Cultural safety, diversity and the servicer user and carer movement in mental health research

This study will be of interest to anyone concerned with a critical appraisal of mental health service users’ and carers’ participation in research collaboration and with the potential of the postcolonial paradigm of cultural safety to contribute to the service user research (SUR) movement. The history and nature of the mental health field and its relationship to colonial processes provokes a consideration of whether cultural safety could focus attention on diversity, power imbalance, cultural dominance and structural inequality, identified as barriers and tensions in SUR. We consider these issues in the context of state-driven approaches towards SUR in planning and evaluation and the concurrent rise of the SUR movement in the UK and Australia, societies with an intimate involvement in processes of colonisation. We consider the principles and motivations underlying cultural safety and SUR in the context of the policy agenda informing SUR. We conclude that while both cultural safety and SUR are underpinned by social constructionism constituting similarities in principles and intent, cultural safety has additional dimensions. Hence, we call on researchers to use the explicitly political and self-reflective process of cultural safety to think about and address issues of diversity, power and social justice in research collaboration.

Perceived Value of Mobile Service Use and its Consequences

The thesis is positioned in the services marketing field. Previous mobile service research has identified perceived value or relative advantage as a stable predictor of use of services. However, a more detailed view of what customers value in mobile services is needed for marketing diverse types of mobile content and attracting committed customers. The direct relationships between multidimensional value and loyalty constructs have received limited attention in the previous literature, although a multidimensional view is needed for differentiating services. This thesis studies how perceived value of mobile service use affects customer commitment, repurchase intentions, word-of-mouth and willingness to pay. The doctoral thesis consists of three journal articles and one working paper. The four papers have different sub-aims and comprise individual empirical studies. Mixed methods including both personal interviews and survey data collected from end-users of different types of mobile content services are used. The conceptual mobile perceived value model that results from the first explorative empirical study supports a six- dimensional value view. The six dimensions are further categorized into two higher order constructs: content-related perceived value (emotional, social, convenience and monetary value) and context-related (epistemic and conditional value) perceived value. Structural equation modeling is used in the other three studies to validate this framework by analyzing the relationships between context- and content-related value, and how the individual perceived value dimensions affect commitment and behavioral outcomes. Analyzing the direct relationships revealed differences in the effect of perceived value dimensions between information and entertainment mobile service user groups, between effects on commitment, repurchase intentions and word-of-mouth intentions, as well as between effects on commitment to the provider and to the mobile channel as such. This thesis contributes to earlier perceived value literature by structuring the value dimensions into two groups. Most importantly, the thesis contributes to the value and loyalty literature by increasing understanding of how the different dimensions of perceived value directly affect commitment and post-purchase intentions. The results have implications for further theory development in the electronic services field using multidimensional latent constructs, and practical implications for enhancing commitment to content provider and for differentiated marketing strategies in the mobile field. The general conclusion of this thesis is that differentiated value-based marketing of mobile services is essential for attracting committed customers who will use the same providers’ content also in the future. Minna Pihlström is associated with the Centre for Relationship Marketing and Service Management (CERS) at Hanken.

Child Protection Work and Family Support Practice in Five Family Centres

Academic interest in the work of family centres in the United Kingdom has largely been concerned with categorising the work of such centres in terms of issues of childcare ideology, working practices and degree of service user control. Meanwhile, the re-focusing of child protection services in order to develop child welfare services has largely dominated childcare social work in recent years, with scant attention paid to the role of family centres in relation to this debate. This study is concerned with examining the perspectives of staff and service users in five 'client focussed' family centres in Northern Ireland in relation to how child protection issues are understood and dealt with. It was found that staff enter into negotiations with both referrers and service users to conceptually reframe child protection work as family support practice. This leads to the development of partnership relationships between staff and service users based upon mutual high regard. The work of such centres leaves them well placed to provide integrated services to children in need in line with current government priorities, but could leave some children vulnerable where child protection issues are not amenable to conceptual reframing along family support lines.

Innovative Approaches to Involving Service Users in Palliative Care Social Work Education

Service user involvement in social work education is now a firmly established concept in UnitedKingdom.As a result, it is common practice for service users to occupy central roles the education and training of social work students and staff in both qualifying and postqualifying programmes. This paper describes an initiative, undertaken inNorthern Ireland, which compares two methods of user involvement employed with undergraduate and postqualifying social work students. In both situations the students firstly observed discussedDVDexcerpts of narratives from people affected by cancer and secondly observed live facilitated interview with a 25-year-old male service user who shared his experiences being diagnosedwith cancer at a young age.Understanding the social work role in palliative care is crucial as all social workers, regardless of practice context, will have some degree involvement in helping individuals and families to address end-of-life care issues. paper compares the findings of evaluations from two student groups which may help inform social work educators about the effectiveness of different teaching methods used achieve meaningful and effective user involvement with seldom heard groups.

