Our grounded theory (see Fig. 1) on socio-economically deprived families’ limited access to FAPS is as follows: Depending on families’ modes of recognizing and handling problems in everyday life, routes towards identification of candidacy with services/offers tend to be furthered (in green) or hindered (in red). The modes are structurally anchored in different resources, from weak (in red) to stronger resources (in green), and the modes’ effects on identification of candidacy for FAPS are weakened or strengthened by other influencing factors (see clouds in Fig. 1).
Mode of recognizing and handling problems in everyday life
As the way problems were recognized and handled determined not only what was seen as a problem but also when and what kind of action was required, families’ modes of recognizing and handling problems in everyday life were found to be core phenomena that structure the process towards (non-)identification of candidacy for FAPS. We identified four different modes in the data:
- Mode A – existentially threatening: The family’s current life situation was perceived as existentially threatening. The focus of coping was on the problem perceived as existentially threatening.
- Mode B – normalizing: The burden of multiple problems in the family’s everyday life was perceived and experienced as normal (now). Problems were normalized, often not recognized as such.
- Mode C – pragmatic processing: The family’s everyday life continued on, despite financial precariousness. Problems were pragmatically recognized at a low threshold and dealt with pragmatically (mostly within the family).
- Mode D – worried: Problems were constantly produced in everyday life by worried and anxious parents monitoring their child. Problems were dealt with at an early stage (low problem threshold).
The modes are not exclusive categories. All families analysed had a main mode, but they sometimes also applied strategies that were prevalent in (an)other mode(s).
Mode A: Existentially threatening
Some families saw their existence threatened by one main problem. A high level of financial precariousness, unsecured residence status (e.g. provisionally admitted foreigners – Permit F), or a single father’s incompatibility of poorly paid shift work (working poor status) with caring for his child were such existentially threatening problems. For instance, one mother, a social welfare recipient, sometimes ran out of food: “I said there'd be money today. I checked. It hasn't come yet. I only have 2 francs... I bought potato chips for the children” (NH, mother, age 36).
Parents’ perception and identification of a main existential burden in their daily life created a specific pressure to cope with that issue first, because it was seen as the origin of all misery: “…you know, I think if we get a residence permit, all my problems are over” (GAA, father, age 50). Therefore, a specific and thematic focus on action and coping was set in these families. All other issues were regarded as secondary or as a consequence of the existentially threatening problem. The families’ coping and survival strategies were focused on the existentially threatening problem even though identified problems were often beyond the parents’ control due to Swiss legislation, social welfare practice, and low employment opportunities for low-skilled workers. As a result, few resources were freed up for dealing with other problems and issues on a day-to-day basis. Topics in the area of addiction prevention such as substance use, media use, or parenting skills were subordinated to the processing of and coping with the situation perceived as existentially threatening. Hence, health issues and problems were only perceived (if at all) when they were very acute (high problem threshold), which turned out to be a barrier to identification of candidacy for (addiction) prevention services. Moreover, parents with this mode of problem construction and problem handling, in contrast to modes C (pragmatic processing) and D (worried), seemed to have low agency. Probably caused by multiple deprivations and problem load, they preferred support for their children and not for themselves (e.g. in order to better support their child or resolve the problem on their own). Hence, they identified more easily with offers for children than with offers for parents, which led to non-identification of their candidacy for FAPS.
Mode B: Normalizing
Some families, even though they were confronted with multiple problems in everyday life (e.g. financial deprivation, parent’s mental illness, child’s psychosocial problems), perceived this situation as normal rather than exceptional. Multiple problems and difficulties were constructed and perceived as part of the family’s everyday life. For example, the aggressive behaviour of a 10-year-old son who had beaten his mother was framed by his mother as a kind of normal, male behaviour. Another mother felt there was no need for support (professionally or by herself) for her daughter after her ex-partner’s (the girls’ father’s) second suicide attempt. The situation was normalized. The daughter just had “…to go through it, he is her father, you know” (SS, mother, age 44), the mother told us.
