The objective of this licentiate’s dissertation is the developing occupational role of ‘personligt ombud’ (PO), a case manager for persons with severe psychiatric disabilities. The purpose of PO, put forward by a government’s commission (Psykiatriutredningen) 1992, was to implement a new way of providing support and to coordinate interventions with an aim to improve the life conditions of persons with severe psychiatric disabilities. The aim of this licentiate’s dissertation is to characterize PO as a phenomenon within disability politics. The empirical data were collected in three counties, viz the counties of Blekinge, Kalmar and Kronoberg. All POs within these counties were inter-viewed as well as influential managers. Clients of the POs were also interviewed. The results imply that POs construct their understanding of their clients’ problems within a medical discourse, individualizing the problems as a result of illness. However, in their actions to solve problems they take social measures relating to a citizen discourse, focusing on citizen rights and living conditions. The occupational role of the PO develops within these discourses in conflict. The POs’ courses of action were analyzed as four stylized patterns that can be identified with methods and theory in Social Work: rehabilitation, paternalism, empowerment and advocacy. Empowerment and advocacy can be seen as new courses of action used by POs as professionals within the public sector for sup-porting this target group. Conclusions indicate that while formulating medical explanations to their cli-ents’ problems, the lack of language to formulate and analyze the structural and social problems is creating a risk of POs strengthening the exclusionary proc-esses. Nevertheless, the occupational role of the PO has developed a new ex-pected function as society integrated support, built on empowerment, advocacy and user control.

This paper is focused on new trend in business process automation -- case management; main goal of the paper is proofing of concept for life insurance origination using case management. To fulfill this goal I had to analyze available reports from leading research companies such as Forrester and Gartner. The methodology of achievement the goal of the thesis is complemented with my own practical experiences. This thesis consists from theoretical and practical sections. There are characteristics of case management, general architecture of case management illustrated on IBM Case Manager, market insight of case management and typical case management use cases in theoretical section. Practical section is focused on case management utilization for life insurance origination process. To achieve this, there are defined sample insurance company and process analysis of life insurance origination, analyzed requirements for the proof of concept, its solution architecture and of course the proof of concept is implemented. The last chapter contains evaluation of the proof of concept and includes typical expected case management effects for financial sector. The main contribution of the paper to case management topic is the first complete description of the topic in Czech language and creating proof of concept for case management approach in financial sector.

The 2014-2016 Ebola pandemic in Sierra Leone significantly increased the orphan population and the need for social support programs, especially for student-orphans in higher education. Poorly prepared disaster response managers have little knowledge about how college student-orphans experience social services. The purpose of this transcendental phenomenological study was to explore how post-Ebola student-orphans enrolled in an agricultural university in rural Sierra Leone experienced post disaster specialized case management to enhance student performance. Criterion sampling techniques including specific inclusion and exclusion criteria guided the recruitment, that included 10 research participants taking part in the semi structured interviews. Ecological system theory and postpositivist ontology informed this transcendental phenomenological research. The modified van Kaam transcendental phenomenological data analysis enabled the development of themes from lived experiences of post-Ebola case management for student-orphans. The findings of the research showed that student-orphans experienced specialized case management with three characterizations: (a) sadness, (b) happiness, and (c) anger which included information helpful for crisis and disaster case management administration and staff across similar circumstances. The social change implication for the study results include information useful for human service administrators and staff in designing and employing post disaster programs for college student-orphans.

More than 5 million Americans have heart failure, with approximately 5% of those affected being veterans. As the number of patients with CHF continues to rise, new treatment options are needed to improve the quality of care. Current studies show Telehealth is one treatment option. The purpose of this scholarly project was to determine if veterans diagnosed with CHF were able to maintain optimal weight and blood pressure following participation in Care Coordination Home Telehealth (CCHT) program. The CCHT program provides care to veterans, through the use of monitoring devices placed in their home. Bandura's self-efficacy theory was used as a guide to develop veterans' self-management skills. A retrospective chart review was conducted on 26 veterans with CHF enrolled in the CCHT program. Post participation weight and blood pressure were analyzed at 16 weeks to determine whether there was a difference from the pre-participation measures. There was no change in systolic blood pressure, diastolic blood pressure, or weight levels during the 16-week period. Limitations of this project were the small sample size (n = 26), attrition rate (n = 43), no data on nurse interaction, and a short follow-up period. Implications for nursing practice and enhancing the program's efficacy are recommended. This scholarly project has the potential to support social change by expanding veteran's access to care.