'Like waking up in a Franz Kafka novel': Service users' experiences of the child protection system when domestic violence and acrimonious separations are involved

The challenges that arise in respect of child abuse reports made in the context of domestic violence and/or acrimonious separation have been the subject of recent academic discussion. This paper adds a service user perspective to the debate and reports on the findings from a study conducted in the Republic of Ireland. In addition to the previously established evidence about such cases, it demonstrates the level of powerlessness and frustration experienced by families who found it difficult to have their needs heard or met. It also illustrates the very detrimental emotional impact on children and parents who frequently encountered indifference as well as insensitive and gendered responses from child protection staff. The findings indicate that mainstream statutory child protection services do not have the capacity to deal with these complex cases, and advocates the adoption of alternative approaches. Importantly, the study demonstrates the necessity to pay attention to the views of service users in developing an appropriate response.

User perspective on palliative care services: experiences of middle-aged partners bereaved through cancer known to social work services in Northern Ireland

This qualitative research study explores experiences of partners bereaved through cancer, who were resident in an urban area of Northern Ireland and who had been service users of the social work services. Data were collected in 2004 from 10 individuals who participated in semi-structured interviews. Emergent themes were identified using thematic content analysis and findings analysed under four categories: cancer journey; impact of bereavement; process of adjustment and change; and experience of support services. Opportunities to facilitate communication were not always maximised, often resulting in poor bereavement outcomes. Although hospices undertook bereavement risk assessment, participants were unaware of its use and queried its accuracy without service user involvement. The most cited informal support was family and friends, although such help was time-limited. Service user feedback regarding social workers was generally positive; however, there was a lack of knowledge about their role in palliative care. Post-bereavement adjustment was influenced by the quality of social networks, the responsibilities of lone parenthood, and challenges to life values and core beliefs. A framework for palliative care social work has been recommended based on research findings.

Social Work Students Learn about Social Work Values from Service Users and Carers

Teaching on social work values is centrally important in social work education as a core aspect of underpinning knowledge in preparing students for practice. This paper describes an innovative project occurring within the first year of the degree in social work, where service users and carers have assisted students with their understanding of social work values. The positive contribution of service users and carers in facilitating students to make links between theory and practice is now well documented. Applying this user perspective to the educational domain of values, however, is relatively uncharted territory given the challenges that have traditionally accompanied the teaching of values. Importantly, this paper describes the ‘value talk’ which occurred when first-year students sought further meaning from service-user and carer groups in their community settings following classroom teaching on values. The paper not only discusses the detailed preparations involved in the project but also the learning which resulted, drawing on the evaluation findings from the students and participating groups. Whilst the findings show that the students' understanding of social work values has been most significantly influenced by the contributions from service users and carers, it is recognized that further research is needed to monitor the longer term impact on social work students' practice after they qualify.

Enabling Social Work Students to Deal with the Consequences of Political Conflict: Engaging with Victim/Survivor Service Users and a ‘Pedagogy of Discomfort’

This paper describes the evaluation of an educational project, delivered in a Bachelor in Social Work degree (BSW) program in Northern Ireland. The project aimed to equip social work students to be more culturally competent in this divided society, with a central focus on including victim/survivor service users in social work training. A number of pedagogical approaches are noted, with particular consideration of Boler's ‘pedagogy of discomfort’ as a model that includes the multidimensional nature of the learning process when topics carry a high emotional tariff. The evaluation of the students' experience indicated that: there was strong support among students for the project; the unique contribution of service users was affirmed; and the project appeared to increase students' awareness and capacity to practice in a divided society. The evaluation of the trainers' experience highlighted key processes in the delivery of collaborative training. The authors argue that the lessons learned are broadly applicable to other forms of service user and carer involvement in social work training and in other societies in which health and social care professionals have to deal with the legacies of political conflict.

Applying the recovery approach to the interface between mental health and child protection services

There are a range of theoretical approaches which may inform the interface between child protection and adult mental health services. These theoretical perspectives tend to be focused on either child protection or mental health with no agreed integrating framework. The interface continues to be identified, in research, case management reviews and inquiry reports, as complex and problematic. This paper proposes that more positive, integrated approaches to service user engagement, risk assessment and management may lead to better outcomes in working with families experiencing parental mental health problems and child protection concerns. It is proposed that the recovery approach, increasingly used in mental health services, can inform the processes of engagement, assessment and intervention at the mental health and child protection interface. The article provides a critical overview of the recovery approach and compares it with approaches typifying interventions in child protection work to date. Relevant research and inquiries are also examined as a context for how to more effectively respond to cases where there are issues around parental mental health problems and child protection. The article concludes with case material to illustrate the potential application of the recovery approach to the interface between mental health and child protection services.

