Alcohol Misuse Among Older Adult Public Housing Residents

Low-income older adults living in public housing are at heightened risk for substance misuse. This study identified the prevalence of alcohol misuse among older public housing residents (n?=?187) and explored predictors of problem drinking. Including weekly drinking levels and binge drinking, 23% of the sample engaged in problem drinking behaviors. Logistic regression analysis revealed that race, gender, employment status, years smoking, and illegal drug use were significant predictors of problem drinking. No residents were receiving substance abuse treatment. As the number of older adults increase, training social workers to assess and treat alcohol misuse in older adults is critical.     

Living with an elephant: Growing up with parental substance misuse

Although parental substance misuse is now a focus of concern in child welfare practice, we know little about what it is really like for children who grow up in families where adult drug and/or alcohol use is an issue. Set against a backdrop of research links between parental substance misuse and child maltreatment, this article examines a number of studies that focus on the experiences of children and young people in this context. Emerging themes are identified which provide insight into the world of children for whom a substance is, effectively, a family member –‘the elephant in the living room’– and the implications for practice, particularly in relation to children's visibility, disclosure and confidentiality, are considered. It is argued that a focus on the ‘elephant’ often leads to children remaining ‘invisible’ to those whose role it is to ensure their welfare.     

A family affair? Kinship care and parental substance misuse: some dilemmas explored

Both the Children Act 1989 and the Human Rights Act 1998 support the principle that children should remain within their birth families wherever possible and that this option must be considered when children are unable to live with their parents. Where parental substance misuse is an issue, family placements, whether formally or informally arranged, are increasingly being used and the support of grandparents, in particular, has been identified as a significant protective factor for children. This paper examines some of the issues that can arise with such placements, particularly in view of the part that substance misuse may play within the wider family system, the impact of parental drug and alcohol use on attachment and child development, and the complex dynamics that can ensue. Drawing on themes emerging from parental substance misuse literature and kinship care research, some practice dilemmas will be explored. While acknowledging the complex aetiology of substance misuse and the dangers of pathologizing family systems in which it is found, some hypotheses about potential risks and challenges will be debated. It will be argued that, although such placements can often provide children with a safe haven, they may demand a specific type of support and monitoring, if children’s welfare is to be safeguarded.     

Three stories about mother: narratives by women who have lived in care

Families and social work interventions in their lives are at the core of child welfare. Child welfare practices can shape children's and parents' family memories and narratives of different family relations. However, there is little social work research so far based on the personal narratives of people who have lived in care. The study data consist of the written life stories and biographical interviews of three women who have lived part of their childhood in children's homes. In their narratives, the most central family relation was their relationship to the mother. They used different narrative strategies in their stories while trying to manage both living their childhood in care and presenting their mother morally in the same story. The central moral and emotional stance in the narratives of the mother–daughter relationship was love. Through the analysis, three moral characters of the mother were constructed. The first told about an absent mother, the second a loved and loving mother and in the third, the mother's moral character was continuously negotiated and contested. Constructing a personal story and moral character of oneself and of one's mother can be truly risky in the context of a childhood in care.     

Go to the Hospital or Stay at Home? A Qualitative Study of Expected Hospital Decision Making Among Older African Americans With Advanced Heart Failure

To address the need for more information concerning hospital decision making, we conducted in-depth interviews among African Americans with heart failure and their family caregivers (n?=?11 dyads). Using a case scenario, we asked participants about their anticipated hospitalization decisions. Most patients indicated that they would seek care to avoid further deterioration or death from their worsening condition. Many family caregivers anticipated having an active influence on hospitalization decisions. Findings suggest that social workers should encourage the development of adequate home-based services, recognize diverse communication styles, and use this information to facilitate medical decision making by these patients and their caregivers.     

Using Photovoice to Identify Service Needs of Older African American Methadone Clients

ABSTRACT

This article presents findings from a photovoice project designed to identify service needs of older-adult African American methadone clients, as well as their current barriers to and supports for abstinence. The project involved 10 participants (aged 53 to 63 years old) recruited from a methadone maintenance program in a large Northeastern U.S. city. Thematic analysis techniques were used to analyze participants’ narratives of their pictures. Transportation emerged as a significant challenge to accessing services, and caregiving was a motivation for remaining abstinent. Future research should use similar participatory methods and engage a broader group of aging people struggling with substance abuse.     