Extended hospital length of stay (LOS) causes increased health care costs and incidence of never events, such as hospital-acquired infections, pressure ulcers, and falls, which are not reimbursed by Medicare. This study examined if there would be a statistically significant decrease in the LOS of patients after the implementation of a discharge process improvement initiative (DPII), The model for improvement and small tests of change concept were used to guide the DPII at a hospital in northern California. Sources of data included archival data obtained from the hospital's quality improvement department that showed LOS prior to and after the implementation of the DPII. The LOS for 2015 and 2017 were compared using the t test for independent samples. The LOS in 2015 was longer (M = 4.59, SD = 3.66) than in 2017 (M = 4.09, SD = 3.81), a statistically significant difference, M = 0.50, 95% CI [0.32, 0.67], t (77) = 5.574, p = .005, d = 1.3, showing that the implementation of the DPII led to a reduction in the LOS. This reduction cannot be attributed solely to the DPII because other projects were implemented at the same time, such as the Clinical Decisions Unit and multidisciplinary rounds. Future research could focus on the relationship between reduced LOS and readmission and the degree of collaboration among health care team members. The implications of this study for social change include the potential to lower health care costs and increase patients' awareness of their responsibility for their own health.

Introduction: Early detection and case management remain the main strategies in malaria control programme (MCP) in a low endemic area such as in Java Island, Indonesia. These strategies require an understanding of the community’s care-seeking behaviour in relation to the various health services. Since most malaria cases in Java are diagnosed at home by the village malaria workers (VMWs), this study aimed to examine the user-provider interface in early detection and case management of malaria, particularly the interaction between the clinical malaria patients and the VMWs. Methods: The number of blood slides examined and the laboratory results over a 20-year period were retrieved from the routine malaria surveillance system. The population at risk of malaria and the rainfall data were obtained from secondary sources. In addition, age, sex, malaria species, types of drugs, drug and dosage and time lapse between slides taken and examined were recorded from the malaria registers at the three endemic health centres from 1994-1998. The quality of diagnosis was examined by re-reading 153 slides at the Faculty of Medicine, Gadjah Mada University. Prior to using rapid assessment procedures (RAP), we proposed 11 criteria and applied these to 15 published RAP studies in health. For each of the papers, two authors assessed the adequacy of information provided independently. Using the criteria as a guideline for developing a protocol, a RAP study of malaria was thereafter carried out. Data were retrieved from 38 free-listings, 28 in-depth interviews, seven focus group discussions and unstructured observation. A qualitative thematic content analysis was applied. Finally, based on the RAP results, a one-year longitudinal study of care-seeking behaviour of all clinical malaria cases treated by the VMWs was conducted in Mlonggo II area. Age, sex, daily actions and date of consultations were recorded by all VMWs in a diary that covered prior all contacts between the patients and the VMWs. Also, 24 interactions between the VMWs and the patients were audiotaped. Results: The incidence of malaria during the 1990s fluctuated, albeit at the lower level than that of the 1980s, and it reached a peak (3.5/1000 population) during an outbreak in 1996-97. There was no clear association between the El Nino phenomenon and incidence of malaria. The incidence was almost twice as high in children <15 years than in adults (15+ years). In <5 year old children the risk of P. vivax malaria was higher than the risk of P. falciparum. Comparisons between active and passive case detection (ACD and PCD) showed that almost 60% of 10, 493 confirmed malaria cases in Jepara were identified from ACD. ACD also detected significantly higher percentage of P. falciparum gametocyte infections than PCD (14.7% vs. 5.7%). The duration between slides taken to examination was however longer for ACD than for PCD (2.3 vs. 1.1 days). Applying the criteria to the published RAP studies, it was found that information was limited to address subjectivity, staff and ethics criteria. In Jepara, malaria (known as katisen or panas tis) was considered a common but minor illness. This was also reflected by the most common action taken by the patients, i.e. not doing anything. However, when the illness was perceived as important, the community had a good access to different health care providers. Eighty seven percent of cases had been treated by the VMWs on day four of the illness period. On day two, the proportion not treated was significantly higher in male than in female cases (60.7% and 54.6%; p 0.01) and in those <15 years of age compared with those 15+ years (71.3% and 56.9%; p<0.001). Insufficient understanding of malaria signs and symptoms likely leads to delay in illness recognition and treatment. Interactions between the VMWs and the patients were mostly focused on medical tasks, and low compliance with treatment was a common concern of the VMWs in the interaction. Conclusion: El Nino phenomenon was not associated with an epidemic in Jepara. A possible association between age and the risk of P. vivax malaria needs further investigation. In this decentralised health care system, ACD should be continued in a focus endemic area and therefore, efforts to retain the VMWs should be considered. This research showed similar findings between the RAP study and the longitudinal study. A consistent gap was found between the common understanding and the biomedical description of malaria. The performance of the VMWs supports the MCP through early contact with clinical malaria patients. Visits of VMWs within four days of symptom recognition appear to be the ideal situation for both the programme and the community. If case management continues to be the main strategy in MCP in this low endemic area, the emic perspective of the people must be well integrated to improve home treatment. Likewise, simple interventions to strengthen the role of VMWs in home management should be conducted.

