Thesis (MSW(Social Work))-University of Pretoria, 2008. / Includes bibliographical references.

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Background: Second-generation Tamil youth experience intergenerational trauma from their first generation parents, along with various other mental health stressors which can continue well into adulthood. Early intervention and access to community-based mental healthcare services can serve as a protective factor and prevent chronic mental health issues. However, cultural and access barriers prevent second-generation Tamil youth from accessing much needed mental healthcare support. The purpose of this study is to explore how second-generation Tamil youth describe their experiences accessing community-based mental healthcare services and to identify barriers and facilitators to accessing mental healthcare services. Methods: This study used Qualitative descriptive design and was informed by the Penchansky and Thomas Access framework with Saurman’s addition. Nine second-generation Tamil youth in the Greater Toronto Area were interviewed using a semi-structured interview guide to collect information about their experiences accessing community-based mental healthcare services. Concurrent data analysis was conducted to promote rich data collection which helped identify themes among participant responses. Each theme helped identify barriers and facilitators to accessing community-based mental healthcare services. The thematic analysis clarified details and descriptions of the experiences of second-generation Tamil youth. Results: Data analysis revealed six themes that fit within the dimensions of access: awareness, availability, acceptability, affordability, accessibility and accommodation. Findings from this study helps identify barriers and facilitators to accessing community-based mental healthcare services as experienced by participants. Conclusion: While second-generation Tamil youth were able to describe their experiences accessing community-based mental healthcare services, not all participants were successful in accessing a service. Further research is necessary to explore key strategies to ensure accessible mental healthcare support for second-generation Tamil youth, to better meet their unique needs, and to remove barriers preventing early access to services. Findings from this study are important to help inform the practice of nurses and practitioners, policy, and public education to better support the unique needs of the second-generation Tamil population and other newcomer groups and promote mental health. / Thesis / Master of Science (MSc) / Second-generation Tamil youth are an understudied population with a growing need for mental health support. This study describes the experiences of second-generation Tamil youths and their access to community-based mental healthcare services in the Greater Toronto Area. Nine participants were interviewed using a semi-structured interview guide to collect data on their experiences accessing community-based mental healthcare services. Concurrent data analysis was conducted with data collection, and themes around the dimensions of access emerged: awareness, availability, acceptability, affordability, accessibility and accommodation. Further research is necessary to explore key strategies to implement when providing mental healthcare support to the second-generation Tamil youth population to better meet their unique needs, and tackle barriers preventing early access to services. Findings from this study are important to help inform the practice of nurses and practitioners alike, policy, and education to better support the unique needs of the second-generation Tamil population and promote mental health.

Kiekvienas iš mūsų susimąstome, apie savo senatvę ir užduodame sau klausimą: kokia ji bus? Ar mes jausimės mylimi, aprūpinti, nepalikti likimo valioje? Ir šioje vietoje pastariems aspektams didelę reikšmę turi sveikatos priežiūros bei socialinių paslaugų teikimo gerinimas. Vienas iš tokio gerinimo pavyzdžių – vykdytas tarpvalstybinis Improving Access to Community-based Services for Older People Living at Home projektas (toliau IACS).Šio darbo tikslas – išanalizuoti vyresnio amžiaus žmonių prieinamumą prie sveikatos priežiūros ir socialinių paslaugų vietos bendruomenėje. Darbo tikslui ir uždaviniams įgyvendinti pasirinkti atitinkami teorinės analizės metodai, tokie kaip: mokslinė literatūros analizė, loginės analizės metodas, lyginamasis teorinės analizės metodas. Empiriniams duomenims gauti Kauno atvejui buvo atliktas kokybinis tyrimas, pasitelkiant pusiau struktūruotą fokus grupės interviu metodą. Praplečiant tyrimą iki tarpvalstybinio lygmens, kvazi-socialinio eksperimento būdu, bendruomeninių paslaugų patirčių palyginimui buvo gauti kokybiniai duomenys ir iš kitų šalių, t.y. Austrijos bei Lenkijos.Darbe pristatyta socialinės atskirties sąvoka, jos mažinimo būdai Europos Sąjungos ir Lietuvos kontekste. Taip pat nusakytas tamprus ryšys tarp socialinės atskirties, senėjimo politikos bei sveikatos, socialinių paslaugų poreikio pagyvenusiems žmonėms.Socialinės atskirties politika formuojama pagal socialinės politikos modelius. Šia prasme pasirinktinai išnagrinėti Lietuvos bei... [toliau žr. visą tekstą] / Each of us think about our retirement, and ask ourselves the question: what is it? Will we feel loved, cared of, and not left in the hands of fate? At this point, health care and social services improvement is of great importance for the aforementioned aspects. One of the examples of improvement is the conducted international project Improving Access to Community-based Services for Older People Living at Home (IACS).The goal of the present paper is to analyze community’s health care and social services facilities availability for older people. To accomplish aims and tasks that were set, corresponding theoretical analysis methods were selected: analysis of scientific literature, method of logical analysis, comparative method of theoretical analysis. To collect empirical data for Kaunas, qualitative study using semi-structured focus group interview method was performed. In order to raise study to an international level in a quasi-social experiment way and to compare community service experiences, qualitative data were obtained from other countries, i.e. Austria and Poland. The paper introduced the concept of social exclusion and the ways to reduce it the European Union and Lithuania contexts. Strong relationship between social exclusion, aging policy, health and social services available older people was also articulated.Social exclusion policy is formed by social policy models. In this sense, Lithuanian and Swedish social policy models were arbitrarily selected and examined... [to full text]

