Background: South Asian Muslim (SAM) communities remain significantly underserved by mainstream drug and alcohol (D&A) recovery services in England. Cultural and religious misalignment in service design creates structural barriers to engagement. Family members from SAM communities who support individuals with substance use disorders have identified structural, cultural, and religious barriers that hinder engagement with mainstream treatment services. This study builds on this body of evidence by working with service providers, commissioners and community stakeholders through participatory co-production to examine how these barriers can be addressed. Methods: Three participatory co-production workshops were held over a 12-week period. Data were also generated from a field visit to a culturally adapted recovery service and a content analysis of an Islamically adapted 12-step recovery workbook. Participants included commissioners, service providers, community ambassadors and service users (total n = 42 across three workshops; some participants attended more than one workshop). Results: Four interconnected themes that shaped recovery engagement were identified: (1) stigma and izzat operating as a collective structural risk management system; (2) confidentiality functioning as a precondition for engagement rather than a by-product of it; (3) service design, space and visibility as determinants of access; and (4) co-construction of religiously coherent recovery pathways. Low engagement among participants reflected rational risk management, in response to real social consequences, rather than cultural resistance. Conclusions: Findings suggest that inclusive recovery systems may benefit from the adaptation of mainstream services rather than the creation of parallel provision. Six evidence-based design principles are proposed for commissioners and service providers. Findings contribute to the evidence base for equitable health, culturally responsive D&A intervention design and have relevance beyond SAM communities to other marginalised faith communities across England.

Abstract Background Parental Intimate Partner Violence and Abuse (IPVA) is a complex issue, which requires a sensitive response from a range of services. This review aimed to identify and synthesise qualitative research examining the perceptions and experiences of parents and children affected by IPVA and their interactions or engagement with various child welfare, health and legal systems and services. Methods We conducted a systematic review of the international literature, searching 11 electronic databases from inception to November 2023 and supplemented this with a grey literature search. Studies were included if they provided qualitative accounts from adult and/or child victims/survivors of IPVA and/or adult perpetrators reporting on experiences of child welfare, health, and/or criminal justice intervention. Results A thematic synthesis of 39 individual studies (38 papers and 1 book chapter) which include the perspectives of (n-825) mothers/adult females (n-107) children and (n-58) fathers was undertaken. Three overarching themes were identified: (1) the importance of supporting the family whilst safeguarding the child (2) systems failing of services to hold the perpetrator to account and (3) systems that retraumatize the Family. Conclusions Services should provide a whole-family approach, which responds to the needs both the parent and child victim/survivor, and recognises the parental identity of the perpetrator. Interventions with adult victims/survivors should take a strengths-based approach, whilst holding the perpetrator to account. Particular care is needed when families are involved in family court to avoid re-traumatisation.

Despite growing recognition of drug and alcohol (D&A) use as a public health concern, carers from South Asian and Muslim (SAM) communities in the UK remain largely invisible. This article explores how stigma, emotional pressures and faith-based prohibitions shape SAM carers' experiences of supporting individuals with problematic D&A use, with a culturally informed approach. A qualitative study recruited eight carers, two practitioners and two community ambassadors in two UK regions during July 2023-January 2024. Carers supported individuals whose substance use they identified as problematic, describing patterns consistent with the classification of mental and behavioural disorders in the tenth version of the International Classification of Diseases, though formal verification was not obtained, as this would have excluded 'hidden carers'. Recognising that SAM frameworks define any use as problematic (lower thresholds than clinical criteria), we used reflexive, community-led sampling. Semi-structured interviews with participatory research group members identified three themes: faith, stigma and silence; social and psychological impacts on SAM families; and religious and cultural barriers to addressing D&A use. Most carers rely on informal networks for support due to a lack of awareness of mainstream services and religious institutions not equipped to address their needs relating to problematic D&A use. Definitional mismatches between cultural (any use is problematic) and clinical frameworks (specific diagnostic criteria) obscure recognition of escalating D&A problems, leaving carers distressed and services inaccessible. This study, led by a SAM community member, gives voice to hidden carers' experiences and identifies their unique challenges through methodological innovation. Our findings advocate for co-produced, culturally sensitive services that bridge definitional gaps and position SAM carer support within a social justice agenda addressing cultural responsiveness and structural inequities.