Carers and Co-Production: Enabling Expertise through Experience?

Purpose To provide a brief overview of the literature to date which has focussed on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration. Design The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice. Findings Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision-making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care. Research Limitations Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic. Practical Implications Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the ‘triangle of care’ with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors. Social Implications The families of people with severe and enduring mental illness (SMI) assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al, 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The ‘co-production of care’ reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the ‘triangle of care’ with carers bringing their own skills, resources and expertise. Originality/Value This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a ‘triangle of care’.

Contributo para a validação da versão portuguesa do instrumento de avaliação VOICE (service users perceptions of impatient care, Views on Inpatient Care)

RESUMO: Nos últimos anos assistiu-se a um reposicionamento das pessoas portadoras de doença mental na sociedade, no sentido de viverem em pleno os seus direitos, sem restrições. Esta tendência acompanhou as transformações que se têm vivido na forma como os utentes dos serviços de saúde interagem com os mesmos e com os profissionais de saúde, de forma a permitir uma maior autonomização e responsabilização no que concerne ao tratamento da sua doença, a relação que estabelecem com o seu médico, e a participação na avaliação e monitorização da qualidade dos serviços. Mais recentemente, também no mundo científico, esta afirmação se fez sentir, com o surgimento de investigação liderada por utentes, no sentido de estudar de forma adequada questões que partem do seu ponto de vista, e que possibilitem a produção de conhecimento significativa no contexto das suas experiências. Com o presente trabalho pretende-se contribuir para a validação da versão portuguesa do VOICE (Service Users’ Perceptions of Inpatient Care, Views on Inpatient Care) (Evans et al., 2012), instrumento para a avaliação dos serviços de internamento de agudos em psiquiatria, construído a partir de um investigação liderado por utentes e partindo das suas perspectiva. O VOICE é constituído por 19 questões, agrupadas em sete domínios: admissão; cuidados e tratamento; medicação; equipa de técnicos do internamento; terapia e atividades; ambiente e diferenças. O presente estudo envolveu uma amostra de 85 utentes de um serviço de internamento de agudos de uma instituição psiquiátrica do Norte de Portugal. A versão portuguesa do VOICE apresentou boa aceitação por parte dos utentes e boas características psicométricas - a consistência interna foi alta (α = 0,87) e todos, exceto um item (item 6), apresentam elevadas correlações item-total (variando de 0,18 - item 6 a 0,71 - item 11; M = 0,54, DP = 0,15), sugerindo ser um instrumento útil na avaliação dos serviços de internamento de agudos. No futuro torna-se necessário alargar o estudo a outros contextos de internamento e envolvendo amostras mais alargadas.-------------- ABSTRACT: In recent years there has been a gradual process to help people with the experience of mental illness regaining their full rights. Following the advances in the understanding of mental health problems, and the use of medication to help patients overcome symptoms, service-users have become more autonomous and responsible in the way they deal with health professionals, and are now called to participate in assessing and monitoring mental health services and policies. In the context of these transformations we have assisted to the emergence of research led by service-users (in this case of psychiatric and mental health services) in order to emphasize their point of view, and to enable the production of significant knowledge resulting from their experiences, and perceptions. The present study aims to contribute to the dissemination of service-user led research, based on the adaptation and validation of the Portuguese version of the VOICE - Service Users' Perceptions Questionnaire, Views on Inpatient Care. (Evans et al., 2012). The VOICE is composed of 19 questions, grouped in seven domains: admissions, care and treatment, medication, team of technicians during hospitalization, therapy and activities, environment and diversity. The present study involved a sample of 85 inpatient of a psychiatric institution in Northern Portugal. The Portuguese version of the VOICE showed good psychometric properties and was well accepted by patients [high internal consistency (α = 0,87); and high correlation of each item, except item 6, with the total score (ranging from 0.18 on item 6 to 0.71 on item 11; average=0,54; SD=0,15), suggesting it to be a useful tool for assessing inpatient services. In the future there is a need to extend the study to other contexts and include larger samples.