Battling parenting: The consequences of secure care interventions on parents

Secure care in Sweden is the most intrusive child welfare intervention, and children and their family members have restricted contact. For each child in secure care, there are at least twice as many affected family members and parents who must manage the consequences of this institutionalization. Clearly, it is just as important to understand how secure care affects parents as it is to understand how secure care affects children. To address this issue, we conducted in-depth interviews with 11 parents to eight children who had been placed in secure care during their childhood, focusing on the institutional and societal structures that affected these parents and their parenting. With a narrative approach, stories alluding to a metaphor of war are identified. These stories reveal how all parents (but especially single mothers) are affected by their diverse socio-economic positions and the rigid frames of family life presumed by child welfare interventions. In these narratives, parenting emerges as a social practice rather than a skill. Above all, the stories demonstrate a great deal of vulnerability and sensitivity of parenting. The findings raise critical questions about the meaning and overarching consequences of institutional interventions in a family life.     

Substance use and decision‐making in adolescent best friendship dyads: The role of popularity

In adolescent best friendship dyads, we examined: (a) similarity in substance use and decision‐making; (b) associations between participants' decision‐making and their own and best friend's substance use, (c) the influence of relative popularity within the dyad on these associations. Participants (n = 172; 12–18 years) named their best friend, completed popularity ratings, and a substance use questionnaire. Computer tasks were administered to assess risk‐taking and immediate reward preferences. Reciprocated same‐sex best friendship dyads (n = 49) were distinguished on their popularity, and we controlled for age differences between dyads in the analyses. Best friends were similar in substance use and risk‐taking preferences. More popular friends' risk‐taking preferences were positively associated with alcohol use of less popular friends. These findings underscore best friendship similarity in risky behaviors, and the influence of popular friends.     

Linking illicit substance misuse during pregnancy and child abuse: what is the quality of the evidence?

In most Australian states, legislation makes provision for professionals to report their concerns about the future welfare of an unborn child to appropriate authorities. The legislation establishes guidance for the implementation of family supports to minimize future child protection involvement. Given the legislation and the potential benefits, empirical research linking substance misuse during pregnancy and child protection involvement is relatively limited. We review 21 original studies linking substance misuse during pregnancy with child protection outcomes and the potential generalizability of results to the Australian context. The majority of studies reviewed were conducted in the USA and were mostly retrospective. Other differences between studies include sample sizes, comparison groups, study setting, participants’ ethnicity and pattern of drug use. In the postnatal literature, it is well established that child abuse is associated with a complex array of factors including partner, as well as broader family factors and yet, the studies reviewed focus upon maternal substance abuse without including the wider context. Given the available evidence‐based literature, it is difficult to come to definitive conclusions that can assist clinicians involved in frontline decision‐making for early intervention. Well‐designed research, accessible by antenatal health‐care professionals, is needed to adopt an evidence‐based approach to risk assessment in the prenatal context.     

Helping families where parents misuse drugs or alcohol? A mixed methods comparative evaluation of an intensive family preservation service

Option 2 is an intensive family preservation service for families with serious child protection concerns related to parental misuse of drugs or alcohol. A previous evaluation indicated that it reduced the number of children entering care and, as a result, produced cost savings; however, little data were gathered from families. This study involved interviews with 15 families (46 children) who had received the service, and a comparison group of 12 families (28 children) referred but not provided the service due to no workers being available. Outcomes and experiences were compared, on average, 5.6 years following referral. Findings included a significant reduction in children entering care, and improvements in relation to substance misuse, parental well‐being and family cohesion. There was no difference in emotional and behavioural welfare of children. Qualitative accounts were very positive about the impact of the service, identifying effective engagement of parents and key elements of good practice in supporting families to change. The findings provide additional support for suggesting that high quality, intensive interventions with families affected by parental substance misuse can be effective. Key lessons for current attempts to deal with the increase in children entering care and the English government's ‘troubled families’ initiative are considered.     