Community asset mapping (CAM) is a strength-based approach to re-engaging with and re-developing communities through research. The approach aims to identify and document a community's existing resources whilst recognising that people within a community hold valuable knowledge about the assets in their area. Generating knowledge and mapping resources from people who represent different parts of a community focusses on the area's strengths rather than its deficits. In this chapter, we report and reflect on our use of CAM whilst exploring the concept of ‘recovery’ within a local authority area in the North East of England. In doing so, we describe and critically appraise our own practices as we seek to co-produce and implement the research. However, we also report positively on our research and the ways in which we promote and achieve inclusion and implement an anti-stigma approach within our methods. We conclude this chapter by making suggestions for those who are considering this topic or type of research.

To examine the perspectives and experiences of multi–agency practitioners involved in supporting families affected by domestic abuse (DA) to inform changes that are required to better meet the needs of affected families. This article focuses on (a) how DA is differentially understood and interpreted, (b) the possible reasons identified for differential understanding and interpretation and (c) its perceived impact on risk assessment and service delivery. A case study approach within a North East Local authority located in the United Kingdom (UK), was adopted. Thirty-one 1:1 online qualitative interviews were conducted with multidisciplinary professionals between June – December 2022. The findings are based upon a combination of deductive-inductive thematic analysis. There was an absence of a shared understanding of DA among practitioners involved in multi-agency working despite a national-level definition available in the UK. This was identified as one of the key barriers to multiagency working subsequently affecting consistent response to families affected by DA. Data from this case study emphasizes the importance of developing a uniform understanding of DA among practitioners to adequately respond to the distinctive needs of families who are affected by it. The findings from the article can also inform broader debates in the DA literature related to complexities surrounding definitions and associated interpretations. Practice and policy implications are also discussed.

Women Who Use Drugs (WWUD) are amongst the most stigmatised groups in society and are subject to stigma as they engage with services and within their own recovery communities. WWUD who are also mothers have been found to experience increased stigma and disproportionate surveillance by professionals when accessing services, leading to a constant fear of child removal and apprehension to accessing, engaging and seeking support. In this study, we report findings from a community asset mapping project conducted with drug and alcohol recovery services in the North-East of England. The aim of this study is to examine the gender-specific and recovery-related experiences of WWUD when accessing services and women-only spaces. Semi-structured interviews (n = 13) and focus groups (n = 4) were carried out with professionals working in the recovery community and women in recovery from substance use. A reflexive thematic analysis approach was used to analyse the data, resulting in three themes being identified: (1) The role of peer support in empowering women in recovery; (2) Navigating recovery as a mother; and (3) Working with women in recovery. Findings revealed that gender-specific groups provide a sense of safety, connection, identification, and empowerment for WWUD. This study further highlights the gender-based stigma WWUD experience when accessing services, and the challenges they experience where appropriate spaces are limited in the recovery community. We conclude by recognising the importance of sisterhood for WWUD and recommending the promotion of gender-specific peer support groups and for practitioners working with WWUD to reflect on their own stigmatising behaviour and how this can manifest in the increased monitoring of women and mothers in recovery.

People Who Use Substances (PWUS) are among the most stigmatised groups in society. Stigma associated with substance use is known to be detrimental to the individual’s wellbeing, and substance use is often used as a mechanism by policy makers and services to legitimise exclusion. PWUS often do not benefit from the drug and alcohol services that are available to them. Community Asset Mapping (CAM) is a strengths-based approach involving the re-engagement of communities through active involvement in research. There are criticisms and concerns about equity and the burden on participants involved in CAM projects; however, the broad aim of CAM is to identify and document the strengths and pre-existing resources that exist within a community. In the following study, we utilised CAM processes and principles in a large city in the Northeast of England to enable people with lived experience of substance use and practitioners working in drug treatment services to come together and identify resources in the form of services and groups that support recovery. In the process, we were concerned with identifying, engaging with, and involving groups that were known to the recovery community but also were not part of an existing recovery network. Qualitative data were obtained from semi-structured interviews (n = 13) and focus groups (n = 2). A reflexive thematic analysis approach was used to analyse the transcriptions, and from this we generated four themes: (1) community visibility, (2) ownership of the recovery agenda, (3) the impact of stigma and shame, and (4) the benefits of involvement. Our findings revealed a partly fragmented but also well-established, connectedand resourced local recovery community in the city. We were also able to identify a number of recovery groups and services that had previously not been known to the existing recovery community. Additionally, we identified that public and societal substance-related stigma continued to be a barrier that inhibited individuals and recovery groups from making themselves more visible and available to others.

