What is Practice Research in Social Work - Definitions, Barriers and Possibilities

Practice is subject to increasing pressure to demonstrate its ability to achieve outcomes required by public policy makers. As part of this process social work practice has to engage with issues around advancing knowledge-based learning processes in a close collaboration with education and research based perspectives. This has given rise to approaches seeking to combine research methodology, field research and practical experience. Practice research is connected to both “the science of the concrete” – a field of research oriented towards subjects more than objects and “mode 2 knowledge production” – an application-oriented research where frameworks and findings are discussed by a number of partners. Practice research is defined into two approaches: practice research – collaboration between practice and research – and practitioner research – processes controlled and accomplished by practitioners. The basic stakeholders in practice research are social workers, service users, administrators, management, organisations, politicians and researchers. Accordingly, practice research is necessarily collaborative, involving a meeting point for different views, interests and needs, where complexity and dilemmas are inherent. Instead of attempting to balance or reconcile these differences, it is important to respect the differences if collaboration is to be established. The strength of both practice and research in practice research is to address these difficult challenges. The danger for both fields is to avoid and reject them.

Building the capacity for learning and change through reflective conversation

Conversation is central to the process of organizational learning and change. Drawing on the notion of reflective conversation, we describe an action research project, "learning through listening" in Omega, a residential healthcare organization. In this project, service users, staff, members of management committees, trustees, managers, and central office staff participated in listening to each other and in working together towards building capacity for creating their own vision of how the organization could move into the future, according to its values and ethos. In doing so they developed ways of engaging in reflective conversation that enabled progress towards a strategic direction.

THE EFFECTS OF COST-SHARING ON USE OF SERVICES AND CONSUMER CHARACTERISTICS IN A STATE'S CRIPPLED CHILDREN'S DIVISION

The present study analyzed some of the effects of imposing a cost-sharing requirement on users of a state's health service program. The study population consisted of people who were in diagnosed medical need and included, but was not limited to, people in financial need.^ The purpose of the study was to determine if the cost-sharing requirement had any detrimental effects on the service population. Changes in the characteristics of service consumers and in utilization patterns were analyzed using time-series techniques and pre-post policy comparisons.^ The study hypotheses stated that the distribution of service provided, diagnoses serviced, and consumer income levels would change following the cost-sharing policy.^ Analysis of data revealed that neither the characteristics of service users (income, race, sex, etc.) nor services provided by the program changed significantly following the policy. The results were explainable in part by the fact that all of the program participants were in diagnosed medical need. Therefore, their use of "discretionary" or "less necessary" services was limited.^ The study's findings supported the work of Joseph Newhouse, Charles Phelps, and others who have contended that necessary service use would not be detrimentally affected by reasonable cost-sharing provisions. These contentions raise the prospect of incorporating cost-sharing into programs such as Medicaid, which, at this writing, do not demand any consumer payment for services.^ The study concluded with a discussion of the cost-containment problem in health services. The efficacy of cost-sharing was considered relative to other financing and reimbursement strategies such as HMO's, self-funding, and reimbursement for less costly services and places of service. ^

‘The best thing I’ve ever done is ring these people…’: Making a Difference through Family Support

Effective family support strategies offer early intervention and help for families and children at risk of experiencing social exclusion and maltreatment. This paper reports a study which evaluated client outcomes from participation in an Intensive Family Support Service by comparing views of workers and service users on perceived benefits. It profiles the characteristics and circumstances of families recruited to service, services and interventions delivered and the potential of IFSS to lead to safe and positive outcomes for children and families. Findings discussed highlight the individualized and collaborative approach and the high degree of engagement with service users that facilitated gains in the domains of child and family functioning targeted. Implications of the findings for policy and practice in responding to vulnerable families and children are discussed.

Influencia de un nuevo marco jurídico en la competitividad del sistema portuario español

