Title: Governing parental opioid use: a relational ethnography
Funder: Economic and Social Research Council

Abstract: OUR RESEARCH AIMS TO: 1) Advance theoretical and real-life understandings of how parents who use opioids and their families are governed in the UK, 2) Build capacity and capability for transformational change in this field of policy and practice, 3) Prepare for an international comparative analysis of ethnographic research on the governance of parental drug use across the USA, Canada, Australia and the UK. OUR KEY OBJECTIVES include: PHASE ONE (0-6 months) We will establish two multi-stakeholder Learning Alliances (LAs) - one in Scotland, one in England - comprising service users, service providers and policymakers (approx. 25), to collaborate with the research team for the duration of the study. The LAs will co-produce the research and study outputs and assist with dissemination. We will convene an initial 1/2 day workshop with each LA in the first 5 months of the project to scope the policy and practice field to inform our ethnographic fieldwork and policy analysis (Phase Two). Thereafter, we will convene 3 meetings per year. PHASE TWO (7-27 months) We will conduct a relational ethnography across two sites - one in Lothian, Scotland and one in London, England - with a focus on relations between parents/families and professionals/services, governing practices and their effects. Four researchers (2 per site) will conduct the fieldwork over 21 months - one will work primarily with parents who use opioids and their families (15 per site) and the other with services who support families affected by parental opioid use (6 per site). Data collection will include: participant observation (detailed field notes), qualitative interviews with family members (45 per site), focus groups with approx. 40 practitioners, and interviews with 6 managers and 6 policymakers (per site). We will embed a critical policy analysis within the ethnographic fieldwork to identify, collate and interrogate policies employed in the governing of parental opioid use e.g., national & local guidance, clinical guidelines, organisational procedures & assessment practice tools. Our policy analysis will situate our ethnographic data within a wider political, ideological, economic and structural context. PHASE THREE (28-36 months) We will compare ethnographic and policy analysis data across and within the two study sites (England and Scotland) and synthesise the findings. Two expert events (London/Edinburgh) with our 'end users' will be convened in conjunction with our LAs, to present preliminary findings and develop innovative solutions and responses to parental opioid use. We will utilise our comparative analysis and learning from our expert events to advance theoretical understanding on the governance of parental drug use and the social ecology of the field as a whole. We will demonstrate how policies and practices collectively constitute governing through illustrative case narratives, excerpts from interviews/focus groups with families/professionals, and evidence on policies, processes and relations that produce certain kinds of responses, subjectivities, trajectories, and impacts including unintended consequences. We will implement an ambitious impact strategy to maximise translation of findings into policy and practice (short/medium/long term). Final analysis will be completed by month 33, then we will focus on study outputs, dissemination, knowledge exchange events, final report writing, and development plans for international comparative studies. PLEASE NOTE: We use the term "parents who use opioids/drugs" to indicate mothers and fathers (biological/non-biological, resident/non-resident), and pregnant women/expectant fathers, who take psychoactive drugs, primarily illicit opioids (e.g. heroin, fentanyl) and/or opioids prescribed for the treatment of addiction (e.g. methadone, suboxone). However, we acknowledge that polydrug use is the norm. We aim to avoid terminology that is stigmatising and/or assumes a biomedical approach.

Lay abstract: 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.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: MENTAL HEALTH