Domestic violence and abuse (DVA) is a global public health challenge. Project Cautioning And Relationship Abuse (CARA) is an out-of-court resolution used across police forces in England and Wales for lower risk, alleged first-time DVA offenders. This article reports on qualitative interviews and focus groups with professionals (police, commissioners, and CARA facilitators and managers, N = 31) about their experiences of delivering CARA following its national rollout. Reflexive thematic analysis indicated strong multiprofessional support for CARA across geographical areas. Professionals recommended changes to enhance current delivery, relating to differential assessment of risk; adaptations to training/implementation; and exploring perceptions of CARA by voluntary sector organizations.

Involving People with Lived Experience (PwLE) in the development and delivery of teaching provides a more in-depth insight and authenticity to students learning about important social concerns like substance use. Involving PwLE is recognised as an approach to teaching and collaboration which is beneficial for those involved as learners and (if done correctly) for those who gift their time to sharing their opinions and experiences. More is known within the literature about the benefits for academics and students in relation to involving PwLE in the development, design, and delivery of teaching, less is known about how PwLE experience their involvement and how they prepare for their involvement in the process. In this reflective chapter, we utilise our own collective experiences of working with and/or supporting the involvement of PwLE in the development of teaching resources and teaching practices. The reflections contained here are based upon own highly subjective experiences of working with and supporting PwLE to get involved in the development of resources and delivery of teaching content. From these reflections, we hope that you the reader is able to understand more about how PwLE and this will encourage you to become engaged with this process. In doing so, we hope you also gain some insights into your own teaching practices and learning needs.

Self-help groups are increasingly utilised by communities of interest and shared experience, services, and government departments as platforms for supporting and improving health and social care outcomes for drug and alcohol users. Traditional 12-step self-help groups like Narcotics Anonymous and Alcoholics Anonymous (NA and AA) are worldwide organisations and each have their own programme of change, language, criteria for membership, processes for problem resolution, and self-transformation. Within these types of groups, members are openly encouraged to identify with and adopt an (diseased) identity that is consistently invoked to work on the self. In the self-help recovery literature, it is widely recognised that individuals can benefit by thinking about themselves as “diseased” and then acting and behaving in a manner which is congruent with their reframed “identity”. Less is known about the processes involved in this and social-, psychological-, and health-related implications for individuals in drug- and alcohol-specific self-help groups. A thematic analysis of data from (n-36) in-depth qualitative interviews with long-term (6 months–10 years) self-help users identified four themes associated with the adoption of a diseased identity and self-help group processes: (1) normalising the disease and illness; (2) identifying as diseased; (3) living as a diseased individual; and (4) one addict helping another addict. The results of this research should not be interpretated as a critique of the 12-step approach or groups. Instead, it should be recognised that whilst improvements to individual wellbeing are reported, identifying as diseased can exacerbate negative self-perceptions that individuals hold about themselves, their character, capabilities, and ability. Being diseased, accepting disease, and identifying as diseased also has the potential to inhibit their engagement with wider social networks and professional services outside of their own fellowship or group. We conclude this paper by exploring the implications of a “diseased identity” and self-help processes for individuals who access self-help groups, and health and social care practitioners who support self-help users as they engage with services and self-help groups.

This paper considers the ethical and practical issues of recruiting for, and administering a quantitative survey with marginalised populations. These issues were identified through a focus group discussion, which consolidated and expanded upon informal conversations held previously by five researchers about their experiences of conducting a face-to-face survey (using predominantly quantitative questions) with people who used amphetamine type substances in North East England, UK. Inductive and deductive thematic analysis of the focus group discussion led to the generation of three key themes: researcher positionality, emotions, and role dilemmas; study design; and ethics in practice. This paper therefore aims to extend literature which explores ethical and practical issues involved in studies with marginalised populations. It makes methodological suggestions for how work across a range of disciplines could make face-to-face survey research, and future studies with marginalised populations, more inclusive for both participants and researchers.