El sistema portuario español movió en el año 2013 aproximadamente 458,54 millones de toneladas, 13,8 millones de TEUs, con un total de 131.128 buques que accedieron a puerto para el conjunto de las 28 Autoridades Portuarias. Con el 62% de las exportaciones y el 86% de las importaciones realizadas por vía marítima, una rentabilidad del 2,34 %, muy cerca del objetivo del 2,5 % de rentabilidad media annual establecida legalmente, y una cifra de negocios aproximada de 1.028 millones de euros equivalentes al 1,1 % del PIB que genera un empleo directo e indirecto vinculado de 145.000 personas, concluimos que estamos hablando de un sector estratégico para la economía del país. Desde hace décadas, en muchos puertos del mundo se han venido desarrollando terminales “hub” o de concentración y distribución de cargas. Las navieras concentran entre este tipo de terminales sus líneas transoceánicas con buques de enormes dimensiones y capacidad de carga para producir los tránsitos de contenedores desde estas líneas a otras líneas llamadas “feeder”, con buques de menor tamaño que enlazan el “hub” con los puertos de su área marítima de influencia. La excepcional ubicación geoestratégica de España, con aproximadamente ocho mil kilómetros de costa, ha originado que los puertos españoles de mayor dimensión aspiren a incorporarse a esta red marítima internacional de contenedores y determina que en nuestro sistema portuario los movimientos de contenedores de tránsito tengan gran importancia. Sin embargo, la crisis económica ha tenido un efecto decisivo en el sector marítimo, determinando una lucha feroz entre todos los puertos, nacionales e internacionales, por captar este tipo de tráficos, lo que origina una búsqueda de las compañías navieras de puertos cada vez más eficientes en términos calidad/coste del servicio. La entrada en vigor del Texto Refundido de la Ley de Puertos y la piedra angular de su reforma, la Ley 33/2010, plantea como objetivo principal la mejora de la competitividad del sistema portuario español y liderar su recuperación, ofreciendo unas condiciones de entorno favorables a los puertos españoles que acaben por incentivar la captación de tráficos e inversión privada a través de una oferta de servicios e infraestructura de calidad y a precios competitivos que consoliden su posición dentro del tráfico marítimo mundial. Surge, por tanto, la conveniencia de investigar la influencia de las medidas propuestas por dicha norma legal y las soluciones ofrecidas a las demandas de un sector considerado estratégico para la economía del país, y cuya resolución se considera imprescindible para consolidar su recuperación. Por eso, se han analizado los aspectos más importantes de la reforma mediante la realización de un resumen ejecutivo y se ha estudiado la influencia de las medidas que incorpora desde el punto de vista de tres factores, que previamente se han considerado como fundamentales para la recuperación del sistema portuario español, y que históricamente habían sido demandados por el mismo, como son, en primer lugar, un progresivo sistema de flexibilización tributaria que permitiera a los puertos españoles ganar en términos de competitividad respecto a otros modelos portuarios mucho más flexibles en materia tarifaria, en segundo lugar, una necesaria liberalización del régimen de prestación de los servicios portuarios que posibilite el libre acceso a cualquier interesado en su prestación y, en último lugar, el progresivo abaratamiento de los costes inherentes a dichos servicios, fundamentalmente la manipulación de mercancías. Con posterioridad se ha investigado el trámite parlamentario al que se ha sometido la ley, fruto del enorme consenso alcanzado entre las dos principales fuerzas políticas del país, que determinó que se presentaran más de 700 enmiendas al proyecto original, y en algunos casos, se ha prestado especial atención a determinadas enmiendas que se consideran, en opinión de este investigador, novedosas y aventuradas, razón por la cual quizás no fueron incorporadas definitivamente al texto legal. Y se han analizado las principales demandas y aportaciones extraídas de la Sesión Informativa sobre la tramitación del entonces proyecto de ley ofrecida por la Comisión de Fomento del Congreso de los Diputados a los principales representantes del sector, comunidad portuaria, universidad y sindicatos. Siendo conscientes de la incidencia que tiene el servicio portuario de manipulación de mercancías en el paso de la mercancía por el puerto, se ha hecho una referencia concreta al peculiar régimen jurídico y laboral del personal vinculado al servicio. Avanzamos que las características de la relación laboral especial, y su peculiar régimen jurídico, con una dualidad de relaciones laborales, tiene una influencia decisiva en la nómina del trabajador que se repercute en los usuarios del servicio, fundamentalmente el naviero y el operador de la terminal, que en definitiva, incide en la competitividad del puerto. Y se ha constatado el auge aperturista de numerosas legislaciones portuarias europeas, prestando especial atención al proyecto frustrado de liberalización de los servicios portuarios en la Unión Europea de la conocida como Directiva Loyola de Palacio del año 2003 y al Libro Blanco de Transportes del año 2011. Así como a las deficiencias advertidas por el Dictamen de la Comisión Europea de fecha 27/09/2012 en relación al régimen jurídico del servicio portuario de manipulación de mercancías, que lo considera disconforme y contrario con las normas de libertad de establecimiento en Europa y que amenaza con una previsible reforma unilateral de la legislación portuaria española, a instancias europeas. Bajo este planteamiento, se ha procedido a analizar el marco de prestación de dichos servicios desde el punto de vista de la propia comunidad portuaria. Inicialmente, a través de un estudio de fuerzas de la competitividad del sector de los servicios portuarios en el sistema portuario español que nos permitirá trazar un mapa estratégico del mismo a través del “Modelo de las Cinco Fuerzas de Porter” concluyendo, que el poder de los prestadores de servicios portuarios como proveedores de los mismos, fundamentalmente en la manipulación de mercancías, es máximo, con un único colectivo, los estibadores portuarios, que al amparo de la normativa legal vigente tienen la exclusividad de su prestación. Dichas circunstancias restan competitividad al sistema frente a alternativas portuarias más flexibles y desincentivan la inversión privada. Y, en segundo lugar, mediante un proceso participativo en distintas encuestas sobre el modelo legislativo y sobre el marco formativo del sector con los propios agentes afectados dentro de la comunidad portuaria, desde la triple perspectiva de la vertiente pública que representan las Autoridades Portuarias, como gestores de las infraestructuras, la vertiente privada que representan los usuarios y prestadores de servicios, como principal cliente del puerto y desde el punto de vista de la propia mano de obra portuaria materializada en la representación sindical de dichos trabajadores. Los resultados nos permitirán concluir, respectivamente, la incidencia del servicio portuario mercancía por el puerto, por representar más de la mitad de los costes. Así como la aspiración de los trabajadores adscritos a dicho servicio de consolidar un título formativo que unifique y potencie su capacitación profesional, circunstancia esta última, también demandada por toda comunidad portuaria. Analizadas las conclusiones extraídas en cada una de las líneas de investigación se han detectado una