In a new reform in 2001, Swedish authorities emphasized the need for support for persons with psychiatric disabilities living in the community. This reform included the establishment of a new occupation: the Swedish case manager, personligt ombud (PO). In examining this new occupation, the overall aim of this thesis is to analyze how the Swedish case manager, PO, as an evolving occupation, affects and is affected by the organisational and professional field in which it enters. More specifically, the aim is to describe and analyse, using organisational and professional theories, the changing processes that the PO con-tributes to in the welfare system and the practice of social policy, the field of social psychiatry focusing on the discretion for professionals and in the under-standing of the professional role to help as described by clients. Three studies have been carried out. The first study, for the licentiate´s degree, focused on the PO occupational role and functions for the welfare system as well as for mental health service users. In the second study, the results from the first study were analyzed together with the results of another reform, namely, the Swedish care manager reform, in order to investigate their joint implications for social policy and its practice. The third study focused on what meaning the PO has for the clients and particularly what features of the service the clients find to be helpful. In summary, the results indicate that the PO contributes to the development of a negotiated rights model, by taking on the assignment of advocacy as a client representative, and then defining the social worker as a representative for the organisation with the assignment of needs assessment. In the field of social psychiatry, the PO fills a vacancy by supporting the legitimacy of the professionals as well as their organisations. Furthermore, the PO has a function of providing organised transparency through restricting the discretion of other professionals. The discretion of the PO itself has weak boundaries allowing for great liberty of action. Finally, the PO service has led to a new understanding of the professional role, as built on reciprocity with the client, using knowledge evolving from the interaction between the professional PO and the client. These findings suggest that the PO could be understood as a new occupation evolving from weak professional traits to, as suggested, a new model for professionalism, called user-mandated professionalism. This emphasizes the reciprocative foundation of knowledge between the service user and the professional.

Syftet med studien var att undersöka hur familjerättsekreterarna upplever barns situation i samband med deras uppdrag med vårdnads-, boende- och umgängesärenden. Frågeställningarna var; Hur definierar familjerättssekreterarna sitt uppdrag vid vårdnads-, boende- och umgängesärenden vid föräldrars separation? Vilka instrument/verktyg använder familjerättssekreterarna för att ta reda på barns situation i samband med vårdnads-, boende- och umgängesärenden vid föräldrars separation? Hur upplever familjerättssekreterarna att barns fysiska och psykiska hälsa samt relation till föräldrarna påverkas i samband med föräldrarnas separation? Studien utfördes med en kvalitativ forskningsmetod där undersökningen innefattade åtta semistrukturerade intervjuer med familjerättssekreterare. I vår studie har vi utgått från systemteorin och gräsrotsbyråkratin. Detta för att familjerättssekreterarna har myndighetsutövning och att de vid utredningsärenden tittar på hur familjemedlemmarna samspelar med varandra. Resultatet tolkades utifrån den fenomenologiska ansatsen som visade att det fanns väsentliga skillnader i hur familjerättssekreterare tolkade vad som ingick i deras uppdrag. Familjerättssekreterarnas främsta instrument vid ärendehanteringar visade sig vara samtal. Ett annat viktigt resultat var att alla familjerättssekreterare ansåg att barns hälsa påverkades av sina föräldrars separation samt att deras relation till föräldrarna också påverkades både negativt och positivt, på kort och långt sikt. / The purpose of this study was to examine how family law secretaries experience the situations of the children in accordance with their assignments in the custody, residence and contact cases. These questions were asked: What instruments/tools are used to determine the children’s situation in the custody, residence and contact cases during the parental separation? How do family law secretaries define their role in custody, residence and contact cases at the parents’ separation? This study was conducted by using a qualitative research method which included eight semi-structured interviews with family law secretaries. As a basis for our study we have used the systems theory and street-level bureaucracy. This is because the family law secretaries have authority and in the case investigations they observe how the family members interact with each other. The results were interpreted by the phenomenological approach, which showed that there were significant differences in how family law secretaries interpreted what was included in their assignment. The family law secretaries’ foremost instrument during case handling was shown to be conversation. Another important result was that all family law secretaries felt that the childrens health was affected by their parents’ separation and that the childrens relationship to their parents was also affected, both negatively and positively in the short and long term.