Any topic can be sensitive, and every subject area will have sensitive issues and topics that academics in higher education and further education settings will be expected to negotiate. Your ability to negotiate sensitive topics is important because the ways in which you engage and teach about sensitive topics will affect your ability to provide a positive learning experience and teaching alliance with students. In practice, you will face enormous pressure to 'deliver' on teaching, which will only be mirrored by similar freedoms in deciding on how and what needs to be done to get students to where they need to be. Negotiating, identifying, preparing for and delivering teaching on sensitive subjects and topics can be difficult in individual academics. This chapter, seeks to prepare you for developing a deeper understanding of some of the philosophical, theoretical, and practical-based concerns and issues related to teaching sensitive topics and subjects. This chapter begins with providing a rationale for what follows, and it explores some of the key themes, positionality, identity, transformational learning and lived experience, that are explored in greater depth in the collection. This chapter also contains a detailed breakdown of the structure and the content of this edited collection, and it concludes with some reflective comments about the implications of the collection for you as an individual and your career.

Children in care of the state are amongst the most disadvantaged in society. They have often experienced adverse childhood experiences leading to their care entry including abuse and neglect. Longitudinal data suggests problems children in care of the state experience within adolescence persist into adulthood, showing “a continuing legacy of adversity.” Emerging literature shows that edge of care interventions can bring about benefits. These interventions support families to meet their child’s needs and prevent, or reduce, the likelihood of children going into care. However, it is not clear how or why these interventions work. It is important to develop this understanding to inform the development of effective, theory-informed practice to benefit this population. We reviewed and synthesised published literature to expose mechanisms by which interventions may promote and support family preservation for children at the edge of care. Our synthesis uses a realist approach to examine mechanisms by which interventions, in various contexts, can promote and support family preservation for children at the edge of care. Previous work by the team shaped the initial search strategy and in line with RAMESES realist review guidelines, no restrictions were placed on the types of study to be included in the synthesis. From 7,530 potentially relevant references identified, 61 papers were included in final extraction. Extracted data was themed, prior to developing narrative and formulating programme theories. Effective edge of care service operation seemed to be based on four core programme theories pertaining to the need for family skills training, home-based delivery, dedicated worker, and rapid response to need.

This paper presents findings of a study which explored lived experience(s) of social workers responsible for supporting children and families during COVID-19. To represent voices of practitioners while addressing a gap in qualitative data highlighting their day-to-day experience(s) the study aims and objectives were to: (1) develop insight into personal and professional challenges practitioners faced during COVID-19 and (2) consider lessons learned from social workers' lived experiences for post-pandemic staff care. Following ethical approval, data was collected through informal conversation with 34 social workers. Reflexive thematic analysis of digitally recorded data identified the overarching theme: 'Managing change, risk and uncertainty', which underpinned four sub-themes including: (1) Determining thresholds and responding to referrals (2) Managing at a physical distance (3) Navigating work-home life roles, responsibilities and priorities and (4) Challenges for self-care and staff support. To safeguard against professional burn-out, and encourage practitioners' post-pandemic well-being, opportunities for critical reflection and staff care should be fostered. As supervision remains central to staff care, ideas for cultivating safe spaces for critical reflection presented in this paper include use of aspects of the values-based and relationship-based supervision model developed in the aftermath of the Grenfell Tower fire.

Introduction Interventions related to the perpetration of Domestic Violence and Abuse (DVA) have gained traction over the past several years, in response to dissatisfaction by victims, an inadequate response from the criminal justice system, increased demand on police time and a lack of rehabilitative responses to the perpetration of domestic abuse. The CARA model is a conditional diversionary caution, offered by police for first time offenders of ‘standard’ or ‘medium risk’ domestic abuse, that engages perpetrators in awareness raising workshops and signposts them onto further services. Although quasi-experimental studies have indicated that CARA showed promise at reducing reoffending, the CARA model has yet to be evaluated nationally and there is no qualitative evidence related to understanding or learning about the lived experience of perpetrators and victims as they engage with the intervention. Methods Using a concurrent pragmatic mixed methods design model we will undertake a national evaluation of CARA by triangulating quantitative data from up to nine police forces, and routine data from service providers, with qualitative data from workshop participants, victims and professional stakeholders to: (1) understand the long-term impact of CARA implementation on DVA reoffending and engagement with services and (2) explore perceptions and experiences of both delivery and receipt of CARA. We will use qualitative methodologies that draw on interpretivist and phenomenological perspectives, as well as quantitative methodologies using interrupted time series models, Poisson regression models, Geo mapping and a cost benefits analysis. Ethics and dissemination Where currently the CARA model is being introduced as a national option for standard risk first-time offending, we will engage with policymakers and academics nationally in the live debate on its effectiveness and suitability during its roll-out. Ethical approval was approved by the University of Southampton on the 1st June 2022 (Ref: ERGO ID: 71818.A1).

