Abstract Background Exposure to family adversities including domestic violence, parental mental ill-health, and poverty in childhood increases the risk of self-harm and suicide attempts in adolescents. However, few studies have assessed the influence of clustered family adversity and poverty trajectories throughout childhood on self-harm behaviours and suicide attempts. Methods In this population-based longitudinal study, we used data on 9316 children from the UK Millennium Cohort Study. Exposure trajectories of poverty and family adversities were characterised using group-based multi-trajectory models (age 9 months−14 years). Multivariable logistic regression models were used to examine the association of trajectories with self-harm and suicide attempts at age 17. Population-attributable fractions were calculated to quantify the contribution of family adversity and poverty to the outcomes at the country level. Results Of 9316 participants, 2087 (22.4%) reported self-harm behaviours and 659 (7.1%) had made a suicide attempt. Compared with children experiencing low poverty and adversity, children in the persistent adversity groups were more likely to report both self-harm and suicide attempts; those exposed to persistent poverty and poor parental mental health were particularly at increased risk of self-harm (OR = 1.71, 95% CI: 1.30–2.24) and suicide attempts (OR = 3.98, 95% CI: 2.76–5.74). Overall, we estimated that about 13.2% of self-harm behaviours and 36.9% of suicide attempts were attributable to persistent family adversities and poverty. Conclusions Children growing up with persistent exposure to family adversities and poverty are more likely to harm themselves and attempt suicide, particularly those who experience the combination of persistent poverty and long-term poor parental mental health. Early detection of children at risk and intervention such as anti-poverty approaches to prevent long-lasting adversities are key to alleviating risky behaviours in UK adolescents.

PurposeA total of 478,000 children in England are reported to live with a parent who uses substances. The presence of a stable non-substance using caregiver within the family has been found to be one protective factor for children (Velleman and Templeton, 2016), yet there is a lack of research examining how to intervene with non-substance using parents/caregivers. This study aims to co-produce an intervention for non-substance using parents/caregivers and their children.Design/methodology/approachThis study had three phases: interviews with practitioners, exploring their perceptions of whom non-substance using parents/caregivers seek support from, the type of support needs they had and what influenced their decision-making; interviews with parents/caregivers to examine their support needs and experiences of help seeking; and co-production workshops with parents/caregivers and practitioners to discuss the findings and design of an intervention.FindingsParents/caregivers reported experiencing challenges in talking to their child(ren) about the other parent/caregiver's substance use. They highlighted the importance of a structured intervention to support them to initiate conversations with children about how parental substance use impacted the child and wider family in a way that parents/caregivers felt was age-appropriate and sensitive and supported them in their caregiving role to children.Research limitations/implicationsA limitation of this study relates to the participation of parents/caregivers who were not in receipt of support services. Recruitment was predominantly via specialist carer support organisations, and although this often presented an opportunity to talk with parents/caregivers who were open to the idea of discussing parental substance use, the authors are mindful of the differing view that parents who were not in receipt of support may have expressed about the potential of an intervention.Practical implicationsThis study highlights the often-overlooked impact of parental substance use on parents/caregivers who do not use substances and often manage dual roles as caregiver to a child and their partner/ex-partner or family member who uses substances. In particular, it seeks to emphasise the impact on parents/caregivers parenting and acknowledge the challenge of managing their own emotions whilst maintaining stability for the child.Social implicationsThis research suggests characteristics of an intervention that could be used to support family relationships when talking to children about the impact of parental substance use. It attempts to create space for families to convey that it is ok for children to talk about how this impacts upon their lives.Originality/valueThere is a lack of research examining how to intervene with non-substance using parents or other caregivers to support them in their parent/caregiver role. This study suggests ways for parents/caregivers to provide emotional support to their child(ren) impacted by parental substance use.

