 2000, Ballyfermot the country as a result of skilled or unskilled (Table A1.5). Drugs Task Force purchased the ‘Celtic Tiger’ (see Table In 1991, nearly half of the adult premises at Drumfi n Park which is A1.2). Ballyfermot shared in population in Ballyfermot (48%) the main base for delivering many this process with a marginally were in these two categories but of Ballyfermot STAR’s services, higher reduction in deprivation this proportion dropped to nearly including its family support scores (19.0) compared to Dublin four in ten (39%) in 2002, refl ecting programme. The Community (16.3) or Ireland (15.4). However a general trend over time in the Employment programme, designed its overall relative position reduction of persons designated to support those making the - in being among the 5 per cent as semi-skilled or unskilled. journey to recovery from drug most disadvantaged EDs in the However, the concentration in use, is run from premises called country - remains unchanged. Ballyfermot of semi-skilled and

9 unskilled manual categories in 1.3 Illegal Drug Use that there is an 18 month waiting 2002 was about twice that found in Ballyfermot period before accessing drug in Dublin (16%) and Ireland treatment services in Ballyfermot. (20%). Conversely, the presence In 2001, Ballyfermot Drug Task of professional classes remains Force estimated that there were Persons accessing drug treatment meagre within the area (rising 1,000 problem heroin users in the services, according to the National from 6% in 1991 to 10% in 2002). area12, a fact which clearly justifi es Drug Treatment Reporting System, Although the proportion nearly the title of its strategic plan for are typically in the age range 16-36 doubled in the eleven-year time 2001-2002 - ‘Ballyfermot Has A years19. Three quarters of them span between 1991 and 2002, the Drug Problem’. If the prevalence are male (77%) and two thirds live 12 Ballyfermot Drug increase trails behind the general rate is based on the population with their parents / family (68%). Task Force, 2001:55 trend in Dublin (from 29% to 36%) aged 15-4413 - the age group most A substantial minority (21%) are 13 Based on and Ireland (from 25% to 32%). likely to be involved in heroin use early school leavers, a tenth are data prepared by - then this produces a prevalence still in education (11%) with only GAMMA, 2004 Education levels improve over rate of 10%; if this is further a third (32%) in employment. In 14 Drug Misuse time, as younger age cohorts adjusted to take account of the fact Ireland, as elsewhere, persons Research tend to stay longer at school. that three quarters of all drug users with problem drug use tend to Division, 2003 Comparative measures only exist are men14, then the prevalence rate live in areas of concentrated 15 National Advisory for the 1996 and 2002 Censuses, is 15% for men and 5% for women. disadvantage and this is clearly Committee on Drugs, since the 1991 Census expressed the case in Ballyfermot. 2005:Tables 6 and 14 In other words, one in 7 men and the proportion of people attaining one in 20 women are estimated to 16 Ballyfermot Drug each level of education for those in be heroin users in Ballyfermot. In Task Force, 2001:59 the labour force only; as of 1996, 2002, the ‘last month prevalence’ 1.4 Services of 17 Quoted in the proportions are expressed as of heroin use among young adults Ballyfermot STAR Ballyfermot Drug proportion of the adult population (15-34 years) in Ireland was 0.1% Task Force, 2001:64 (Table A1.6). The proportions of while in the South Western Area Ballyfermot STAR offers a wide 18 Ballyfermot Drug the adult population in Ballyfermot Health Board, which includes range of services to address Task Force, 2001:66 with primary education only Ballyfermot, the prevalence the needs of individuals and 15 19 Drug Misuse has dropped by about twenty was 0.4% . This implies that families affected by drugs. Research percentage points over the past Ballyfermot has a heroin problem The key services are: Division, 2003 eleven years, a remarkable which is 25 times greater than in The Family Support Programme achievement. However, levels the surrounding South Western The Community remain extraordinarily high when Area Health Board region and 100 Employment Programme compared to Dublin and Ireland. times greater than in Ireland. In 2002, nearly half the adult Complementary Therapies population in Ballyfermot (47%) Heroin and cannabis are the two Drop-in Services attended primary education main illegal drugs being used Community Education Programme only, compared to 19% in Dublin in Ballyfermot. According to We now briefl y describe and 22% for the country as a Ballyfermot Drugs Task Force, each of these. whole. At the other end of the “This trend has remained the same educational spectrum, the fi gures over the years. The use of ecstasy with respect to the attainment and speed has not been prevalent 1.4.1 Family Support of third level education are even but in recent times the local drugs Programme more extreme. In 2002, the adult unit has come across a small population in Ballyfermot who amount of cocaine abusers”16. This programme began in 1999 attended third level education with the formation of family support still amounted to only 7% by The number of persons from groups. These groups were formed contrast with 34% in Dublin and Ballyfermot who were accessing to help parents and their partners 26% in the country as a whole. drug treatment services in 1999, cope with the isolation and other the latest year for which data consequences of addiction in the This profi le indicates that is available from the National family. Persons can stay in any of Ballyfermot is a highly Drug Treatment Reporting the groups for as long as they need disadvantaged area in terms of System, was 29817. Nearly half and many have been attending for deprivation scores, including of them came from two EDs, a number of years (see Table 4.5 unemployment, social class Cherry Orchard C (26%) and below). A number of groups now and education. Although the Drumfi nn (20%). Ballyfermot has exist within the project as follows: area experienced a reduction three drug treatment centres in absolute deprivation scores - Aisling, Fortune House and (i) Family Support Group which during the decade between Cuan Dara - but over half their meets every Wednesday - usually 1991 and 2002, its relative clients in 1999 were not from referred to as ‘the Wednesday position in terms of affl uence and Ballyfermot indicating, according Night Group’ - has an average deprivation remains unchanged. to Ballyfermot Drugs Task Force, attendance of 5-15 people, that ‘Ballyfermot residents were and is facilitated by the Family going elsewhere for treatment’18. Support Worker. The main focus One of the reasons for this may be of this group is on peer support

10 through sharing experiences (iv) Peer Support Group which 1.4.2 Community and information about how to comprises 8-10 members who Employment Programme cope with illegal drug use in the are recovering from drug use, for Recovering Drug Users family. Over the years, the group many of them already drug-free. has built up an expertise on the This group, which is sometimes This is a three year programme symptoms associated with different referred to as the ‘aftercare group’, funded by the FÁS under drugs, their health consequences, is designed to support those who the Community Employment the type of treatment services wish to change their drug using Programme. The programme available as well as the impact behaviour and prevent relapse. has 15 places for former drug of drug use on different family The group is facilitated by the users, each at different stages members. This is an ‘open’ group Family Support Worker. The in the recovery process. The 20 An Cosán is a centre of learning, which is offered to parents who group has a stable membership programme comprises a range leadership and fi rst come to Ballyfermot STAR and and has developed to become of courses, mainly accredited enterprise; see www. would like to meet other parents an advisory committee within by FETAC (Further Education ancosan.com for support. A trained therapist in Ballyfermot STAR on a range of and Training Awards Council), to bereavement and loss also attends issues which affect service users. build the skill base of participants this group to offer support and In the longer term, the group including computers, horticulture, guidance where needed. Training would also like to have an impact art & design, health & safety, is offered within the group on how on all aspects of public policy fi rst aid, relapse prevention, to provide peer support. In order which are relevant to drug use. music technology, and childcare. to facilitate the integration of new Training is provided through a members, the group spends a day (v) Bereavement Group comprises number of local facilities which outside the community - called about 5 parents who have are designed to create a ‘normal’ ‘Isobel’s Day’ - at An Cosán20 in experienced a death or other training environment which is Tallaght which helps them to relax serious loss in the family. The free from any associations with and refl ect away from the daily group is facilitated by a trained illegal drugs. An individual care struggles of coping with drug use. bereavement and loss therapist. plan is devised in consultation with each participant focusing (ii) Personal Enrichment Group (vi) Sibling Group is made up of on their personal development which meets every Monday - 5 teenage girls who meet for two as well as on their career usually referred to as ‘the Monday hours every Wednesday after aspirations. A work experience Night Group’ - has an attendance school. The group, whose siblings placement is also offered and of 5-15 people, and is also are involved in illegal drug use, complementary therapies are facilitated by the Family Support do arts and crafts as well as available. The overall ethos of the Worker with a psychotherapist personal development, including programme is to cultivate self- sometimes in attendance. A key a programme on grief and loss belief so that each person has the focus of this group is on personal programme; some afternoons confi dence to achieve his / her development and the group is seen are also spent going to the goals and is given every support as a progression opportunity for cinema or to a local restaurant. and encouragement to do so. members of the Family Support The group is facilitated by the Group; parents in this group will Assistant Family Support Worker. fi rst have attended the Family 1.4.3 Complementary Support Group for a period. In (vii) Summer project involves Therapies addition to the weekly meetings, activities for parents and children the group has also organised such as picnics at the beach, The project offers a range of weekend activities such as a visiting the zoo, outings to a complimentary therapies with personal development course in farm, etc. These are organised the aim of helping people to feel Glendalough in Co. Wicklow. by the Assistant Family Support less stressed and more relaxed, Worker and take place every thereby enabling them to cope (iii) Men’s Group which has fi ve Wednesday over an 8-week better with the diffi culties besetting members and meets weekly. One period between July and August. them as a result of drug use in of the factors which contributed to Up to 70 children of parents the family. Participants on the the formation of this group was the who use the project attend. A family support programme and need for a separate space for men free bus service is provided by the Community Employment and fathers given that a majority Dublin Bus and the Sibling Group programme make particular use of in the Family Support Group and take responsibility for making the complementary therapies. The the Personal Enrichment Group sandwiches for the picnic. range of therapies include Shiatsu, were women. The main focus of full body acupuncture, auricular this group is on mutual support (viii) Christmas Party has acupuncture, massage, meditation, and personal development. In become an annual even which reiki and relaxation techniques. addition to the weekly meetings, is organised for the younger These services are provided the group has also organised children of parents who attend by a trained therapist but other weekend programme outside the project. Over 100 parents members of the project are also the community. The group is and children normally attend and being trained in complimentary facilitated by a psychotherapist. Santa gives each child a gift. therapies. In recent years, over

11 200 family members and a further 1.5 Summary & Conclusion of the fact that three quarters of 50 people in recovery have availed all drug users are men24, then of complementary therapies. Ballyfermot STAR (Supporting the prevalence rate is 15% for Aftercare Recovery) was set up men and 5% for women. In other in 1998 and receives mainstream words, one in seven men and one 1.4.4 Drop-in Service funding through the Ballyfermot in twenty women are estimated to Drugs Task Force. Its basic aim be heroin users in Ballyfermot. In A range of services are offered is to support drug users and 2002, the ‘last month prevalence’ to both active drug users as their families, and to provide of heroin use among young adults well as other family members, information and education on drug (15-34 years) in Ireland was 0.1% 21 All data in this who drop into the centre. These issues to the wider community. while in the South Western Area section is supplied by Trutz Haase, services are offered by the Family This is done by helping people to Health Board, which includes Social and Economic Support Worker and include cope with, and overcome, their Ballyfermot, the prevalence Consultant; see information, advice, counselling, problems by building on strengths was 0.4%25. This implies that Appendix One at the end of this report. complementary therapies as and reducing the tendency to Ballyfermot has a heroin problem well as referral to other services. identify with addiction. The project which is 25 times greater than in 22 Ballyfermot Drug The type of diffi culties presented has a staff of 12 people and is a the surrounding South Western Task Force, 2001:55 through this service include company limited by guarantee with Area Health Board region, and 23 Based on trouble with the law, drug charitable status for tax purposes. 100 times greater than in Ireland. data prepared by dealers or money lenders, health GAMMA, 2004 problems, family problems arising Ballyfermot, sometimes referred The number of persons from 24 Drug Misuse from illegal drug use, physical to by its postal address as Ballyfermot who were accessing Research threats, supports with childcare, drug treatment services in 1999, Division, 2003 ‘Dublin 10’, consists of seven etc. Assistance is offered on a electoral divisions (EDs), and the latest year for which data is 25 National Advisory one-to-one basis rather than is the catchment area for both available from the National Drug Committee on Drugs, 2004:Tables 6 and 14 with the family as a unit. Ballyfermot Partnership and Treatment Reporting System, Ballyfermot Drug Task Force. was 29826. Although Ballyfermot 26 Quoted in In 2002, all seven EDs had a has three drug treatment centres Ballyfermot Drug Task Force, 2001:64 1.4.5 Community combined population of just over - Aisling, Fortune House and Education Programme 20,000 and were amongst the Cuan Dara -over half their 27 Ballyfermot Drug 5 per cent most disadvantaged clients in 1999 were not from Task Force, 2001:66 Each year the project runs two EDs in the country21. The Ballyfermot indicating, according education programmes for the decade between 1991 and to Ballyfermot Drugs Task Force, general public in Ballyfermot: (i) 2002 is notable in Ireland for that ‘Ballyfermot residents were a community addiction studies the decline in deprivation and going elsewhere for treatment’27. course and (ii) a community health the growth in prosperity which One of the reasons for this may be course. Both courses, which are was experienced throughout the that there is an 18 month waiting accredited by FETAC (Further country as a result of the ‘Celtic period before accessing drug Education and Training Awards Tiger’. Ballyfermot shared in treatment services in Ballyfermot. Council), comprise about 20 this process and, in absolute sessions, each session lasting terms, experienced a similar As we have seen, Ballyfermot about 3 hours, plus a residential improvement to Dublin and Ireland STAR offers a wide range of weekend. The community in terms of reduced deprivation services to address the needs addiction studies course, which is scores, increased employment of individuals and families run by the Ballymun Youth Action and improvements in education. affected by drugs. These include: Project, covers topics such as However its relative position in a family support programme, drugs and addiction and how they terms of affl uence and deprivation a Community Employment effect individuals, families and remains unchanged and it is still programme, complementary communities and well as how to one of the most disadvantaged therapies, a drop-in service, respond to their consequences. areas in Dublin and Ireland. and a community education The community health course, programme. In our assessment which is run by Sláinte Pobail, is In 2001, Ballyfermot Drug Task of the needs generated by the about promoting positive lifestyles Force estimated that there were impact of drug use we focus on through raising awareness and 1,000 problem heroin users in service users in the family support developing skills in nutrition, stress the area22, a fact which clearly programme and the Community management, relaxation, shiatsu, justifi es the title of its strategic Employment programme. massage, understanding the plan for 2001-2002 - ‘Ballyfermot The methodology which we body and using complementary Has A Drug Problem’. Expressed use to assess those needs is therapies for common complaints as a prevalence rate for the described in the next chapter. such as colds and fl u’s. population aged 15-4423 - the age group most likely to be involved in heroin use - this implies that 10% of the target population in Ballyfermot are heroin users; if this is further adjusted to take account

12 2 Methodology

2.1 Introduction with children and with partner, National Household Survey, the etc. In light of this understanding, Living in Ireland Survey, etc. 28 See McKeown, The main purpose of this study our assessment of need meets Pratschke and Haase, 2003 is to assess the needs of service three essential requirements users who attend Ballyfermot for measuring well-being29: 2.4 Interviews with 29 See Brooks STAR. Service users come from Service Users and Hanafi n, 2005; Hanafi n and families affected by drug use 1. It covers the key Brooks, 2005; which means that at least one dimensions of need Interviews were carried out with family member in the household two groups of service users. The 30 McKeown, Pratschke and is using illegal drugs. We focus 2. It uses tried and tested fi rst group comprised participants Haase, 2003 in particular on service users in instruments to measure on the family support programme. the family support programme, those dimensions of need These are mainly parents 31 See McKeown, Haase and many of whose children use whose children are involved in Pratschke, 2001; drugs, and the Community 3. There is comparable data drug use. Interviews were held 2004a; 2004b Employment programme, all of for Ireland against which to assess with 45 of these participants, 32 Adapted from whom are making the journey if families affected by drug use and this represents the vast Derogatis, 1992. towards recovery from drug use. in Ballyfermot fall below a majority of those who were using 33 National Advisory In this chapter we describe the threshold which is regarded this service at the time of the Committee on methodology used to assess the as statistically normal for interviews in 2004/5. The second Drugs, 2005. needs of these service users and other Irish families. group comprises participants 34 See Centre for on the Community Employment begin by defi ning the concept of Health Promotion need used in the report (Section programme and these are in Studies, 2003. 2.2). We describe the instruments 2.3 The Questionnaire the process of recovery from 35 Adapted from used in the questionnaire to drug use. Interviews were held Watson, Clark, and assess needs (Section 2.3) and The questionnaire used to with all of the participants on Tellegen, 1988. the number of interviews which measure need among those the programme at that time. 36 Adapted from were undertaken (Section 2.4). who use Ballyfermot STAR Bem, 1974. We explain how the data was draws together a range of The number of service users who analysed (Section 2.5) and give instruments which have been were interviewed, broken down by 37 Adapted from Ryff and Keyes, an overview of the structure tried and tested internationally. their location within Ballyfermot 1995; Ryff, 2001. of the report (Section 2.6). Equally important, they have is summarised in Table 2.2. This been used in a national study shows that interviews were held 38 LIIS is a survey of income and living 30 of family well-being in Ireland with 45 participants from the standards carried 2.2 Defi nition of Need and some have also been used family support programme and out by the Economic in the evaluation of Springboard 18 participants on the Community and Social Research Institute between 31 In order to carry out a study of projects in Ireland . As such, Employment programme. 1994 and 2001; need, it is necessary to begin they provide useful benchmarks Service users are drawn from since replaced by a new annual survey against which to measure the all areas of Ballyfermot but with a clear defi nition of need. called the Survey Persons are said to be in need well-being of persons affected by with stronger concentrations on Income and when their well-being is below a drug use in Ballyfermot. These coming form Cherry Orchard Living Conditions, as part of an EU-wide threshold that is regarded as either instruments and the dimensions B (24%) and Kylmore (18%). survey (EU-SILC). normal or minimal. In this study, of need which they measure the ‘normal’ threshold is defi ned are summarised in Table 2.1. 39 Adapted from Gerard, 1994. by reference to the average 2.5 The Analysis level of well-being experienced In addition to these indicators, 40 Straus, Hamby, by parents in a representative the questionnaire collected data The analysis of data involved a Finkelhor and Runyan, 1995. sample of Irish families28. As on the background characteristics number of different stages. First, such, it represents a ‘statistical’ of service users in Ballyfermot we carry out a brief descriptive 41 Adapted from rather than a ‘clinical’ norm and STAR, including: age, sex, analysis of the background Rusbult, Martz, and Agnew, 1998. the results are best regarded as marital status, education, characteristics of service users. indicative rather than defi nitive. housing status, household We do this by describing their 42 Adapted composition, employment, age and gender, family structure from Miller and Lefcourt, 1982. Need is a multi-dimensional fi nancial well-being. This data and household characteristics, as concept covering all aspects of was collected using questions well as housing status, education, 43 / 44 Kurdek, 1994. which allow for comparison with employment, and fi nancial position. the person’s well-being including: 45 Strauss, Hamby, physical, psychological, emotional, national data sets such as the These background characteristics Boney-McCoy and support networks, relationships Census of Population, Quarterly are described in Chapter Three. Sugarman, 1996.

