Background
Methods
Step 1: Selecting interventions for adaptation
Step 2: Developing a theory of change model
Step 3: Qualitative study
Qualitative interviews and focus groups
Qualitative method | Participant group | Number of participants | Gender | Placement type/job role | Substance use |
---|---|---|---|---|---|
Individual interviews | LAC | 19 | F = 9, M = 10 | Foster care = 5 Residential care = 8 Independent/supported living = 5 Living with biological parent = 1 | Current/previous substance use = 16 Never used substances = 3 |
Carers | 13 | F = 8, M = 5 | Foster carers = 6 Residential workers = 4 Supported living workers = 2 Biological parent = 1 | ||
Drug and alcohol workers | 3 | F = 1, M = 2 | Service manager = 1 Drug and alcohol worker = 2 | ||
Dyad interviews | Social workers | 4 | F = 4 | LAC managers = 2 Social workers = 2 | |
Focus groups | Drug and alcohol workers | 5 | F = 3, M = 2 | Service manager = 1 Drug and alcohol worker = 4 | |
Social Workers | 4 | F = 3, M = 1 | Senior Social workers = 3 Social worker = 1 | ||
Carers | 4 | F = 3, M = 1 | Foster carers = 4 | ||
Total participants | 52 |
Step 4: Qualitative analysis and findings
Key themes and how they influence manual adaptation
Theme 1: Therapeutic relationships
“You need to put in the groundwork initially. I think with teenagers you need to gain their trust, you need to work for it. Because if they have been hurt, which they will have been, they will try to push you away. They won’t want to trust you.” (Carly, Social worker, focus group)
“it is not a job because there is no job that makes you work 24 hours a day, 7 days a week and 365 days of the year, but this one does” (James, Foster carer, focus group).
“Just by keeping to your word, even little things like keeping your appointments and attending on time, looking into things when you say you’re going to…” (Susan, Social Worker, focus group).
“When you work with someone you have to build a bond up first, before you can open up to them…..It’s, well the way I’ve done is just ask questions about them, and then if they tell you, then you know well if they’ve told me this then I can tell them that” (Sophie,17, YP interview).
“Myself and his YOT worker had agreed between us that we would have our phones on 24/7. So that if he wanted to get in touch and check in we knew he was okay. So we did, we took turns and he did check in and he did arrange to meet up which was really good” (Steph, Social worker, focus group)
“Any child that comes to live with me, I know they are not mine, however I will work with them, I will play with them, I will live with them and I will do everything to my best ability in every area, in every arena because I want what is best for them.” (Liz, foster carer, interview).
“Like Josie talks to me, not like I’m just someone she has to work with, she talks to me like she cares” (Carla, 17, YP interview)
“We had a young man who had been abused by a family member. He was feeling guilty himself about it and thought that we would feel disgusted that things like that had been done. It is letting him see that we are not disgusted. Straight away, I have heard all of this before, you are not the only one. It is not your fault.” (Carol, female, foster carer, focus group).
“…my family is ‘f…. up’…really ‘f….. up’. And if I sat there and told someone they’d probably run a mile, they probably would. So that’s why I’ve never really opened up to anyone, cause if I did they probably would run away, do you know what I mean?” (Ewan, 17, YP interview)
Theme 2: Engagement and challenges of working with looked after children
“It was like in a room…and like there’s a table there and it had like little seats round, and like, he was just on about things. Do you know, he didn’t make it very good, like, he didn’t make it very fun and enjoyable kind of thing. It was just like, boring. He was just writing things down that I was saying basically and it just upset me. He just kept on going over it and over it and over it, he was like “so how did that feel? Bla bla bla.” I didn’t really feel comfortable” (Isabelle, 13, YP interview)
“That are not many young people who you’ll get to the point where you’re doing that one to one counselling really. It is few and far between. You’re being creative…” (Adam, drug and alcohol worker, focus group).
“Writing it down or doing it like arts and crafts way because I don’t like just talking and having conversations cause I just get a bit bored and lose track, then I’ll start fiddling about.” (Abbie, 18, YP interview)
“I think what’s coming out here is that with the kids we work with, the drug and alcohol issue is over there, if you like, and a whole raft of other issues are here. As workers we’re dealing with all of these here and that tends to sort the drug and alcohol issues out quite naturally” (Laura, Drug and alcohol worker, focus group)
“So they might, you know, have contact with their brothers or sisters, you know, it is just they get moved around, and when they are moved around they are vulnerable, they are desperate to have friends or they are desperate to have somebody to call their own…… people get attracted to them who are, I would say, not the type of kids I would want my kids to knock around with” (Liz, foster carer, Interview).
“It is quite sad sometimes when they haven’t got anybody in the family, not even an uncle or a cousin or somebody who they can put down as a support really” (Steph, social worker, focus group).
“My boyfriend and his friends, and there’s a few of my friends. Actually they’ve got their own lives as well, they’ve got their own houses and their partners and they’re all settling down as well, so…there’s not really many people there. When you think about it though, how many of them can you turn to if you’ve got a problem? Cause there’s not a lot” (Abbie, 18, YP interview).
“There’s two main people I’ve got in my life which provides me with support. One’s my boss, he’s a farm manager, I work with him most days. Another person is the manager of [name of school], he owns the company and he helps quite a lot by, when I moved out of here the first time, he’s the one that made me come back, and let me get my head back” (Philip, 17, YP interview).
Step 5: Co-production of intervention manuals
Qualitative method | Participant group | Number of participants | Gender | Placement type/Job role | Substance use |
---|---|---|---|---|---|
Finalisation Workshop | Professionals | 14 | F = 10, M = 4 | Drug and Alcohol worker = 9 Social Worker = 1 Project support workers = 4 | |
Young People | 13 LAC = 5 Non-LAC = 8 | F = 7, M = 6 | Living with biological family = 6 Non-LAC Living in supported accommodation due to family breakdown due to drug use = 1 Non-LAC Living with grandparents due to family breakdown due to drug use = 1 Non-LAC Supported accommodation = 3 LAC Residential care = 1 LAC Foster care = 1 LAC. | All 13 participants were currently in/or had previously attended specialist drug and alcohol services | |
Total participants | 27 |
Theme | Subtheme | Implications |
---|---|---|
Therapeutic relationships | Time and reciprocal self-disclosure Genuine care Non- judgemental approach | Practitioners to make contact with LAC and to have a pre-treatment sessions to engage the YP to build up a rapport and encourage a relationship prior to commencing work. Therapists to have the option to make safe self-disclosures within the sessions. |
Engagement and Challenges | The need to use creative methods to enhance engagement. YP inability to recognise support Treatment goals wider than substance use. | Resources were developed to complement each session within the MET and SBNT manuals. The resources provided a worksheet and suggested activities to work in a creative way with LAC. The original criteria for a ‘network member’ was made more flexible to enable less traditional members to engage with sessions and act as a support. Treatment goals could be wider than substance misuse alone. |