Master of Public Health - MPH / Community health workers (CHWs) are integral to improve Primary health care (PHC) coverage, utilising their unique skills within the community to make services accessible and equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South Africa, has set priorities and requirements for the provision of funding to Non-profit organisations (NPOs) for forming coalitions with the Health Department to deliver various aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are underscored by a strong sense of intersectoral collaboration to work together to attain sufficient and sustainable progress. Collaboration between CHWs and PHC facilities is important in aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring UHC

The South African National Development Plan (NDP) (National Planning Commission, 2011, p. 1) provides the road map for a reformed public health system by 2030. The proposed health system will be facilitated by, amongst others, training an appropriate balance of healthcare professional s including a cadre of community health workers (CHWs) that have a broad skills mix suited to reaching a larger number of people with first level intervention. With this in mind, a pilot group of CHWs were up-skilled as Rehabilitation Care Worker s (RCWs). The training program was a joint project between the Division of Disability Studies and the Departments of Occupational Therapy, Physiotherapy and Speech and Language Therapy at UCT. Problem: Little is known about the perspectives of RCWs on the benefits and challenges of additional training in rehabilitation and disability related skills. Rationale: To inform the curriculum for a rehabilitation care worker (RCW) training program and the Western Cape Department of Health (WCDoH) of ways in which this cadre of worker could contribute to the realization of the 2030 Healthcare Plan. Aim: To describe the outcomes of a pilot RCW training program from the perspective of the pilot group of graduates. The objectives were to identify the areas of practice where RCWs feel competent/incompetent, to identify aspects of the health services where RCWs believe they can contribute the most/the least and to identify the facilitators/barriers they experienced when deployed in the health field. Methodology: A qualitative descriptive study was conducted. Method: Focus groups were carried out with three groups of six participants. Findings: The plot that permeated the participants’ perspectives revolved around how the RCWs were pioneers in breaking new ground for the Western Cape Department of Health (WCDoH). Two themes informed the plot: "we move health services to a new level" and "we manage change in new ways". Discussion: It is argued that the pilot RCW curriculum achieved its’ objective of equipping a cadre of worker with basic rehabilitation, care and disability inclusion skills. While the envisaged role of RCWs in the health service and in making the NDP a reality is supported, it is argued that attention needs to be given to supervision structures and to training of all other health workers in order to promote inter professional practice. Conclusions: The pilot group of RCWs believe that they have acquired a new and large variety of skills that have enabled them to make a broad and positive impact in their places of work, at home and in the broader community.

Home and community based services (HCBS) are designed to provide services that meet the increasing and diverse needs of the older adult population who wish to age-in-place for as long as possible in their homes and community. Yet, little is known about the choices people make when selecting services. The purpose of this study was to assess HCBS use among vulnerable older adults. Andersen’s (1995) behavioral model of health services use provided theoretical guidance for selecting and explaining predisposing, enabling, and need-based variables associated with service use within the Community Living Program (CLP) federal initiative. Through consumer direction of services, 18 routine or one-time services were offered to 76 participants enrolled in the Virginia CLP. Two-step cluster analysis identified four distinct profiles of service users, ranging in size from 7 to 34 members. Services used within the groups ranged from 11 to 16 services. Use of personal care services (p=.033) and respite (p=.010) were significantly associated with group membership differentiation. Within each cluster, the percentage of participants using each service varied greatly. The most important variables that differentiated service user membership were caregiver relationship to participant, participant living arrangement, participant disability type, and length of time caregiver provided care. Between-cluster membership was significantly different with regard to average service cost per day for services used (p=.002) and the likelihood of moving to a nursing home if services were not provided (p=.034). Findings inform future research and have implications for practitioners assisting vulnerable older adults in selecting services to meet different care needs. / Master of Science