13 TABLE 2.1 Instruments for Measuring the Well-Being of Persons Affected by Drug Use

Dimensions of Parental Well-Being Scale for Measuring Well-Being

Physical Well-Being 1. Revised Symptom Checklist32, comprising 19 items and fi ve sub-scales: (i) somatisation (ii) anxiety (iii) hostility (iv) general symptoms (v) other.

Smoking, Drinking and Drugs 2. Smoking, Drinking and Drugs questions from NACD’s Drug Prevalence Survey33 3. National Health and Lifestyle Surveys34.

Positive and Negative Emotions 4. Positive and Negative Affect Scales (PANAS)35, comprising 20 items and two sub-scales: (i) positive affect (ii) negative affect. 5. Bem Sex-Role Inventory36 comprising 20 items and two sub-scales: (i) independence (ii) interdependence.

Psychological Well-Being 6. Scales of Psychological Well-Being37, comprising 18 items and six sub-scales: (i) autonomy (ii) environmental mastery (iii) personal growth (iv) positive relations with others (v) purpose in life (vi) self-acceptance.

Financial Well-Being 7. Living in Ireland Survey (LIIS)38 by ESRI

Home Environment 8. Compiled from various scales

Negative Life Events 9. Compiled from various scales

Social Support Network 10. Compiled from various scales

Quality of Parent-Child Relationship 11. Parent-Child Relationship Inventory (PCRI)39 comprising 25 items and fi ve sub-scales: (i) satisfaction with parenting (ii) involvement with child (iii) communication with child (iv) limit-setting (v) autonomy.

The original scale has 78 items and 12. Parent-Child Confl ict Tactics Scale (CTS-PC)40 comprising 18 items and four sub-scales: six sub-scales. (i) non-violent discipline (ii) psychological aggression (iii) minor physical assault (iv) severe physical assault.

Quality of Couple Relationship 13. Marital Satisfaction Scale41, comprising 5 items and no sub-scales. 14. Social Intimacy Scale42, comprising 7 items and no sub-scales.

Ways of Resolving Confl ict 15. Confl ict Resolution Style Inventory43, comprising 16 items and four sub-scales: (i) problem-solving (ii) confl ict engaging (iii) compliant (iv) withdrawing.

Ability to Resolve Confl icts 16. Ineffective Arguing Inventory44, comprising 4 items and no sub-scales.

Forms of Confl ict 17. Confl ict Tactics Scale II45, comprising 16 items and four sub-scales (i) minor psychological (ii) severe psychological (iii) minor physical (iv) severe physical.

TABLE 2.2 Number and Location of Service Users who were Interviewed

Location Family Support Community Employment Total

N % N % N %

Cherry Orchard A 2 4 0 0 2 3

Cherry Orchard B 11 24 4 22 15 24

Cherry Orchard C 7 16 2 11 9 14

Decies 2 4 2 11 4 6

Drumfi n 3 7 1 6 4 6

Kilmainham A 7 16 2 11 9 14

Kylmore 7 16 4 22 11 18

Other 6 13 3 17 9 15

Total 45 100 18 100 63 100

14 Second, we analyse the drug users in the family (one, or experiences which families have more than one), imprisonment for with drugs including the number drug use, death of family member of drug users in the family and the from drug use, grandparent who type of drug use of family members has acted as full-time parent. (whether active, stable or drug- For each aspect of drug use, we free). We also analyse if a family calculated the mean scores of member has been imprisoned for service users on each dimension drugs, has died from drugs, and of their well-being and compared how long the service user has them to the mean for Ireland been attending Ballyfermot STAR. using the effect size statistic. 46 The concept of 47 See Table 5.1 effect size is typically below, based on This is done in Chapter Four. The results of this analysis used in randomised Layzer, Goodson, are reported in Chapter Six. control trials (RCTs) Bernstein and Price, Third, we analyse the extent to compare the 2001; Nelson, difference between Westhues and of need by comparing the an experimental MacLeod, 2003. The mean scores of service users 2.6 Structure of Report and a control group. effect size of family in Ballyfermot STAR with the The convention support programmes established by (0.2 to 0.5), though mean scores of a nationally The report is divided into Jacob Cohen (1988) statistically regarded representative sample of seven chapters as follows: and referred to as a small effect, can parents in Ireland. We do this by as ‘Cohen’s d’, is have very substantial that a coeffi cient implications. For calculating the effect size, which between 0.2 and example, the effect is a simple way of standardising 1 Context 0.5 indicates a small size of the High / effect, between 0.5 Scope Perry Pre- and comparing the difference and 0.8 indicates a School Programme between two groups on a range 2 Methodology moderate effect, and in the US when of test scores. The formula above 0.8 indicates a participants reached large effect. A guide the age of 23 was involves subtracting the mean 3 Characteristics to the interpretation 0.36 (Schweinhart of one group (service users in of Service Users of effect sizes is and Weikhart, 1997) Ballyfermot STAR) from the mean summarised in the but the economic table below and return at age 27 is of the other (a representative 4 Drug Use in Families shows, for each estimated to be $8 sample of parents in Ireland) and of Service Users effect size, the for every $1 invested dividing by their pooled standard proportion of the (Barnett, 1996) rising experimental group to $17 for every $1 deviation. Thus, the effect size is 5 Well-Being of Service Users (EG) whose scores invested by age measured in standard deviation exceed the average 40 (Schweinhart, units and the score varies from 0.0 6 Infl uence of Drug Use score of the control 2004). In the medical group (CG), based fi eld, there are 46 to 3.0 ; given that the baseline on Family Well-Being on the assumption even more dramatic fi gure for Ireland is 0.0, the effect that scores are illustrations of how size measures how far service 7 Summary, Conclusions normally distributed. small effect sizes can have enormous users in Ballyfermot are from the and Implications Effect % exceeds practical signifi cance. this norm. Most programmes in Size CG For example, the effect size of the area of family support tend to 0.0 50 aspirin in reducing achieve effect sizes in the range 0.1 54 heart disease is 0.2 to 0.547. As a rule of thumb 0.2 58 0.03, yet is widely 0.3 62 prescribed by doctors therefore, effect sizes in this 0.4 66 because the cost range tend to indicate a signifi cant 0.5 69 of the intervention level of need while effect sizes 0.6 73 is cheap and the 0.7 76 potential benefi ts in excess of 0.5 can be regarded 0.8 79 are very large (cited as quite large relative to the 0.9 82 in McCartney and capacity of programmes to meet 1.0 84 Dearing, 2002). 1.2 88 that need. These considerations 1.4 92 will be used as a guide in the 1.6 95 interpretation of results. The 1.8 96 2.0 98 results of our analysis of need 2.5 99 are reported in Chapter Five. 3.0 99.9

Source: CEM Fourth, we assess how the well- Centre, University of being of service users varies Durham, England. www.cemcentre.org according to the experiences of drug use within the family. This offers a systematic way of assessing how drug use impacts on well-being. The analysis examined the following aspects of drug use in the families of service users: type of drug use (active, stable or drug-free), number of

15

3 Characteristics of Service Users

3.1 Introduction 3.2 Age and Gender 3.3 Parents and of Service Users Grandparents 48 McKeown, This chapter describes some Pratschke and Haase, 2003 background characteristics of Participants on the family support Most participants on the family service users in Ballyfermot STAR. programme have an average support programme are parents 49 The report, These service users are drawn age of 48 years and are more (91%) but a high proportion entitled ‘Supporting Grandparents ... from the family support programme likely to be female (Table 3.1). of Community Employment Supporting Children’ (45) and the Community By contrast, participants on participants are also parents (78%) (Citywide Family Employment programme (18). We the Community Employment (Table 3.2). However participants Support Network, 2004a) was launched begin by describing the age and programme are signifi cantly on the family support programme in Dublin at Ozanam gender of service users (Section younger with an average age of are more likely to be grandparents House in October 3.2) and whether they are parents 29 years and there are slightly (60%) and a signifi cant proportion 2004. or grandparents (Section 3.3). We more males than females. of these (44%) have acted in describe the family type (Section the role of full-time parent to 3.4), household characteristics their grandchildren, possibly (Section 3.5), housing status as a consequence of drug use. (Section 3.6), education (Section The emergence of a signifi cant 3.7), employment (Section 3.8), proportion of grandparents who and fi nancial position (Section 3.9). act as full-time parents, due We conclude by summarising the to the consequences of drug distinguishing features of service use, was highlighted in a recent users by comparison with Ireland report and conference which (Section 3.10). Unless otherwise drew attention to the challenges specifi ed, the data for Ireland and lack of support faced by refers to a national survey of grandparents in this position49. parents and children in 200348.

TABLE 3.1 Demographic Characteristics of Service Users

Variable Family Support Community Employment Total

N % N % N %

Male 15 33 10 56 25 40

Female 30 67 8 44 38 60

Total 45 100 18 100 63 100

Mean Age 48 29

TABLE 3.2 Service Users who are Parents and Grandparents

Variable Family Support Community Employment

% who are parents 91 78

% who are grandparents 60 6

% grandparents who act as parents 44 0

17 TABLE 3.3 Family Types

Variable Family Support Community Employment Ireland

% % %

Two parents - married 56 7 68

Two parents - cohabiting 15 36 11

One parent - single 2 50 12

One parent - separated / divorced / widowed 27 7 9

Total 100 100 100

TABLE 3.4 Household Characteristics

Variable Family Support Community Employment

% living with all of one’s children 32 57

% living with some of one’s children 54 7

% living with none of one’s children 15 36

% living with parents 0 50

Mean number of persons in household 3.7 4.2

TABLE 3.5 Housing Status

Variable Family Support Community Employment Ireland

% % %

Own outright 20 0 36

Own with mortgage 29 0 38

Renting from private landlord 4 11 11

Rent from Local Authority 31 28 7

Buying from Local Authority 16 6 3

Living with parents 0 50 0

Rent-free / not stated 0 6 5

Total 100 100 100

*Source: Census of Population 2002, Housing, Volume 13.

18 TABLE 3.6 Age Completed Full-time Education

Variable Family Support Community Employment Ireland*

% % %

Under fi fteen 64 17 15.4

Fifteen to sixteen 27 44 24.5

Seventeen to nineteen 9 39 37.2

Twenty and over 0 0 22.9

Total 100 100 100

Mean Age 14.3 15.8

*Source: Census of Population 2002, Education and Qualifi cations, Volume 7.

3.4 Family Type essentially because the latter school at an earlier age compared comprises a high proportion of to other parents in Ireland. Data on family type is summarised single fathers who are not living More than six out of ten (64%) in Table 3.3 with comparative data with their children. Half of those of those on the family support for Ireland. This reveals that the on the Community Employment programme left school before 15 majority of participants on the programme are living with their years compared to only a minority family support programme (71%) parents and this accounts for the of parents in Ireland (15%). live in households comprising two larger household size of this group Participants on the Community parents, most of them married; (4.2) compared to those on the Employment programme stayed a signifi cant minority (29%) family support programme (3.7). at school longer, but only 40% live in one parent households, stayed after reaching sixteen years mainly as a result of divorce / compared to 60% in Ireland. separation / widowhood. This 3.6 Housing Status is fairly similar to the pattern in The earlier age on leaving Ireland where the vast majority of The housing status of service school among service users households with children (79%) users is summarised in Table is also refl ected in their level are two parent households. 2.3 with comparative data of educational attainment as By contrast, participants on for Ireland. This reveals that summarised in Table 3.7. In the Community Employment about two thirds of those on Ireland, about a third of parents programme are more likely to live the family support programme (35%) have no higher than a in a one parent household (57%), (65%) live in owner-occupied Junior Certifi cate; in Ballyfermot nearly three times higher than housing compared to three STAR, more than nine out the corresponding rate of lone quarters of Irish parents (74%). of ten (92%) of those in the parenthood in Ireland (21%). Half of those on the Community family support programme, and Employment programme live half (50%) on the Community in their parent’s home and one Employment programme, are in 3.5 Household of them is purchasing a home this position. Conversely, two Characteristics from the local authority. Nearly thirds (65%) of Irish parents have a third of service users rent from a Leaving Certifi cate or higher Information on the household the local authority, about four compared to less than a tenth characteristics of service users times higher than in Ireland. of participants on the family is summarised in Table 3.4. This support programme (10%), and reveals that, of those who are less than a third (28%) of those parents, the majority are living 3.7 Education on the Community Employment with their children. A higher programme. Overall therefore, proportion of participants on The age on completing full-time service users in Ballyfermot the family support programme education is summarised in Table STAR have a signifi cantly lower (86%) are living with their children 3.6. This reveals that service level of education compared compared to the Community users in Ballyfermot STAR are to the average Irish parent. Employment programme (64%), signifi cantly more likely to leave

19 3.8 Employment service users in Ballyfermot STAR corresponding proportion of is well above that experienced not Irish parents (74%). Nearly a third The situation with regard to work only by Irish households generally of all service users rent from is summarised in Table 3.8. This but also by reference to specifi c the local authority, about four reveals that more than half (58%) groups which are vulnerable times higher than in Ireland. the participants on the family to poverty. In other words, the support programme are in paid benefi ts of Ireland’s recent • service users tend to leave work, similar to the proportion in economic success do not seem to school early and the highest Ireland (55%). By defi nition, all have improved the fi nancial well- qualifi cation for the majority is participants on the Community being of a substantial proportion of a Junior Certifi cate, whereas 50 Whelan, Nolan Employment programme are in service users in Ballyfermot STAR. the majority of parents in and Maitre, 2005 part-time work. Service users in Ireland (65%) have a Leaving 51 Whelan, Nolan Ballyfermot STAR are different Certifi cate or higher. and Maitre, 2005 from the average Irish parent in 3.10 Summary & Conclusion 52 The report, two important respects. First, a • As in Ireland, a majority of entitled ‘Supporting much smaller proportion are full- This chapter described some service users are in paid work. Grandparents ... time home-makers (9% in family background characteristics of However service users in Supporting Children’ (Citywide Family support, and none in Community service users in Ballyfermot Ballyfermot STAR are different Support Network, Employment) compared to STAR. Service users fall into two from the average Irish parent in 2004a) was launched main categories: those on the two important respects: (i) only in Dublin at Ozanam Ireland (40%), possibly because House in October their children have grown up. family support programme (45) a small proportion are full-time 2004. Second, the proportion who are and those on the Community home-makers (9%) compared to unable to work due to sickness Employment programme (18). We Ireland (40%); and (ii) a substantial or disability is much higher compared these to a nationally proportion are unable to work (20% in family support and 33% representative sample of parents due to sickness or disability in Community Employment) in Ireland since most service users (20% in family support and 90% compared to Ireland (2%). are also parents: 91% of those on in Community Employment) the family support programme and compared to Ireland (2%). 78% of those on the Community 3.9 Financial Position Employment programme. • the level of fi nancial strain among service users in Financial well-being has an From this analysis it emerged Ballyfermot STAR is well above important subjective dimension that service users in Ballyfermot that experienced not only by Irish which is measured by the capacity STAR are distinctive in a households generally but also to live on one’s income. This number of respects: by reference to specifi c groups dimension was measured by which are vulnerable to poverty asking service users in Ballyfermot • the majority of participants in the such as households with children, STAR to describe their fi nancial family support programme (71%) older people, unemployed, position and the results are live in two parent households, and the ill / disabled51. summarised in Table 3.9. This similar to the situation in Ireland. shows that more than a quarter By contrast, participants on These fi ndings are consistent of participants on the family the Community Employment with the profi le of Ballyfermot support programme (27%), and programme are more likely to live described in Chapter Two and more than half the participants in a one parent household (57%), with its status as one of the on the Community Employment nearly three times higher than most disadvantaged parts of programme (55%), experience the corresponding rate of lone Ireland. The comparative analysis fi nancial strain. This is defi ned as parenthood in Ireland (21%). serves to highlight the level of having some or serious diffi culty disadvantage experienced by managing fi nancially and is much • participants on the Community service users in Ballyfermot STAR higher than the corresponding Employment programme are relative to other parents in Ireland, proportion of Irish parents (15%). younger (the mean age is 29), particularly in terms of lower levels It is useful to place this result in the are more likely to be living with of education, a relatively high context of a recent report which all their children although half still level of fi nancial strain, and a very found that the level of fi nancial live with their own parents; on the substantial proportion who are strain among Irish households other hand, participants on the unable to work due to sickness fell considerably between 1994 family support programme are or disability. The analysis also and 2001 (from 31% to 10%), but more likely to be grandparents identifi ed a substantial proportion also fell for a range of households and a substantial proportion (44%) of grandparents who have acted experiencing poverty including have acted in the role of full-time as full-time parents, possibly as a households with children (from parents to their grandchildren, consequence of drug use, which 37% to 12%), older people (from possibly for drug-related reasons. is consistent with the fi ndings of 23% to 12%), unemployed (from a recent report on this issue52. 54% to 20%), and the ill / disabled • a majority of family support We now analyse in more detail (from 48% to 19%)50. Signifi cantly, participants (65%) live in owner- some aspects of the drug use the level of fi nancial strain among occupied housing, less than the experienced by these families.

20 TABLE 3.7 Highest Qualifi cation in Education

Variable Family Support Community Employment Ireland*

% % %

None 7 6 0

Primary Education Only 67 44 9

Junior Certifi cate 18 22 26

Leaving Certifi cate 2 28 43

Third-level Diploma 4 0 17

Third-level Degree or higher 2 0 5

Total 100 100 100

*Source: Census of Population 2002, Education and Qualifi cations, Volume 7.