An Ecological Systems Comparison Between Homeless Sexual Minority Youths and Homeless Heterosexual Youths

ABSTRACT

This study examined risk and protective outcomes by comparing homeless sexual minority youths to heterosexual homeless youths regarding family, peer behaviors, school, mental health, stigma, discrimination, substance use, and sexual risk behaviors. Structured interviews (N = 147) were conducted with individuals aged 16 to 24 years old in Toronto. Bivariate analyses indicated statistically significant differences between homeless sexual minorities (n = 66) and their heterosexual counterparts (n = 81) regarding all variables: family, peer behaviors, stigma, discrimination, mental health, substance use, and sexual risk behaviors, with the exception of school belonging. Implications for future research are suggested.     

The concept of family: Perspectives of Spanish young people in foster care

This article employs concepts from family sociology to explore how ‘family’ is conceptualised in 14 life narratives of young people in foster care in Spain. The article draws on a multi-method approach with young people who are in long-term non-kinship foster care. Seven girls and seven boys aged 10 to 22 took part in the study. The empirical material reveals an interplay between biological preference and foster family affective practices in young people's narratives, illuminating a struggle to make sense of the concept of family in foster care. Most of the participants understand family as shared affective practices sustained through love, commitment, consistent care and reciprocity rather than blood ties. Some show a preference for biological connectivity, while others describe family as determined by rituals and family displays. The key practice implications highlight the importance helping young people positioning themselves in birth family relationships, and supporting their sense of family belonging.     

Empathic Action and Family Resilience: A Narrative Examination of the Benefits of Helping Others

ABSTRACT

Empathy is identified as a protective factor that has been helpful for children considered at high risk for poor mental health and social functioning due to experiencing stressful circumstances such as family violence, substance abuse of a parent, or poverty. Yet, little is known about its relevance to a family's ability to overcome adversity. This study examined the narratives of 20 resilient families who maintained family functioning despite experiencing a multitude of risk factors including poverty, death of a child, significant health problems, or substance abuse problems. Narrative analysis was used to identify the ways families situated empathic actions within their stories of resilience. Findings suggest families developed increased compassion for others as a result of their own experiences with loss, trauma, or stress and discussed how helping others increased their ability to cope with the challenges they faced. Future research and practice implications are outlined and support the usefulness of strengths-based concepts and interventions.     

Engaging on the ‘front line’: exploring how family support teams construct meaning in their work with young mothers

This paper explores the provision of family support services for young mothers within a Sure Start Children's Centre, drawing on data collected within a larger study. It identifies how the family support team attempted to build supportive relationships with young mothers between the ages of 16 and 19 years. The findings presented here draw on narrative interviews (n = 10) and focus group interviews (n = 2) with the family support team that included early years workers, family support workers and their managers. The findings captured how the participants actively resisted the stigma (Goffman 1963) of teenage motherhood in order to support young mothers in gaining the necessary skills and knowledge to care for their child. Drawing on the findings, this paper argues that the building of a supportive relationship enables a young mother to construct positive counter‐narratives about her parenting experience. This suggests that the family \to offer informal early support to young mothers who are at risk of more formal intervention. However, the complexity of this task should not be underestimated because in doing this, the family support team must at all times ensure the well‐being and safety of the child.     

Parental substance misuse and child care social work: findings from the first stage of a study of 100 families

Parental misuse of drugs or alcohol is known to be a common issue for child care social workers, yet there has been surprisingly little British research on the topic. The study reported here attempts to address this gap. All files going for long‐term allocation in four London boroughs over on average 1 year were examined (290 files). Parental substance misuse (PSM) emerged as a major feature of social work caseloads. Of the 290 cases, 100 (34%) involved concerns about parental substance misuse. The families involving substance misuse were more vulnerable on a variety of measures: the children were younger, the parents had more individual problems and the families lived in more difficult social situations. PSM cases tended to be ‘heavy end’ at the point of allocation: they accounted for 62% of all children subject to care proceedings and 40% of those placed on the child protection register. There was a fairly even spread between alcohol and drug misuse, and a number of cases involved both. Substance misuse specialists were rarely involved in working with families, primarily because parents said that they did not think that they had a problem. Suggestions for ways in which policy and practice with PSM might be improved are made in light of these findings.     