serie de ineficiencias dentro del mismo que dicho marco regulador no ha sabido resolver, por lo que se ha considerado la conveniencia de formular, como herramienta de ayuda a gestores del sistema portuario español, una relación de medidas que, en opinión de este investigador, se consideran necesarias para mejorar el régimen de prestación de los servicios portuarios y se ha propuesto un borrador de modificación del actual Texto Refundido que pueda servir de base para materializar una futura reforma legal. Las conclusiones obtenidas en la investigación deben sentar las bases de una profunda reflexión sobre la necesidad de encaminar, como alternativa a una previsible modificación a instancias europeas, una reforma legal que decididamente apueste por la competitividad del sistema portuario español desde el punto de vista de la liberalización de servicios, el abaratamiento de los costes de la estiba y la necesaria profesionalización de los trabajadores adscritos al servicio portuario de manipulación de mercancías. During 2013 the Spanish Port System moved nearly 458,54 million tons of freight, 13,8 million TEUs, involving a total of 131.128 ships for the 28 existing Port Authorities. With 62% of exports and 86% of imports made through sea transportation, a 2,34% profit, close to the 2,5% average annual profit goal legally established, revenues of 1.028 million € equivalent to a 1.1% of Spain’s GDP and a figure of 145.000 people a directly or indirectly employed we can conclude that maritime industry is undoubtedly one of the strategic and key sectors for the country’s economy. Since several decades many ports in the world have been increasingly developing “Hub” terminals, those which concentrate and distribute freight. Shipping companies place among these type of terminals their transoceanic sea liners along with huge dimension & capacity ships to make the container transit from these liners to other called “feeder” which are smaller freight ships that connect the “hub” with the ports within its maritime area of influence. Spain’s exceptional geostrategic location with over 8.000 km of coastline has originated that those big dimension Spanish ports aspire to become a part of a container international maritime network which also determines that transit container move is key within our port system. Nevertheless the economic crisis has had a decisive impact on the maritime sector originating a fierce battle between all ports, national and international ones, all of them fight against each other to catch this type of maritime traffic which triggers an ongoing shipping companies search in cost/service quality efficient ports. The cornerstone of the Restated Text of Port Law is Law 33/2010, which lays out as main goal the Spanish Port System competitiveness improvement and lead its recovery offering favorable environment conditions to Spanish ports which help encourage maritime traffic attraction and private investment through a wide offer of services, quality of infrastructure and competitive prices which can consolidate its positioning within the world’s maritime traffic. It is therefore key to investigate the influence of the measures proposed by the above mentioned law and also the solutions offered to the demands of a sector which is considered strategic for the country’s economy and which solution is essential to consolidate the recovery. It is because of this that the most important aspects of the reform have been analyzed through the making of an executive summary and it has also been studied the influence of the measures it includes from the point of view of three factors which have previously been considered as key for the Spanish port system recovery. The system has historically demanded a progressive tax flexibility, which would permit Spanish ports be more competitive compared to other port models much more flexible in rates, a necessary liberalization of the port service provision regime and last but not least, to cut the price of costs related to those services, mainly freight handling. Following this, the parliamentary process of the law has also been studied as a consequence of the vast consensus reached by the main political forces in the country which clearly determined that more than 700 amendments to the original project were presented. In some cases the focus has been on amendments which are adventurous and new, reason why they were finally not included to the final legal text. Being well aware of the importance that freight handling procedure has, I have made a specific reference to the legal and working framework of those employees related to this service. We conclude that the special working relationship, its different legal regime, along with the working relationship dualism has a big impact and decisive influence over the worker’s salary which also affects service users, mainly shipowners and terminal operators, having a bad effect on the port’s competitiveness. The above confirms the new opening trend of main European port laws with special attention to the frustrated European Union port services liberalization project, also known as Directive Loyola de Palacio (2003) and the White Paper on Transports (2011). It is important to highlight that the European Commission has also observed several deficiencies with regard to the freight handling port service Law Regime being in disagreement with it, considering it is against the free establishment rules in Europe. The Commission is likely to present a unilateral reform to the Spanish Port Law. Under this approach the service provision framework is being analyzed from the Port Community point of view. Initially the analysis will focus on the study of the competition forces within the port services industry in Spain, this will allow us to draw up an strategic map through “Porter’s Five Forces Model” concluding that the power of port services providers as freight handlers is maximum, with an only collective, stevedores, which has the exclusivity for their services. All these circumstances not only decrease the system’s competitiveness versus other more flexible but also restrain private investments. Secondly, through a participating procedure in different surveys about the legislative model and about the training framework with the affected agents within the port community, there is a triple perspective: Public point of view represented by Port Authorities as infrastructure managers, Private point of view represented by users and service suppliers as main Port’s customer and finally, port workforce, represented by union leaders. Results will let us conclude that freight handling service is the most critical port service and represents more than half of the costs. This service related workers aspire to obtain a training certificate that unifies and boosts their professional role which is also chased by the entire port community. Once conclusions have been analyzed for all research lines, several deficiencies have been found and the regulatory framework hasn’t yet been able to solve them, it has therefore been a series of necessary measures that help improve the port services provision regime. A new proposal to the Restated Law Text has been drafted as the first step to embrace a future legal reform. Conclusions obtained on the research should set the new basis of a deep reflection about the need to bent on a new legal reform which firmly bets on Spanish port system competitiveness from three key points of view, service liberalization, ship load cost reduction and professionalization of freight handling related workers.