PurposeMental health champions (MHCs) and young health ambassadors (YHAs) are two innovative public health interventions. MHCs are practitioners who work in schools and other youth settings and aim to be the "go to" person for mental health in these settings. YHAs are a linked parallel network of young people, who champion mental health and advocate for youth involvement, which was co-produced with young people across all stages of development implementation. This paper aims to identify the potential benefits, barriers and facilitators of these interventions.Design/methodology/approachSemi-structured qualitative interviews (n = 19) were undertaken with a purposive sample of n = 13 MHCs, and n = 6 YHAs, between June 2021 and March 2022. Interviews were audio-recorded, transcribed, anonymised and then analysed following a thematic approach. Ethical approval was granted by Newcastle University's Faculty of Medical Sciences Ethics Committee.FindingsThe findings are organised under five key themes: motivating factors and rewards for MHCs and YHAs; outcomes for children and young people (CYP) and others; impact on youth settings and culture; facilitators of successful implementation; and implementation challenges and opportunities.Practical implicationsThese findings are intended to be of relevance to practice and policy, particularly to those exploring the design, commissioning or implementation of similar novel and low-cost interventions, which aim to improve mental health outcomes for CYP, within the context of youth settings.Originality/valueThe interventions reported on in the present paper are novel and innovative. Little research has previously been undertaken to explore similar approaches, and the individual experiences of those involved in the delivery of these types of interventions.

Within traditional drug and alcohol (D&A) treatment services, the majority of those accessing support are of white ethnicity, with only a small percentage of people from the British South Asian (BSA) and Muslim community engaging in treatment services. This paper aims to explore perceived barriers to accessing traditional D&A services within the British South Asian and Muslim communities, based on qualitative data from interviews with family members and a practitioner. Qualitative data were obtained via 11 semi-structured interviews involving a practitioner (n = 1), and family and friends (n = 10) of those with historic and current D&A use in the community. Reflexive thematic analysis revealed four themes: (1) awareness of drug and alcohol use in the community, (2) drug and alcohol use as a taboo topic and the impact of admitting use, (3) knowledge of services for treatment, (4) how to increase awareness and accessibility of treatment. There was an increasing awareness of D&A use in the BSA and Muslim community. Despite this, limited conversations and misconceptions around D&A use and recovery led to those using D&A and their family members feeling stigmatised within their community and unable to seek support. This paper concludes by recommending increased communication between the BSA and Muslim communities and D&A treatment services to ensure accessibility of treatment by improving cultural competency.

Stigmatisation is the process by which an individual is devalued based on their attributes, characteristics, and/or behaviour, with this often leading to prejudice, social and health-related harms, active discrimination, and microaggressions. The aim of this paper is to show how social harms can occur and how stigma is damaging to the health and wellbeing of a person in recovery. To do so, we focus on the harms that arise from the internalisation of labels that mothers who use drugs encounter in a treatment and recovery setting whilst in active recovery, and how this stigmatisation can manifest negative self-beliefs. Qualitative data was used from two semi-structured focus groups involving females with lived experience of substance use (n = 13). A reflexive thematic analysis approach was used to analyse the interview transcripts, and three themes were identified: (1) the enduring nature of stigma; (2) gender disparity and the need for mothers- and women-only spaces; and (3) stigma as a barrier to services and wellbeing. Findings revealed the enduring nature of stigma amongst mothers who were in active recovery, with women feeling judged more harshly than men and experiencing pressure to live up to a “good mother” ideal whilst in recovery. This paper demonstrates that mothers in recovery are still stigmatised and, as a consequence, approach services with increased sensitivity, with stigma often resulting in disengagement or reluctance to access healthcare settings. We conclude that staff in health, social, and primary care settings need to develop a strong therapeutic alliance with mothers in recovery and promote anti-stigma approaches in their practice, in order to mitigate stigma and reduce harms to health and wellbeing.