Powerful Youth: Determining Successful Participation in an HIV Support Group for Youth

In this article, the authors report on a qualitative study that explored the use of narrative therapy with a diverse group of older adults dealing with mental health and substance misuse issues. Narrative therapy supports individuals to critically assess their lives and develop alternative and empowering life stories that aim to keep the problem in its place. Although the literature suggests this is a promising intervention for individuals, there is a lack of research on narrative therapy and group work. Aiming to address this gap, the authors developed and researched a narrative therapy group for older adults coping with mental health and substance misuse issues in Toronto, Canada. Taking an ethnographic approach, field notes and interviews provided rich data on how, when, and for whom, such a group could be beneficial. Findings contribute to the literature on group work, older adults, and narrative therapy.     

A qualitative study of the practices and experiences of staff in multidisciplinary child sexual exploitation partnerships in three English coastal towns

This article presents findings from a qualitative study of the practices and experiences of people working in multidisciplinary child sexual exploitation (CSE) partnerships in three coastal towns in England. The study is based on focus groups conducted with 36 practitioners from a range of professional groups, including police, social work, substance misuse, education, specialist youth workers, sexual health, and statutory and non-statutory children's services. The article begins with an overview of the three towns and the structure of their responses to CSE. It goes on to explore a range of factors, which contribute to the local issues around CSE and which affect and direct multiagency working. These include practitioner perspectives on CSE vulnerability, the discrepancy between young peoples' and practitioners' views about “exploitation”, a discussion of how CSE perpetrators initiate and develop contact with young people and the role of incentives—including drugs and alcohol—as part of CSE exploitation. We finish by drawing out some general conclusions.     

Cultural and Intergenerational Narratives: Understanding Responses to Elderly Family Members in Declining Health

Culture exerts powerful influences on each generations' responses to older members in declining health. Narratives, the stories people tell about their lives, depict the different the ways that the elderly and their children experience their world. Their personal narratives chronicle their connections to culture the past. They also illustrate the ways that the cultural values are transformed to accommodate the present and future. The stories are influenced by immigration, assimilation, development, interpersonal relationships, and life events. These differences between the cultural narratives of the elderly and the following generation are particularly apparent during times of chronic stress. One such situation occurs during chronic illness when the younger generation is called upon to provide for the elderly and chronically ill.     

Children living with parental substance misuse: A cross‐sectional profile of children and families referred to children's social care

Parental substance misuse is a significant public health and children's rights issue. In the United Kingdom, social workers frequently work with children and families affected by substance misuse. However, relatively little is known about this population, particularly at point of referral to children's social care. This paper reports on the largest known study of parental substance misuse as a feature of children's social care work in England. The paper provides a cross‐sectional profile of 299 children living with parental substance misuse and referred to children's social care in one local authority in England. Data were collected from social work case files at the point of referral to social care about the child, family, the wider environment, and parental substance misuse. The findings show that children affected by parental substance misuse frequently had other support needs relating to their well‐being and mental health. Children were also likely to be experiencing other parental and environmental risk factors. The significant historical—and in some cases intergenerational—social care involvement for some families indicates potential issues with the capacity of services to meet needs. Recommendations for practice are discussed with a particular focus on the need for early, comprehensive support for children and families.     

Substance Use Decision-Making – Are Clinicians Using the Evidence?

Clinical assessment and treatment decision-making is a complex, everyday task for the substance use workforce. This Canadian study conducted with community substance use providers in the Interior region of British Columbia examines the factors clinicians pay attention to in their decision-making. A randomized factorial survey approach, using three unique vignettes embedded with factors of interest, was used to test the effect of case and respondent factors on assessment and treatment decisions. Responses were received from 106 participants, representing approximately a 35% response rate, yielding a sample size (n) of 308 vignettes. Multiple regression tested the independent effects of the vignette and clinician factors on assessment and treatment decisions. Factors within the vignette associated with withdrawal, physical illness and mental health issues emerged as the most predictive elements. The social complexity of people’s lives, client’s stated treatment preferences and readiness for change, and respondent characteristics were obscured in decision-making. This study indicates a lack of fidelity in the use of core assessment and treatment-matching tools, suggesting that clinician decision-making may, in everyday practice, be more heuristic and evidence-informed than evidence-based. Further research on normative decision-making practices in the substance-field is warranted.