Aprender conociendo a las personas usuarias de los servicios

Se presentan tres experiencias de innovación docente realizadas en la asignatura de Iniciación a las Habilidades Profesionales, primer curso del Grado en Trabajo Social, Universidad de Alicante. Objetivos: 1) Implicar en la docencia a las personas usuarias de los servicios, considerándolos expertos por su experiencia personal con Trabajadores Sociales y con la sociedad en general. 2) Proporcionar un contexto de aprendizaje que permita conocer, comprender y aprender a comunicarse profesionalmente con personas usuarias de servicios. Metodología: Aprendizaje significativo basado en la interacción con personas usuarias de los servicios con tres modalidades: a) Diseño conjunto de actividades de enseñanza-aprendizaje entre una entidad social y el profesorado de la asignatura Iniciación a las Habilidades Profesionales del Grado en Trabajo Social de la Universidad de Alicante; b) Diseño con enfoque multidisciplinar (profesorado de Trabajo Social con el profesorado de Ciencias de la Actividad Física y Deporte) y la entidad social; c) Diseño internacional con participación de las universidades Queen’s University, Belfast (Northern Ireland) (coordinadora del proyecto) junto con las universidades de Ljubljana (Slovenia) y Alicante. Los resultados proporcionan evidencias sobre la pertinencia de la colaboración docente de personas expertas por su experiencia y de la utilización de una metodología docente basada en el aprendizaje significativo para la adquisición de competencias.

Mental health recovery and occupational therapy in Australia and New Zealand

Every individual with mental illness has the right to be safe and cared for. Most people will receive the love and care from their families and friends, but they will also expect mental-health professionals, occupational therapists and the community to work together to provide the necessary services to support their recovery from mental illness. This article highlights the development of the recovery approach for people with mental illness in Australia and New Zealand. The implications of recovery concepts for occupational therapy, in the areas of individualized approach, participation of service users and carers, person-centred assessment and intervention, intersectoral links and mental-health promotion, are discussed. There are a number of key areas requiring further research and debate, notably the most effective means of implementing and evaluating recovery-focused interventions.