As demonstrated, the threshold to perceive something as posing a need for action was high. Circumstances that would be constructed as problematic in other families were not perceived that way and were therefore not relevant enough for the family to take action to change the situation. Many issues were accepted, relativized, or normalized, if they were not highly urgent, visible, and/or new to the family. This was also the case concerning health issues. A health problem usually became an issue for the family only when it was acute and visible, for example when there were clear, acute complaints or signs on the body: “…a little bad what I saw, she [the daughter/AP] has this thing with the... wrist cutting - I went with her to a counsellor” (SP, mother, age 44). (Health) issues that did not become visible and a problem, that did not exceed a certain problem threshold, received little attention. Therefore, mode B was generally a barrier towards identification of candidacy for addiction prevention services. As in mode A (existentially threatening), also here we reconstructed that the parents had low agency. If support was actually sought and received, it was mostly for their children and not for the parents in order to better support the children. This led to non-identification of candidacy for FAPS. However, by means of professional services provided to children, some children got in contact with health-promoting and life skill-oriented offers that were not family-related (non-participation of parent/s).
Mode C: Pragmatic processing
In the families with mode C, everyday life took a more or less orderly course despite resource constraints. Issues and problems emerged from the surface of everyday family life, were noticed, and received attention. Problems and relevant topics were constantly discovered by the families, taken up pragmatically, then processed and worked through, one after the other. We therefore called this mode ‘pragmatic processing’. Conversations between parents and children were found to be a favoured strategy for tackling issues, as the following comments by a mother to her daughter illustrates: “…and when that [menstruation/AP] comes, you don't have to be afraid, you can come to me, then we'll talk about that” (AK, mother, age 35). Topics of prevention, also within the area of addiction prevention (media literacy, parenting skills), came into focus if parents observed a discrepancy between their conceptions and their children’s behaviour, or if children brought up an issue. Thus, due to the recognizing of problems in mode C, paths to identification of candidacy for FAPS generally opened up. However, due to the problem handling strategies in mode C, identification of candidacy with addiction prevention services in these families often did not come about. Why? The dominant mode of handling issues and problems found in these families was: ‘We’ll find a solution by ourselves’. These families drew a clear line between inside and outside the family. They relied on themselves and their private network when resolving problems. Equipped with high agency and overall high problem-solving capabilities, these families had a high problem threshold before accepting (professional) help or service offers from outside the family, also concerning FAPS. But the data material showed that also pragmatic-processing families could identify their candidacy for addiction prevention services. Parents who saw it as a matter of course to participate in parents’ events and who were firmly integrated in a (help) system, e.g. were part of a parents’ council, attended educational and information events for parents regardless of the topic (see ‘ Experiences with offers and integration in systems of assistance’ below).
Mode D: Worried
In families with mode D, relevant topics and (possible) problems were regularly produced in everyday life. This was due to the parents’ worried and sometimes anxious approach to reality and daily living. In one of the interviews this became evident in that the mother mentioned her worries over 17 times (e.g. worries about her son’s safety, his emotional sensibility, or his future). The duality of worrying and caring for children is apparent with these parents; as one mother puts it: “Well, I am rather the worried mother, I try to prevent all kinds of things” (KG, mother, age 34). These parents monitor their child intensively in order to promote the child’s psychosocial development and to provide the best possible future for their child.
The way that problems were actively constructed and produced within the family was the reason why even if (possible) problems were not yet present, these parents – in our data, mothers – by definition were very sensitive in everyday life and had an impulse to act on before something became a problem. These mothers therefore quite easily identified the family’s candidacy for addiction prevention services and other health-promoting offers.
In contrast to many families with mode C (pragmatic processing), these families were less oriented towards the inner family circle in their approach to preventive issues and dealing with (potential) problems. They actively and broadly put out feelers for supporting and encouraging information and offers in their social environment. For them, it was part of the normal case, part of their educational self-image, to constantly make use of offers, no matter what topic, and to independently process the knowledge that they acquired: “Because (3) no matter what, you learn something. Even if it is bad. I see things this way (2). [...] I register for all seminars, everything that is offered by the parents’ council and that comes from the school and I really go everywhere. There is a private school [...], they often have free offers for people and I go there too, just to listen. And sometimes there are topics that don't concern me at all […]. But still better to go and listen than (1) not participating in anything” (IR, mother, age 44).
