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The unique nature of the needs of children with disabilities and the varied dynamics of family life mean that service provision cannot be boxed neatly into the individual arenas of health, education or social care. These children and their families' present service providers with complex challenges that often test the system. The co-ordination of, and communication between, members of the team around the child often falls to the parent. The concept of 'key working' has been suggested as a way of co-ordinating service provision for children with a disability and their families. However, it has been reported that there are less than one-third of these families who have such a support mechanism in place (Department of Health 2004a). The policy and legislative framework exists for the introduction of the 'key worker' system to health, education and social care practice (Department of Health 2oo4a). Therefore, it is difficult to discern why the key worker role is not more prevalent. However a contributing factor may be that there is no universally recognised definition for the role and no consensus on the specific tasks that should be undertaken by a key worker. Using grounded theory methodology, this qualitative study investigated and explored the dynamics of team working for children with disabilities and the process of co-ordination of services with specific reference to the role of the key worker. Using interviews and focus groups data were generated from professional members of the team, as well as parents of children with disabilities. Analysis of the data identified issues in current practice that present barriers to effective team working and the application of the key worker role. A model of supportive practice was developed to promote improved collaborative team working and utilise the key worker role to provide a more positive experience of service provision for children with disabilities and their families.

The Family Quality Of Life (FQOL) of families who have a child with Tourette Syndrome (TS) has not yet been investigated globally. The purpose of this study was to gather data and listen to the voices and opinions of families of children with TS in order to examine the extent to which the existence of a child with TS, in the family, affected their FQOL. The research was conducted according to the mixed methods approach, combining quantitative and qualitative methods. Data was collected concerning the research population that included all the families who have a child with TS living at home, and registered at the Tourette Syndrome Organisation in Israel. Additionally, semi-structured interviews were conducted with 10 of these 25 families of children with TS. The questionnaire was analysed statistically and the interviews were analysed using a content analysis method. Conclusions derived from the research findings allowed the emergence of the ACEIST model, including five new sub-domains of FQOL that reflect the experiences of the studied families: Advocacy, cooperation, explanation, information, and severity of TS. This is a new way to view FQOL of families having a child with TS, very precise and operative and specific to those families. This ACEIST model fills the gap in knowledge identified in this field, contributing to knowledge regarding FQOL of families who have a child with TS. The new model has practical implications for the education, social and health policies in Israel regarding families who have a child with TS.

This thesis investigates the lives of seven disabled people who were sexually abused in childhood by utilising narrative methodology and the application of the social model of disability. Flexible methods of participation were offered to participants and continuous ethical evaluation formed the backbone of the research relationship. Thematic analysis generated three interlocking and overarching "grand" themes that constituted the substantive chapters of the thesis (power, identity and narrative) and provided a structure within which the findings were embedded. Narratives of power illustrate how the sexually abused disabled child is potentially located at the collision point of a number of oppressive societal beliefs and practices related to the treatment of both children and disabled individuals. These debilitating attitudes become apparent in the workings of certain organisational structures and the general functioning of some family environments. Narratives of identity deals with the issue of how a, sometimes, fragile identity created by disability oppression becomes fragmented by the sexual abuse experience. It also illustrates that from this compromised starting position, participants have been able to forge a series of self-affirming collective identities. The chapter entitled narratives of the narrative concerns itself, ostensibly, with the reconstruction of the abuse narrative. Within this chapter it can be seen that when the usual defence mechanisms (dissociation) become less necessary for survival, and when the external triggers are prevalent, the sexual abuse narrative emerges creating narrative chaos (Frank, 1995) and emotional destabilisation. The personal healing process has involved the reconstruction of a more reflective, self-absolving and coherent version of events, which contains narrative truth (Spence, 1994). In concluding this thesis, several tasks were undertaken including the weaving together of the complex relationship between disability and child sexual abuse, and a highlighting of the key pressure points where difficulties were exaggerated. It also involved: consideration of whether narrative methodology fulfilled its purpose, a reflection on the work's theoretical positioning and the implications of the thesis for policy and practice.