TABLE 3.8 Employment Status

Variable Family Support Community Employment Ireland

% % %

Paid work - full-time 29 0 37.4*

Paid work - part-time 29 100** 17.6*

Unemployed / seeking paid work 4 0 2.2

At school / college 0 0 0.7

Full-time home-maker 9 0 40.1

Unable to work - sickness / disability 20 90 1.9

Retired 9 0 0

Total 100 - 100

*The breakdown between full-time and part-time work is estimated from the Quarterly National Household Survey, 2003. **By defi nition, all participants on the Community Employment programme are in part-time work.

TABLE 3.9 Financial Position

Variable Family Support Community Employment Ireland

% % %

In serious diffi culties 11 11 0.8

Finding it diffi cult to manage 16 44 13.7

Making ends meet 49 44 47.0

Comfortable 24 0 36.9

Well-off 0 0 1.6

Total 100 100 100

21

4 Drug Use in Families of Service Users

4.1 Introduction have been attending Ballyfermot Employment programme have STAR (Section 4.6). We conclude nine family members who have This chapter describes the nature by summarising the key fi ndings used drugs in the past fi ve years. and extent of drug use within of the chapter (Section 4.7). families who use the services of Ballyfermot STAR. We begin by 4.3 Current Drug Status describing which family members 4.2 Drug Use by of Family Members have been involved in drug use, Family Members including the average number The majority of service users per family (Section 4.2). Drug use The data in Table 4.1 indicates attending Ballyfermot STAR have is normally classifi ed according that, on average, each service a family member who is currently to whether it is active (meaning user has two family members an active or stable drug user. the use of illegal drugs), stable who have used illegal drugs in According to Table 4.2, nearly (meaning the use of prescribed the past fi ve years. Participants half the participants on the family alternatives to illegal drugs such on the family support programme support programme (46%) have as methadone), or drug-free are more likely to have a child a family member who is an active (meaning no longer taking drugs). who used drugs (75%) but nearly drug user. This contrasts with Using this classifi cation, we a fi fth (18%) of the participants the experience of participants describe the current drug status or their partners have also been on the Community Employment of family members (Section 4.3). involved in drugs. All participants programme where nearly two thirds We also report on whether family on the Community Employment (62%) have a family member who is members have been imprisoned programme have used drugs as a stable drug user. This difference for using illegal drugs within the well as over a fi fth of their partners refl ects the fact that participants past fi ve years (Section 4.4), and (22%). In the extreme, some in the on the Community Employment whether a family member has family support programme have programme are themselves died as a result of using illegal six family members who have more likely to have used drugs drugs (Section 4.5). Finally, we used drugs in the past fi ve years and to have stabilised their indicate how long service users while some in the Community usage through the methadone.

TABLE 4.1 Family Member Using Drugs

Variable Family Support Community Employment

N %* N %**

Respondent 8 18 18 100

Partner 6 13 4 22

Children 34 76 0 0

Other 7 16 8 44

Total 55 29

Mean per family 2.1 2.2

Maximum per family 6 9

Minimum per family 1 1

*The percent is based on 45 service users in the family support programme. **The percent is based on 18 service users in the Community Employment programme.

23 4.4 Family Members 4.6 Length of Time Attending 4.7 Summary & Conclusion Imprisoned for Drug Use Ballyfermot STAR This chapter described the nature Table 4.3 shows that the majority The length of time which service and extent of drug use within of service users (59%) have a users have been attending families who are service users of family member who has been Ballyfermot STAR is summarised Ballyfermot STAR. Our analysis imprisoned for using drugs. in Table 4.5. For those on the follows the convention which This is more likely to have family support programme, about classifi es drug use according occurred among the families half (53%) have been attending for to whether it is active (meaning of those on the family support up to three years while the other the use of illegal drugs), stable programme (64%) compared half (47%) have been attending for (meaning the use of prescribed to those on the Community three years or more. By contrast, alternatives to illegal drugs such as Employment programme (44%). Community Employment is a methadone), or drug-free (meaning two year programme and half no longer taking drugs). The key of the participants (50%) have fi ndings of the chapter are: 4.5 Family Members been in Ballyfermot STAR for Died From Drug Use less than a year, the other half • on average, each service user (50%) for more than a year. has two family members who A fi fth of the families attending have used illegal drugs in the Ballyfermot STAR (19%), past fi ve years; in the extreme, according to Table 4.4, have some have between six and nine experienced the death of a family family members who have used member as a result of drugs. This drugs in the past fi ve years. experience is four times more likely among participants on the • participants are more likely family support programme. to be attending the family support programme because

TABLE 4.2 Current Drug Status of Family Member

Variable Family Support Community Employment

% %

Active 46 19

Stable 26 62

Drug-free 28 19

Total 100 100

TABLE 4.3 Family Member Imprisoned for Using Drugs

Variable Family Support Community Employment Total

% % %

Yes 64 44 59

No 36 56 41

Total 100 100 100

24 one of their children has used participants on the family have been coming to Ballyfermot • drugs (76%), whereas all support programme are evenly STAR for family support over a participants on the Community divided between those who number of years. In light of these Employment programme have have been attending Ballyfermot results, we assess the needs themselves used drugs. STAR for under three years and of service users by comparing those who have been attending their well-being to the well-being • active drug users are more for more than three years, of other Irish parents. That is likely to be found in the families while Community Employment the theme of the next chapter. of participants on the family participants are evenly divided support programme (46%) between those attending for whereas stable drug users are less than a year and those more likely to be found among attending for more than a year. participants on the Community Employment programme (62%). These fi ndings indicate that drug use is a serious issue for the • the majority of service users families who attend Ballyfermot (59%), particularly those on the STAR. It tends to involve about family support programme, have two family members who are a family member who has been active or stable drug users, imprisoned for using drugs. and a majority of service users have seen family members go • a fi fth of families (19%), to prison; a signifi cant minority particularly those on the family have experienced the death of a support programme, have family member due to drugs. The experienced the death of a family consequences of drug use do not member as a result of drugs. pass quickly and this is refl ected in the fact that many families

TABLE 4.4 Family Member Died From Using Drugs

Variable Family Support Community Employment Total

% % %

Yes 24 6 19

No 76 94 81

Total 100 100 100

TABLE 4.5 Length of Attendance at Ballyfermot STAR

Variable Family Support Community Employment

% %

Up to a year 22 50

One to two years 13 50

Two to three years 18 0

Three to four years 31 0

Four years and over 16 0

Total 100 100

25

5 Well-Being of Service Users

5.1 Introduction psychological well-being (Section heart pounding or racing, feeling 5.4), negative life events (Section that something bad is going to 53 McKeown, In this chapter we assess the 5.5), support networks (Section happen to you), hostility (such Pratschke and Haase, 2003 well-being of service users in 5.6), satisfaction with home and as feeling easily annoyed or Ballyfermot STAR relative to the neighbourhood (Section 5.7), irritated, temper outbursts you 54 The concept of well-being of a representative relationship with children (Section cannot control, having urges to effect size is typically used in randomised sample of parents in Ireland using 5.8), and relationship with partner break or smash things, getting control trials (RCTs) a common set of measurement (Section 5.9). We conclude with a into frequent arguments) and to compare the instruments (listed in Table 2.1 summary of the key fi ndings and other (felt weak all over, suddenly difference between an experimental 53 above) . In order to establish the their implications (Section 5.10). felt hot all over, cold sweats). and a control group. extent of need among service The convention users, we compare their mean The results on physical well-being established by Jacob Cohen (1988) and re- scores with the mean scores 5.2 Physical Well-Being are summarised in Table 5.2. ferred to as ‘Cohen’s of Irish parents generally. We These show that the number and d’, is that a coeffi cient standardise the difference in mean The presence of physical frequency of physical symptoms between 0.2 and 0.5 indicates a small scores between the two groups symptoms can be a sign of is much higher among service effect, between 0.5 using the effect size statistic. either physical problems or users in Ballyfermot STAR than in and 0.8 indicates a psychological problems, or both. the general population of parents moderate effect, and above 0.8 indicates a As explained in Chapter Two, Where symptoms are based in Ireland. This means that the large effect. A guide the concept of effect size is a entirely on self-report, as here, physical well-being of service to the interpretation of effect sizes is sum- they are a reliable indicator of users is signifi cantly below the simple way of standardising marised in the table and comparing the difference psychological problems. Indeed average for Ireland, with an effect below and shows, between two groups on a range it has been found that subjective size of 0.6 for family support for each effect size, the proportion of the of test scores. The formula ratings of personal health - but not participants and 1.1 for Community experimental group involves subtracting the mean the objective ratings of a medical Employment participants. (EG) whose scores of one group (service users in expert - are associated with levels Service users on the Community exceed the average score of the control Ballyfermot STAR) from the mean of happiness and associated Employment programme have group (CG), based of the other (a representative personality traits. In other words, a dramatically reduced physical on the assumption sample of parents in Ireland) and person’s self-reported symptoms well-being and signifi cant that scores are normally distributed. dividing by their pooled standard may indicate more about their interventions would be required deviation. Thus, the effect size is psychological than their physical to bring it closer to the norm. Effect % exceeds measured in standard deviation state. Indeed, there is growing Size CG units and the score varies from evidence that a person’s physical Health behaviour infl uences 0.0 50 0.0 to 3.054; given that the baseline well-being is infl uenced by their physical well-being and it is likely 0.1 54 0.2 58 fi gure for Ireland is 0.0, the effect psychological well-being since that drug use has caused the 0.3 62 size measures how far service “the immune systems of happy reduced physical well-being of 0.4 66 users in Ballyfermot are from people work more effectively participants on the Community 0.5 69 0.6 73 than those of unhappy people Employment programme while this norm. Most programmes in 0.7 76 the area of family support tend ... [which] may account of the the stresses and strains of drug 0.8 79 to achieve effect sizes in the longevity of happy people”56. use within the family is likely to 0.9 82 1.0 84 range 0.2 to 0.5, as illustrated in have contributed to the reduced 1.2 88 Table 5.155. As a rule of thumb We measured symptoms using physical well-being of those on 1.4 92 therefore, effect sizes in this a shortened version of the the family support programme. 1.6 95 1.8 96 57 range tend to indicate a signifi cant Symptom Check List (SCL) . In Table 5.3 we summarise data 2.0 98 level of need while effect sizes The full SCL has 90 items which on the prevalence of smoking, 2.5 99 in excess of 0.5 can be regarded was shortened to 19 items to drinking and prescribed drugs. 3.0 99.9 as quite large relative to the measure aspects of physical For each of the substances Source: CEM capacity of programmes to meet well-being including general listed, service users were asked: Centre, University of that need. These considerations symptoms (such as poor appetite, ‘During the last month, have you Durham, England. www.cemcentre.org will be used as a guide in the overeating, trouble falling asleep, taken any of the following?’ The interpretation of results. sleep that is restless or disturbed, results reveal that smoking rates feeling weak or hot all over, cold are higher among both groups In this chapter we report on sweats), somatisation (such as the of service users compared to the different dimensions of frequency of headaches, pains in Ireland but the usage of alcohol is need which we found among heart or chest, nausea or upset lower. Perhaps more signifi cantly service users. These include stomach, soreness of muscles), is the high usage of sedatives, physical well-being (Section 5.2), anxiety (such as nervousness, tranquilisers and anti-depressants emotional well-being (Section 5.3), suddenly scared for no reason, which is 36% among participants

27 on the family support programme, modest infl uence on emotional environmental mastery (eg. ‘in and 72% among participants well-being and, according to general, I feel I am in charge of the on the Community Employment one review of the evidence, situation in which I live’), personal programme; this compares to a “probably account for no more growth (eg. ‘I think it is important national prevalence in Ireland of than between 8 and 15 per-cent to have new experiences that around 5% for these drugs. These of the variance in happiness”64. challenge how you think about are prescription drugs, commonly yourself and the world’), positive referred to as benzodiazepines, Against this background, we relations with others (eg. ‘I have and a recent study noted that summarise the results on not experienced many warm and “a considerable proportion of emotional well-being in Table trusting relationships with others’), 55 See Table 5.1 patients who are initiated on 5.4. These show that service purpose in life (eg. ‘I sometimes below, based on Layzer, Goodson, benzodiazepine continue to take users in Ballyfermot STAR have feel as if I’ve done all there is to Bernstein and Price, them for many years”58. Consistent much higher levels of negative do in life’) and self-acceptance 2001; Nelson, with the fi ndings on physical emotions compared to the (eg. ‘when I look at the story Westhues and MacLeod, 2003. The symptoms, the high usage of average Irish parent, with an of my life, I am pleased with effect size of family benzodiazepines confi rms that effect size of 1.2 for family support how things have turned out’). support programmes service users in Ballyfermot STAR participants and 1.1 for Community (0.2 to 0.5), though statistically regarded have a signifi cantly reduced Employment participants. Service The results of the survey are as a small effect, can level of well-being compared to users also tend to have fewer summarised in Table 5.5 and reveal have very substantial the average parent in Ireland. positive emotions than Irish that service users in Ballyfermot implications. For example, the effect parents. Participants on both STAR have a signifi cantly lower size of the High / the family support programme level of psychological well-being Scope Perry Pre- and community Employment than Irish parents. The reduced School Programme 5.3 Emotional Well-Being in the US when programme tend to have similar psychological well-being of participants reached Emotional well-being is measured levels of emotional well-being participants on the Community the age of 23 was 0.36 (Schweinhart by each person’s experience of which is mainly characterised by Employment programme is and Weikhart, 1997) positive and negative emotions. high levels of negative emotions. particularly striking (with an effect but the economic Positive emotions increase well- size of 1.0) and is more than twice return at age 27 is estimated to be $8 being while negative emotions as low as that of participants on the for every $1 invested reduce it. The emotional quality 5.4 Psychological Well-Being family support programme (with an (Barnett, 1996) rising of a person’s life can be reliably effect size of 0.4). There is also a to $17 for every $1 invested by age 40 measured by the Positive and Psychological well-being in its different profi le to the psychological (Schweinhart, 2004). Negative Affect Scales (PANAS)60 broadest sense refers to the well-being of both groups. For In the medical fi eld, and this is used here. We also achievement of one’s potential. family support participants, the there are even more 61 dramatic illustrations use Bem Sex-Role Inventory to It is sometimes referred to as main psychological strengths are to of how small effect describe if the person’s orientation ‘eudaimonic happiness’ because be found in feelings of autonomy, sizes can have to the world is predominantly of its emphasis on personal personal growth, and relations enormous practical signifi cance. For independent or interdependent. growth and development and is with others while for Community example, the effect contrasted with subjective well- Employment participants their size of aspirin in Positive and negative emotions being - sometimes referred to as only relative strength is in the reducing heart disease is 0.03, yet is are independent of each other and ‘hedonic happiness’ - which places area of personal growth. It is widely prescribed by both have a cognitive as well as a greater emphasis on positive possible, though diffi cult to doctors because the 65 cost of the feeling dimension. Psychological feelings and satisfaction with life . prove in the present study, that intervention is cheap research has established that Both types of happiness, though participation in Ballyfermot and the potential a person’s emotional state is distinct, are related and both tend STAR may have contributed benefi ts are very large (cited in equally infl uenced by genetic to increase with age, education, to these positive aspects of McCartney and and environmental factors and emotional stability and extraversion psychological well-being. Dearing, 2002). each individual has a ‘happiness (meaning a disposition to engage

56 Carr, 2004:29 set-point’ - their normal level in frequent social interactions). of happiness - that remains However recent research suggests 5.5 Negative Life Events 57 Derogatis, 1992; relatively constant over time62. that psychological well-being see also www. pearsonassess- There is general consensus that may have a more signifi cant Life events, particularly the ments.com positive emotions, despite having infl uence on physical health negative life events which we 58 Ballymun Youth a heritable dimension, can be than subjective well-being66. measure here, can have an Action Project, 2004:8 increased over time through immediate and dramatic impact ‘environmental’ infl uences. In The concept of psychological on a person’s sense of well-being. 59 National Advisory this context, environmental well-being has been developed This is obvious from some of the Committee on Drugs, 2005. infl uences mainly refer to the Carol Ryff and her Scales of negative life events listed in the person’s ‘internal’ environment, Psychological Well-Being67 are questionnaire: death of a loved 60 Adapted from Watson, Clark, and particularly ways of thinking about used here. This instrument has one, serious personal illness Tellegen, 1988. the past, the present and the six sub-scales of psychological or injury, drastic fall in income, future63 rather than the ‘external’ well-being measuring autonomy alcohol or drug problems, etc. 61 Adapted from Bem, 1974. environment - such as age, sex, (eg. ‘I have confi dence in my However in the longer term, the income, education, etc. - which opinions, even if they are contrary infl uence of life events, whether have been found to have relatively to the general consensus’), positive or negative, is generally

28 TABLE 5.1 Effect Sizes for Family Support Programmes and Pre-School Prevention Programmes

Outcome Domain Average Effect Size: Average Effect Size Short-term (end of treatment) Longer-term (follow-up)

Meta-Analysis of 665 experimental and quasi-experimental studies of family support programmes (Layzer, Goodson, Bernstein and Price, 2001)

Child cognitive development 0.293 0.345

Child social-emotional development 0.223 0.150

Child physical health and development 0.123 0.112

Child injury, abuse, neglect 0.213 0.152

Parenting attitudes and knowledge 0.230 0.273

Parenting behaviour 0.257 0.204

Family functioning / family resources 0.169 0.002

Parent mental health / health risks 0.137 0.226

Family economic self-suffi ciency 0.099 0.464

Outcome Domain Average Effect Size: Average Effect Size Short-term (child at pre-school) Longer-term (child up to 9 yrs)

Meta-Analysis of 34 experimental and quasi-experimental studies of pre-school prevention programmes for children (Nelson, Westhues and MacLeod, 2003)

Cognitive impacts on children 0.52 0.30

Socio-emotional impacts on children 0.27 0.27

Parent / family wellness impacts 0.33 0.30

Meta-Analysis of 2,513 experimental and quasi-experimental studies of psychotherapy (Asay and Lambert, 1999)

Psychotherapy 0.82

TABLE 5.2 Physical Well-Being of Service Users in Ballyfermot STAR Compared to Ireland

Variable Family Support Community Employment Ireland

Mean Effect Size* Mean Effect Size* Mean

Physical well-being 28.1 +0.6 30.6 +1.1 19.4

Somatisation 6.8 +0.5 5.6 +0.1 5.3

Anxiety 7.1 +0.9 6.4 +1.1 3.3

Hostility 4.9 +0.2 5.2 +0.4 4.0

General 5.7 +0.4 7.5 +1.0 4.5

Other 3.6 +0.4 5.8 +1.5 2.3

* Effect size refers to the difference from Ireland and is measured by subtracting the two means from each other and dividing by their pooled standard deviation.