These parents, in contrast to parents with modes A (existentially threatening) and B (normalizing), did not exclusively search for offers for their children or put their effort into resolving problems on their own (mode C, pragmatic processing). Drawing on strong agency as parents, parents with mode D (worried) sought support, information, and help in addiction preventive and health-promoting offers in order to better support and educate their child. FAPS, which aim to strengthen and develop the skills of parents, therefore fitted the needs and the habitus of these parents.
Structural anchoring of the modes
The qualitatively reconstructed modes of recognizing and handling problems in everyday life were not simply psychological modes. They did not exist detached from a social and structural context. Rather, socio-demographic and structural references became apparent in the data material, which served as the basis for the shaping of these modes (see Figure 1). If one had to draw a line between the four modes A to D that separates families with a high level of and sometimes multiple resource deprivation from families with slightly better resources, the line would run between two groups, A/B (existentially threatening/normalizing) and C/D (pragmatic processing/worried). In A (existentially threatening) and B (normalizing) there were mainly families with very low educational attainment (even no school-leaving certificate, illiteracy) and low occupational status. Some of them were only provisionally admitted foreigners in Switzerland (Permit F). In A (existentially threatening), the financial resources were very weak. All families were social welfare recipients. In B (normalizing) there were families receiving social welfare as well as unemployed parents (including those receiving a part of a pension from the Swiss invalidity insurance). Some families with mode B were characterized by multiple deprivations and the burden of having many problems and challenges at the same time (financial, social, and health related). In contrast, families with modes C (pragmatic processing) and D (worried) were generally slightly better off financially. Almost all of them had educational attainment ranging from basic vocational education and training (e.g. apprenticeship) to professional education/tertiary degrees (also from abroad, which were not formally accepted in Switzerland!). It is further noticeable that many of them had lived in Switzerland for a longer period of time (compared to families with mode A, existentially threatening, with a shorter period of residence) and/or had Swiss citizenship. Moreover, social networks tended to be better developed in families with modes C/D (pragmatic processing/worried) than with modes A/B (existentially threatening/normalizing).
Hierarchization of (adolescence) issues: addiction prevention at the bottom
A hierarchization of problems as seen in the described modes, impacting identification of candidacy for FAPS, takes place also concerning issues that parents think are relevant and important for the development of their (adolescent) child. Addiction prevention issues were in general deemed less important than other problem burdens and educational issues related to adolescence. The parents were mostly concerned about their child’s education and school performance, the child’s physical changes and sexual development, new financial demands from the child (new clothes, shoes, etc.), and the child’s increased autonomy, raising parental questions about safety.
All of the parents assessed their child’s interest in psychoactive substances as either non-existent or not problematic, even though children sometimes displayed interest or even indicated (first) substance use in the interviews. The parental (mis)perception that their child was not yet concerned with substance use was therefore an important prerequisite for non-identification of their candidacy for FAPS. The parents based their perception of the child’s non-interest in substance use on the following aspects:
- Child’s stage of development, believing that the child was too young or too far removed from the subject: “…but I have a feeling she's still a little far from that [substance use topics/AP]. ((yes)) Well, she's not that interested yet. But I know this is something that's sure to come” (VS, mother, age 35)
- Child’s explicitly expressed disinterest in substance use in conversations with parents
- Child having no friends who used substances (assessment of the peer environment)
- Gender-biased risk assessment, thinking that daughters were less at risk for using psychoactive substances than sons
Interestingly, parents were more critical and sensitized to children’s media use (games, Internet, smartphone, etc.) than to their substance use; there was a difference between the parents’ desired media use by the child and the child’s actual use (e.g. identifying excessive smartphone use). More families attended (preventive) programmes dealing with child’s media use than programmes dealing with substance use, parenting, or life skills. It seems that content-wise identification of candidacy for FASP tackling media use was easier than for FASP tackling substance use/abuse.