Background: Care-experienced young people (CEYP) have higher rates of PTSD than their peers; however, their post-traumatic stress disorder (PTSD) symptoms are often missed. The Child Revised Impact of Events Scale (8 items; CRIES-8) is a well-validated and widely available screening tool, which could identify children at risk of PTSD.Objective: This project aimed to understand barriers and facilitators for the use of the CRIES-8 with CEYP accessing mental health services, as a means of increasing their access to evidence-based support.Methods: We recruited 243 mental health professionals from 28 mental health teams across England and provided training in the CRIES-8 and cognitive therapy for PTSD. Focus groups and interviews were conducted approximately every three months for 12-18 months, as well as a brief one-off questionnaire about implementation completed 6-9 months post-training. Qualitative data were analysed via thematic analysis.Results: While 80% of the sample did use the CRIES-8, only 50% used it with CEYP, and overall use was sporadic and inconsistent. The main barriers included capacity, CEYP access to mental health services, and professionals' beliefs around diagnoses and routine outcome measures, particularly for CEYP. Flexibility and proactivity amongst the team were important facilitators. In practice, there were a variety of methods to implement the CRIES-8, each with a different impact on service resources and the young person completing it.Conclusions Further service-based research to develop and test methods to address the identified barriers is essential to ensure that CEYP receive access to best-evidenced, needs-matched treatments.

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.

Objectives The transition into fatherhood is considered a profound life stage, involving personal development, lifestyle and emotional adjustments. Fathers’ mental health can be adversely impacted by this transition. Fathers express isolation, exclusion and limited support within perinatal services. Restricted emotional support for fathers presents negative consequences for the whole family dynamic. Limited research has explored father and professional input associated with paternal perinatal support and how healthcare services and child and family services can respond to engaging fathers and their mental and emotional support needs. This qualitative study aims to explore fathers’ mental health and well-being experiences (referring to emotional or/and social well-being) and support needs within the perinatal period, as well as current viewpoints of perinatal services (maternity, healthcare and social care services) from both fathers’ and professionals’ perspectives.Design In-depth semistructured interviews and focus groups were carried out as part of a qualitative study.Setting Fathers’ resident within the North East and North Cumbria (NENC) and services and organisations from the voluntary, community and social enterprise (VCSE) sector and social care services across the NENC, who associate with supporting families and children, and perinatal mental health.Participants Fathers (n=21) and professionals (VCSE and social care services) (n=9).Results Reflexive thematic analysis of 30 participants’ accounts identified two main themes and five subthemes: (1) ‘The Pregnant and Postnatal Man’ and (2) Removing the cloak of fatherhood invisibility. These themes centred around the isolation of fathers and limited emotional and mental support within the parenting transition.Conclusions The findings suggest that greater father inclusion within perinatal services, policies and antenatal education may help fathers feel more recognised and supported throughout the perinatal journey. Recognition of fathers’ emotional well-being and mental health, by adopting a ‘whole family’ emotional support approach within perinatal services was considered important to support fathers and the family dynamic in facilitating a positive transition for the whole family.

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.

A growing proportion of children entering state care are born to mothers involved in recurrent care proceedings; a group often characterised by trauma, social disadvantage, and low trust in services. Although a range of interventions have been developed to prevent care entry and support reunification, there remains limited understanding of how and why these approaches operate within complex child protection systems.This study reports a four-stage realist synthesis of 108 academic and grey literature sources to examine what works, for whom, and in what contexts to prevent care entry and enable reunification for mothers at risk of recurrent proceedings. Programme theory development was informed by three stakeholder advisory groups comprising mothers with experience of child removal, practitioners, and academic experts.Findings show that outcomes are shaped not only by individual interventions, but by how these interact with the relational and organisational dynamics of child protection systems. Trauma is conceptualised as both relational and systemic, emerging through interactions between individual experiences and the high-threat, low trust dynamics of child protection systems and influencing interactions between mothers, practitioners, and multi-agency teams. Two key mechanisms underpin improved outcomes: (1) a relational bridge, wherein a trusted practitioner supports communication and shared understanding between mothers and professionals; and (2) a neutral outsider, who promotes fairness, redistributes power, and aligns multi-agency working around shared goals. These mechanisms may be particularly important for women who experience structural disadvantage. Where these mechanisms are absent, interventions may either engage mothers without achieving credible risk reduction or manage risk in ways that undermine engagement.The findings highlight the importance of designing child protection services that build trust, clarify roles, and support coordinated decision-making across agencies. By providing a practice-relevant explanatory framework, this study contributes to understanding how services can better prevent unnecessary care entry and support safe, sustainable reunification, with implications for improving outcomes for children and families.