29 regarded as having relatively well-being is ‘bi-directional’ in the ‘I wish I lived in a different house’, little infl uence on the experience sense that happier people tend ‘I like my neighbourhood’, ‘This of happiness. Studies of ‘lotto to have stronger support and is a safe area to live in’, ‘I don’t winners’, for example, have been friendship networks but these trust my neighbours’, ‘My area used to show the limited impact of networks in turn also contribute is convenient to shopping’, ‘My positive life events but negative life to a person’s happiness71. area has good public transport’, events also tend to have a limited ‘My area is very run down’, I’d like impact, as the following example We measured support networks to move away from this area’. shows: “Individuals who become by asking respondents to rate the paraplegic as a result of spinal cord supportiveness of the following The responses are summarised 62 For a review of accidents quickly begin to adapt to people, if they needed help: your in Table 5.8 and reveal that this research, see Carr, 2004:Chapter their greatly limited capacities, and partner, your parents, your brothers service users in Ballyfermot One within eight weeks they report more and sisters, your children, your STAR are more satisfi ed with net positive than negative emotion. relatives, your friends, people their neighbourhood compared to 63 Seligman, 2002; for further information Within a few years, they wind up at work, your neighbours, etc. the norm in Ireland. Participants on cognitive therapy, only slightly less happy on average The results are summarised on the Community Employment see www. than individuals who are not in Table 5.7 and indicate that programme are even more satisfi ed beckinstitute.org paralyzed. Of people with extreme service users in Ballyfermot with their neighbourhood than 64 Seligman, quadriplegia, 84 per cent consider STAR have signifi cantly weaker participants on the family support 2002:61 their life to be average or above support networks than other programme. This is the only 68 65 Carr, 2004:38-9 average” . These fi ndings suggest parents in Ireland. Participants dimension where service users that the way people respond to on the Community Employment display a higher level of well-being 66 Ryff, 2004 life’s events may be more important programme have much weaker compared to the norm in Ireland. 67 Ryff, 2001. in determining their well-being than support networks (with an the actual events themselves. effect size of 1.7) compared 68 Seligman, 2002:48 to participants on the family 5.8 Parent-Child Relationship Bearing these considerations support programme (with an 69 For a review, see in mind, it is useful to compare effect size of 0.9) but both are The parent-child relationship is McKeown, 2000:11- 13 the experiences of service users well below the norm for Ireland. regarded as pivotal to the healthy in Ballyfermot STAR with other growth and psychological well- 70 See Scovern, parents Ireland as summarised being of children, particularly 1999, pp. 272-273; 73 Sprenkle, Blow and in Table 5.6. This reveals that 5.7 Neighbourhood in their early years . We Dickey, 1999, p.334, service users in Ballyfermot Satisfaction measured the parent-child respectively review STAR have experienced a higher relationship using the Parent-Child the evidence. number of negative life events The exact way in which Relationship Inventory (PCRI)74 71 Carr, 2004:20-24; in the past year compared to the neighbourhoods infl uence well- which covers fi ve aspects of Seligman, 2002:56 average parent in Ireland. For being is diffi cult to measure that relationship: satisfaction, 72 For a review of participants on the Community and depends in part on how involvement, communication, studies, see Employment programme, the neighbourhood characteristics limit-setting, and independence. Sampson, Morenoff number of negative events (4.7) is are defi ned. Some of the ways and Gannon-Rowley, 2002; see also dramatically higher compared to in which neighbourhoods The results are summarised in Pratschke, J., 2002. participants on the family support impact on well-being include Table 5.9 and reveal that service

73 For a review of programme (0.2) or the average characteristics such as the quality users in Ballyfermot STAR have a the evidence, see Irish parents (0.11). These fi ndings of neighbourliness or ‘social weaker parent-child relationship Shonkoff and Phillips, are consistent with the results capital’ between families in the than the average parent in Ireland. 2000:225-266 on psychological well-being but area, the degree to which there is In turn, participants on the family 74 Gerard, 1994. offer a more dramatic illustration a shared sense of trust and values support programme (with an of the adversities facing service in the neighbourhood, including effect size of 0.5) have a weaker users in Ballyfermot STAR the value placed on education, the parent-child relationship than physical appearance and safety participants on the Community of the area, as well as the quantity Employment programme (with 5.6 Support Networks and quality of neighbourhood an effect size of 0.2), possibly resources such as childcare, family refl ecting the younger age of There is extensive research centres, recreational facilities, parents and children in the latter, to show that support networks libraries, schools, health clinics, and the drug-related tensions are a signifi cant infl uence on arts and crafts classes, etc. The in the parent-child relationship the well-being of individuals scale of infl uence exercised by associated with the former. and their families69. In addition, neighbourhood is estimated to Signifi cantly the main strengths positive support networks are vary between 5% and 20%72. in the parent-child relationship for known to improve physical service users in Ballyfermot STAR health and mental health and We measured satisfaction are in the areas of communication to aid in recovery from illness with neighbourhood by asking and involvement (such as feeling and adversity70. It is generally respondents to indicate their level close to, or spending time with, the acknowledged that the relationship of agreement with nine statements child) while the main weakness is in between support networks and as follows: ‘I like where I live’, setting limits, as indicated by their

30 TABLE 5.3 Prevalence of Smoking, Drinking and Drugs among service users in Ballyfermot STAR compared to Ireland

Variable Family Support Community Employment Ireland*

% % %

Cigarettes 49 94 33.1

Alcohol 53 56 69.6

Sedatives, tranquilisers or anti-depressants 36 72 4.9

*Source: Based on interviews with a nationally representative sample of Irish adults for the Drug Prevalence Survey59.

TABLE 5.4 Emotional Well-Being of Service Users in Ballyfermot STAR Compared to Ireland

Variable Family Support Community Employment Ireland

Mean Effect Size* Mean Effect Size* Mean

Positive affect 36.3 -0.2 33.1 -0.1 37.8

Negative affect 30.6 -1.2 29.8 -1.1 23.1

* Effect size refers to the difference from Ireland and is measured by subtracting the two means from each other and dividing by their pooled standard deviation.

TABLE 5.5 Psychological Well-Being of Service Users in Ballyfermot STAR Compared to Ireland

Variable Family Support Community Employment Ireland

Mean Effect Size* Mean Effect Size* Mean

Psychological well-being 68.6 -0.4 62.1 -1.0 74.4

Autonomy 12.3 -0.1 11.2 -0.5 12.8

Environmental mastery 10.3 -0.5 9.0 -1.0 12.1

Personal growth 13.6 -0.1 12.8 -0.1 13.1

Relations with others 11.7 -0.1 9.4 -0.9 12.1

Purpose in life 11.2 -0.2 12.5 -1.3 12.0

Self-acceptance 9.5 -0.7 7.2 -1.0 12.3

* Effect size refers to the difference from Ireland and is measured by subtracting the two means from each other and dividing by their pooled standard deviation.

TABLE 5.6 Negative Life Events Experienced by Service Users in Ballyfermot STAR Compared to Ireland

Variable Family Support Community Employment Ireland

Mean Effect Size* Mean Effect Size* Mean

Negative life events 0.2 -0.9 4.7 -3.0 0.1

* Effect size refers to the difference from Ireland and is measured by subtracting the two means from each other and dividing by their pooled standard deviation.

31 response to statements such as ‘I Non-violent discipline is the most of stability. The consensus from have a hard time getting through frequently used form of discipline research suggests that while the to my child’, ‘I sometimes give in by all parents, but Ballyfermot majority of children of separated to my child to avoid a row’, and ‘I parents use it more frequently than parents do not experience any often lose my temper with my child’. the average Irish parent, especially long-term negative effects, parents on the Community around 20% of children are The study examined the issue Employment programme. Parents adversely affected in the longer of limit-setting in more detail by in Ballyfermot STAR also use more term, particularly in those cases asking service users about their than twice as much psychological where the parents were involved methods of disciplining the child. aggression than Irish parents. in sustained confl ict before and 75 Straus, Hamby, We did this using the Parent-Child Minor physical assaults occur after separation, suggesting that Finkelhor and 75 Runyan, 1995. Confl ict Tactics Scale (CTS-PC) much less frequently than confl ict has a more harmful effect which asks parents how frequently either non-violent discipline than instability84. One of the most 76 See McKeown they used each of 18 different or psychological aggression respected researchers in this area and Kidd, 2002:28. forms of discipline. Given the but parents on the Community reached the following conclusion 77 Department of sensitivity of this issue, and the Employment programme tend to based on a lifetime of work in this Health and Children, fact that responses to questions use it nearly twice as much as Irish area: “About 75 to 80 per cent 1999; 2002. on aggression are heavily parents. Severe physical assault is of adults and children show few 78 Waite, 1995:499 infl uenced by how the questions used infrequently by all parents. serious long-term problems in are framed76, respondents were adjustment following divorce and 79 Bray and Jouriles, 1995 given the following preamble to are functioning within the normal this question: “Children often do 5.9 Relationship with Partner range. Many who have long-term 80 For reviews, see things that are wrong, disobey, problems after a divorce had Stack and Eshleman, 1998; Waite, 1995; or make their parents angry. No Intimate relationships between problems that preceded the break- Kiecolt-Glaser and matter how much a parent loves couples, particularly those up. ... The easiest way in which to Newton, 2001 their children, there are times when involving marriage, have been raise happy, competent children is 81 Halford and things get out of hand. This is a list extensively studied and the one in which two mature, mutually Markman, 1996 of things that might happen when results consistently show a supportive adults are committed

82 Harker and you have differences with your strong association between to protecting and promoting the Keltner, 2001 child(ren). Please indicate how marriage and well-being. One well-being of their children in many times you did each of these review of the evidence explains a harmonious environment. ... 83 See McLanahan, Donahue and things over the course of the past the association as follows: “on But happy, competent children Haskins, 2005; year by ticking the relevant box”. average, marriage seems to can and do develop in all types Harold, Pryor, and produce substantial benefi ts for of nurturant, well-functioning Reynolds, 2001; McKeown and The Parent-Child Confl ict Tactics men and women in the form of families, including divorced, Sweeney, 2001: Scale (CTS-PC) differentiates better health, longer life, more and single-parent, and re-married Chapter Four; One four types of discipline: (i) non- better sex, greater earnings (at families, through the courageous, Plus One, 1999. violent discipline (eg. ‘explained least for men), greater wealth, and selfl ess, and frequently dedicated 84 See Hetherington why something was wrong’, better outcomes for children”78. care-giving of parents”85. and Kelly, 2002; ‘grounded the child’, ‘gave the Consistent with this, other other research, such as a longitudinal child something else to do instead reviews show that separated and These considerations highlight study of over 5,000 of what he / she was doing’); (ii) divorced adults have the highest the importance of measuring the mothers and children in Australia, also psychological aggression (eg. rates of acute medical problems, quality of couple relationships as found that while ‘shouted, yelled or screamed at chronic medical conditions, a way of assessing the well-being children are more him / her’, ‘swore or cursed at the and disability79. It is generally of parents and their children. adversely affected by confl ict than by child’); (iii) minor physical assault recognised that the association The results are summarised instability, they are (eg. ‘shook the child’, ‘spanked the between marriage and well-being in Table 5.11 and show clear adversely affected by child on the bottom with your bare is ‘bi-directional’80 in the sense that differences in the quality of couple instability even in the absence of confl ict. hand’); and (iv) severe physical marriage tends to make people relationships between participants As the authors point assault (‘hit the child with a fi st happier81, but happier people on the family support programme out, “partner change or kicked him / her hard’, ‘threw are also more likely to marry82. and those on the Community and marital confl ict [are] independent or knocked the child down’). It is Employment programme. In causes of a wide clear that some of these forms Children are deeply-affected by the general, participants on the variety of child of discipline, particularly those quality of their parents’ relationship, family support programme have behaviour problems” (Najman, Behrens, designated as ‘severe physical irrespective of its marital status. couple relationship which are Andersen, Bor, assault’, constitute child abuse Indeed the well-being of children broadly similar to other parents O’Callaghan, and as the term is understood in may be more affected by the in Ireland but with lower levels of Williams, 1997:1364). Ireland and elsewhere77. quality of the relationship between confl ict. By contrast, participants 85 Hetherington and their parents than by the quality of on the Community Employment Kelly, 2002:279-280. 83 For a review of the The results are summarised in the parent-child relationship itself . programme have less satisfying evidence in the Table 5.10 and indicate that service Two aspects of the relationship relationships than other parents in context of Irish users in Ballyfermot STAR tend between parents seem particularly Ireland and are characterised by research, see Murch and Keehan, 2003. to use much more discipline on important for the well-being of a much higher level of physical and their children compared to Irish children; the fi rst is the absence of psychological aggression, refl ected parents, with an effect size of 0.5. confl ict, the second is the presence in effect sizes of around 0.5.

32 TABLE 5.7 Support Networks of Service Users in Ballyfermot STAR Compared to Ireland

Variable Family Support Community Employment Ireland

Mean Effect Size* Mean Effect Size* Mean

Support networks 5.6 -0.9 4.8 -1.7 7.1

* Effect size refers to the difference from Ireland and is measured by subtracting the two means from each other and dividing by their pooled standard deviation.

TABLE 5.8 Satisfaction with Neighbourhood of Service Users in Ballyfermot STAR Compared to Ireland

Variable Family Support Community Employment Ireland

Mean Effect Size* Mean Effect Size* Mean

Neighbourhood Satisfaction 31.8 +1.0 33.2 +1.4 24.9

* Effect size refers to the difference from Ireland and is measured by subtracting the two means from each other and dividing by their pooled standard deviation.

TABLE 5.9 Parent-Child Relationships of Service Users in Ballyfermot STAR Compared to Ireland

Variable Family Support Community Employment Ireland

Mean Effect Size* Mean Effect Size* Mean

Parent-child relationship 48.2 -0.5 51.6 -0.2 53.5

Satisfaction 11.3 -0.3 11.6 -0.3 12.4

Involvement 12.3 +0.1 13.2 +0.5 12.0

Communication 12.0 +0.1 12.4 +0.3 11.7

Setting limits 5.3 -0.9 7.0 -0.5 8.6

Independence 7.3 - 0.4 7.5 - 0.4 8.8

* Effect size refers to the difference from Ireland and is measured by subtracting the two means from each other and dividing by their pooled standard deviation.

TABLE 5.10 Parental Discipline Practices of Service Users in Ballyfermot STAR Compared to Ireland

Variable Family Support Community Employment Ireland

Mean Effect Size* Mean Effect Size* Mean

Overall discipline (2+3+4) 29.1 +0.5 28.6 +0.5 13.8

1. Non-violent discipline 31.0 +0.3 41.0 +0.9 22.9

2. Psychological aggression 25.6 +0.7 21.4 +0.5 10.6

3. Minor physical assault 2.7 +0.0 7.1 +0.4 2.6

4. Severe physical assault 0.8 -0.1 0.1 -0.3 0.6

* Effect size refers to the difference from Ireland and is measured by subtracting the two means from each other and dividing by their pooled standard deviation.

33 This seems to mirror the higher well-being is signifi cantly lower for parent-child relationships level of aggression towards family support participants (with an compared to the average parent children found among Community effect size of 0.2) but particularly in Ireland, with family support Employment participants and for participants on the Community participants having weaker raises questions about the Employment programme (with relationships (effect size of potential impact which these an effect size of 1.0). Both 0.5) compared to Community family patterns may have on groups of service users have Employment participants (effect the well-being of children. somewhat different psychological size of 0.2). Both groups of service strengths and weaknesses. For users have similar strengths and participants on the family support weaknesses; the main strength 86 Ballymun Youth 5.10 Summary & Conclusion programme their main strengths is having a more communication Action Project, 2004:8 are to be found in feelings of and involvement with the child In this chapter we assessed the autonomy, personal growth, and compared to the norm in Ireland well-being of service users in personal relations while their main while the main weakness is setting Ballyfermot STAR relative to the weakness is self-acceptance; for appropriate limits on the child. well-being of parents in Ireland. participants on the Community The issue of limit-setting is a In order to establish the extent of Employment programme their particular problem for both sets of need among service users, we main psychological strength is service users - effect size of 0.9 compared the mean scores of both feeling a sense of personal growth for family support participants and sets of parents and standardised while their main weaknesses are 0.5 for Community Employment the difference using the effect size in areas such as purpose in life, participants - who use much statistic. self-acceptance, environmental more discipline on their children mastery, and personal relations. compared to Irish parents. Non- The results show that the physical violent discipline is the most well-being of service users is Negative life events, and the way frequently used form of discipline signifi cantly below the average for in which they are remembered, by all parents, but Ballyfermot Ireland, with large effect sizes for can have a signifi cant infl uence parents use it more frequently than family support participants (0.6), on psychological well-being and the average Irish parent. Parents but particularly for Community the results of this study show that in Ballyfermot STAR also use more Employment participants (1.1). service users in Ballyfermot STAR than twice as much psychological The poorer physical well-being of have experienced a higher number aggression than Irish parents. service users in Ballyfermot STAR of negative life events in the past Minor physical assaults occur is also indicated by the fact that year compared to the average much less frequently than other 36% of participants on the family parent in Ireland. Community forms of discipline but parents support programme, and 72% of Employment participants had a on the Community Employment participants on the Community much higher number of negative programme tend to use it nearly Employment programme use events (4.7) compared to family twice as much as Irish parents. sedatives, tranquilisers and anti- support participants (0.2) or the Severe physical assault is used depressants; this compares to a average Irish parent (0.11). These infrequently by all parents. national prevalence in Ireland of fi ndings are consistent with the around 5% for these drugs. These results on psychological well- In terms of intimate relationships are prescription drugs, commonly being but offer a more dramatic with partners, we found that referred to as benzodiazepines, illustration of the adversities which participants on the family support and a recent study noted that face service users in Ballyfermot programme have relationships “a considerable proportion of STAR. which are broadly similar to other patients who are initiated on parents in Ireland but with lower benzodiazepine continue to take Participants on the Community levels of confl ict. By contrast, them for many years”86. We have Employment programme have participants on the Community also seen in Chapter Three that the much weaker support networks Employment programme have less proportion of service users who are (an effect size of 0.9) compared to satisfying relationships than other unable to work due to a disability participants on the family support parents in Ireland and these are - 20% in family support and 90% in programme (an effect size of 1.7), characterised by a much higher Community Employment - is much but both are well below the norm level of physical and psychological higher than in Ireland (2%). for Ireland. In view of this, it is aggression, refl ected in effect likely that Ballyfermot STAR is a sizes of around 0.5. This seems In terms of emotional well-being, signifi cant source of support for to mirror the higher level of service users in Ballyfermot many service users. However all aggression towards children found STAR have much higher levels service users are satisfi ed with the among Community Employment of negative emotions compared neighbourhood in which they live participants and raises questions to the average Irish parent and this is the only dimension of about the potential impact which with high effect sizes for both well-being where service users are these family dynamics may have family support participants (1.2) above the norm for Ireland. on the well-being of children. and Community Employment participants (1.1). Similarly, the In general, service users in These results throw light on overall level of psychological Ballyfermot STAR have weaker the extent of need among

