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A number of studies suggest that the lack of "gender sensitive" drug treatment services for women represents a pressing social problem, second only to the problem of "women's substance abuse" itself. This article interrogates these "problem representations" by asking on what basis they are considered uniquely problematic. Through a critical analysis of research on women published between 1990-2012 in relevant high impact journals, the article identifies a dominant view of women in the drug field as a "special population" with "unique treatment needs." The article suggests that this view not only reinforces a limited understanding of the harms associated with women's substance abuse, but might also paradoxically enable programs and services for women to remain as "add-ons" and/or narrow the range of "gender sensitive" approaches adopted.

Most studies of relapse and recovery among women drug users with children focus on improving their access to drug treatment. This article explores disengagement from a sociological perspective, as a process of personal and social identity transition. Drawing on an ethnographic study of young mothers and pregnant women attempting to disengage from injecting drug use, I suggest that this process is further compounded by a number of factors. Many women find it difficult to establish ties to the non-drug-using world, in part due to social isolation and in part due to ongoing stigmatization. Despite wanting to do what is best for their children, many are also ambivalent about giving up drug-using activities and relationships that remain integral to their identities. I argue that these are significant, complicating factors in the process of disengagement for women with children, which have implications for the kind of services and programs available to them.

In 2003, the UK Advisory Council on the Misuse of Drugs published Hidden Harm, the product of an inquiry that exposed the “problems” of parental drug use and its neglect by professionals. It outlined an extensive program of reforms designed to protect children from harm. Despite its far-reaching influence, it has rarely been subject to scrutiny, with analyses focusing on its impact instead. Drawing on Bacchi’s post-structuralist “What’s the Problem Represented to be” approach, we examine problematizations within Hidden Harm and their implications for the governance of family life. We illustrate how Hidden Harm produced a simplified version of parenting and child welfare within the context of drug use by largely equating drug use with “bad” parenting and child maltreatment and by ignoring the social determinants of health and the wider social ecology of family life. Using a tried-and-tested driver of policy change, Hidden Harm created a “scandal” about the lack of intervention by professionals that was used to justify and legitimize increased state intervention into the lives of parents who use drugs. Hidden Harm proposed simplistic “solutions” that centered on drug treatment, child protection and the responsibilization of professionals to govern “risky” parents. We argue these rationalities, subjectivities and strategies serve to marginalize and stigmatize families further and hide alternative approaches to understanding, representing and responding to the complex needs of children and families who are disproportionately affected by health and social inequalities. By uncovering what is hidden in Hidden Harm, we aim to stimulate further research and theoretically informed debate about policy and practice related to child welfare, parenting and family life within the context of drug use. We conclude with some ideas about how to reframe public discourse on parents who use drugs and their children, in tandem with collaborative responses to alleviate child poverty and inequalities.

Introduction:The educational needs of the health and social care workforce for delivering effective integrated care are important. This paper reports on the development, pilot and evaluation of an interprofessional simulation course, which aimed to support integrated care models for care transitions for older people from hospital to home.Theory and methods:The course development was informed by a literature review and a scoping exercise with the health and social care workforce. The course ran six times and was attended by health and social care professionals from hospital and community (n = 49). The evaluation aimed to elicit staff perceptions of their learning about care transfers of older people and to explore application of learning into practice and perceived outcomes. The study used a sequential mixed method design with questionnaires completed pre (n = 44) and post (n = 47) course and interviews (n = 9) 2–5 months later.Results:Participants evaluated interprofessional simulation as a successful strategy. Post-course, participants identified learning points and at the interviews, similar themes with examples of application in practice were: Understanding individual needs and empathy; Communicating with patients and families; Interprofessional working; Working across settings to achieve effective care transitions.Conclusions and discussion:An interprofessional simulation course successfully brought together health and social care professionals across settings to develop integrated care skills and improve care transitions for older people with complex needs from hospital to home.