Partnerships in mental health: Addressing barriers to social inclusion

Current trends in mental health services emphasize working in partnership with consumers and other government and non-government community organizations for improvement in quality of life for service users. People with a mental illness experience social exclusion, thereby limiting their ability to participate fully in community life. Occupational therapists have a substantial role to play in helping service users to overcome barriers to their community inclusion. Partnerships need to be formed to increase access to community resources and participation in activities that are enjoyed by other members of the community. Such partnerships have a health promotion emphasis and foster the relationship between mental-health services and the wider community, thus shifting the focus from direct occupational therapy service delivery to community-based rehabilitation interventions.This article describes the development, implementation and evaluation of an Australian healthy lifestyle course devised to meet the identified rehabilitation goals of people with mental illness to lose weight, get fit, commence vocational study and get a job. The course was run in partnership between mental health consumers, occupational therapists from the St George Mental Health Rehabilitation Service and staff and students from the Sutherland College of Technical and Further Education.

Personalised social care for adults with disabilities: A problematic concept for frontline practice

This paper explores the complexities and contradictions of frontline practice that pose problems for personalised social care through enhanced choice. It draws on semi-structured interviews with community care workers, social workers, occupational therapists and care managers in a social service department. Practitioners interviewed were asked about their current assessment and documentation system, including the assessment documents currently used; how they approached information gathering and the topics they explored with service users; and their experience of documenting assessment and care management. The paper argues that the validity and sustainability of personalised social care in frontline practice relies on developing a thorough understanding of the complex and implicit assessment processes operating at the service user/practitioner interface and the inevitable tensions that arise for practitioners associated with the organisational context and broader service environment. The findings demonstrate the variability among practitioners in how they collect information and more importantly, the critical role practitioners occupy in determining the kinds of topics to be explored during the assessment process. In so doing, it shows how practitioners can exert control over the decision-making process. More importantly, it provides some insight into how such processes are shaped by the constraints of the organisational context and broader service environment. Complexities and contradictions may be an inherent part of frontline practice. The issues discussed in this paper, however, highlight potential areas that might be targeted in conjunction with implementing personalised social care through enhanced choice for people with disabilities.

Domestic violence and child abuse: developing sensitive policies

Domestic violence is everywhere and nowhere. No statutory organization or health service has work with either perpetrators or survivors of domestic violence (usually women and children) as the primary focus of their service, yet all agencies will have very significant numbers among their clients/service users. It is therefore crucial that the policy framework is developed both within and between agencies to address the need, and scope, of intervention in this area and particularly the impact on children. Currently, significant steps have been taken by some agencies in the UK to address this previously neglected issue, though the developments are patchy. This paper draws on a UK-wide research study which mapped the extent and range of service provision for families where there is domestic violence and also developed a framework of good practice indicators for ‘Mapped the extent and range of service provision for families where there is domestic violence and also developed a framework of good practice indicators’ provision in this area. This article examines one of the indicators of good practice arising from the research—that of policy development—within social service departments and within the multi-agency arena.

A study of outcomes measures in forensic mental health

Outcomes measures, which is the measurement of effectiveness of interventions and services has been propelled onto the health service agenda since the introduction of the internal market in the 1990s. It arose as a result of the escalating cost of inpatient care, the need to identify what interventions work and in what situations, and the desire for effective information by service users enabled by the consumerist agenda introduced by Working for Patients white paper. The research reported in this thesis is an assessment of the readiness of the forensic mental health service to measure outcomes of interventions. The research examines the type, prevalence and scope of use of outcomes measures, and further seeks a consensus of views of key stakeholders on the priority areas for future development. It discusses the theoretical basis for defining health and advocates the argument that the present focus on measuring effectiveness of care is misdirected without the input of users, particularly patients in their care, drawing together the views of the many stakeholders who have an interest in the provision of care in the service. The research further draws on the theory of structuration to demonstrate the degree to which a duality of action, which is necessary for the development, and use of outcomes measures is in place within the service. Consequently, it highlights some of the hurdles that need to be surmounted before effective measurement of health gain can be developed in the field of study. It concludes by advancing the view that outcomes research can enable practitioners to better understand the relationship between the illness of the patient and the efficacy of treatment. This understanding it is argued would contribute to improving dialogue between the health care practitioner and the patient, and further providing the information necessary for moving away from untested assumptions, which are numerous in the field about the superiority of one treatment approach over another.