34 service users in Ballyfermot are being targeted at people with among service users which provide STAR, where need is defi ned extensive needs. The results a platform for implementing a as a signifi cant difference from are striking not just in terms of strength-based approach. These the average parent in Ireland, the extent of need over a large include a sense of personal and usually involving an effect size of range of domains, but also the psychological growth, a high level 0.2 or more. We have seen that depth of need in those domains, of communication and involvement service users, but particularly as indicated by effect sizes of with children and, for participants those on the Community 0.5 or more. The fact that many on the family support programme, Employment programme, have needs, particularly among those a satisfying relationship with their dramatically lower levels of on the Community Employment partner. Acknowledging these physical, psychological and programme, exceed 0.5 implies strengths can create optimism emotional well-being compared to that they also exceed what can be and hope which are essential the average Irish parent. Service achieved by many family support ingredients in bringing about users also face challenges in the programmes which tends to positive change as service users area of parenting and experience produce effect sizes in the range are supported to broaden and build particular diffi culties in setting 0.2 to 0.5 (see Table 5.1 above). their natural healing abilities to appropriate limits on their children. This means that a signifi cant care for themselves, their children For participants on the Community challenge for Ballyfermot STAR and their partners. Employment programme, intimate - and other agencies responding relationships with partners are to the needs generated as a We now analyse in more detail less satisfying and are marked by consequence of drug use - is how patterns of drug use relatively high levels of physical to fi nd programmes which can within families infl uences the and psychological aggression. make signifi cant inroads into distribution of well-being. That the diverse needs identifi ed. At is the theme of Chapter Six. It is clear from these results that the same time, the study also the services of Ballyfermot STAR revealed particular strengths

TABLE 5.11 Aspects of Couple Relationship as Perceived by Service Users in Ballyfermot STAR Compared to Ireland

Variable Family Support Community Employment Ireland

Mean Effect Size* Mean Effect Size* Mean

Relationship fulfi lment 15.8 -0.1 15.0 -0.2 16.2

Relationship intimacy 49.0 -0.2 44.9 -0.5 50.9

Ways of resolving confl ict

Problem-solving 9.7 0.0 9.7 0.0 9.7

Confl ict-engaging 4.1 -0.4 6.0 +0.2 5.4

Compliant 5.2 0.0 4.4 -0.3 5.3

Withdrawing 6.3 0.2 6.2 +0.2 5.7

Ineffective arguing 5.3 -0.2 5.1 -0.2 5.9

Forms of aggression 18.3 -0.1 60.7 +0.5 22.2

Psychological 16.6 -0.1 43.6 +0.6 18.5

Minor psychological 15.9 -0.0 31.6 +0.6 16.0

Severe psychological 0.7 -0.3 12.0 +0.5 2.5

Physical assault 1.7 -0.1 17.1 +0.4 3.7

Minor physical 1.4 -0.1 11.1 +0.4 2.1

Severe physical 0.3 -0.2 6.0 +0.3 1.6

* Effect size refers to the difference from Ireland and is measured by subtracting the two means from each other and dividing by their pooled standard deviation.

35

6 Infl uence of Drug Use on Family Well-Being

6.1 Introduction the concept of effect size is a 6.2 Family Well-Being simple way of standardising and and Type of Drug User 87 See for It has been well established that comparing the difference between example, Balanda and Wilde, 2003; two groups on a range of test physical and psychological health Drug use, as we have seen Burke, Keenaghan, has a ‘social gradient’ in that scores. The formula involves in Chapter Four, is normally O’Donovan and people living in disadvantaged subtracting the mean of one group classifi ed according to whether Quirke, 2004 households and areas tend to have (service users in Ballyfermot it is active (meaning the use of 88 The concept of poorer health than those living STAR) from the mean of the illegal drugs), stable (meaning the effect size is typically in more affl uent households and other (a representative sample of use of prescribed alternatives to used in randomised control trials (RCTs) 87 areas . It is likely that this is part parents in Ireland) and dividing by illegal drugs such as methadone), to compare the of the explanation for the scale their pooled standard deviation. or drug-free (meaning no difference between of need among service users Thus, the effect size is measured longer taking drugs). Using an experimental and a control group. in Ballyfermot STAR which we in standard deviation units and these categories, we classifi ed The convention identifi ed in the previous chapter. the score varies from 0.0 to 3.088; participants on the family support established by However it is also possible that the given that the baseline fi gure programme according to whether Jacob Cohen (1988) and referred to needs of service users have been for Ireland is 0.0, the effect size they were living in a family as ‘Cohen’s d’, is infl uenced and intensifi ed by their measures how far service users containing a person whose drug that a coeffi cient between 0.2 and experience of drug use within the in Ballyfermot are from the this use was active (21), stable (9), 0.5 indicates a small family. This possibility is explored norm. Most programmes in the or drug-free (8). The well-being effect, between 0.5 in this chapter by analysing how area of family support tend to of these three sub-groups is and 0.8 indicates a moderate effect, and achieve effect sizes in the range the well-being of family members measured in effect sizes and above 0.8 indicates a varies according to the family’s 0.2 to 0.589. As a rule of thumb summarised in Table 6.1. From this, large effect. A guide experience of drug use. therefore, effect sizes in this three important fi ndings emerge. to the interpretation of effect sizes is range tend to indicate a signifi cant summarised in the The analysis focuses on level of need while effect sizes First, service users who live table below and participants in the family support in excess of 0.5 can be regarded in drug-free families have shows, for each effect size, the programme since this group is a as quite large relative to the signifi cantly higher levels of well- proportion of the much larger sample (45) compared capacity of programmes to meet being compared to those living in experimental group to the group on the Community that need. These considerations families where drug use is either (EG) whose scores exceed the average Employment programme (18). will be used as a guide in the active or stable. This applies to score of the control We examined how the well- interpretation of results. most of the key dimensions of group (CG), based being of service users varies well-being including physical, on the assumption that scores are according to fi ve different aspects We begin by examining if well- psychological and emotional normally distributed. of drug use in the family: being is related to whether well-being, satisfaction with the Effect % exceeds family members who use drugs home environment, quality of the Size CG • Type of drug use (active, are currently active, stable or couple relationship, and the ability stable or drug-free) drug-free (Section 6.2). We also to set appropriate limits for children 0.0 50 0.1 54 assess if well-being is related to though not to other aspects of 0.2 58 • Number of drug users the number of drug users in the the parent-child relationship. 0.3 62 (one or more than one) family (Section 6.3). Similarly, we 0.4 66 0.5 69 analyse if well-being is infl uenced Second, service users who live 0.6 73 • Imprisonment for drug use by whether a family member has in drug-free families also have 0.7 76 been imprisoned because of drugs signifi cantly higher levels of well- 0.8 79 0.9 82 (Section 6.4), or died from drugs • Death from drug use being compared to the average 1.0 84 (Section 6.5). Given the potential Irish parent. This also applies 1.2 88 Grandparent who acted stresses associated with being to many of the key dimensions 1.4 92 • 1.6 95 as full-time parent. a grandparent who has acted in of well-being including physical, 1.8 96 the role of a full-time parent, we psychological and emotional 2.0 98 For each aspect of drug use, we also assess if this experience well-being, satisfaction with the 2.5 99 3.0 99.9 calculated the means scores of has any infl uence on the person’s home environment, the quality of service users on each dimension well-being (Section 6.6). In light of the couple relationship, but not Source: CEM Centre, University of of their well-being and compared this analysis, we conclude with a the parent-child relationship. This Durham, England. it to the mean for Ireland using summary of the key fi ndings and indicates that service users on www.cemcentre.org the effect size statistic (the mean their implications (Section 6.7). the family support programme scores are presented in Table constitute a highly diverse group A6.1 at the end of this chapter). involving a majority (79%) with As explained in previous chapters, quite extensive needs and a

37 minority (21%) with no needs evidence of the impact of drug use of causation. At the same time, it as we have defi ned the term. on family well-being since it is clear seems plausible to infer from the that those living in families with data that well-being is infl uenced Third, there is no consistent an active or stable drug user have by drug use rather than the reverse pattern differentiating service signifi cantly lower levels of well since those who are currently users living in families where drug being compared to people living in drug-free were previously active use is either active or stable. This drug-free families. Given that this or stable; the reverse scenario suggests that the crucial transition data is cross-sectional (meaning - that becoming drug-free may affecting the well-being of these that it was collected at one point have been infl uenced by variations families is the transition to in time) rather than longitudinal in family well-being - appears becoming drug-free. (meaning data collected at different less plausible since this would points over time), it is not possible imply that these families did not These fi ndings provide strong to be certain about the direction experience the same reductions in

TABLE 6.1 Variations in Well-Being According to Drug Use of Family Members

Variable Drug Use of Family Member

Active (N=21) Stable (N=9) Free (N=8)

Effect Size*

Personal Well-Being

Physical symptoms 0.7 0.9 -0.5

Psychological well-being -0.1 -0.9 0.3

Positive affect -0.1 -0.7 0.5

Negative affect 1.3 1.4 0.2

Negative life events 1.0 1.0 1.0

Support networks -0.9 -0.7 -1.0

Home environment 1.0 0.9 1.5

Relationship with Children

Parent-child relationship -1.0 0.2 0.2

Setting limits for children -1.2 -0.7 -0.3

Psychological aggression towards children 1.1 0.3 0.5

Minor and severe aggression to children 0.3 -0.3 -0.3

Relationship with Partner

Fulfi lment with partner 0.1 -0.1 0.0

Intimacy with partner -0.1 -0.4 0.1

Problem-solving style with partner 0.1 -0.1 0.3

Confl ict-engaging style with partner -0.2 -0.1 -1.3

Confl ict withdrawing style with partner 0.0 0.3 0.0

Confl ict compliant style with partner -0.2 0.3 0.2

Ineffective arguing with partner -0.2 0.5 -1.0

Psychological aggression towards partner 0.0 0.2 -0.4

Physical aggression towards partner 0.0 -0.2 -0.4

*The effect size refers to the difference between the mean scores of service users and the average parent in Ireland, measured in standard deviation units.

38 well-being which are currently being 6.3 Family Well-Being and levels of psychological well-being experienced by families containing Number of Drug Users compared to those with only one active or stable drug users. In drug user; also, those with more other words, it is reasonable to The number of drug users in the than one drug user in the family infer from the data - despite its family during the past fi ve years had a poorer relationship with their methodological limitations and the was classifi ed as either ‘one’ or children but a better relationship relatively small number of cases ‘more than one’. The results, as with their partner compared to - that the presence of a drug user summarised in Table 6.2, show no those with only one drug user in in the family has a signifi cant consistent pattern in both sets of the family. Faced with this pattern negative impact on the well- families in terms of their well-being. of results, it is diffi cult to draw any being of other family members. For example, those with more than clear conclusions about how well- one drug user in the family had being is affected by the number of better physical health and similar drug users in the family.

TABLE 6.2 Variations in Well-Being According to Number and Imprisonment of Drug Users

No. of Drug Users in Family Imprisoned for Drugs

1 (N=20) >1 (N=25) Yes (N=29) No (N=16)

Effect Size* Effect Size*

Personal Well-Being

Physical symptoms 0.8 0.5 0.4 1.1

Psychological well-being -0.3 -0.4 -0.3 -0.5

Positive affect -0.1 -0.4 -0.1 -0.4

Negative affect 1.4 1.0 0.9 1.7

Negative life events 1.0 0.7 1.2 0.6

Support networks -1.1 -0.8 -0.9 -0.8

Home environment 1.2 0.9 1.0 0.9

Relationship with Children

Parent-child relationship -0.3 -0.6 -0.5 0.6

Setting limits for children -1.0 -0.9 -0.6 -1.8

Psychological aggression towards children 0.7 0.7 0.5 1.1

Minor and severe aggression to children -0.5 0.2 -0.1 0.1

Relationship with Partner

Fulfi lment with partner -0.4 0.3 0.2 -0.5

Intimacy with partner -0.4 0.0 0.0 -0.3

Problem-solving style with partner 0.1 -0.1 0.5 -0.6

Confl ict-engaging style with partner -0.5 -0.3 -0.7 0.1

Confl ict withdrawing style with partner 0.1 0.2 -0.1 0.7

Confl ict compliant style with partner -0.1 0.0 -0.2 0.2

Ineffective arguing with partner 0.1 -0.4 -0.6 0.4

Psychological aggression towards partner -0.4 0.1 -0.1 -0.1

Physical aggression towards partner -0.4 0.0 -0.1 -0.3

*The effect size refers to the difference between the mean scores of service users and the average parent in Ireland, measured in standard deviation units.

39 6.4 Family Well-Being users as well as improvements 6.5 Family Well-Being and Imprisonment in the relationship with children and Deaths from Drugs and partners. This is a clear and Each service user was classifi ed consistent pattern and is probably The well-being of service users according to whether, or not, due to the fact that imprisonment was analysed according to a family member had been in removes a family member who whether, or not, anyone in the prison for using illegal drugs in may have been causing signifi cant family had died from drugs. The the past fi ve years. The results distress for the family. This result results, as summarised in Table of the analysis are summarised is also consistent with the fi nding 6.3, indicates that the death of a in Table 6.2 and they show in Section 6.2 which showed family member through drugs is that imprisonment tends to that any form of drug use in the associated with reduced physical, be associated with improved family, both active and stable, psychological and emotional physical, psychological and has negative consequences well-being as well as a poorer emotional well-being for service for other family members. relationship with the children but

TABLE 6.3 Variations in Well-Being According to Death from Drugs & Grandparents Acting as Parents

Death from Drugs Grandparents acted as Parents

Yes (N=11) No (N=34) Yes (N=12) No (N=15)

Effect Size* Effect Size*

Personal Well-Being

Physical symptoms 0.8 0.6 2.5 0.9

Psychological well-being -0.8 -0.2 -1.9 -0.7

Positive affect -0.6 -0.1 -0.3 -0.4

Negative affect 1.8 1.0 1.5 1.3

Negative life events 1.1 1.0 0.0 0.8

Support networks -1.1 -0.8 -2.0 -0.9

Home environment 1.0 1.0 1.6 1.1

Relationship with Children

Parent-child relationship -1.5 -0.2 -1.0 -0.5

Setting limits for children -1.1 -0.9 -1.2 -0.7

Psychological aggression towards children 0.8 0.7 0.8 0.5

Minor and severe aggression to children -0.2 0.1 -0.2 0.0

Relationship with Partner

Fulfi lment with partner 1.1 -0.3 -0.2 -0.6

Intimacy with partner 0.6 -0.3 0.0 -0.7

Problem-solving style with partner 0.6 -0.1 0.0 -0.3

Confl ict-engaging style with partner -0.2 -0.5 0.0 -0.3

Confl ict withdrawing style with partner -0.1 0.2 0.4 0.4

Confl ict compliant style with partner -0.1 0.0 0.3 -0.1

Ineffective arguing with partner -1.1 0.0 0.0 0.4

Psychological aggression towards partner -0.6 0.0 -0.4 -0.6

Physical aggression towards partner -0.4 -0.1 -0.4 -0.4

*The effect size refers to the difference between the mean scores of service users and the average parent in Ireland, measured in standard deviation units.