Thesis (PhD (Curriculum Studies))--University of Stellenbosch, 2010. / Bibliography / ENGLISH ABSTRACT: This dissertation is an interpretive analysis of the meanings and understanding of the construct 'service' in its relation to scholarly engagement with external non-academic communities at curricular level. The study links to other studies relating to community engagement in higher education or focusing on internal service to the university community, but it is unique in its theorising of service with and in external non-academic communities. The specific aim of the study was to develop a theoretical framework to view, understand, analyse and evaluate scholarly-related service activities which represent the community component of experiential learning pedagogies. The primary data for the study were generated through unstructured interviews with the four actor groups participating in such activities, namely module coordinators, students, community organisation representatives and community members. Their responses were interpreted, analysed and triangulated through grounded theory methodology. A substantive theory consisting of four interrelated processes, through which these activities take place, was developed culminating in a theoretical framework that integrates the four processes into one coherent process of cyclical interchange of social commodities. In this process there is a reciprocation of scholarly service and community service where the latter represents the service of the community to the university culminating in the interchange of tangible and intangible products that represent the commodities. The co-creation of useful contextual knowledge represents the ultimate outcome of this process through an interchange of tacit, codified and implicit knowledge of professionals and laymen in society. The theoretical framework provides a better understanding of the difference between the relationships with external communities and the actual service actions that take place during scholarly service activities. Within such understanding the framework suggests rethinking of how service activities are planned and integrated in community engagement at curricular level. / AFRIKAANSE OPSOMMING: Hierdie proefskrif is 'n interpretatiewe ontleding van die betekenisse en begripsverband van die konstruk "diens" op 'n kurrikulêre vlak binne die vakkundige interaksie met eksterne nieakademiese gemeenskappe. Die studie hou verband met ander studies oor gemeenskapsinteraksie binne die hoër onderwys asook dié wat fokus op interne diens aan die universiteitsgemeenskap. Die studie is egter uniek ten opsigte van die teoretisering van diens binne en in samewerking met eksterne nie-akademiese gemeenskappe. Die spesifieke doel van die studie was om 'n teoretiese raamwerk te ontwikkel waardeur wetenskapsverwante diensaktiwiteite wat die gemeenskapskomponent van ervaringsleerpedagogië verteenwoordig beskou, verstaan, geanaliseer en geëvalueer kan word. Die primêre data vir die studie is versamel deur middel van ongestruktureerde onderhoude met die vier groepe wat 'n rol speel in kurrikulumverwante gemeenskapsdiensaktiwiteite, naamlik module koördineerders, studente, verteenwoordigers van gemeenskapsorganisasies en lede uit die gemeenskap. Hulle antwoorde is met behulp van die metodologie van gefundeerde teorie geïnterpreteer, ontleed en deur kruistoetsing geverifieer. 'n Selfstandige teorie, bestaande uit vier verwante prosesse waardeur hierdie aktiwiteite plaasvind, is ontwikkel wat uiteindelik beslag gekry het in 'n teoretiese raamwerk wat op sy beurt die vier prosesse in een koherente proses van sikliese verwisseling van sosiale kommoditeite integreer. In hierdie proses is daar ’n duidelike verwantskap tussen vakkundige diens en gemeenskapsdiens waar laasgenoemde die diens van die gemeenskap aan die universiteit verteenwoordig. Hierdie verwisselende verwantskap lei tot die uitruiling van tasbare en nie-tasbare produkte wat die sosiale kommoditeite verteenwoordig. Die medeskepping van bruikbare kontekstuele kennis verteenwoordig die uiteindelike uitkoms van die proses waarin basiese kennis, die geskrewe kennis en die inherente aangeleerde kennis van kundiges en ongeskoolde persone in wisselwerking tree. Die voorgestelde teoretiese raamwerk verskaf beter insig in die verskil tussen die verhouding met eksterne gemeenskappe en die werklike diensaksies wat plaasvind gedurende vak-gebaseerde diensaktiwiteite. Binne sodanige verstaan stel die raamwerk voor dat die manier wat sulke aktiwiteite beplan word, herbedink behoort te word.

Older adults are living longer than ever before. By 2060, the U.S. population aged 65 or older is projected to reach 98 million. As adults age, the prevalence of chronic diseases and disabilities increases. The need for Meals on Wheels (MOW) services is growing alongside the aging population. Yet, little is known about the geographic variation of services. Little is documented about the organizational capacity of MOW organizations in terms of geography. The current policies supporting home-and community-based services, including MOW, may be insufficient to support all older adults in all types of communities. An analysis of the More Than a Meal® Comprehensive Network Study was conducted to determine geographic variation in services delivered through MOW programs and to document organizational capacity by geography. Chi-squared analyses were performed to identify relationships between twenty services offered through MOW organizations and categorial offerings within nutrition, in-home safety, socialization, and community connections categories. Spidergrams were created to document organizational capacity holistically and for three individual organizations for each of the geographic areas: Rural Only, Partial Rural, and Non-rural Service Areas. Using these findings, a policy analysis was conducted to determine policy recommendations to inclusively support rural older adults. Older adults living in rural areas access the full complement of services provided by MOW programs differently than do their non-rural counterparts. Specifically, a statistically significant relationship was found between the stratified component of in-home safety for rural, partial rural and non-rural service areas. When evaluated on the individual service offering level, statistically significant relationships between rurality and congregate meals, nutrition education, nutrition assessment, coordination of USDA food assistance programs, and telephone reassurance were seen. Spidergram documentation of capacity created visual representations of geographic similarities and differences. The policy analysis produced three potentially viable policy additions for the Older Americans Act around a provision for innovation programs, a report on in-home safety, and business acumen provisions. This work lays the foundation for further analysis of existing data with a lens of geographic specificity, as well as articulates the importance of looking at organizational capacity as a part of policy recommendations for understanding rural community-based organizations.

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