Integrated team working: a literature review

Introduction: This literature review was conducted to provide a background understanding of the literature around integrated health and social care prior to a research project evaluating two integrated health and social care teams in England, UK. Methods: A systematic literature search of relevant databases was employed to identify all articles relating to integrated health and social care teams produced in the last 10 years in the UK. Results: Sixteen articles were found and reviewed; all were reviewed by the first reviewer and half by the second reviewer. Discussion: Key themes identified were: drivers, barriers and benefits of integrated working; staff development; and meeting the needs of service users. Conclusion: Recommendations for integrated working include; a focus on the management of integrated teams; a need to invest in resources for the successful integration of teams; a need for the development of clear standards for monitoring the success and failure of integrated teams; and the need for further empirical evidence of the processes used by integrated teams. These findings will be valuable for practitioners who are establishing services or want to improve integrated care in their own practice.

Building cliques and alliances as practices to 'make things happen' in complex networks

The Roma population has become a policy issue highly debated in the European Union (EU). The EU acknowledges that this ethnic minority faces extreme poverty and complex social and economic problems. 52% of the Roma population live in extreme poverty, 75% in poverty (Soros Foundation, 2007, p. 8), with a life expectancy at birth of about ten years less than the majority population. As a result, Romania has received a great deal of policy attention and EU funding, being eligible for 19.7 billion Euros from the EU for 2007-2013. Yet progress is slow; it is debated whether Romania's government and companies were capable to use these funds (EurActiv.ro, 2012). Analysing three case studies, this research looks at policy implementation in relation to the role of Roma networks in different geographical regions of Romania. It gives insights about how to get things done in complex settings and it explains responses to the Roma problem as a „wicked‟ policy issue. This longitudinal research was conducted between 2008 and 2011, comprising 86 semi-structured interviews, 15 observations, and documentary sources and using a purposive sample focused on institutions responsible for implementing social policies for Roma: Public Health Departments, School Inspectorates, City Halls, Prefectures, and NGOs. Respondents included: governmental workers, academics, Roma school mediators, Roma health mediators, Roma experts, Roma Councillors, NGOs workers, and Roma service users. By triangulating the data collected with various methods and applied to various categories of respondents, a comprehensive and precise representation of Roma network practices was created. The provisions of the 2001 „Governmental Strategy to Improve the Situation of the Roma Population‟ facilitated forming a Roma network by introducing special jobs in local and central administration. In different counties, resources, people, their skills, and practices varied. As opposed to the communist period, a new Roma elite emerged: social entrepreneurs set the pace of change by creating either closed cliques or open alliances and by using more or less transparent practices. This research deploys the concept of social/institutional entrepreneurs to analyse how key actors influence clique and alliance formation and functioning. Significantly, by contrasting three case studies, it shows that both closed cliques and open alliances help to achieve public policy network objectives, but that closed cliques can also lead to failure to improve the health and education of Roma people in a certain region.

An exploratory study of the role of trust in medication management within mental health services

Objective - To develop understandings of the nature and influence of trust in the safe management of medication within mental health services. Setting - Mental health services in the UK. Method - Qualitative methods were applied through focus groups across three different categories of service user—older adult, adults living in the community and forensic services. An inductive thematic analysis was carried out, using the method of constant comparison derived from grounded theory. Main Outcome - Measure Participants’ views on the key factors influencing trust and the role of trust in safe medication management. Results - The salient factors impacting trust were: the therapeutic relationship; uncertainty and vulnerability; and social control. Users of mental health services may be particularly vulnerable to adverse events and these can damage trust. Conclusion - Safe management of medication is facilitated by trust. However, this trust may be difficult to develop and maintain, exposing service users to adverse events and worsening adherence. Practice and policy should be oriented towards developing trust.

Medication error in mental health:implications for primary care

Medication errors are associated with significant morbidity and people with mental health problems may be particularly susceptible to medication errors due to various factors. Primary care has a key role in improving medication safety in this vulnerable population. The complexity of services, involving primary and secondary care and social services, and potential training issues may increase error rates, with physical medicines representing a particular risk. Service users may be cognitively impaired and fail to identify an error placing additional responsibilities on clinicians. The potential role of carers in error prevention and medication safety requires further elaboration. A potential lack of trust between service users and clinicians may impair honest communication about medication issues leading to errors. There is a need for detailed research within this field.