Whittaker Anne, Williams Nigel, Chandler Amy, Cunningham-Burley Sarah, McGorm Kelly, Mathews Gillian
Substance Misuse Directorate, NHS Lothian, Astley Ainslie Hospital, Edinburgh, UK.
NHS Lothian, Edinburgh, UK.
Health Soc Care Community. 2016 Sep;24(5):e72-80. doi: 10.1111/hsc.12249. Epub 2015 May 4.
Parenting and family support are key prevention and intervention strategies for improving outcomes for children and families affected by parental drug misuse. However, little is known about the delivery of parenting support for drug-dependent parents, particularly within universal healthcare services. This study aimed to explore the way healthcare practitioners engage with this challenging agenda. Four multidisciplinary focus groups involving a purposive sample of 18 experienced healthcare professionals were conducted in Scotland. Participants included general practitioners, midwives, public health nurses and addiction staff who work together to provide care for vulnerable families. A focus group topic guide was developed to explore the views and experiences of these healthcare professionals in relation to providing parenting support for drug-using parents, predominantly those receiving opioid substitution therapy. Data were analysed using a constant comparison method and thematic approach. The overarching narrative which united the focus group discussions was about the 'burden of care' that these families pose for frontline healthcare professionals. Recurring themes centred on three key issues: the problematic nature of drug-using parents themselves; clinical challenges in living up to the ideals of professional practice; and the wider context in which current practice is governed. Professionals expressed ambivalence over their parenting support role; anxiety over responsibility for intervening with this 'hard-to-engage' population; and concern over 'dwindling' resources and lack of organisational support. Nevertheless, strategies and opportunities for providing parenting support were acknowledged and there was consensus about the need for further skills training. Despite a proliferation of policy and good practice guidance on the delivery of parenting support for drug-dependent parents, the findings of this study suggest that significant challenges remain. Notably, our findings raise questions about whose role it is to provide parenting support to drug-using mothers and fathers, especially those who are not involved in the child protection system.
育儿和家庭支持是改善受父母药物滥用影响的儿童和家庭状况的关键预防和干预策略。然而，对于为依赖药物的父母提供育儿支持的情况，尤其是在全民医疗服务体系内，人们了解甚少。本研究旨在探讨医疗从业者应对这一具有挑战性议程的方式。在苏格兰开展了四个多学科焦点小组，有目的地抽取了18名经验丰富的医疗专业人员作为样本。参与者包括全科医生、助产士、公共卫生护士和成瘾治疗工作人员，他们共同为弱势家庭提供护理。制定了焦点小组主题指南，以探讨这些医疗专业人员在为吸毒父母提供育儿支持方面的观点和经验，主要是那些接受阿片类药物替代疗法的父母。使用持续比较法和主题分析法对数据进行了分析。贯穿焦点小组讨论的总体叙述是这些家庭给一线医疗专业人员带来的“护理负担”。反复出现的主题集中在三个关键问题上：吸毒父母自身存在的问题；在践行专业理想方面面临的临床挑战；以及当前实践所处的更广泛背景。专业人员对其育儿支持角色表达了矛盾心理；对干预这一“难以接触”人群的责任感到焦虑；对资源“减少”和缺乏组织支持表示担忧。尽管如此，人们认识到了提供育儿支持的策略和机会，并且对于进一步技能培训的必要性达成了共识。尽管在为依赖药物的父母提供育儿支持方面出台了大量政策和良好实践指南，但本研究结果表明重大挑战依然存在。值得注意的是，我们的研究结果引发了关于应由谁为吸毒父母，尤其是那些未纳入儿童保护系统的父母提供育儿支持的问题。
