Multi-purpose clinically relevant measures such as the Child and Adolescent Needs and Strengths (CANS; Lyons, 2009) and the Global Appraisal of Individual Needs (GAIN; Dennis et al., 2003) can be useful for improving services at the individual client, program, organization, and system levels. Yet, emerging research suggests that such measures are often not used consistently or effectively (Mellor-Clark, Cross, Macdonald, & Skjulsvik, 2016), and that poor use of these measures can be in part attributed to how they were put into practice (de Jong, 2016). Systematically conducted, empirical research on the effective implementation of such tools is scarce (Boswell, Kraus, Miller, & Lambert, 2015). Thus, the current study examined the factors and processes that contribute to the effective implementation of clinically relevant measures, specifically the CANS and GAIN, in community-based mental health agencies serving children and adolescents. A second objective was to examine the role of staff participation in the implementation process. Three general research questions guided the study, including: (1) How can clinically relevant measures such as the CANS be implemented effectively? (2) What are the perceived consequences of staff participation in adapting and implementing a version of the CANS and how do these consequences come about? and (3) How does the implementation context affect the process and its outcomes? The study employed qualitative, multiple-case study methods. Four child and youth mental health agencies in Ontario participated, including a total of 44 staff with varying roles (e.g., frontline and management). Several cross-case and within case comparisons were made to examine the contribution of staff participation and tool features, such as tool adaptability, to implementation outcomes. Data was analyzed using guidelines developed by Yin (2009), Miles and Huberman (1994), and Thomas (2006). Results suggest that staff participation in the process of putting clinically relevant measures into practice contributes to effective implementation and increased uptake and use of the measures. When staff are engaged in the process, they have reasons and opportunities to interact, talk about the use of the measure, and “co-create fit” between the measure and their work context. This improved fit then facilitates increased staff commitment and ability to use the measure effectively. Agency leaders play a key role in enabling this fit-making process through: encouraging and supporting a participatory approach to implementation, creating implementation structures, following through with planned activities, and being open and responsive to staff feedback. Findings suggest that the implementation context provides incentives or reasons for implementing a measure, affects the initial fit between the measure and staff members’ work, and affects the feasibility of engaging staff in the fit making process. In conclusion, this study is one of the few empirical studies to examine implementation of clinically relevant measures. The findings have important implications for research and practice, which will be discussed.

The literature indicates that engaging parents in child/youth mental health services is crucial for achieving positive outcomes. Yet, little research exists on how providers and organizations might hinder or facilitate parental engagement. This study aims to address this gap in literature by answering three research questions: (1) how do service providers working in child and youth mental health services define parental engagement? (2) Why does engaging parents in treatment remain a challenge for service providers? (3) What organizational- and provider-level factors contribute to this challenge? To facilitate this aim, semi-structured interviews were conducted with four service providers, including those working in community-based or outpatient child and youth mental health services. Participants were recruited using a snowball sampling recruitment method. Interviews were audio-recorded, transcribed and analyzed following principles of Constructivist Grounded Theory. Study results highlighted system- (e.g., access), organizational- (e.g., expectations and constraints), provider- (e.g., stance) and parental-level (e.g., shame) factors impacting parental engagement in services. These findings coincide with the documented impacts of neoliberalism and New Public Management on shaping mental health services. This study thus challenges traditional conceptualizations of engagement and underscores the interplay of complex factors that occur between service-levels. An expanded definition of parental engagement is therefore warranted if providers and organizations intend on holistically engaging parents in their child/youth’s care. / Thesis / Master of Social Work (MSW)

Submitted by Aelson Maciera (aelsoncm@terra.com.br) on 2017-06-14T19:40:40Z No. of bitstreams: 1 DissJFS.pdf: 1537912 bytes, checksum: 5c0bc9f181d07163e84cc47cb09da0fb (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-28T07:54:58Z (GMT) No. of bitstreams: 1 DissJFS.pdf: 1537912 bytes, checksum: 5c0bc9f181d07163e84cc47cb09da0fb (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-28T07:55:11Z (GMT) No. of bitstreams: 1 DissJFS.pdf: 1537912 bytes, checksum: 5c0bc9f181d07163e84cc47cb09da0fb (MD5) / Made available in DSpace on 2017-06-28T08:01:35Z (GMT). No. of bitstreams: 1 DissJFS.pdf: 1537912 bytes, checksum: 5c0bc9f181d07163e84cc47cb09da0fb (MD5) Previous issue date: 2016-12-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The historical path of the attention to the mental health of children and adolescents accompanied, in a particular and late way, the paths taken in the care of the adult population with psychic suffering, so that from the beginning of the nineteenth century there is recognition of the needs of care to the child and adolescent population, being, at first, the historical care delegated to the educational and social assistance sectors. However, from a few milestones, such as the Brazilian psychiatric reform and the declaration of human rights, it became possible to develop a new conception for childhood and adolescence, as well as the recognition of child and adolescent psychosocial care in the public policy arena. However, literature in the area has pointed to the scarcity of research that focuses on the assistance to Mental Health of adolescents, since they have presented significant indexes of psychic suffering, and indicate the need for more research that can subsidize the actions and policies aimed at this population. Thus, the present study aimed to identify how psychosocial attention has been given to the adolescent from the perspective of professionals linked to a service of Strategic Psychosocial