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Cette thèse veut optimiser l’évaluation d’enfants de 2 à 5 ans vivant avec un trouble développemental du langage (TDL), en se centrant moins sur leurs déficits et davantage sur leur participation sociale. Premièrement, la stabilité des atteintes langagières documentées par l’orthophoniste à l’âge préscolaire est vérifiée dans un échantillon d’enfants référés en clinique spécialisée. Deuxièmement, les méthodes d’évaluation de la participation pertinentes à cet âge, particulièrement dans le domaine de la socialisation, sont recensées. Troisièmement, l’applicabilité d’un modèle d’évaluation hiérarchique de la compétence sociale en collaboration avec le personnel éducateur et enseignant est testée dans une population clinique. Deux études de cohorte ont été menées avec des données extraites des dossiers médicaux d’enfants ayant consulté dans une clinique psychiatrique en petite enfance sur une période de dix ans (N = 466), et les écrits scientifiques ont été synthétisés par une revue de la portée. Selon la première étude, la présence ou l’absence de difficultés langagières demeure très stable (94%) entre deux conclusions orthophoniques, chez des enfants référés en clinique spécialisée durant la petite enfance (n = 149). Au terme de la revue de littérature, les 480 publications retenues font état de 186 méthodes différentes visant à évaluer la participation d’enfants de 2 à 5 ans, notamment dans le domaine de la socialisation. Cette revue confirme aussi que le Profil socio-affectif de l’enfant (PSA; LaFreniere et al., 1997) est une mesure de la compétence sociale répandue dans le monde. La dernière étude permet d’identifier dans l’échelle de compétence sociale du PSA deux facteurs distincts, proposés selon le modèle théorique d’Ashton (2018). En contrôlant plusieurs caractéristiques d’enfants consultant en clinique avec TDL (n = 217) et sans TDL (n = 99), un modèle d’équation structurelle supporte la pertinence d’évaluer d’abord l’adaptation sociale (liée à la satisfaction des enfants, des pairs et des adultes dans l’interaction) puis, seulement si des difficultés d’adaptation sont observées, le fonctionnement social (lié aux comportements que l’enfant actualise). Les retombées de cette thèse sont importantes. D’abord, elle démontre que des enfants référés en bas âge vers des services spécialisés ont un profil langagier extrêmement stable au préscolaire, par opposition à ce qui avait été documenté dans la population générale. L’identification précoce du risque de persistance peut influencer les services offerts à ces enfants durant une période critique de leur développement. Ensuite, l’évaluation des impacts fonctionnels, désormais requise pour conclure à un TDL, peut être facilitée par la recension interdisciplinaire de mesures d’évaluation de la participation, notamment dans le domaine de la socialisation. Finalement, l’applicabilité d’un modèle hiérarchique d’évaluation de la compétence sociale, testé dans une population clinique en utilisant un outil déjà utilisé au Québec, pourrait favoriser la concertation de l’orthophoniste, du personnel éducateur et des partenaires d’autres disciplines, afin de favoriser l’inclusion de l’enfant dans les contextes éducatifs en petite enfance. En somme, les trois études offrent des ressources supplémentaires à l’orthophoniste et à toutes les personnes intéressées par un paradigme d’évaluation plus social que médical, dans le cadre de pratiques collaboratives et centrées sur la famille. / This thesis aims to optimize the assessment of children aged 2 to 5 years with a developmental language disorder (DLD), focusing less on their deficits and more on their social participation. First, the stability of language impairments documented by the speech-language pathologist (SLP) at preschool age is verified in a sample of children referred to a specialized clinic. Second, participation assessment methods relevant to children aged 2 to 5 years, particularly in the area of socialization, are identified. Third, the applicability of a hierarchical assessment model of social competence in collaboration with educators and teachers is tested in a clinical population. Two cohort studies were conducted using data extracted from the medical records of children seen in an early childhood psychiatric clinic over a ten-year period (N = 466), and the scientific literature was synthesized by a scoping review. The first study’s results documented that the presence or absence of language difficulties remained very stable (94%) in children referred to a specialized clinic during early childhood (n = 149) when two SLP assessments were compared. The 480 publications retained at the end of the literature review report 186 different methods for assessing the participation of children aged 2 to 5 years, particularly in the area of socialization. This review also confirms that the Social Competence and Behavior Evaluation (SCBE; LaFreniere & Dumas, 1995) is a widely used measure of social competence in the world. The last study identifies two distinct factors in the SCBE social competence scale, based on Ashton's (2018) theoretical model. Controlling for several characteristics of children consulting in clinic with DLD (n = 217) and without DLD (n = 99), a structural equation model supports the appropriateness of first assessing social adjustment (related to child, peer, and adult satisfaction with interaction) and then, only if adjustment difficulties are observed, social functioning (related to the behaviors the child actualizes). The implications of this thesis are significant. First, it demonstrates that children referred to specialized services at an early age have an extremely stable language profile in the preschool period, in contrast to what has been documented in the general population. Early identification of persistence risk may influence the services provided to the child during a critical period of development. Second, the assessment of functional impacts, now required to conclude that a child has DLD, can be facilitated by the interdisciplinary review of measures of participation, particularly in the area of socialization. Finally, the applicability of a hierarchical model of social competence assessment, tested in a clinical population using a standardized tool already in use in Quebec, could foster collaboration among SLPs, preschool educators and teachers, and partners from other disciplines, to promote child inclusion in early childhood and preschool settings. In sum, all three studies provide additional resources for the SLP and all those interested in a more social than medical assessment paradigm, within collaborative, family-centered practices.