Childhood exposures to adversity are common and increase risk for negative health and social outcomes throughout the life course. There is limited evidence regarding interventions to prevent or reduce the impact of adverse childhood experiences (ACEs), particularly for families with multiple adversities. Here we present the findings of mixed methods research to co-design a complex intervention to prevent adverse childhood experiences, and their impacts. Using established research methods, and the framework of the Medical Research Council (MRC) complex interventions development guidance, the work was conducted in four stages, shaped by stakeholder engagement and input at every stage. The first stage, Discover, was exploratory and employed evidence synthesis and quantitative (n = 11,564) and qualitative (n = 31) research methods to understand needs, experiences, and evidence gaps. The Define stage developed three intervention principles and identified intervention options, through a series of six co-design workshops with 41 participants and an academic research team workshop. The Develop and Deliver stages were undertaken through a Policy Lab (22 participants), and developed options for intervention design, before converging on a defined intervention that could be delivered and tested. Through this process, we developed a ‘village-style’ intervention, which functions at three levels: individual service users, operational, and system/strategy. Central to this are link or community health workers who would build relationships with family members, and act as a single point of contact. They should develop an understanding of family needs and the interaction of multiple complex adversities, and advocate for families, facilitating access to services. Crucially, they should use this understanding to work at and feed into operational and strategic levels to reshape services and enhance access for all families at risk of or experiencing adversity. Entry into the intervention through assessments at existing universal touch points, for example at routine perinatal or newborn appointments, should provide a prevention focus and follow the principles of proportionate universalism. Sensitive enquiry regarding financial stress may be a component of the assessment, in response to the findings of this work regarding the contexts created through the interaction of poverty and other adversities. The proposed intervention is designed to improve individual and family outcomes, and generate positive system-level changes. A feasibility study and evaluation will be required in future work, to assess the effects, costs and benefits. The processes and frameworks we developed and used may provide an adaptable template for future intervention co-design work.

Childhood family adversity is associated with increased risk of developing mental health problems over the life course. We investigated how perceived emotional support in adolescence may mitigate the impact of childhood family adversity on adolescent mental health. We used longitudinal data from the UK Millennium Cohort Study on 9,269 children followed to age 17 years. Individuals were assigned to exposure trajectories characterised using group-based trajectory models that included measures of poverty and family dynamics up to age 14 years. Using counterfactual causal mediation analysis and four-way decomposition modelling approach, we evaluated how perceived emotional support at age 14 (measured using the three-item Short Social Provisions Scale) influences the association of childhood family adversity trajectories on mental health at ages 14 and 17, assessing the relative contributions of mediation and interaction simultaneously. Compared with children experiencing low family adversity and poverty, those exposed to childhood family adversity were almost three times more likely to experience poor mental health (RR 2·99, 95% CI 2 ·41 to 3·57) at age 14 and age 17 (RR 2·58, 95% CI 2·09 to 3·06). Perceived emotional support mitigates up to 18% (95% CI: 9% to 26%) of this effect at age 14, and 13% (95% CI: 5% to 22%) at age 17, mainly due to interactive mechanisms. Childhood family adversity has a strong effect on mental health, which is partially mitigated by emotional support in adolescence. Policies that support positive family functioning may be particularly beneficial for children who have experienced adversity.

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.

Whole family approaches which integrate adult and child focused services are often required when responding to families affected by domestic abuse, however little is known about how to enact and embed these approaches. The purpose of this study is to undertake a multifaceted examination of the complex and inter-related factors that can impact the implementation of integrated approaches in three regions of England. We utilized a case study design, conducting n = 53 in-depth qualitative interviews with a varied sample of practitioners, managers and senior leaders in three local authority sites in England, which were implementing different innovative whole family approaches. We analyzed the data using the core constructs of Normalization Process Theory. Across the three case study sites, addressing domestic abuse within families was of high strategic importance. Having a shared understanding of the practice approach, why they were working in this way, and how this differed from what came before it was important to enacting and embedding the approaches. Regular structured opportunities to come together in multi-agency networks of participation supported reciprocal learning and resulted in joint enterprise. The implementation of the innovative approach was further supported by practitioners from different services thinking together and acting together. A clear and shared understanding of the practice model, along with regular opportunities for multi-agency and multi-professional networks to ‘think together’ and ‘act together’ in meaningful ways is most likely to support the implementation, integration and embedding of the innovative approach.

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.