40 an improved relationship with the has acted as full-time parent. points over time) - a plausible partner. This association suggests For each aspect of drug use, we explanation for the variation that deaths from drug use have calculated the means scores of in well-being among services signifi cant negative consequences service users on each dimension users is the different experiences for family members, particularly in of their well-being and compared of drug use within the family. terms of the individual well-being. them to the mean for Ireland Drugs impose a burden on both using the effect size statistic. users and their families, as we have seen in Chapter Five, but 6.6 Family Well-Being The results provide strong the burden is more intense for and Grandparents Acting statistical evidence to show that those families with an active or as Full-time Parents drug use has a negative impact on stable drug user, for those who 89 See Table 5.1, based on Layzer, family well-being. This was shown have experienced the death of Goodson, Bernstein We have seen in Chapter Four by the fact that families with a drug a family member from drug use, and Price, 2001; that six out of ten service users user, whether active or stable, had and for those grandparents who Nelson, Westhues and MacLeod, 2003. are grandparents and four out consistently lower levels of well- have been called upon to play The effect size of ten have acted in the role of being compared to families which the role of full-time parents. of family support full-time parents, possibly as are drug-free. This was evident programmes (0.2 to 0.5), though a consequence of drug use by in the fact that these service These results call attention to the statistically regarded their children. We analysed the users had reduced physical, need for a broader understanding as a small effect, can difference in well-being between psychological and emotional of how drug use impacts negatively have very substantial implications. For those grandparents who have, well-being, were less satisfi ed on family members who are not example, the effect and those who have not, acted as with their home environment, had drug users. Drug use generates size of the High / Scope Perry Pre- full-time parents and the results poorer relationships with their a wide range of needs within School Programme are summarised in Table 6.3. The partners, and were less able to the family in terms of individual in the US when results show that grandparents set appropriate limits for their and relationship well-being, and participants reached the age of 23 was who have acted as full-time children. Consistent with this, these have to be recognised and 0.36 (Schweinhart parents show consistently lower the impact of drug use on family addressed as part of an overall and Weikhart, 1997) levels of well-being compared to well-being is also suggested by the drugs strategy. The provision but the economic return at age 27 is other grandparents. This is evident fact that imprisonment tends to be of services such as Ballyfermot estimated to be $8 in reduced physical, psychological associated with improved physical, STAR are an important part of for every $1 invested and emotional well-being as well psychological and emotional well- the response to families affected (Barnett, 1996) rising to $17 for every $1 as a poorer relationship with being for service users as well as by drug use and this response invested by age their children but an improved improvements in the relationship needs to be informed by a fuller 40 (Schweinhart, relationship with the partner. The with their partners and children. understanding of the scale of 2004). In the medical fi eld, there are reasons for the reduced well-being This may be due to the fact that need generated by drug use. even more dramatic of grandparents may be due to imprisonment removes a family illustrations of how the demands of parenting as one member who has been causing small effect sizes can have enormous gets older, but may also refl ect signifi cant distress for the family. practical signifi cance. the negative consequences of For example, the effect size of having a family member who uses Drug use has also brought death aspirin in reducing drugs or, in some cases, a family to about a quarter of the families heart disease is member who has died from drugs. and these show consistently 0.03, yet is widely prescribed by doctors lower levels of well-being because the cost compared to those who have not of the intervention 6.7 Summary & Conclusion had this experience. Similarly, is cheap and the potential benefi ts grandparents who have had to are very large (cited This chapter assessed the act in the role of full-time parents, in McCartney and impact of drug use on families by possibly as a consequence of drug Dearing, 2002). analysing how the well-being of use by their own children, also service users in Ballyfermot STAR show consistently lower levels varied according to the family’s of well-being compared to other experience of drug use. The grandparents. This may be due analysis focused on participants to the older age of grandparents in the family support programme relative to the demands of being since this group is a much larger a parent, but may also refl ect the sample (45) compared to the group negative consequences of having a on the Community Employment family member who uses drugs or, programme (18). The following as in some cases, having a family aspects of drug use in each family member who has died from drugs. were analysed: type of drug use (active, stable or drug-free), Despite limitations of the data number of drug users (one or - which is cross-sectional (meaning more than one), imprisonment for that it was collected at one point drug use, death of family member in time) rather than longitudinal from drug use, grandparent who (meaning data collected at different

41 TABLE A6.1 Mean Scores on Selected Variables for Participants on Ballyfermot STAR Family Support Programme

Variable Ireland Drug Use of No. of Imprisoned Death from Grandparents Family Member Drug Users for Drugs Drugs as full-time in Family Parents

Active* Stable** Free*** 1 >1 Yes No Yes No Yes No

Number of Respondents 435 21 9 8 20 25 29 16 11 34 12 15

Personal Well-Being

Physical symptoms 19.4 28.3 30.7 14.6 30.3 26.3 25.6 32.6 31.8 26.9 34.1 31.2

Psychological well-being 74.4 72.3 61.4 77.8 69.6 67.9 69.9 66.4 62 70.8 60.1 64

Positive affect 37.8 37.1 34.3 40.6 37.3 35.5 37.1 34.8 34.0 37.0 34.6 34.6

Negative affect 23.1 31 31 24.4 31.7 29.6 29.1 33.1 33.2 29.7 32.6 32.5

Negative life events 0.1 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.3 0.2 0.3 0.2

Support networks 7.1 5.7 5.9 5.4 5.3 5.8 5.6 5.7 5.1 5.8 5.3 5.4

Home environment 24.9 32.1 31.1 34.5 32.8 31.1 32.6 30.6 32 31.8 30.7 32.9

Relationship with Children

Parent-child relationship 53.5 43.6 55.2 55.1 50.5 46.4 48.3 48.1 37.1 51.3 43.9 48.6

Settings limits for children 8.6 4.6 5.9 7.4 5.1 5.4 6.4 3.3 4.9 5.4 4.6 5.7

Overall discipline 13.8 43.4 16.3 20.0 23.9 33.1 23.2 39.1 26.9 29.7 28 26.4

Non-violent discipline 22.9 36.1 18.4 39.7 24.2 36.4 34.1 25.8 41.9 28 29.9 21.1

Psychological aggression 10.6 36.8 15.3 18.9 23.7 27.1 20.5 34.4 25.1 25.8 26.2 22.7

Minor and severe physical aggression 3.2 6.7 1 1.1 0.2 6 2.7 4.7 1.8 3.9 1.8 3.7

Relationship with Partner

Fulfi lment with partner 16.2 16.5 15.6 16.3 14 17.5 17.1 13.5 19 14.7 15.3 12.7

Intimacy with partner 50.9 49.8 46.4 52.3 46.5 51.5 50.6 46.4 56 46.7 50.8 42.4

Problem-solving style 9.7 10.1 9.3 10.4 10 9.3 11 7.4 11.1 9.2 9.6 8.7

Confl ict-engaging style 5.4 4.7 5.1 2.1 3.7 4.6 3.3 5.6 4.9 3.9 5.4 4.3

Confl ict withdrawing style 5.7 5.7 6.4 5.7 6.1 6.4 5.4 7.7 5.5 6.5 6.8 6.9

Confl ict compliant style 5.3 4.8 6.3 6 5.1 5.3 4.7 6.1 5 5.3 6.1 4.9

Ineffective arguing 5.9 5.3 7.6 2.6 6.2 4.4 3.9 7.8 3.1 6 5.8 7.6

Psychological aggression 18.5 18.7 23 10.6 11.8 21.3 16.3 17 10.3 18.7 13 11.2

Physical aggression 3.7 3.5 1.3 0 0.1 3.3 2.5 0.4 0 2.3 0 0.1

* The term ‘active’ refers to a family where at least one family member is an active drug user. ** The term ‘stable’ refers to a family where no family member is an active drug user but at least one family member is a stable drug user. ** The term ‘free’ refers to a family where all family members are drug free.

42 7 Summary, Conclusions and Implications

7.1 Introduction by illustrating the diverse impacts 7.3). We describe the background of drug use on family life. characteristics of service users 90 Watters and This report was written to assess (Section 7.4) and the extent of drug Byrne, 2004:8. The report is timely given that use within their families (Section the impact of drugs in order to 91 According to the help identify more appropriate Ballyfermot STAR has been in 7.5). The results of our needs- Commission on the responses to the needs of existence for nearly a decade assessment are summarised in Family (1995-1998): “The experience drug users and their families. and provides an opportunity to terms of the key dimensions of of family living is Ballyfermot STAR was one of the systematically assess the needs well-being which include physical, the single greatest fi rst groups in Ireland to recognise of those who use its services psychological and emotional infl uence on an individual’s life and that drug use affects not just the and to refl ect on how all services well-being, support networks, the family unit is a drug user but the whole family in the community - and not just relationships with children and fundamental building including parents, siblings and Ballyfermot STAR - might respond with partner (Section 7.6). The block for society” (Commission on the wider kin such as grandparents. to those needs. As such, the results of the impact-assessment Family, 1996:13; see Since its establishment in 1998, study adopts a ‘needs-led’ rather are also presented by showing also 1998). it has been offering supports to than a ‘service-led’ perspective how the well-being of service 92 Quoted in parents whose children take drugs by focusing on how services can users varies according to the Department of as well as helping drug users to be developed to meet the needs experience of drug use within Health, 2001:15. This concept of make the journey to recovery. This of families affected by drug use. the family (Section 7.7). Finally, health informs report builds on that experience we draw out the key implications the Government’s by offering a systematic The concept of need, as used in of the study (Section 7.8). health strategy and is therefore this report, refers to anyone who assessment of the needs of important in shaping drug users and their families. does not feel healthy or does not a policy-relevant experience a sense of well-being. 7.2 Context understanding of need. The needs of families affected To be healthy, according to the by drug use are not well-known World Health Organisation involves Ballyfermot, sometimes referred 93 All data in this and there is a widespread “a complete state of physical, to by its postal address as section is supplied by Trutz Haase, perception that services are not mental and social well-being ‘Dublin 10’, consists of seven Social and Economic responding adequately to those and not merely the absence of electoral divisions (EDs), and Consultant; see needs. An important conclusion disease or infi rmity ... a resource is the catchment area for both Appendix One at the end of this report; to emerge from a study of family for everyday life, not the objective Ballyfermot Partnership and see also Haase and support services published by of living; it is a positive concept Ballyfermot Drug Task Force. Pratschke, 2005. the National Advisory Committee emphasising social and physical In 2002, all seven EDs had a on Drugs (NACD) in November resources as well as physical and combined population of just over 2004 was that the majority of mental capacity”92. This concept is 20,000 and were amongst the these services “are not aware of diffi cult to apply in research and, 5 per cent most disadvantaged the positive role they could play in as an approximation, we defi ne EDs in the country93. The decade responding to and preventing drug, a person as being in need when between 1991 and 2002 is including alcohol, problems”90. their well-being, as measured notable in Ireland for the growth in along a range of dimensions, prosperity and the corresponding The reality in Ireland, as is signifi cantly below that of the decline in deprivation which elsewhere, is that families who average person in Ireland. was experienced throughout the experience drug-related problems country as a result of the ‘Celtic are often overlooked by policy- In this chapter we draw together Tiger’. Ballyfermot shared in makers, service-providers, the main fi ndings of the report this process and, in absolute community activists, and social and draw out their implications for terms, experienced a similar researchers. This is because drug policy and services. We begin by improvement to Dublin and Ireland use is often seen as a problem summarising the context in which in terms of reduced deprivation which impacts on individuals, Ballyfermot STAR - notably the scores, increased employment communities and society at large socio-economic characteristics of and improvements in education. - but not families. Despite the Ballyfermot and the prevalence However its relative position in acknowledged importance of illegal drug use in the community terms of affl uence and deprivation families in determining well-being91, - delivers its services (Section 7.2). remains unchanged and it is still there is a tendency to overlook The study is based on a survey of one of the most disadvantaged how drug use within the family service users in Ballyfermot STAR areas in Dublin and Ireland. impacts on other family members. and we describe the methodology This report attempts to fi ll a used to assess their needs and signifi cant gap in understanding the impact of drug use (Section

43 In 2001, Ballyfermot Drug Task programme and the Community participants on the Community Force estimated that there were Employment programme. Employment programme, also 1,000 problem heroin users in the representing the vast majority area94, a fact which clearly justifi es of those who used this service the title of its strategic plan for 7.3 Methodology at some time during 2004/5. 2001-2002 - ‘Ballyfermot Has A Drug Problem’. If the prevalence The main purpose of the study is to The analysis of need involved rate is based on the population assess the needs of service users comparing the mean scores aged 15-4495 - the age group most who attend Ballyfermot STAR, of service users in Ballyfermot likely to be involved in heroin use all of whom are affected, directly STAR with the mean scores 94 Ballyfermot Drug - then this produces a prevalence or indirectly, by drug use. We of a nationally representative Task Force, 2001:55 rate of 10%; if this is further defi ne a person as being in need sample of parents in Ireland. We 95 Based on adjusted to take account of the fact when their well-being is below a did this by calculating the effect data prepared by that three quarters of all drug users threshold that is regarded as either size, which is a simple way of GAMMA, 2004 are men96, then the prevalence rate normal or minimal. In this study, standardising and comparing the 96 Drug Misuse is 15% for men and 5% for women. the ‘normal’ threshold is defi ned difference between two groups Research Division, In other words, one in 7 men and by reference to the average on a range of test scores. The 2003 one in 20 women are estimated to level of well-being experienced formula involves subtracting the 97 National Advisory be heroin users in Ballyfermot. In by parents in a representative mean of one group (service users Committee on Drugs, 2002, the ‘last month prevalence’ sample of Irish families100. As in Ballyfermot STAR) from the 2004:Tables 6 and 14 of heroin use among young adults such, it represents a statistical mean of the other (a representative 98 Quoted in (15-34 years) in Ireland was 0.1% rather than a clinical norm and sample of parents in Ireland) and Ballyfermot Drug while in the South Western Area the results should be regarded as dividing by their pooled standard Task Force, 2001:64 Health Board, which includes indicative rather than defi nitive. deviation. Thus, the effect size is 99 Ballyfermot Drug Ballyfermot, the prevalence measured in standard deviation Task Force, 2001:66 was 0.4%97. This implies that The questionnaire used to units and the score varies from 0.0 100 See McKeown, Ballyfermot has a heroin problem measure need among service to 3.0102; given that the baseline Pratschke and which is 25 times greater than in users draws together a range fi gure for Ireland is 0.0, the effect Haase, 2003 the surrounding South Western of instruments which have been size measures how far service 101 McKeown, Area Health Board region and 100 tried and tested internationally users in Ballyfermot are from the Pratschke and times greater than in Ireland. and have been used in a national this norm. Most programmes in Haase, 2003 study of family well-being in the area of family support tend to The number of persons from Ireland101. As such, they provide achieve effect sizes in the range Ballyfermot who were accessing useful benchmarks against 0.2 to 0.5103. As a rule of thumb drug treatment services in 1999, which to measure the well- therefore, effect sizes in this the latest year for which data is being of persons affected by range tend to indicate a signifi cant available from the National Drug drug use in Ballyfermot. These level of need while effect sizes Treatment Reporting System, instruments and the dimensions in excess of 0.5 can be regarded was 29898. Although Ballyfermot of need which they measure are as quite large relative to the has three drug treatment centres summarised above in Table 2.1. capacity of programmes to meet - Aisling, Fortune House and that need. These considerations Cuan Dara -over half their In addition to these indicators, the will be used as a guide in the clients in 1999 were not from questionnaire collected data on interpretation of results. Ballyfermot indicating, according the background characteristics to Ballyfermot Drugs Task Force, of service users including: age, that ‘Ballyfermot residents were sex, marital status, education, 7.4 Background going elsewhere for treatment’99. housing status, household Characteristics of One of the reasons for this may be composition, employment, Service Users that there is an 18 month waiting fi nancial well-being. This data period before accessing drug was collected using questions We analysed the background treatment services in Ballyfermot. which allow for comparison with characteristics of service users national data sets such as the on the family support programme Ballyfermot STAR was set Census of Population, Quarterly and the Community Employment up in 1998 to respond to the National Household Survey, the programme and compared these needs of drug users and their Living in Ireland Survey, etc. to a nationally representative families. Its services include: sample of parents in Ireland. This a family support programme, Interviews were carried out is an appropriate comparison a Community Employment with two groups of service given that most service users are programme, complementary users. The fi rst group (45) also parents: 91% of those on the therapies, a drop-in service, comprised participants on the family support programme and and a community education family support programme, 78% of those on the Community programme. In our assessment representing the vast majority of Employment programme. From this of the needs generated by the those who used this service at analysis it emerged that service impact of drug use we focus on some time during 2004/5. The users in Ballyfermot STAR are service users in the family support second group (18) comprises distinctive in a number of respects:

44 • the majority of participants on households generally but also • the majority of service users the family support programme by reference to specifi c groups (59%), particularly those on the (71%) live in two parent which are vulnerable to poverty family support programme, have households, similar to the situation such as households with children, a family member who has been in Ireland. By contrast, participants older people, unemployed, imprisoned for using drugs. on the Community Employment and the ill / disabled104. programme are more likely to live • a fi fth of families (19%), in a one parent household (57%), These fi ndings are consistent with particularly those on the family nearly three times higher than the overall profi le of Ballyfermot support programme, have the corresponding rate of lone and with its status as one of the experienced the death of a family parenthood in Ireland (21%). most disadvantaged parts of member as a result of drugs. 102 The concept of effect size is typically Ireland. The comparative analysis used in randomised • participants on the Community serves to highlight the level of • participants on the family control trials (RCTs) Employment programme (mean disadvantage experienced by support programme are evenly to compare the difference between age 29) are younger than those service users in Ballyfermot STAR divided between those who an experimental on family support (mean age 48), relative to other parents in Ireland, have been attending Ballyfermot and a control group. are more likely to be living with all particularly in terms of lower levels STAR for under three years and The convention established by their children although half still live of education, a relatively high those who have been attending Jacob Cohen (1988) with their own parents; on the other level of fi nancial strain, and a very for more than three years, and referred to hand, participants on the family substantial proportion who are while Community Employment as ‘Cohen’s d’, is that a coeffi cient support programme are more unable to work due to sickness participants are evenly divided between 0.2 and likely to be grandparents (60%) or disability. The analysis also between those attending for 0.5 indicates a small effect, between 0.5 and a substantial proportion (44%) identifi ed a substantial proportion less than a year and those and 0.8 indicates a have acted in the role of full-time of grandparents who have acted attending for more than a year. moderate effect, and parents to their grandchildren, as full-time parents, possibly as a above 0.8 indicates a large effect. A guide possibly for drug-related reasons. consequence of drug use, which These fi ndings indicate that drug to the interpretation is consistent with the fi ndings of use is a serious issue for the of effect sizes is a majority of family support a recent report on this issue105. families who attend Ballyfermot summarised in the • table below and participants (65%) live in owner- STAR. It tends to involve about two shows, for each occupied housing, less than the family members who are active or effect size, the corresponding proportion of Irish 7.5 Drug-Related Experiences stable drug users, and a majority proportion of the experimental group parents (74%). Nearly a third in Families of Service Users of service users have seen family (EG) whose scores of all service users rent from members go to prison; a signifi cant exceed the average the local authority, about four The survey of service users minority have experienced the score of the control group (CG), based times higher than in Ireland. collected data on the nature and death of a family member due on the assumption extent of drug use within their to drugs. The consequences of that scores are service users tend to leave families. This produced a number drug use do not pass quickly and normally distributed. • Effect % exceeds school early and the highest of key fi ndings as follows: this is refl ected in the fact that Size CG qualifi cation for the majority is many families have been coming 0.0 50 a Junior Certifi cate, whereas on average, each service user to Ballyfermot STAR for family • 0.1 54 the majority of parents in has two family members who support over a number of years. 0.2 58 Ireland (65%) have a Leaving have used illegal drugs in the 0.3 62 0.4 66 Certifi cate or higher. past fi ve years; in the extreme, 0.5 69 some have between six and nine 7.6 Needs of Service Users 0.6 73 As in Ireland, a majority of family members who have used 0.7 76 • 0.8 79 service users are in paid work. drugs in the past fi ve years. We assessed the well-being of 0.9 82 However service users in service users in Ballyfermot STAR 1.0 84 Ballyfermot STAR are different participants are more likely relative to the well-being of parents 1.2 88 • 1.4 92 from the average Irish parent to be attending the family in Ireland. Using the methodology 1.6 95 in two important respects: (i) support programme because described above, we present the 1.8 96 only a small proportion are one of their children has used results for each dimension of need. 2.0 98 2.5 99 full-time home-makers (9%) drugs (76%), whereas all 3.0 99.9 compared to Ireland (40%), participants on the Community 7.6.1 Physical Well-Being possible because their children Employment programme have The physical well-being of service Source: CEM Centre, University of are older; and (ii) a substantial themselves used drugs. users is signifi cantly below the Durham, England. proportion are unable to work average for Ireland, with large www.cemcentre.org due to sickness or disability • active drug users are more effect sizes for family support (20% in family support and 90% likely to be found in the families participants (0.6), but particularly in Community Employment) of participants on the family for Community Employment compared to Ireland (2%). support programme (46%) participants (1.1). The poorer whereas stable drug users are physical well-being of service • the level of fi nancial strain more likely to be found among users in Ballyfermot STAR is among service users in participants on the Community also indicated by the fact that Ballyfermot STAR is well above Employment programme (62%). 36% of participants on the family that experienced not only by Irish support programme, and 72%