<p>The objective of this licentiate’s dissertation is the developing occupational role of ‘personligt ombud’ (PO), a case manager for persons with severe psychiatric disabilities. The purpose of PO, put forward by a government’s commission (Psykiatriutredningen) 1992, was to implement a new way of providing support and to coordinate interventions with an aim to improve the life conditions of persons with severe psychiatric disabilities.</p><p>The aim of this licentiate’s dissertation is to characterize PO as a phenomenon within disability politics.</p><p>The empirical data were collected in three counties, viz the counties of Blekinge, Kalmar and Kronoberg. All POs within these counties were inter-viewed as well as influential managers. Clients of the POs were also interviewed.</p><p>The results imply that POs construct their understanding of their clients’ problems within a medical discourse, individualizing the problems as a result of illness. However, in their actions to solve problems they take social measures relating to a citizen discourse, focusing on citizen rights and living conditions. The occupational role of the PO develops within these discourses in conflict.</p><p>The POs’ courses of action were analyzed as four stylized patterns that can be identified with methods and theory in Social Work: rehabilitation, paternalism, empowerment and advocacy. Empowerment and advocacy can be seen as new courses of action used by POs as professionals within the public sector for sup-porting this target group.</p><p>Conclusions indicate that while formulating medical explanations to their cli-ents’ problems, the lack of language to formulate and analyze the structural and social problems is creating a risk of POs strengthening the exclusionary proc-esses. Nevertheless, the occupational role of the PO has developed a new ex-pected function as society integrated support, built on empowerment, advocacy and user control.</p>

In a recent report on the state of homelessness in Canada, it is estimated that at least 200,000 Canadians access homeless emergency services or sleep outside per year, with approximately 30, 000 homeless on any given night (Gaetz, Donaldson, Richter, Gulliver, 2013, 5). A strategy to address homelessness is Housing First. Housing First is an evidenced-based housing intervention strategy which provides homeless individuals with immediate access to housing and supports. A unique feature of this program is that participants are offered immediate housing of their choice. Prior to the introduction of Housing First, housing intervention strategies focused on “housing readiness” and often required sobriety or psychiatric treatment prior to entry. The Housing First approach has demonstrated significant recovery, cost savings and housing retention rates in The Mental Health Commission of Canada’s (MHCC) At Home/Chez Soi project—one of the world’s largest research studies utilizing a randomized control trial to study the outcomes of the Housing First approach. The At Home/Chez Soi project operated in five cities across Canada; Toronto, Montreal, Moncton, Winnipeg and Vancouver. Approximately 14% of At Home/Chez Soi participants had three or more moves and a portion of individuals in the MHCC’s study struggled to achieve stable housing. In an early findings report released by the MHCC one of the main themes that emerged from qualitative interviews conducted by At Home/Chez Soi project researchers included “changes in the social aspects of day to day life” once acquiring housing. Some of these changes were described to be negative. This finding highlights the impacts that the acquisition of housing may have on the experiences of Housing First participants. This demonstrates a need for further research to explore how social experiences relate to housing retention and mental health recovery in Housing First programming. In this research, I address this gap by focusing on understanding the social experiences of participants of Housing First programming for whom the transition into stable housing was difficult. More specifically, I ask “In relation to factors that impact housing retention, what is the experience of social connection and sense of community for a group of participants who had difficulty transitioning into housing provided through the At Home/Chez Soi Housing First program?” In this thesis, I present qualitative findings from narratives collected from 5 participants of the At Home/Chez Soi project for whom the transition to stable tenancy was difficult. Semi-structured interviews were conducted with five participants who had a range of experiences with housing retention including one participant who remained in their first apartment, and four others who had between 1-4 moves during their involvement in the At Home/Chez Soi project. In this research, I explored whether the fundamental needs of social connection and sense of community are instrumental in producing positive outcomes such as mental health recovery and housing retention in Housing First programming. Using narrative methodology and interpretive description, I further explore how the unmet needs of social connection and sense of community can assist in understanding the challenges experienced by individuals who struggle to transition into stable housing. The findings demonstrate that participants experienced a shift in social connection and sense of belonging to the “street”, to a feeling of connection to the housed community. All of the participants expressed wanting to disassociate themselves from the DTES. This was difficult because of stigmatization particularly on the part of the landlords and neighbours in their new communities. Discriminatory treatment in their housing served to reinforce negative feelings of self. The process of shifting to a sense of belonging to the housed community presented additional challenges, such as periods of isolation and/or being in the difficult position of saying “no” to friends in order to preserve their tenancy by abiding by the rules of the Residential Tenancy Act (RTA). Participants overcame these challenges by making adjustments in meeting their social needs. Some ways that participants demonstrated resilience included connecting with professionals, creating community in local shops, setting boundaries with old friends, and in some instances, cutting off from old friends. I conclude that social connection is paramount for these individuals. I also contend that the participants are resourceful in ensuring these needs are met. Recommendations for new or existing Housing First programming are made to ensure sensitivities and practices are geared to supporting these connections including offering flexibility and choice around locations and activities for weekly meetings with case managers. Other recommendations, specific to the transition into housing include incorporating a survey of important shops or services during the housing search process, and ensuring a good landlord-tenant fit during the housing selection process. / Graduate / 0617 / jynene_s@hotmail.com