Abstrakt  Bakgrund: Sexuell ohälsa och våldsutsatthet är vanligt bland ungdomar och kan få allvarliga hälso-och beteendemässiga konsekvenser för unga kvinnor och män. Ungdomsmottagningarnas centrala mål är att främja sexuell och reproduktiv hälsa. Barnmorskors roll innebär bland annat att upptäcka ungdomar med sexuellt riskbeteende och våldsutsatthet. Motiv: Utmaningen i barnmorskors dialog med ungdomar är att få dem att dela med sig av negativa erfarenheter vilket sällan sker spontant. Därav utvecklades bedömningsverktyget SEXIT för att underlätta kommunikationen mellan barnmorskor och ungdomar. Studier i norra Sverige saknas angående barnmorskors upplevelse av bedömningsverktyget SEXIT. Syfte: Syftet med studien var att narrativt undersöka hur barnmorskor på ungdomsmottagning upptäcker och bemöter risk- eller våldsutsatta ungdomar innan, under och efter implementering av bedömningsverktyget SEXIT. Metod: En kvalitativ intervjustudie genomfördes med sex barnmorskor. Intervjuerna analyserades enligt Riessman’s sätt att bilda en narrativ metaberättelse där intervjuerna kodades och tematiserades. Genusperspektiv användes som inspiration.  Resultat: Analysprocessen resulterade i fem narrativa teman som presenterades i en bestämd tidsordning. Första temat, Förtroendeingivande barnmorskor med ambition att fånga upp våldsutsatthet där frågor om våld tappas bort, handlade om hur de fångade upp våld och risktagande innan SEXIT. Tema två, SEXIT en ögonöppnare i teorin men svårare att implementera i praktiken, avser hur barnmorskorna upplevde kursen, resterande tre teman, SEXIT - innebär både motstånd och möjligheter, Tiden - en grundläggande förutsättning för att upptäcka våldsutsatthet och risktagande bland ungdomar, att rutinmässigt utfråga unga kan avslöja sexuell ohälsa, innehöll narrativ som handlade om motstånd, möjligheter, utmaningar som kunde bidra till att upptäcka ungdomar med sexuell ohälsa. Konklusion: Innan SEXIT intog barnmorskorna delvis en undvikande roll gällande riskbeteenden och erfarenhet av våld. Efter SEXIT intog barnmorskorna en mer aktiv roll med direkta frågor baserat på det ifyllda SEXIT-underlaget. SEXIT kan vara ett användbart verktyg, men narrativen tyder på ett visst motstånd mot användning vid dropp-in. / Abstract  Background: Sexual risk taking and violence are common among adolescents and can have serious health and behavioral consequences for them. The youth clinics' central goal is to promote sexual and reproductive health. The role of midwives includes, among other things, detecting adolescence with sexual risk behavior and exposure to violence. Motive: The challenge in midwives' dialogue with adolescence to make them share negative experiences, which rarely happens spontaneously. From this, the SEXIT assessment tool was developed to facilitate communication between midwives and adolescents. Studies in northern Sweden are lacking regarding experience of the assessment tool SEXIT. Aim: The aim was to narratively investigate how midwives at youth clinics discover and meet with at-risk or violent adolescence before, during and after implementation of the SEXIT assessment tool.   Methods: A qualitative interview study was conducted with six midwives. The interviews were analysed according to Riessman's method of forming a narrative meta-narrative where the interviews were coded and thematized. Gender perspective was used as inspiration. Result: The analysis identified five narrative themes presented chronologically. The first theme, "Confidence-inspiring Midwives," focused on midwives detecting violence issues before SEXIT. Theme two, "SEXIT: Theory verses Practice," explored the challenges of implementing SEXIT in real-life situations. The remaining three themes, "SEXIT: Resisting and Embracing," "Time: Essential for Detecting Violence among Adolescence," and "Routine Questioning Reveals Sexual Health Issues in Adolescence," discussed narratives on resistance, opportunities, and challenges in uncovering sexual health concerns in adolescents. Conclusion: Before SEXIT, the midwives partly assumed an avoidant role regarding risk behaviours and experience of violence. After SEXIT, the midwives took a more active role with direct questions based on the SEXIT assessment tool. It can be a useful tool, but the narrative signifies resistance to use SEXIT during drop-in.

