Governing parental opioid use: a relational ethnography

WHY DO WE NEED THIS STUDY?
Children and families affected by parental drug use include some of the most disadvantaged families in society. For example, parents often have severe health and social problems, live in poverty, and their children frequently end up in the care system. Parents and families are often stigmatised and excluded from mainstream society and do not always receive the right kind of treatment and family support. These problems can be repeated from one generation to the next. Improving their lives is therefore a key goal for health and social care services as well as for government.

Many countries (including the UK, Australia, USA and Canada) have established ways of working with families affected by parental drug use. However, there is wide variation in these policies and practices. There is little knowledge of how they operate in practice (within and across different agencies) and how they impact on children and families. There is a need to look at how the whole system works from a family perspective.

Our study aims to do this by looking at how parental drug use is managed in practice by interviewing, observing and spending time with parents and families as well as health and social care service providers to understand more about how the system works.

WHAT WILL THE STUDY INVOLVE?
First, we will set up two groups called Learning Alliances: one in Scotland and one in England. A Learning Alliance is a group of people who have knowledge and experience in a particular topic, such as parental drug use. The Learning Alliances will include service users, policymakers and those in charge of managing public services for parents who use drugs and their families. The Learning Alliance will help the research team in all aspects of the project, including planning the research itself, commenting on our findings, and making suggestions about what can be done, in practice and policy, to respond to the findings.

Second, we will employ researchers to spend time with 30 families who have a drug-using mother and/or father, and who agree to take part, 15 in Scotland and 15 in England. The researchers will find out what life is like for them day-to-day over a period of approx. 12-21 months. We will also, with permission, conduct interviews (approx. 90) with family members, children, friends, and other associates of the families to try to get a clearer understanding of their connections with agencies and their wider communities.

Third, the researchers will also spend time in 12 services (approx. 3 months each) and interview staff (approx. 100) who provide care to parents who use drugs. Researchers will take notes about what they see and hear in the services about how drug-using parents are treated and dealt with. The services will include NHS, social work and third sector agencies in a range of different areas.

Lastly, we will review and examine policies about the treatment and management of parents who use drugs to compare how polices differ in different agencies and countries (Scotland/England) and what effects the different policies have on how parents who use drugs and their families are managed and treated.

WHO WILL BENEFIT?
Our study findings will help a range of people and agencies in different ways.

It will benefit parents who use drugs and their families in the future because it will help to show how practices and policies might better meet their needs. It will benefit society more widely as it will provide a better understanding of the everyday lives of parents and their families.

It will also benefit professionals, services and policymakers by offering new understandings about how existing practices and policies may or may not be benefiting the people they seek to help.

It will benefit the international community by showing how policies and practices could be improved for families and it could help academics develop new interventions to help parents who use drugs and their families.

OUR MAIN BENEFICIARIES INCLUDE:

PARENTS WHO USE OPIOIDS, THEIR CHILDREN, AFFECTED FAMILY MEMBERS (e.g. kinship carers).
This study focuses on relations between parents who use opioids and governmental agencies. It aims to reveal family stories, experiences and insights into what matters to them, how policies and practices affect them, and their visions for the future. We know from clinical experience and the academic literature that parents who use opioids are a stigmatised and marginalised population whose voices and experiences are often delegitimised. This study aims to empower parents and their families by giving them a voice and making their lives more visible and understood. Data generated by the project will highlight parents' perspectives and families will be involved in both the Learning Alliances and arts-based public engagement programme. Involvement in each of these will provide families with platforms for change, advocacy, power-sharing and capacity building through the co-production of study outputs.

By seeking to influence policy and practice as described below our study will impact upon the lives of a much larger population than those who participate directly in the study. We appreciate that there are no mutually exclusive groups - for example, 3rd sector agencies delivering services also seek to influence policy and practice.

PRACTITIONERS/MANAGERS/AGENCIES WHO WORK WITH FAMILIES AFFECTED BY PARENTAL OPIOID USE including statutory organisations (e.g. NHS drug/child health/maternity services, GPs, Children & Families Social Work, Criminal Justice, Family Law,) and 3rd sector agencies (e.g. Addaction, Adfam, Circle, NSPCC).
Our study places an equal emphasis on illuminating the views, experiences and real-life dilemmas and situations faced by frontline practitioners/services who work with families affected by opioid use. This study will give voice to their personal insights and professional understandings of inter-professional, organisational, structural, political and ideological factors, which shape and define their everyday actions and capabilities. This study will highlight the conditions of frontline practitioners/services and will provide them with a means to work collaboratively as change agents with academics, policymakers, commissioners and the people they serve.

POLICYMAKERS AND COMMISSIONERS at a local level (e.g. Alcohol & Drug partnerships, Integrated Joint Boards (Scotland) & national level (e.g. Public Health England, Scottish Government Drug Policy Unit).
This study will contribute to important policy and practice debates about parents who use drugs and how society represents and responds to their needs. These debates happen in multiple arenas so we will showcase our findings and stimulate debate on reform through 'expert events' and stakeholder engagement, policy forums, reports for commissioners and professional bodies, and engagement with the media. Our focus on the social ecology of the field aims to assist policymakers and commissioners to shift the focus from 'drugs', 'drug-using parents' and 'vulnerable children', to wider policies and practices that constitute the problem and responses to it.

ORGANISATIONS THAT INFLUENCE POLICY including professional bodies (e.g. British Psychological Society, British Association of Social Workers, Royal College of Psychiatrists), drug sector organisations (e.g. Collective Voice, Scottish Drugs Forum) & children's charities (e.g. Action for Children, CORRA Foundation).
We recognise the challenges of influencing policy and practice and will actively engage with organisations who have substantial expertise of doing so. These collaborations will provide us with access to their professional networks and their understanding of the most effective strategies for producing change. In return, they will benefit from early access to a substantial research resource which will provide evidence for their interactions with policymakers and the public.