Care (CAPS) and to Basic Health Care services (UBS and USF). In order to respond to the proposed objectives, a qualitative, descriptive and exploratory research was developed. The study was attended by 19 professionals from the Strategic Psychosocial Attention Service (CAPSij) and Basic Health Care (UBS and USF) and located in a medium-sized municipality in the interior of the State of São Paulo. Four data collection instruments were developed, two forms for characterization of professionals and services, and two semi-structured interviews for professionals. The data coming from the forms were analyzed in a descriptive way and those of the interviews were investigated by the Thematic Analysis, one of the techniques foreseen in the Content Analysis Method. The main results of the interviews with CAPSij professionals indicated that it acts as a gateway to the mental health demand of adolescents in the municipality, which is perceived as a challenge, considering the role of the service in the definition of eligible cases or not for the CAPSij. In addition, the participants also reported on the difficulties that the team faces with regard to the adherence of the adolescents users to the service, indicating the need for more strategies that facilitate the linkage of the same and the effectiveness of the work, as well as in relation to the users' families. The difficulty in enabling RAPS in the municipality was also a challenge pointed out by professionals. On the other hand, the data show the commitment of the participants in care actions focused on the premises of policies and the search for network articulation, especially with the Basic Health Care. The results of the interviews with the professionals of Basic Health Care Pointed out the challenges in the care and follow-up of the adolescent population in general, especially those who experience the psychological suffering that, according to the statements, hardly reach the service and, when they arrive, are referred to CAPSij. It was also observed that the activities carried out in adolescent ABS services are fundamentally curative, and health promotion and prevention actions are rare, as well as those of a network of care that, when they occur, are triggered by the CAPSij. Therefore, it was possible to verify with the present study that the psychosocial attention of adolescents in the investigated context is a field under construction and, currently, it occurs in CAPSij. It is hoped that the findings obtained may provide more subsidies for reflection and planning of policies and more effective interventions directed at the population of adolescents in psychological distress. / O percurso histórico da atenção à saúde mental de crianças e adolescentes acompanhou, de maneira particular e tardiamente, os caminhos trilhados no cuidado com a população adulta com sofrimento psíquico, de modo que, a partir do início do século XIX, há o reconhecimento das necessidades de cuidado à população infantojuvenil, sendo, a priori, o histórico assistencial delegado aos setores educacionais e de assistência social. Entretanto, a partir de alguns marcos, como a reforma psiquiátrica brasileira e a declaração dos direitos humanos, tornou-se possível o desenvolvimento de uma nova concepção para a infância e a adolescência, bem como o reconhecimento da atenção psicossocial infantojuvenil no cenário das políticas públicas. No entanto, a literatura da área tem apontado sobre a escassez de pesquisas que focalizem a assistência à Saúde Mental de adolescentes, visto que estes têm apresentado índices significativos de sofrimento psíquico, e indicam a necessidade de mais investigações que possam subsidiar as ações e políticas voltadas a essa população. Assim, o presente estudo objetivou identificar como tem ocorrido a atenção psicossocial ao adolescente sob a ótica de Profissionais vinculados a um serviço de Atenção Psicossocial Estratégica, no caso o Centro de Atenção Psicossocial Estratégica Infantojuvenil (CAPSij), e a serviços da Atenção Básica em Saúde referentes à Unidade Básica de Saúde (UBS) e à Unidade de Saúde da Família (USF). Para responder aos objetivos propostos, foi desenvolvida uma pesquisa qualitativa, de caráter descritivo e exploratório. O estudo contou com a participação de 19 profissionais de serviços de Atenção Psicossocial Estratégica (CAPSij) e Atenção Básica em Saúde (UBS e USF) localizados em um município de médio porte do interior do Estado de São Paulo. Foram desenvolvidos quatro instrumentos de coleta de dados, sendo dois formulários para caracterização dos profissionais e dos serviços, e dois roteiros de entrevistas semiestruturados destinados aos profissionais. Os dados advindos dos formulários foram analisados de forma descritiva e os das entrevistas foram tratados por meio da Análise Temática, uma das técnicas previstas no Método da Análise do Conteúdo. Os principais resultados das entrevistas com os profissionais do CAPSij indicaram que o órgão atua como porta de entrada da demanda de saúde mental de adolescentes no município, o que é percebido como um desafio, considerando o papel solitário do serviço na definição dos casos elegíveis ou não para o CAPSij. Além disso, os participantes relataram, também, sobre as dificuldades que a equipe enfrenta no que se refere à adesão dos adolescentes usuários ao serviço, indicando a necessidade de mais estratégias que facilitem a vinculação deles e a efetivação do trabalho, assim como em relação às famílias dos usuários. A dificuldade em viabilizar a RAPS no município também foi um desafio apontado pelos profissionais. Por outro lado, os dados mostram o empenho dos participantes nas ações de cuidado voltadas às premissas das políticas e a busca de articulação em rede, em especial com a Atenção Básica em Saúde. Os resultados advindos das entrevistas com os profissionais da Atenção Básica em Saúde apontaram os desafios no cuidado e acompanhamento da população adolescente de forma geral, especialmente aquela que vivencia o sofrimento psíquico que, segundo as falas, dificilmente chegam ao serviço e, quando chegam, são encaminhadas para o CAPSij. Observou-se, ainda, que as atividades realizadas nos serviços de ABS junto aos adolescentes são fundamentalmente curativas, sendo raras as ações de promoção e prevenção em saúde, bem como aquelas de articulação de rede de atenção que, quando ocorrem, são disparadas pelo CAPSij. Portanto, foi possível verificar, com o presente estudo, que a atenção psicossocial de adolescentes no contexto investigado é um campo em construção e, atualmente, dá-se no CAPSij. Espera-se que os achados obtidos possam fornecer mais subsídios para reflexão e planejamento de políticas e intervenções mais efetivas direcionadas à população de adolescentes em sofrimento psíquico.