[pt] O presente estudo parte da insistente indagação sobre os motivos da falência das redes públicas brasileiras de atenção à saúde. Apesar de instituído na Constituição da República de 1988 como um sistema público de saúde que se pretende de cobertura integral e acesso universal, o Sistema Único de Saúde (SUS), na prática, não avançou neste sentido. Pelo contrário, são enormes as desigualdades em saúde no Brasil. O objetivo deste estudo é demonstrar que uma das principais chaves para a superação desta adversidade se encontra na forma como as ações e serviços públicos de saúde no Brasil são financiadas. Afirma-se que o atual modelo de financiamento do SUS apresenta ineficiências e promove iniquidade. No primeiro capítulo são apresentados os aspectos do direito à saúde sob a ótica global, buscando traçar um panorama dos conceitos e tendências desta área do conhecimento. O segundo capítulo discute o conflito entre a infinitude das demandas de saúde e a escassez de recursos para supri-las, procurando destacar a importância do equilíbrio entre as dimensões da equidade e da eficiência durante o exercício da tarefa de alocação de recursos sanitários. O terceiro e o quarto capítulos tratam propriamente do financiamento do SUS. O terceiro capítulo se ocupa com o padrão dos gastos públicos, tornando evidente que os governos brasileiros historicamente se imiscuem da responsabilidade de promover o financiamento adequado das ações e serviços públicos de saúde. O quarto e último capítulo aborda um outro aspecto problemático do financiamento do SUS, qual seja, a ausência de um pacto interfederativo que promova a colaboração mútua entre os entes federativos, situação que prejudica a harmonia do sistema. / [en] This research explores the persistent question regarding the reasons for the failure of the Brazilian Public Health System. Although the Brazilian Constitution of 1988 envisioned its Unified Health System (Sistema Único de Saúde) to become an universal system intended to guarantee full access and coverage for all, in practice this concept has never materialized. On the contrary, there are enormous inequalities on the delivery of health in Brazil. This research aims to demonstrate that methods of financing are one of the key elements to overcome such arduous situation. It is asserted that the current health financing model in Brazil is inefficient and ultimately promotes inequality. The first chapter reflects on aspects related to right to health from a global perspective, mapping the key concepts and tendencies of Global Health. The second chapter deliberates on the conflict between the infinite demand for health and the scarcity of resources to fulfill such demand, them, highlighting therefore the great importance of achieving a balance between equity and efficiency when conducting the task of allocating health resources. The third and the fourth chapters are addressed to the financing of the Brazilian s Unified Health System. The third chapter considers the Brazilian pattern of public health spending, in order to demonstrate that, historically, Brazilian governments evaded their responsibility of providing adequate health financing. The fourth and last chapter examines another problematic aspect of the public health financing in Brazil, which is the lack of cooperation between the federal units, the absence of such inter-federal covenant is believed to be detrimental to the health system as it impacts on its harmony and unity.

This research study examines Jewish women’s traditions from the perspective of midwives, in the United States (US), particularly midwives in Florida and New York, based on their work caring for women of childbearing age in the Hasidic Ashkenazi and Sephardic Orthodox communities. The reproductive traditions examined in this research may be practiced differently depending on a woman’s degree of religiosity and the rabbinic authorities in their communities. The primary data I collected in this study are based on ethnographic methods, including participant-observation with midwives, and semi-structured interviews with midwives and rebbetzins. The secondary data draws on my analysis of the professional context for the practice of midwifery in the US, and Talmudic texts and rabbinical rulings related to family planning, reproduction, and sexuality education. This study shows how midwives are central to these traditions and facilitate not only the family planning and childbearing experiences, but also the religious practices that go with reproductive healthcare. This research also demonstrates how midwives who take care of Jewish women negotiate on behalf of their patients with the local rabbis to provide care that is patient-centered and clinically recommended on the one hand but is culturally appropriate on the other hand. My research study builds on and contributes to anthropological scholarship about Jewish women and reproductive healthcare, and considers whether, and how, the reproductive health practices of the Hasidic women are surviving in a changing world.

