Suchergebnisse

This book calls attention to the impact of stigma experienced by people who use illicit drugs. Stigma is powerful: it can do untold harm to a person and place with longstanding effects. Through an exploration of themes of inequality, power, and feeling 'out of place' in neoliberal times, this collection focuses on how stigma is negotiated, resisted and absorbed by people who use drugs. How does stigma get under the skin? Drawing on a range of theoretical frameworks and empirical data, this book draws attention to the damaging effects stigma can have on identity, recovery, mental health, desistance from crime, and social inclusion. By connecting drug use, stigma and identity, the authors in this collection share insights into the everyday experiences of people who use drugs and add to debate focused on an agenda for social justice in drug use policy and practice. Michelle Addison is Assistant Professor in Criminology at Durham University, UK. William McGovern is Assistant Professor at Northumbria University, UK. Ruth McGovern is Senior Lecturer in Public Health Research at Newcastle University, UK.

Evidence suggests that looked after children and care leavers start to use alcohol earlier than their peers and at higher levels. Much of this epidemiological research focuses upon a pathological vulnerability within the young people concerned, but qualitative research which elicits their experiences with alcohol enables a more nuanced understanding. This article explores the experiences and reflections of young people in care regarding their exposure to and use of alcohol. Twenty qualitative semi-structured interviews were conducted with young people who were members of Children in Care Councils (CiCCs) across the North East of England, and a socio-ecological model was used to guide data analysis. The findings suggest that experience prior to being in care, such as witnessing the detrimental effects of alcohol misuse and transitions within the care system, can both precipitate and deter an individual's use, particularly when entering and living in residential care. The study highlights how a mixture of social and contextual factors influence young people in care's perceptions and use of alcohol.

Abstract
Many parents who come into contact with early help and children's social care services are risky drinkers. This study aimed to investigate the feasibility and acceptability of conducting a trial of brief alcohol interventions within this setting. We conducted a three-arm pilot feasibility cluster randomised controlled trial in the North-East of England. The additive interventions were: i) screening and a healthy lifestyle leaflet (control); ii) brief advice; iii) extended brief intervention. The trial was later reduced to two-arm due to the extended brief intervention being infeasible. Of the 1769 parents that were approached, 429 consented to be screened (24%), the majority were eligible to participate (n = 415; 97%), 147 of which (35%) scored ≥5 on the AUDIT-C screening tool. There were 108 parents (74%) who consented to participate in the trial (n = 50 control; n = 58 brief advice). Follow-up rates at 6 and 12-months were 61% and 43%. The TLFB30 was found to be a suitable tool to measure the primary outcome of heavy episodic drinking. Qualitative data showed that parents and practitioners largely found trial procedures to be acceptable, however, care should be taken when discussing alcohol risk with parents in this setting. Most of the a-priori success criteria were met in this pilot feasibility trial. The findings suggest that it may be feasible to conduct a two-arm randomised controlled trial of brief alcohol interventions to parents in contact with early help and social care. The TLFB30 was found to be a suitable tool to measure the primary outcome of heavy episodic drinking.

Purpose
Young people who are looked after by the state face challenges as they make the transition from care to adulthood, with variation in support available. In the past decade, funding has been directed towards organisations to pilot innovations to support transition, with accompanying evaluations often conducted with a single disciplinary focus, in a context of short timescales and small budgets. Recognising the value and weight of the challenge involved in evaluation of innovations that aim to support the transitions of young people leaving care, this paper aims to provide a review of evaluation approaches and suggestions regarding how these might be developed.


Design/methodology/approach
As part of a wider research programme to improve understanding of the innovation process for young people leaving care, the authors conducted a scoping review of grey literature (publications which are not peer reviewed) focusing on evaluation of innovations in the UK over the past 10 years. The authors critiqued the evaluation approaches in each of the 22 reports they identified with an inter-disciplinary perspective, representing social care, public health and organisation science.


Findings
The authors identified challenges and opportunities for the development of evaluation approaches in three areas. Firstly, informed by social care, the authors suggest increased priority should be granted to participatory approaches to evaluation, within which involvement of young people leaving care should be central. Secondly, drawing on public health, there is potential for developing a common outcomes' framework, including methods of data collection, analysis and reporting, which aid comparative analysis. Thirdly, application of theoretical frameworks from organisation science regarding the process of innovation can drive transferable lessons from local innovations to aid its spread.


Originality/value
By adopting the unique perspective of their multiple positions, the authors' goal is to contribute to the development of evaluation approaches. Further, the authors hope to help identify innovations that work, enhance their spread, leverage resources and influence policy to support care leavers in their transitions to adulthood.

AbstractGlobal research has shown that most young people who are care experienced are not prepared to transition to independent living at 18 years of age and require support into early adulthood. We used rigorous systematic methods to identify English‐based peer reviewed and grey literature describing innovations relevant to care experienced young people as they transition into adulthood, with a focus upon lessons for their implementation and diffusion. We synthesised the evidence narratively and organise data linked to seven key areas important to the transition to adulthood: (1) Health and well‐being; (2) relationships; (3) education and training; (4) employment; (5) participation in society; (6) accommodation; (7) other. Twenty‐five papers met our inclusion criteria. This review has found that, whilst there are a broad spectrum of innovations taking place within the social care environment for care experienced young people to support their transition into adulthood, there exists limited insight into how best to support implementation and diffusion of evidence‐based innovation. We drew upon the 'Consolidated Framework for Implementation Research', developed in the setting of clinical service delivery, to highlight challenges in implementing and diffusing evidence‐based innovation for care experienced young people transitioning into adulthood.

Abstract
We examine the outcome measurement landscape in care leaver innovation, where many innovations to support transitions of young people leaving care fail to sustain beyond a fixed-term pilot, and fewer impact wider transition policies. Our empirical qualitative study comprises interviews with 31 senior UK children's social care policy and practice professionals, 103 interviews across five innovation-focused case studies within England with a range of public and private providers. We consider these data in relation to evaluations from a nationally diffused social care innovation. We identified three measurement landscape challenges. First, we highlight the limits of the economically oriented measurement and identify an overlooked outcome measurement demand. Second, we emphasise a need to stratify care leaver population outcomes to better reflect individuals transition through different domains of life and trajectory. Third, we identify areas of precarity around the intended use of care leaver experience. We conclude that tensions exist between the pull towards a unified approach to outcome measurement and the reality of decoupled outcome requirements and legitimacy-seeking priorities which differ according to stakeholder. These tensions entrench stagnant innovation. Recognition of roles and legitimacies that exist across the process of care leaver innovation is warranted. Opportunities for action are discussed.

AbstractMeeting the multiple and often complex needs of families (children, young people and adults) within 'Early Help' support is dependent upon practitioners from different sectors sharing relevant and timely information, after gaining a family's voluntary consent to share information. This article reports on qualitative one-to-one interviews with adults in families (n = 32), one mother/father dyad interview (n = 2) and focus groups with practitioners (n = 47) in five local authority areas in North East England receiving or providing Early Help support. We explored experiences of providing consent to share personal information and consider the usefulness of a digital health data system when providing Early Help support to families. Communication Privacy Management theory was used as a framework to analyse the data. Key themes in participants' accounts include the degree of need for help and support; the importance of trusting relationships; stronger and structured joint working practices; and understanding how information is shared. This work provides insights into current information sharing practices for some of the most vulnerable families and the wider social contexts. It has implications for the usefulness of a digital data system that shares GP health data with Early Help services and suggests the role this could have in the parent–practitioner relationship.