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Introduction: Healthy Homes and Neighbourhoods (HHAN), an integrated care programme in the Sydney Local Health District (SLHD), seeks to address the needs of disadvantaged families through care coordination, as one of its components. This research aims to determine for whom, when and why the care coordination component of HHAN works, and establish the reported outcomes for clients, service-providers and partner organisations. Methods: Critical realist methodology was utilised to undertake a qualitative evaluation of the impact of care coordination. Purposive sampling was used to select a total of 37 participants for interview, including consumers, service-providers and key stakeholders. Thematic analysis was undertaken to derive the major modes of intervention of HHAN, and data representing these elements was coded and summarised under contexts, mechanisms and outcomes. Results: Analysis indicates that care coordination has a positive impact on clients' sense of independence, self-awareness and outlook on life. Trust and favourable interpersonal relations were identified as major underlying mechanisms for a successful client-provider working relationship. The identified modes of intervention facilitating positive consumer outcomes included accessibility, flexibility and service navigation. Persistent siloes in health and systemic resistance to collaboration was seen to hinder effective care delivery. Conclusions: This study suggests that a care coordination model may be effective in engaging disadvantaged families in healthcare, assist them in navigating the health system and can lead to beneficial health and social outcomes. Successful implementation of care coordination requires flexible programme design and experienced and skilful clinicians to fulfil the care coordinator role. There is a need to appreciate the negative impact that the complex and siloed health system can have on disadvantaged families.

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Despite the policy and academic interest in helping disadvantaged young people into employment and education, and towards a more positive future, little is known about the process of supporting positive transitions for young people. In Australia and internationally, youth work is increasingly considering alternatives to the traditional deficit-oriented and risk-averse approach to supporting young people experiencing social or material disadvantage. With an outset in youth practitioners' perspectives on their work and underpinned by key concepts drawn from the Positive Youth Development approach, this paper seeks to improve understandings of how best to support disadvantaged young people's ability to thrive, facilitate practitioner dialogue and strengthen practice. Qualitative interviews were conducted with twelve youth practitioners and a focus group run with an additional eight. The paper explores three concepts emerging from the analysis that were identified as key to understanding the unique potential youth work practitioners have to support positive transitions with and for disadvantaged young people: having an ecological focus, encouraging personal agency and fostering alternative possibilities. The findings propose new possibilities for working with young people with whom mainstream services struggle to engage. The paper concludes by discussing the practical implications and limitations of this approach.

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People who use illicit drugs frequently become targets for welfare intervention, often positioned both as complicit in the reproduction of intergenerational poverty and marginalisation, and as sources of hope for interrupting such patterns. This article draws on empirical research exploring the experiences of highly marginalised people with histories of illicit drug‐use to investigate how they negotiate service encounters in the context of the participants’ previous experiences with welfare interventions. In doing so, the article seeks to texture the conception of the support and control nexus, drawing out the systemic and service level factors of welfare services which inhibit people who use drugs from benefitting from available support. We conducted 12 in‐depth interviews with participants subject to interventions by health, social or legal services between July and September 2018. All interviews were audio‐recorded, transcribed verbatim and coded in NVivo. Transcripts were analysed using a grounded theory approach where data were subject to an iterative process of constant comparisons to identify emergent themes and theoretical concepts. The findings suggest that the blending of welfare services and systems of control has unintended and often negative consequences for highly marginalised people. In effect, the drug treatment programme's aims of assisting people to reduce harm and increase stability are significantly undermined by control mechanisms such as mandatory reporting policies. A better understanding of the ways in which welfare service processes alienate marginalised people from seeking support, as well as from benefitting from the support available, might provide a way to address these concerns.

We were surprised to read Neale and colleagues' conclusions in their recent work on women-only services, which stated: 'Women who have complex histories of alcohol and other drug use do not necessarily want or perceive benefit in women-only residential treatment' (Abstract conclusion, p. 989) [1] and that women were 'routinely fearful and negative about entering women-only treatment ' (p. 994) [1]. These conclusions and interpretations appear to misrepresent the findings based on the data presented and are at odds with the study's qualitative methodology. The authors report that some women were initially apprehensive or fearful but, based on our reading of the data presented, this was neither universal nor necessarily specific to the same-sex environment. Many of the challenges described were perhaps more attributable to the residential and therapeutic environment and therefore equally as likely in a mixed-sex service, or indeed any communal living context. These possibilities, however, were not explored adequately by the authors.We also question the authors' claim regarding the 'widespread acceptance' and 'assumption' that women want women-only treatment, and the lack of evidence provided to support it. Women-only services exist not simply because of a 'belief' that women want them, but also out of necessity. A key issue for many women either referred to, or who seek out, women-only services is child care and protection. Child-care issues have long been acknowledged as barriers for many women seeking substance use treatment [2,3]. Women-only services often provide the only opportunity for women to remain with their children while receiving treatment, or to continue to have visit access, and can be essential for women working towards restoration of their child custody [4]. These issues, however, were not considered in the broader analysis of results.The data presented were decontextualized, as if women's perceptions of the acceptability or 'benefit' of residential treatment were based solely on gender considerations. While it is not at all our intention to diminish the impact of gender, there is no way of understanding participants' views relative to the importance of other factors influencing decision-making about undergoing residential treatment.Irrespective of the findings, it is difficult to understand how a qualitative research study recruiting only 19 women from just one residential service can justify such a generalizing statement. This both undermines the research presented and qualitative research more generally [5]. As internationally acknowledged experts in their field, the authors are no doubt aware that qualitative research can provide rich and detailed insight into the experience of research participants, but it is rarely generalizable beyond the cases to the extent the authors suggest [1]. Although these limitations were identified in the Discussion, the authors failed to couch their conclusions within the context of these limitations.We agree that it is both important and necessary to explore w...

A prevalent critique of Alcoholics Anonymous (AA) is that members must adopt an inflexible illness narrative, taking on an “alcoholic” identity and performing a set of practices to address this condition. Conversely, a small body of research suggests that, rather than comprising the uniform adoption of a rigid narrative, integration into AA is achieved by negotiating individual beliefs, values, and preferences with the AA model. To investigate such processes of negotiation, the current study aimed to explore the politics of belonging in AA. The study involved semi‐structured interviews with 15 AA members recruited from meetings across Sydney, Australia, and data were analyzed thematically. Findings illustrated how participants navigated the politics of inclusion/exclusion within AA. While some aspects of AA were found to be negotiable by participants, a non‐negotiable aspect of AA ideology that emerged was the axiom that “alcoholics” have no control over alcohol and therefore should maintain abstinence. Findings raise questions about how the politics of belonging in AA may shift over time following broader patterns of societal change.