Experiences with offers and integration in systems of assistance
The interviews revealed that negative experiences within a system of assistance potentially hindered further contacts with this specific system, whereas positive experiences facilitated contact; the positively evaluated system of assistance was then often the first reference point when families were confronted with further problems or unresolved questions.
A strong anchoring within governmental institutions that provide social welfare or advice concerning migration (mostly families with mode A, existentially threatening, and B, normalizing) turned out to be more of a barrier to than a resource for identification of candidacy for FAPS. Because these institutions and professionals dealt exclusively with specific, acute, and urgent problems (e.g. providing social welfare, residence permit, etc.), there was no triage of these families to health promotion-related and addiction prevention-related offers by these professionals or institutions.
A firm connection to aid organizations and educational institutions, such as school, parents’ council, community centres, charitable organizations, and so on turned out to facilitate the identification of candidacy for FAPS, as long as the providers conducted addiction-preventive courses. When once integrated in a system and firmly connected to it, families took part in offers from these institutions as a matter of course, regardless of the topic: “I register for all seminars, everything that is offered by the parents' council and that comes from the school and I really go everywhere” (IL, mother, age 44)
Strategies to protect the family
The interviewed families responded differently to being (potentially) addressed as parents by FAPS. Some families used strategies to protect, in some cases even showcase, their role as parents or their family’s image to the outside world. Protection strategies identified were proactive or defensive. Proactive strategies furthered the identification of their candidacy for FAPS, whereas defensive strategies hindered their identification of candidacy for these services.
Several parents with modes C (pragmatic processing) and D (worried) applied proactive protection strategies. These parents expected that participation in parent events would have a positive effect on their image as a family or as parents. Therefore, they identified with an offer regardless of the relevance of the topic because they expected to protect or even booster their image by participating. When S. M., a single mother of two children, was asked why she took part in the parent night on psychoactive substances, she answered: “I just thought that if I didn't go, it would look like I were a bad parent” (SM, mother, age 43).
Parents using defensive strategies were aiming to protect their family’s or the parent’s image by staying away from FAPS. First, some parents with modes A (existentially threatening) and B (normalizing) feared that an interest in certain topics could be seen as an indication of problems in the family. Second, several families – with modes A (existentially threatening), B (normalizing), and C (pragmatic processing) – avoided certain places or persons, regardless of the topic of the event. Based on their often negative experiences, these families assumed that their image was questioned or even threatened in these places or by certain persons: “I have very little contact with the parents [...] And I have no relation to the state school. So this is really difficult for me. Even after six years. I can't find any common ground with them. […] Even with the teachers. I have a completely different opinion than them” (VS, mother, age 35).
Parents’ search for information or support
The data revealed that how families and parents searched for information was important for the process towards or away from identification of their candidacy for FAPS. The identified search movements basically had two grades of activity. They were either active or passive, and they mostly took place in families’ already established help systems (see above). In active search movements, the interviewees initiated the search process on purpose, and they consciously sought information or support services. The search process was activated and guided by a current concern in the family that was demanding attention (often financial issues). Passive search movements were characterized by the fact that they were not initiated by a concern demanding attention and a deliberate search decision. Instead, it was because of parents’ general interest (not limited to financial assistance) that initial information on offers (e.g. flyers, advertisements, etc.) was perceived by the families and search movements were initiated: “I'm the kind of person who collects information and hangs it on the wall. [giggles] Yes, and just on occasions I look at it and look at the date and sometimes I think, hey, that evening I have time to do something. […] Well, I took a few courses like that” (KG, mother, age 34).
Whereas general interest and the willingness and time to receive and consider information from providers formed the bases for passive search movements and could lead to identification of candidacy for FAPS, active search movements were mostly a barrier to identification of candidacy for addiction prevention due to the focus on concerns demanding attention (e.g. financial assistance). Here again, families with mode A (existentially threatening) were the most vulnerable regarding non-identification of candidacy.