Addressing domestic violence and abuse (DVA) requires effective multiagency family safeguarding to protect vulnerable children and adult victims, whilst challenging perpetrator behaviour. This article examines how family safeguarding in the context of DVA was implemented across social care in a local authority (LA) in England. The LA was selected for inclusion based on its innovative approach to implementing family safeguarding in the context of DVA. Qualitative interview data were collected via video conferencing from twenty-two senior leaders, managers, and frontline professionals working across statutory and voluntary organizations in the LA. The mechanisms employed by the LA to integrate social care response to DVA were a community-based intervention to help avert escalation of risk, DVA training for professionals across statutory and voluntary services, and the employment of Independent Domestic Violence Advisors in key roles. Practitioners reported that these mechanisms strengthened multi-agency coherence and collaboration and facilitated culture change. Outcomes impacting on families directly included supporting adult victims of abuse alongside affected children and working with low-risk perpetrators where possible. Implications for social care practice are that multi-pronged approaches supported by DVA specialists can successfully link prevention and response mechanisms when responding to DVA. Implementing family safeguarding in the context of Domestic Violence and Abuse: A case study of a local authority in England Background: Social care response to Domestic Violence and Abuse (DVA) focuses mostly on affected children, but family safeguarding also needs to include support for adult victims of abuse and challenge perpetrators. Aim of study: To explore how a Local Authority (LA) implemented 'family safeguarding' in the context of DVA across the social care system. Methods: Online interviews with 22 senior managers and frontline professionals working across the LA. Findings: The mechanisms used by the LA were (a) early help interventions led by professionals at the community level; (b) DVA training for professionals across social care; (c) funding of DVA specialist roles to work alongside professionals in children's and adult social care and in the community. Outcomes for the LA: These mechanisms were felt to strengthen collaborative working across agencies (childrens social care, adult social care, housing, police) and informed funding decisions. Outcomes for families: DVA Specialists work with adult victims of abuse, affected children, and with low-risk perpetrators where possible. Implications for practice are that these approaches help link prevention and response, supported via DVA specialists in key roles across the LA.

It is estimated that over 100 million people worldwide are affected by the addicted behaviours of a close relative and often experience related adverse health and social outcomes. There are a range of interventions which involve affected family members. Whilst they are largely psychosocial in nature, they differ in their aim and approach. These interventions can largely be categorised as interventions that (1) work with the family to address problems within the family, (2) are focused on the person with addiction problems and include conjoint sessions that may also provide some support to the affected family member or (3) intervene directly with the affected family member only. This chapter discusses a range of different interventions that involve affected family members and provides an overview of the evidence. After considering the main interventions for affected family members, this chapter highlights that most available interventions do not go far enough in responding to the complex and multi-faceted needs of families affected by a relative’s addiction. A number of gaps in the evidence exist including estimation of effect using rigorous evaluative methods, interventions for male affected family members and culturally adapted interventions for affected family members from low- and middle-income countries. Further research is needed to determine the effect of a multi-component psychosocial intervention, which seeks to support both the person with addiction problems and the affected family member.

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.

BackgroundChildhood adversities, such as exposure to parental mental illness, domestic violence and abuse, substance use, and family poverty, have been linked to involvement in violence in early adulthood. However, evidence on the cumulative impact of multiple adversities throughout childhood on violence and crime in adolescence remains scarce. This study investigates the associations between trajectories of family adversity and poverty during childhood, and the risk of involvement in violence and contact with police in adolescence.MethodsWe used longitudinal data from the UK Millennium Cohort Study on 9316 children. Exposure trajectories of family adversities and poverty were characterised (from ages 0–14 years) using group-based multi-trajectory models. The outcomes were weapon involvement, for example, carrying a knife, and police contact measured at age 17 years. Odds ratios and 95% confidence intervals (OR, 95% CI) and population attributable fractions were estimated using logistic regression models, adjusting for confounding factors.ResultsThe prevalence of weapon involvement and contact with police at age 17 years were 6.1% and 20.0%, respectively. Compared with children who experienced low poverty and family adversity throughout childhood, those exposed to persistent poverty and poor parental mental health were at notably increased risk of carrying weapons (adjusted OR (aOR) 2.2, 95% CI 1.3 to 3.6) and reporting contact with police (aOR 2.1, 95% CI 1.6 to 2.8). We estimate that about 32% of weapon involvement and 23% of contact with police at age 17 were attributable to persistent poverty and family adversity.ConclusionExposure to poverty and poor parental mental health throughout childhood doubles the risk of weapon involvement and police contact in early adulthood. These findings emphasise the importance of lifecourse and anti-poverty approaches to reducing involvement in crime in the UK.

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.