Adolescents with different life problems seeking help before and after the introduction of a low-threshold service model: a Finnish qualitative study

There are several concerns related to adolescents living in families with severe and persistent problems. Childhood conditions may contribute to later social exclusion, for example. The aim of this study was to describe study participants’ service experiences before and after the introduction of a low-threshold service model. This model—based on the reformed Youth Act—was developed and implemented during a 2-year project. Data were collected through interviews of seven adolescents during phase one. In phase two, four adolescents responded to essay questions. The views of a youth worker working for this project were also collected, as she played a key role in helping the adolescents. The adolescents participating in this study were girls aged between 12 and 17. Thematic deductive analysis was performed. Two main themes were evident in the participants’ responses regarding their service experiences: the accessibility and acceptability of services. The model highlights the importance of listening to adolescents related to their various problems. The focus is on preventive services and early support. Coordination of preventive services requires special expertise and joint development in inter-professional practices. Moreover, adolescents’ experiences should be taken into consideration in the development of services.

Carriers of pain: Vulnerable meetings between staff and clients with a dual diagnosis

Persons with complex problems challenge nursing. The interest of this study was to identify the tools staff have used to continue working with compassion, empathy and sensitivity amongst vulnerable clients with complex problems, mental ill health and substance use (so-called dual diagnosis). The data were collected in a focused ethnographic study at a low-threshold service for substance users, and were analysed using Leininger’s ethnographic and a phenomenological lifeworld method. The staff attitude was positive towards the clients, they approved of the client’s background. Vulnerability appeared as a common pain, which touched both the staff and clients, and needed to be negotiated. A staff tool was the capability of carrying the pain, not being overwhelmed by it. The implications for practice are to recognize openness, awareness, reflexivity and communion with other staff members, the need for balancing of personal and ethical roles with professional requirements.

Challenges, relationship and outcomes in low-threshold drug services

PurposeThis paper reports on the findings of an action research study that sought to explore the development and provision of community-based low-threshold services within a socially disadvantaged area. In the context of debates, in regard to both the nature and efficacy of low-threshold drugs services and increasingly neo-liberal policy approaches to drug service provision that prioritise outcomes and drug treatment interventions, the purpose of this paper is to report on practitioners’ understandings of challenges, relationship building and outcomes within community-based low-threshold service provision in Dublin, Ireland.Design/methodology/approachAn action research method of co-operative inquiry groups was utilised, with nine practitioners from one community-based drug agency participating in a series of four sessions over a three-month period.FindingsThree key themes emerged in relation to building and sustaining client–practitioner relationships: the mechanisms by which the practitioners engaged with their clients and sought to develop relationships; how safe spaces were created and maintained in order to address client needs; and practitioners’ understanding of challenges and outcomes in low-threshold intervention work.Originality/valueDrawing on a co-operative inquiry method, this paper concludes that practitioner attention to relational distance evidenced in community-based low-threshold service provision, may provide an alternative to episodic, outcome driven drug treatment and intervention.

Engagement in help-seeking of dual diagnosed mothers at a low-threshold service: grasping life through co-created opportunities

Purpose Mothers with a dual diagnosis (mental ill health and substance use) have delays in accessing services, or their care may be interrupted prior to therapeutic relationships being formed. The purpose of this paper is to explore and describe how engagement merges in the context of mothers with a dual diagnosis. Design/methodology/approach This is a qualitative, focused ethnographic study at a low-threshold service for substance abusing families. The data contain interviews, observations, field notes, and reflections. The analysis followed several systematic steps. Findings Engagement is the co-creation of possibilities between workplace staff and the client in different interfaces. It is not a single act, emotion, or verbal communication, but a complex intertwined system of events that can awaken or enable the client to get a grasp on life. The sensitivity of the worker is one tool for engaging the client in manifold ways in different interfaces: even the smallest events with connection are viewed as valuable. Engagement involves the intentional client in the process of interaction: the client needs to participate and become an acting and sensing part of the change, which occurs on an experiential level. The process is described with the metaphor of a seed. Originality/value Engagement as inner involvement challenges the current working methods, and requires sensitivity, because the mothers with a dual diagnosis may not have verbalisable goals when arriving to the services.