Service users’ participation in mental health community-based organizations

Une grande proportion de personnes aux prises avec des problèmes de santé mentale vit dans l’isolement social. Les infirmières en santé communautaire sont interpellées au premier rang pour accompagner ces personnes dans leur processus de rétablissement et pour atténuer leur isolement social. La participation au sein d’organismes communautaires optimise l’expérience de rétablissement, diminue l’isolement social et renforce les réseaux sociaux de personnes ayant des problèmes de santé mentale. Toutefois, la participation des personnes utilisatrices de services dans la structure d’organisation des organismes communautaires est encore peu documentée. Afin de pallier cette lacune, cette étude avait pour objectifs de documenter, décrire la nature de la participation des personnes utilisatrices de services en santé mentale et d’explorer des facteurs facilitatants et des barrières à cette participation. Un devis de méthodes mixtes, qualitatif et quantitatif, a été utilisé. Dans le premier de deux volets, une enquête impliquant la réalisation d’entretiens semi-dirigés a été menée auprès de douze directeurs d’organismes communautaires œuvrant dans le domaine des services en santé mentale. Une version française du questionnaire « Adapted User Involvement » (Diamond, Parkin, Morris, Bettinis, & Bettesworth, 2003) a été administrée afin de documenter l’étendue de la participation des personnes utilisatrices de services dans les organismes visés. Pour le deuxième volet, deux organismes communautaires ont été sélectionnés à partir des résultats du questionnaire et de l’analyse documentaire de documents publics de ces organismes. Les scores obtenus au questionnaire ont ainsi permis de sélectionner des organismes présentant des résultats contrastés en matière de participation des personnes utilisatrices de services. Les entretiens semi-dirigés ont été menés avec différents groupes de répondants (membres de conseil d’administration, personnes utilisatrices de services, employés, directeurs) afin de recueillir de l’information sur les thèmes suivants: la nature de la participation des personnes utilisatrices de services, ainsi que les facteurs facilitants et les défis qui y sont associés. Les résultats de l’analyse montrent que: (1) les facteurs qui favorisent la participation des personnes utilisatrices sont: l’accès à un espace de participation pour les personnes utilisatrices et l’accompagnement de celles-ci par les intervenants de diverses disciplines pendant leur participation au sein des organismes communautaires, (2) les barrières de la participation des personnes utilisatrices au sein des organismes communautaires sont la stigmatisation sociale et les caractéristiques personnelles reliées aux problèmes de santé mentale chez les personnes utilisatrices, et (3) les avantages principaux de la participation des personnes utilisatrices de services se déclinent en services mieux adaptés à leurs besoins et leurs demandes, en leur appropriation du pouvoir (dans leur participation dans l’organisme communautaire) et en leur sentiment d’appartenance à l’organisme. À la lumière des ces constats, l’accompagnement des personnes utilisatrices de services dans leur participation apparaît une avenue prometteuse pour les infirmières en santé mentale communautaire afin de faciliter leur appropriation du pouvoir et d’améliorer leur bien-être.

Using non-personal computers for eLearning: Sri Lankan experience

Communal Internet access facilities or telecentres are considered a good way to provide connectivity to people who do not possess home connectivity. Attempts are underway to utilize telecentres as eLearning centres providing access to learning materials to students who would otherwise not be able to take up eLearning. This paper reports on the findings of qualitative interviews conducted with 18 undergraduate students from two Sri Lankan universities on their eLearning experiences using communal Internet access centres. The findings suggest that despite the efforts by telecentres to provide a good service to eLearners, there are various problems faced by students including: costs, logistics, scarcity of resources, connectivity speeds, excessive procedures, and lack of support. The experiences of these Sri Lankan students suggest that there is much that needs to be understood about user perspectives in using telecentres, which could help formulate better policies and strategies to support eLearners who depend on communal access facilities.

The promotion and disruption of community service delivery systems

In this paper, we report data drawn from a larger project on the functioning of the Queensland community service delivery system, particularly that providing services to people with disabilities. Our reasoning for focusing at this level is that, from the service user's perspective, support is derived from the service delivery system, not just individual service providers. Defining the service delivery system as formal services and informal support networks, we undertook interviews and focus groups with service providers in six areas in Queensland: inner urban, outer urban, rural and remote. The period on which we report is one in which considerable reform activity had been undertaken by funding bodies of the Commonwealth and State governments. We report on those factors we identified which promote the integrated functioning of the service delivery system, as well as those factors that disrupt it. We conclude with a brief evaluative analysis of the current status of the system.

Researching homelessness: Challenging exclusion?

This themed issue of Social Inclusion provides a timely opportunity to reflect on how contemporary research is addressing the multi-dimensional issue of homelessness around the world. The papers presented here provide a wide range of new evidence on homelessness including theoretical, methodological and empirical contributions. They draw on a range of national experiences in Europe and beyond, and addressing the issue of social inclusion and social exclusion of homeless or previously homeless people from a range of perspectives and approaches. It is hoped that the contributions to this themed issue will prove influential in terms of both scholarship and potential to enhance policy making and service delivery to some of our most excluded citizens.