45 of participants on the Community in the past year compared to than twice as much psychological Employment programme use the average parent in Ireland. aggression108 than Irish parents. sedatives, tranquilisers and Community Employment Minor physical assaults109 occur anti-depressants; this compares participants had a much higher much less frequently than other to a national prevalence in number of negative events (4.7) forms of discipline but parents Ireland of around 5% for these compared to family support on the Community Employment drugs. These are prescription participants (0.2) or the average programme tend to use it nearly drugs, commonly referred to as Irish parent (0.11). These fi ndings twice as much as Irish parents. benzodiazepines, and a recent are consistent with the results on Severe physical assault110 is used study noted that “a considerable psychological well-being but offer infrequently by all parents. 103 See Table 5.1 proportion of patients who are a more dramatic illustration of the below, based on initiated on benzodiazepine Layzer, Goodson, adversities which face service 7.6.6 Relationships with Partner Bernstein and Price, continue to take them for many users in Ballyfermot STAR. In terms of intimate relationships 2001; Nelson, years”106. Reduced physical with partners, we found that Westhues and MacLeod, 2003. The well-being is also indicated by 7.6.4 Support Networks participants on the family effect size of family the fact that that the proportion Participants on the Community support programme have couple support programmes of service users who are unable Employment programme have relationship which are broadly (0.2 to 0.5), though statistically regarded to work due to a disability - 20% much weaker support networks similar to other parents in Ireland as a small effect, can in family support and 33% in (an effect size of 0.9) compared to but with lower levels of confl ict. have very substantial Community Employment - is much participants on the family support By contrast, participants on implications. For example, the effect higher than in Ireland (2%). programme (an effect size of 1.7), the Community Employment size of the High / but both are well below the norm programme have less satisfying Scope Perry Pre- 7.6.2 Emotional and for Ireland. In view of this, it is relationships than other parents School Programme in the US when Psychological Well-Being likely that Ballyfermot STAR is a in Ireland and these are participants reached In terms of emotional well-being, signifi cant source of support for characterised by a much higher the age of 23 was service users in Ballyfermot 0.36 (Schweinhart many service users. However all level of physical and psychological and Weikhart, 1997) STAR have much higher levels service users are satisfi ed with aggression, refl ected in effect but the economic of negative emotions compared the neighbourhood in which they sizes of around 0.5. This seems return at age 27 is to the average Irish parent estimated to be $8 live and this is the only dimension to mirror the higher level of for every $1 invested with high effect sizes for both of well-being where service users aggression towards children found (Barnett, 1996) rising family support participants (1.2) are above the norm for Ireland. among Community Employment to $17 for every $1 invested by age and Community Employment participants and raises questions 40 (Schweinhart, participants (1.1). Similarly, the about the potential impact which 2004). In the medical overall level of psychological 7.6.5 Relationships with Children these family dynamics may have fi eld, there are even more dramatic well-being is signifi cantly lower, In general, service users in on the well-being of children. illustrations of how particularly among participants Ballyfermot STAR have weaker small effect sizes on the Community Employment parent-child relationships can have enormous practical signifi cance. programme (an effect size of 1.0). compared to the average parent 7.7 Impact of Drug For example, Both groups of service users have in Ireland, with family support Use on Families the effect size of somewhat different psychological participants having weaker parent- aspirin in reducing heart disease is strengths and weaknesses. For child relationships (effect size It has been well established that 0.03, yet is widely participants on the family support of 0.5) compared to Community physical and psychological health prescribed by doctors programme their main strengths because the cost Employment participants (effect has a ‘social gradient’ in that of the intervention are to be found in feelings of size of 0.2). Both groups of service people living in disadvantaged is cheap and the autonomy, personal growth, and users have similar strengths and households and areas tend to have potential benefi ts personal relations while their main are very large (cited weaknesses; the main strength poorer health than those living in McCartney and weakness is self-acceptance; for is having more communication in more affl uent households and Dearing, 2002). participants on the Community and involvement with the child areas111. It is likely that this is part

104 Whelan, Nolan Employment programme their compared to the norm in Ireland of the explanation for the scale and Maitre, 2005 main psychological strength is while the main weakness is setting of need which we have identifi ed feeling a sense of personal growth appropriate limits on the child. among service users in Ballyfermot 105 The report, entitled ‘Supporting while their main weaknesses are The issue of limit-setting is a STAR. However it is also possible Grandparents ... in areas such as purpose in life, particular problem for both sets of that the needs of service users Supporting Children’ self-acceptance, environmental service users - effect size of 0.9 have been infl uenced and (Citywide Family Support Network, mastery, and personal relations. for family support participants and intensifi ed by their experience of 2004a), was 0.5 for Community Employment drug use within the family and we launched in Dublin 7.6.3 Negative Life Events participants - who use much undertook a separate analysis at Ozanam House in October 2004. Negative life events, and the way more discipline on their children to test for this possibility. This in which they are remembered, compared to Irish parents. Non- was done by assessing how 106 Ballymun Youth can have a signifi cant infl uence 107 Action Project, violent discipline is the most the well-being of service users 2004:8 on psychological well-being and frequently used form of discipline attending the family support the results of this study show by all parents, but Ballyfermot programme varied according to that service users in Ballyfermot parents use it more frequently than the family’s experience of drug STAR have experienced a higher the average Irish parent. Parents use; those on the Community number of negative life events in Ballyfermot STAR also use more Employment programme could

46 not be included in this analysis but may also refl ect the negative of signifi cantly reduced levels of because the number in this group consequences of having a family educational attainment as well (18) is too small. The analysis member who uses drugs or, as as the experience of fi nding it examined the following aspects in some cases, having a family diffi cult to cope fi nancially. In of drug use in their families: type member who has died from drugs. addition, the prevalence of drug of drug use (active, stable or use in Ballyfermot is enormously drug-free), number of drug users Despite limitations of the data high involving about 10% of the in the family (one, or more than - which is cross-sectional (meaning population aged 15-44, and up one), imprisonment for drug use, that it was collected at one point to 15% of the men in this age death of family member from in time) rather than longitudinal category. It is clear therefore drug use, grandparent who has (meaning data collected at different that drug use is a community- 107 Non-violent discipline was acted as full-time parent. For points over time) - a plausible wide problem in Ballyfermot measured by each aspect of drug use, we explanation for the variation in and, although there are stronger the response to calculated the means scores of well-being among service users is concentrations in certain areas, statements such as: ‘explained why service users on each dimension the different experiences of drug those who use Ballyfermot STAR something was of their well-being and compared use within the family. Drugs impose come from all of the nine Electoral wrong’, ‘grounded the them to the mean for Ireland a burden on both users and their Divisions which comprise the area. child’, ‘gave the child something else to do using the effect size statistic. families, but the burden is more These considerations highlight the instead of what he / intense for those families with an need for an area-based approach she was doing’. The results provide strong active or stable drug user, for those to addressing drug-use and the 108 Psychological statistical evidence to show that who have experienced the death socio-economic conditions which aggression was drug use has a negative impact of a family member from drug allow it to fl ourish. In particular, measured by the response to use, and for those grandparents the challenge of preventing young on family well-being. This is statements such as: shown by the fact that families who have been called upon to people becoming involved in ‘shouted, yelled or with a drug user, whether active play the role of full-time parents. drugs must become a priority screamed at him / her’, ‘swore or cursed or stable, have consistently lower and this requires interventions at the child’. levels of well-being compared with families, schools, community to families which are drug-free 7.8 Implications services, sports and recreation 109 Minor physical assault was in terms of reduced physical, activities, etc. As such, an inter- measured by psychological and emotional The results of this study are likely agency approach is essential. the response to well-being, less satisfi ed with their to confi rm the experiences of many A signifi cant fi nding to emerge statements such as: ‘shook the child’, home environment, less able to set families who have been affected from this study is that each family ‘spanked the child on appropriate limits for their children, by drug use, both in Ballyfermot attending Ballyfermot STAR has the bottom with your and poorer relationships with their and beyond. In addition, they may an average of two family members bare hand’. partners. Consistent with this, reinforce the insights of those who are involved in drugs and this 110 Severe the impact of drug use on family who work with these families on highlights how families themselves physical assault was measured by well-being is also suggested by a daily basis, such as those in can be a mode of transmission for the response to the fact that imprisonment tends Ballyfermot STAR. In view of this, the spread of drug use. Supports statements such as: to be associated with improved it is important to draw out the to families are important therefore ‘hit the child with a fi st or kicked him / implications of these results so that not only for the purpose of treating physical, psychological and her hard’, ‘threw or emotional well-being for service policies and services can respond the consequences of drug use knocked the child users as well as improvements in more fully to the signifi cant burden but also from the point of view of down’. the relationship with their partners which drugs impose on users, their preventing its further spread. 111 See for and children, possibly because families and their communities. example, Balanda imprisonment removes a family We conclude by drawing attention 7.8.2 Matching Interventions and Wilde, 2003; Burke, Keenaghan, member who has been causing to fi ve key implications which to the Depth of Needs O’Donovan and signifi cant distress for the family. follow from this study. Although The study has been useful in Quirke, 2004 these implications are derived documenting the diverse range 112 Layzer, Drug use has also brought death from a study of services users in of needs which exist among Goodson, Bernstein to about a quarter of the families Ballyfermot STAR, they are likely families affected by drug use but and Price, 2001; attending Ballyfermot STAR and to have general applicability for also the depth of those needs. Nelson, Westhues and MacLeod, 2003. these show consistently lower many agencies responding to the As we use the term, the depth levels of well-being compared needs generated by drug use. of need refers to the distance in to those who have not had well-being between the average this experience. Similarly, 7.8.1 Recognising service user in Ballyfermot STAR grandparents who have acted the Socio-Economic and the average parent in Ireland. in the role of full-time parents, Infl uences on Drug Use This is a statistical rather than a possibly as a consequence of We have seen that Ballyfermot is clinical defi nition of need but is drug use by their own children, one of the most disadvantaged nevertheless useful in providing also show consistently lower communities in Ireland, based an indication of the challenge levels of well-being compared on objective analysis of national facing any potential intervention. to other grandparents. This may datasets such as the Census Given that most of the needs be due to the demands of being of Population. This reality is identifi ed in Ballyfermot STAR a parent for someone who has refl ected in the lives of those who had an effect size of 0.5 or more, already reared their own children, use Ballyfermot STAR in terms which is larger than the effect

47 size than can be achieved by most in these three areas and evaluating grief suffered by those who have intervention programmes112, this them for effectiveness. More lost loved ones through drugs, as provides a realistic assessment specifi cally, it is necessary to fi nd well as those grandparents who of the challenge which services programmes which effectively have been called upon to act in face in designing interventions interrupt the behaviour and the role of full-time parents, often to help bring the well-being thought patterns which reduce as a consequence of drug use. of families closer to the norm well-being. For example, the The needs of these families have experienced by other Irish patterns of thinking which sustain not been adequately recognised families. This way of thinking negative emotions and low and the study validates their about services - of producing self-acceptance among service case for additional supports. 113 In Ireland, the effect sizes proportionate to the users need to be systematically Parenting Plus scale of need - has the potential programme is addressed through counselling 7.8.5 Meeting Needs Through widely respected to introduce greater clarity into and psychotherapy, either in Building Strengths and used (see www. service provision by setting one-to-one or group sessions. In A key emphasis in the study has parentingplus.ie). Internationally, The appropriate targets and matching Ballyfermot STAR, the demand been on the needs of families Incredible Years interventions which are capable for counselling exceeds supply affected by drug use. This is programme (see of achieving those goals. This and there is an ongoing challenge appropriate but should not be www.incredibleyears. com) is highly implies that all services - both to fi nd suffi cient resources to allowed to overshadow the fact that recommended. those directed at drug users as meet the demand. In the area of the study also identifi es a range well as family members affected parenting, most service users of strengths among service users. 114 A range of relationship by drug use - need to give careful experience similar diffi culties - of These include a sense of personal programmes are consideration to the targets which over-disciplining their children on and psychological growth, a run in Ireland by they are trying to achieve and the the one hand while nevertheless high level of communication ACCORD (www. accord.ie) and MRCS appropriateness of the methods feeling unable to control them on and involvement with children (www.mrcs.ie) to suit used to attain those targets. It is the other - but these diffi culties can and, for participants on the both individuals and clear from this study that the depth groups. be addressed through parenting family support programme, a of need associated with drug use programmes which have a track satisfying relationship with their 115 Seligman, poses a challenge for all services record of proven effectiveness113. partner. Acknowledging these 2002a; see also Asay in terms of fi nding interventions and Lambert, 1999. The same applies to relationship strengths can create optimism which work effectively in bringing skills with one’s partner, which is a and hope which are essential 116 See, for families closer to the norm serious issue among participants ingredients in bringing about example, www. beckinstitute.org experienced by other Irish families. on the Community Employment positive change as service users This has resource implications in programme, particularly in light are supported to broaden and 117 Seligman, 2002b terms of funding services, but it of the relatively high level of build their natural healing abilities 118 See, for also has implications in terms of aggression to which children may to care for themselves, their example, Snyder ensuring that, as far as possible, be exposed, directly or indirectly, children and their partners. and Lopez, 2002; interventions which are used have in those relationships114. The range see also www. beckinstitute.org been tried and tested elsewhere of needs identifi ed in this study These considerations underline the and are delivered according to the suggests that serious investment is importance of a strengths-based 119 Fredrickson, requirements of that intervention. needed in programmes which have approach to family support rather 2002 a proven track-record of success than a ‘defi cit approach’ which 120 Carr, 2004:13-15 7.8.3 Matching Interventions in meeting needs in these areas. tends to characterise therapeutic to the Range of Needs 121 For more interventions in terms of correcting information, visit the We have seen that service users 7.8.4 Recognising the defects and healing of wounds. Positive Psychology experience serious defi cits in Diversity of Needs A strengths-based approach Center at www. three main areas of well-being: positivepsychology. An important fi nding of the study is underlines the importance of org and related links. that, in addition to the generalised the ‘tactics’ and ‘strategies’ (i) physical, psychological burden imposed on drug users and associated with all therapeutic 122 Department of 115 Tourism, Sport and and emotional well-being, families as a consequence of drug interventions . In this context, Recreation, 2001 including support networks use, there is also considerable ‘tactics’ refer to the importance diversity among those affected. of good therapeutic relationships (ii) setting appropriate This diversity is evident in the fact and skills such as building rapport limits on children that the burden is more intense and trust as well as insightfulness for those families with an active in naming problems and fi nding (iii) relationship skills with partner or stable drug user, for those who solutions. ‘Strategies’, on the other (for participants on the Community have experienced the death of hand, refer to building strengths Employment programme only). a family member from drug use, such as courage, interpersonal and for those grandparents who skills, rationality, insight, It is likely that the experiences of have been called upon to play optimism, honesty, perseverance, service users in Ballyfermot STAR the role of full-time parents. realism, capacity for pleasure, mirrors other families affected by putting troubles in perspective, drugs, whether they use services These fi ndings corroborate the purposefulness and mindfulness. or not. In view of this it might be experiences of both service users useful to think of service provision and service providers, particularly The insights of cognitive in terms of delivering programmes those who have highlighted the psychology116 and the emerging

48 science of positive psychology117 7.8.6 Concluding Comment are useful in highlighting some The dominant paradigm which of the barriers which effectively infl uences thinking about drug cut people off from their natural use in Ireland, as exemplifi ed strengths, and are directly in the National Drugs Strategy relevant in this context. A key (2001-2008)122, acknowledges the insight of cognitive therapy is centrality of the drug user and that a person’s psychological the community context, but tends and emotional well-being can to overlook the family. This study be increased by changing the has underlined the importance way they think about the past, of the family dimension and, the present and the future118. by implication, calls attention For example, feelings about to the need for a broader the past can be changed by framework to understand drug questioning the ideology that the use and its consequences. That past determines the present, and broader framework, as we have by cultivating forgiveness and suggested, needs to inform both gratitude towards past events. policies and services to address Feelings about the present the burden which drugs impose can be changed through living on individuals, families and mindfully and cultivating one’s communities. That is a valuable natural strengths, while positive outcome of this study and feelings about the future can refl ects the contribution which be increased through hope and Ballyfermot STAR has made in optimism. Similarly, the ‘broaden- broadening our understanding of and-build theory of positive the consequences of drug use. emotions’119 suggests that people with more positive emotions tend to have a greater capacity for building friendships and support networks as well as being more creative at solving problems and challenges in everyday life120. In other words, people with more positive emotions are more likely to see the world in terms of expansionary ‘win-win’ options rather than contractionary ‘win-lose’ options. This shows the value of cultivating positive emotions because they are known to encourage qualities such as persistence, fl exibility and resourcefulness in solving problems and because they broadening the range of options which people perceive to be available121.