In this study the researcher attempted to determine the current role expectations of a clinic manager in a primary health care setting, to identify factors determining and influencing the role of a clinic manager, to determine what effect the current role expectations had on the management of primary health care services rendered at the clinic, to establish the developmental needs of clinic managers to enable them to adhere to their role expectations, and to identify and recommend measures to support clinic managers in the execution of their managerial role by addressing the identified deficiencies. The researcher selected a quantitative, exploratory, descriptive and contextual design. Clinic managers of fixed clinics in the Free State province were randomly selected to participate in the study and a questionnaire was utilised as data-collection instrument. The study found that the clinic manager's role is comprehensive and varies from telephonic booking patients to assessment of the quality of primary health care programmes. A number of non-managerial functions were identified, such as consultation of patients, management of medicine, dispensing of medicine and ordering of stock. It was also found that the respondents were not involved in a number of management functions such as financial and human resource management, and adherence to the implementation of standards. Factors that negatively influenced the clinic managers' management role included: * Lack of time due to the large number of patients they had to consult due to the shortage of staff. * Shortage of staff. * The execution of non-managerial tasks. Although it was found that the current role of the clinic manager was confusing as it entailed much more than just clinic management, it is foreseen that the role of the clinic manager could in future be clarified if the recommendations are implemented. / Health Studies / D. Litt. et Phil. (Health Studies)

In this study the researcher attempted to determine the current role expectations of a clinic manager in a primary health care setting, to identify factors determining and influencing the role of a clinic manager, to determine what effect the current role expectations had on the management of primary health care services rendered at the clinic, to establish the developmental needs of clinic managers to enable them to adhere to their role expectations, and to identify and recommend measures to support clinic managers in the execution of their managerial role by addressing the identified deficiencies. The researcher selected a quantitative, exploratory, descriptive and contextual design. Clinic managers of fixed clinics in the Free State province were randomly selected to participate in the study and a questionnaire was utilised as data-collection instrument. The study found that the clinic manager's role is comprehensive and varies from telephonic booking patients to assessment of the quality of primary health care programmes. A number of non-managerial functions were identified, such as consultation of patients, management of medicine, dispensing of medicine and ordering of stock. It was also found that the respondents were not involved in a number of management functions such as financial and human resource management, and adherence to the implementation of standards. Factors that negatively influenced the clinic managers' management role included: * Lack of time due to the large number of patients they had to consult due to the shortage of staff. * Shortage of staff. * The execution of non-managerial tasks. Although it was found that the current role of the clinic manager was confusing as it entailed much more than just clinic management, it is foreseen that the role of the clinic manager could in future be clarified if the recommendations are implemented. / Health Studies / D. Litt. et Phil. (Health Studies)

This study explores trainees' experiences of power dynamics within a ritualised training context, with reference to the three major aspects of the study: training, ritual and power. The psychotherapeutic training took place at Agape, a community-based counselling service in Mamelodi, whose theoretical approach to training included a mixture of postmodern, ecosystemic and African traditions. A substantial literature survey examines the major concepts and issues related to the research subject, such as psychotherapeutic training approaches, the philosophies and theories that may inform training procedures, ritual practices in psychotherapy, and organisational and power aspects of psychotherapeutic training. The research process was executed using the qualitative, interpretive research methodology. A sample of six of the trainees who had completed their training at this placement was interviewed, and two of the trainers. The researcher's reflections on her own training experiences are woven into the material. Using the interview technique and through asking a series of open-ended questions, the researcher obtained an account of the subjective, sacralised training interactions at Agape. Themes were identified that had emerged during the interview process. In brief, the themes referred to trainees' theoretical and practical experiences in the training placement, how they made sense of the sacralised therapeutic experiences, and comments on their relationship with trainers and fellow trainees. The most common theme that emerged was that of power. The end product of this study portrays the trainees' understandings of power within a sacralised psychotherapeutic context and their responses to this. This study makes explicit the links between ritualisation and power within an evaluative psychotherapeutic training context, and the consequences of this for training. / Psychology / M.A. (Clinical Psychology)

Aim of the study is to explore the role caring practices within the nurse-patient relationship, in facilitating effective chronic pain management in the primary health care context. Objectives are to analyse the current caring practices within the nurse-patient relationship during the management of patients with chronic pain within primary health care services; explore the challenges experienced by nurses in primary health care services when managing patients with chronic pain; observe the caring practices within the nurse patient interaction for the patients suffering from chronic pain within the Primary health care setting and explain the nurses‟ caring practices when managing their chronic pain in the primary health care setting. Method The research design for this study is sequential, explanatory and mixed method, which is more appropriate due to the complexity of the phenomenon under study. Findings: Although the survey measured the caring practices subjectively which other studies had done consistently, generally nurses associated caring as their core function within the health profession. Nurses do not actively involve the patients in the development of a treatment plan and as a result the caring behaviours that are intended to benefit the patients are not realised and, thus patients report nurses as not being caring. The results indicated that lack of an inclusive treatment plan, which can only be discovered through the development of the therapeutic NPR, is not given priority in the management of patients with chronic pain Conclusions: Caring should not be seen as concrete execution of the set of activities towards the patient but rather as a joint venture between the nurse and the patient. The strength of the model developed in this study is the identification of the nurses‟ internal readiness to create a caring environment by experiencing the love, faith and hope before engaging with the patient. / Health Studies