49

Appendix to Chapter One

Deprivation and its Spatial rural deprivation. Unlike their impact in many areas of life: Articulation in the Republic manifestation as unemployment educational achievements, health, of Ireland: New Measures of blackspots in urban areas, housing, crime, economic status Deprivation based on the Census long-term adverse labour market and many more. Furthermore, of Population, 1991, 1996 and conditions in rural areas tend to social class is relatively stable 2002 by Trutz Haase, Social manifest themselves either in over time and constitutes a key & Economic Consultant, 17 agricultural underemployment or factor in the inter-generational Templeogue Road, Terenure, in emigration. The latter is also, transmission of economic, cultural Dublin 6. E-mail: [email protected] and increasingly, the result of and social assets. Areas with a a mismatch between education weak social class profi le tend to and skill levels, on the one hand, have higher unemployment rates, Introduction and available job opportunities, are more vulnerable to the effects This document presents a new on the other. Emigration, of economic restructuring and deprivation index based on the however, is socially selective, recession and are more likely to 2002 Census of Population. It being concentrated amongst experience low pay, poor working also provides, for the fi rst time, core working-age cohorts and conditions as well as poor housing an analysis of the changes in those with further education, and social environments. deprivation experienced by each leaving the communities area over the past decade. This concerned with a disproportionate Social Class Disadvantage is new deprivation index for the concentration of economically- measured by fi ve indicators: Republic of Ireland is based dependent individuals as well on an innovative and powerful as those with lower levels of • the percentage of population approach to the construction of education. Sustained emigration with a primary school education deprivation indices, which builds leads to an erosion of the local only on the best elements of existing labour force, a decreased approaches to index construction attractiveness for commercial • the percentage of population whilst simultaneously pushing out and industrial investment with a third level education (inverse the boundaries in favour of greater and, ultimately, a decline in effect) conceptual clarity and precision. the availability of services. • the percentage of households Demographic Decline is headed by professionals or How is the new deprivation measured by fi ve indicators: managerial and technical index constructed? employees, including farmers with • the percentage of population 100 acres or more (inverse effect) Most deprivation indices are based aged under 16 or over 65 years of on a factor analytical approach age • the mean number of persons per which reduces a number of room indicator variables to a smaller • the percentage change in number of underlying dimensions population over the previous fi ve • the percentage of households or factors. This approach is taken years headed by semi-skilled or unskilled a step further in the new index: manual workers, including farmers rather than leaving the defi nition • the percentage of population with with less than 30 acres of the underlying dimensions a primary school education only of deprivation to data-driven Labour Market Deprivation is techniques, the authors develop • the percentage of population predominantly, but not exclusively, a prior conceptualisation of these with a third level education (inverse an urban indicator. Unemployment dimensions. Based on the 1991 effect) and long-term unemployment and 1996 deprivation indices for remain the principal causes of Ireland, as well as analyses from • the percentage of households disadvantage at national level other countries, three dimensions with children aged 15 years and and are responsible for the most of social disadvantage are thus under headed by a single parent concentrated forms of multiple identifi ed: Demographic Decline, (inverse effect) disadvantage found in urban Social Class Disadvantage and areas. In addition to the economic Labour Market Deprivation. Social Class Disadvantage is hardship that results from a lack of of equal relevance to both urban paid employment, young people Demographic Decline is fi rst and rural areas. Social class living in areas with particularly and foremost a measure of background has a considerable high unemployment rates are

51 frequently lacking positive role Interpretation of the new Secondly, the rightward shift models. A further expression of deprivation scores of the 1996 and 2002 curves social and economic hardship in relative to that for 1991 refl ects the urban unemployment blackspots Previous deprivation indices for exceptional growth experienced is the large proportion of young the Republic of Ireland (including by the Irish economy over the families headed by a single parent. Haase 1991 and 1996) used decile past decade. The mean score rankings (i.e. dividing all EDs into for 1996 is 7 and the mean score Labour Market Deprivation is ten equally-sized categories) to for 2002 is 15, which captures measured by four indicators: measure the degree of relative the underlying trend. Naturally, deprivation. However, relatively the actual deprivation score for a • the percentage of households large changes at the extremes given area may change over time headed by semi-skilled or unskilled of the affl uence-deprivation even where its position relative to manual workers, including spectrum may not be refl ected other areas remains constant. farmers with less than 30 acres in a change in decile ranking, whilst relatively minor changes at Thirdly, the curves follow a bell- • the percentage of households the middle of the distribution can shaped curve, with most areas with children aged 15 years and easily result in a change of one clustered around the mean and under headed by a single parent or two deciles. For this reason, fewer areas exhibiting extreme the index presented here pays levels of affl uence or deprivation. • the male unemployment rate greater attention to the actual level This explains why it has been of deprivation experienced, using decided not to use a decile • the female unemployment rate fi nely-differentiated deprivation ranking, as the latter does not scores rather than deciles. conserve these distributional Each dimension is measured in characteristics. This is of particular an identical way at each Census The fi gure overleaf demonstrates concern in the case of extremely wave and then combined to a number of important deprived areas, which may greatly form a measure of Overall characteristics of the new set of improve their standing in actual Affl uence and Disadvantage. deprivation measures. Firstly, terms, whilst remaining within This new approach thus allows the scores range between the lowest decile of scores. the same set of dimensions roughly -50 (most disadvantaged) and indicators to be applied to and +50 (most affl uent). More successive waves of Census importantly, the measurement data, establishing a common scale is identical for all three structure and measurement scale. Census waves, thus allowing the However, unlike the deprivation direct comparison of each area’s indices for 1991 and 1996, the score from one wave to the next. scores are no longer expressed The scale is constructed in such in terms of decile rankings, and a way that the mean score for this entails a considerable shift 1991 is set to be equal to zero. as far as the interpretation of deprivation scores is concerned.

Distribution of Overall Deprivation Scores 1991 / 1996 / 2002

1600

1400

1200

1000

800

600

400

200

0

-50 to -30 -30 to -20 -20 to -10 -10 to 0 0 to 10 10 to 20 20 to 30 30 to 50

1991 1996 2002

52 Reading the measures the underlying trend of seven. of the country are distributed The resulting measure thus in concentric rings around Seven measures are included shows relative distribution the main population centres, here: Overall Affl uence and of affl uence and deprivation mainly demarcating the urban Deprivation for the years as it pertains in 1996. commuter belts. The measures 1991, 1996 and 2002, Relative show how rapidly these rings of Affl uence and Deprivation Measure 6 affl uence expanded during the for 1991, 1996 and 2002 and Relative Affl uence and 1990s as large-scale private the Change in Deprivation Deprivation in 2002 housing development took place between 1991 and 2002. The This measure shows the 2002 in the outer urban periphery, 123 Haase and complete set of measures for scores, but after deducting leading to high concentrations Pratschke, 2004 Ireland as a whole, including the underlying trend of fi fteen. of relatively affl uent young the mapping of scores for The resulting measure thus couples in the areas concerned. the individual dimensions shows relative distribution for 2002, are included in a of affl uence and deprivation The spatial distribution of publication by ADM123 which as it pertains in 2002. deprivation over time also describes the construction The second set of measures of the index in greater detail. Measure 7 (Measures 4-6) show the limited Change in Affl uence/ degree to which the relative Measure 1 Deprivation between position of local areas changed Overall Affl uence and 1991 and 2002 during the 1990s. The worst- Deprivation in 1991 The fi nal measure shows affected areas in 1991 were This measure shows the the difference between the generally the worst-affected 1991 scores which are 1991 and 2002 scores The ones in 2002. As is increasingly constructed in such a way that average change between the clear from analyses carried they have a mean of zero. two census waves is 15. Thus, out in different countries, the when judging a particular area’s spatial distribution of relative Measure 2 performance over the inter- deprivation is highly stable Overall Affl uence and censal period, this underlying over time. Indeed, as a recent Deprivation in 1996 trend must be borne in mind. study of England and Wales This measure shows the shows, the distribution of relative 1996 scores using the same deprivation in these two countries structure and measurement Substantive Findings has not changed dramatically scale as the 1991 index. The over the course of a century. resulting measure shows Ireland 1991-2002, a period the growth in affl uence with of sustained growth a mean score of seven. The fi rst set of measures (Measures 1-3) presented here Measure 3 show the actual level of overall Overall Affl uence and affl uence and deprivation in 1991, Deprivation in 2002 1996 and 2002, using identical This measure shows the 2002 intervals for all three measures. scores using the same structure The scores range, in broad and measurement scale as terms, from -50 to +50, with the 1991 and 1996 indices. higher values indicating greater The resulting measure shows affl uence and lower values the further growth in affl uence indicating greater deprivation. with a mean score of fi fteen. The scores are not de-trended; i.e. the (national) mean for 1991 Measure 4 is zero, but the means for 1996 Relative Affl uence and and 2002 are approximately 7 Deprivation in 1991 and 15 respectively, refl ecting the As the 1991 deprivation considerable growth in the Irish scores are already centred economy over this 11-year period. around zero, this measure is identical to Measure 1. The measures provide fascinating insights into the Measure 5 spatial distribution of this growth, Relative Affl uence and most importantly its nodal Deprivation in 1996 character and the overriding This measure shows the 1996 importance of Ireland’s urban scores, but after deducting centres. The most affl uent areas

53 TABLE A1.1 Demographic Characteristics for Ballyfermot, Dublin and Ireland

Area TOTPOP TOTPOP TOTPOP TOTPOP POPCHG POPCHG POPCHG 1986 1991 1996 2002 1991 1996 2002 % % %

Cherry Orchard A 221 1,283 1,398 2,161 480.5 9.0 54.6

Cherry Orchard B 3,832 3,308 3,049 2,918 -13.7 -7.8 -4.3

Cherry Orchard C 4,363 4,274 3,941 3,728 -2.0 -7.8 -5.4

Decies 4,029 3,630 3,264 2,933 -9.9 -10.1 -10.1

Drumfi nn 5,224 4,417 3,987 3,799 -15.4 -9.7 -4.7

Kilmainham A 2,741 2,519 2,445 2,355 -8.1 -2.9 -3.7

Kylemore 3,774 3,212 3,065 2,805 -14.9 -4.6 -8.5

Ballyfermot 24,184 22,643 21,149 20,699 - 6.4 - 6.6 - 2.1

Dublin City 502,749 478,389 481,854 495,781 - 4.8 0.7 2.9

South County Dublin 199,546 208,739 218,728 238,835 4.6 4.8 9.2

Dublin Fingal 138,479 152,766 167,683 196,413 10.3 9.8 17.1

Dun Laoghaire/Rathdown 180,675 185,410 189,999 191,792 2.6 2.5 0.9

Dublin 1,021,449 1,070,590 1,058,264 1,122,821 4.8 - 1.2 6.1

Ireland 3,540,643 3,525,719 3,626,087 3,917,203 - 0.4 2.8 8.0

TOTPOP: Total Population POPCHG: Percentage change in population over previous fi ve years

TABLE A1.2 Overall Deprivation Scores for Ballyfermot, Dublin and Ireland

Area Factor Factor Factor Change Zero Zero Zero Score Score Score 1991 -centred -centred -centred 1991 1996 2002 -2002 Score Score Score 1991 1996 2002

Cherry Orchard A -34.8 -23.0 -9.7 25.1 -34.8 -29.9 -24.9

Cherry Orchard B -27.9 -21.3 -9.3 18.6 -27.9 -28.2 -24.5

Cherry Orchard C -34.9 -31.7 -13.7 21.2 -34.9 -38.7 -28.8

Decies -27.4 -21.0 -9.3 18.1 -27.4 -27.9 -24.4

Drumfi nn -26.0 -19.5 -9.2 16.9 -26.0 -26.4 -24.3

Kilmainham A -26.5 -18.8 -6.1 20.4 -26.5 -25.7 -21.3

Kylemore -32.0 -25.1 -15.7 16.3 -32.0 -32.0 -30.9

Ballyfermot -29.6 -23.2 -10.6 19.0 -29.6 -30.2 -25.8

Dublin City -3.1 5.1 15.3 18.4 -3.1 -1.9 0.2

South County Dublin 3.0 10.8 20.3 17.3 3.0 3.9 5.2

Dublin Fingal 11.8 18.6 26.0 14.2 11.8 11.7 10.8

Dun Laoghaire/Rathdown 20.6 26.3 31.2 10.6 20.6 19.4 16.0

Dublin 4.7 12.2 21.0 16.3 4.7 5.3 5.8

Ireland 1.9 9.1 17.4 15.4 1.9 2.2 2.2

54 TABLE A1.3 Male and Female Unemployment for Ballyfermot, Dublin and Ireland

Area UNEMPM UNEMPM UNEMPM UNEMPF UNEMPF UNEMPF 1991 1996 2002 1991 1996 2002

Cherry Orchard A 45.8 24.9 35.5 48.1 39.6 23.9

Cherry Orchard B 34.9 32.7 15.4 31.5 29.9 11.2

Cherry Orchard C 55.2 58.2 24.1 39.3 43.2 20.2

Decies 37.2 35.1 15.7 29.4 25.5 14.8

Drumfi nn 34.4 33.2 15.4 33.7 28.3 13.2

Kilmainham A 36.3 36.7 17.1 25.7 31.8 11.3

Kylemore 39.8 38.7 20.1 34.8 27.2 15.0

Ballyfermot 39.9 38.2 19.0 33.0 31.2 15.0

Dublin City 24.7 22.4 11.8 17.4 15.2 8.7

South County Dublin 18.3 16.7 8.3 14.4 12.1 7.6

Dublin Fingal 14.1 12.6 7.0 12.1 9.5 6.6

Dun Laoghaire/Rathdown 12.5 10.7 6.1 10.3 8.2 5.2

Dublin 19.7 17.6 9.3 14.9 12.5 7.6

Ireland 18.4 16.4 9.4 14.1 12.0 8.0

UNEMPM: The male unemployment rate according to the Census of Population UNEMPF: The female unemployment rate according to the Census of Population

TABLE A1.4 Family Characteristics for Ballyfermot, Dublin and Ireland

Area AGEDEP AGEDEP AGEDEP LONEPA LONEPA LONEPA 1991 1996 2002 1991 1996 2002

Cherry Orchard A 38.3 39.7 30.3 29.6 33.7 53.3

Cherry Orchard B 35.5 39.2 36.8 14.6 23.4 32.3

Cherry Orchard C 46.1 42.6 33.5 25.3 35.2 47.1

Decies 37.2 34.8 31.7 22.2 26.1 32.7

Drumfi nn 35.5 40.3 38.2 13.1 20.2 30.8

Kilmainham A 37.4 35.7 31.4 18.4 24.6 35.7

Kylemore 35.7 37.4 38.9 20.7 24.0 31.8

Ballyfermot 38.2 38.7 34.7 20.8 27.6 38.3

Dublin City 32.7 31.3 29.0 19.4 25.4 29.1

South County Dublin 36.8 32.3 28.7 13.6 16.9 19.7

Dublin Fingal 36.9 32.9 28.6 9.6 12.7 14.9

Dun Laoghaire/Rathdown 33.2 32.2 31.6 12.5 14.6 13.9

Dublin 34.2 31.9 29.3 14.8 18.8 21.1

Ireland 38.1 35.1 32.3 10.7 13.8 16.7

AGEDEP: Percentage of population aged under 15 or over 64 years LONEPA: The percentage of households with children aged under 15 years and headed by a single parent 55 TABLE A1.5 Social Class Characteristics for Ballyfermot, Dublin and Ireland

Area HLPROF HLPROF HLPROF LSKILL LSKILL LSKILL 1991 1996 2002 1991 1996 2002

Cherry Orchard A 4.1 3.7 5.5 45.5 59.7 36.8

Cherry Orchard B 6.3 6.1 11.3 49.1 41.6 36.4

Cherry Orchard C 4.1 4.4 8.7 52.4 55.2 43.2

Decies 6.6 7.3 11.0 43.9 43.2 38.5

Drumfi nn 6.0 8.2 11.2 48.1 41.5 36.0

Kilmainham A 6.3 8.5 14.1 48.5 40.7 36.4

Kylemore 5.0 6.2 8.1 48.2 44.5 41.4

Ballyfermot 5.6 6.5 10.0 48.3 45.3 38.6

Dublin City 21.7 23.8 29.3 29.3 25.6 20.3

South County Dublin 25.6 26.7 32.7 22.4 21.2 16.2

Dublin Fingal 34.9 35.5 40.2 18.9 17.9 13.6

Dun Laoghaire/Rathdown 43.9 47.4 51.2 14.2 12.0 9.3

Dublin 28.5 30.5 35.7 23.5 20.8 16.2

Ireland 25.2 27.3 31.6 28.2 24.4 20.2

HLPROF: Percentage of persons in households headed by ‘Professionals’ or ‘Managerial and Technical’ employees, including farmers with 100 acres or more LSKILL: The percentage of persons in households headed by ‘Semi-skilled Manual’ and ‘Unskilled Manual’ workers, including farmers with less than 30 acres

TABLE A1.6 Education Levels for Ballyfermot, Dublin and Ireland

Area EDLOW EDLOW EDLOW EDHIGH EDHIGH EDHIGH 1991 1996 2002 1991 1996 2002

Cherry Orchard A 74.4 56.2 41.0 0.5 4.5 6.0

Cherry Orchard B 63.4 58.0 46.9 1.2 3.3 4.8

Cherry Orchard C 63.5 56.5 40.0 1.1 2.1 4.4

Decies 63.6 57.9 47.3 1.3 3.9 6.8

Drumfi nn 62.7 57.3 50.4 1.7 4.6 7.4

Kilmainham A 63.8 56.7 48.1 1.5 4.4 11.9

Kylemore 66.9 61.0 53.4 0.4 2.4 4.8

Ballyfermot n/a 57.9 47.1 n/a 3.5 6.5

Dublin City n/a 31.5 23.6 n/a 22.5 32.1

South County Dublin n/a 23.8 18.0 n/a 19.9 27.3

Dublin Fingal n/a 18.3 13.6 n/a 25.4 33.1

Dun Laoghaire/Rathdown n/a 14.6 11.7 n/a 38.9 45.0

Dublin n/a 25.0 18.7 n/a 25.4 33.5

Ireland n/a 29.5 22.2 n/a 19.7 26.0

EDLOW: Percentage of adult population with a Primary School education only (1991 estimates) EDHIGH: Percentage of adult population with a Third Level education (1991 estimates)

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58

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Report by Kieran McKeown & Grace Fitzgerald Kieran McKeown Limited Social & Economic Research Consultants

SEPTEMBER 2006

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