This thesis focuses on service utilisation among children with mild ID and their families, their needs for support and their experiences of support. Aims The overall aim of the thesis was to explore and describe service utilisation patterns among families of children with mild ID from a systems perspective. Methods A cross-sectional, descriptive and comparative quantitative design was used to describe the extent of service utilisation among 84 children with mild ID and their families (paper I and II). The types and number of services utilised were investigated in relation to the child’s age, gender and school setting. Data concerning the services utilised were collected from the organisational records of social services and paediatric habilitation units. In paper III, a descriptive questionnaire design was used to describe the support needs of families of 38 children with mild ID. A confirmatory design was used to examine the relation between family needs for support and (a) parental self-efficacy and (b) parents’ control over services. A confirmatory design was also used to examine the relation between parents’ experiences of the helpfulness of the support and (a) parental self-efficacy and (b) parents’ control over services. In paper IV a longitudinal, comparative and confirmatory design was used to investigate whether social service utilisation patterns differ over time when children with mild ID in self-contained classes are compared with those integrated into mainstream classes (n=405). Results In total, 60% of the families utilised paediatric habilitation services, and 40% of the families used disability-related services provided by social services. The most commonly utilised services were services concerned support outside of the home, such as respite care and services to improve children’s participation in society. Approximately 25% of the families utilised social problems-related services provided by social services. The most commonly utilised services concerned those to support parents in their parenting roles and financial assistance. In contrast to older children, younger children were more likely to utilise paediatric habilitation services. Older children utilised a higher number of disability-related service types provided by social services. Few differences were found between males and females. The majority of families did not utilise such services that are provided by social services. It was rare for families to use both disability-related services and those that address social problems during the same year. Commonly reported family needs concerned information about what services are available for their child, their child's impairment, how to respond to their child's behaviour and how to teach their child skills. Other common needs included access to parent support networks, to find suitable leisure activities for the child, and more alone time for parents. In contrast to families with mothers who did not participate in paid work, families with mothers who were employed expressed a lower requirement for support such as counselling, contact with other parents of children with impairments, more friends and more alone time for parents. Similar results werefound for families with mothers with higher levels of education. Parents with higher levels of perceived self-efficacy reported a lower need for information, as did also parents with higher levels of control over services. Parents with higher levels of control over services experienced the support as being more helpful. Children with mild ID who attended self-contained classes were more likely to utilise paediatric habilitation services than children integrated in mainstream classes. The same pattern was found for utilisation of disability-related services provided by social services. Integrated children who changed school setting to attend self-contained classes were more likely to begin to utilise disability-related services in comparison with those children who continued to be integrated. The former also had a higher likelihood of increasing the number of disability-related service types utilised. Conclusions In addition to disability-related problems, families of children with mild ID may also be at a higher risk of experiencing social problems when compared with the general population. Furthermore, very few families utilised both disability-related services and services addressing social problems. This implies that collaboration flaws exist between those professionals concerned with child welfare services and those concerned with disability-related services. A strong predictor of service utilisation was the type of school setting: children attending self-contained classes had a higher rate of service utilisation than those attending mainstream classes. This indicates that service systems outside of school are designed to collaborate with groups of pupils in special classes rather than individual children in mainstream classes. The strong need for information by families indicates that an ecological framework should be used to identify those factors that affect information availability and effectiveness. To increase parents’ perceived level of control over services, HSO professionals need to work in a capacity building manner with the explicit goal to enhance parental self-efficacy.

En raison du nombre élevé d'échecs dans les tentatives de changements organisationnels, de plus en plus d'études s'intéressent aux facteurs humains en jeu, tel que l'engagement des employés envers le changement. Il est en effet reconnu que l'engagement affectif envers le changement joue un rôle important dans l'adoption de comportements de soutien des employés en situation de changement. Afin de favoriser cette forme d'engagement, les pratiques de gestion du changement utilisées semblent jouer un rôle important pour répondre aux besoins de cohérence, de compréhension et de soutien des employés face aux changements. Ainsi, il est possible de postuler que les employés percevant un changement comme nécessaire, légitime et accompagné d'un soutien adéquat seront davantage engagés affectivement envers celui-ci. De plus, ces perceptions favoriseraient également l'habilitation psychologique des employés, un état d'esprit facilitant l'adoption de comportements proactifs profitables en situation de changement. Peu d'études se sont attardées, de manière longitudinale, à l'examen du rôle de l'habilitation psychologique dans la relation unissant les caractéristiques reliées à la gestion et l'engagement affectif envers le changement. Pour ces raisons, la présente étude vise à vérifier si les quatre dimensions de l'habilitation psychologique jouent un rôle de médiateur dans les relations unissant certaines caractéristiques reliées à la gestion du changement (nécessité, légitimité, soutien perçu) et l'engagement affectif envers le changement. Au total, 819 employés de deux établissements de santé de l'Estrie ont participé à au moins l'un des trois temps de mesure de cette étude et forment l'échantillon longitudinal utilisé. Les analyses effectuées n'ont pas permis de confirmer le rôle médiateur de l'habilitation psychologique dans la relation entre la nécessité, la légitimité, le soutien perçu et l'engagement affectif envers le changement. Néanmoins, les résultats ont permis de montrer l'importance de favoriser la perception de nécessité et de soutien offert chez les employés, afin d'agir positivement sur leur sentiment de compétence et d'autodétermination en situation de changement. À long terme, ces employés seraient ainsi plus enclins à soutenir les efforts de changement en cours.

A adoção é uma medida excepcional que visa à possibilidade de dar uma família às crianças e adolescentes privados da convivência familiar. Por isso, candidatos à adoção devem passar por um processo de preparação psicossocial e jurídica, orientado pelas equipes técnicas dos Juizados da Infância e Juventude. A falta de um critério norteador nas avaliações pode ser um trazer dificuldades para os profissionais que devem avaliar questões complexas como a adoção e a parentalidade. A partir disso, a presente dissertação teve como objetivo conhecer o funcionamento dos processos de habilitação para adoção no Rio Grande do Sul através de relatos dos psicólogos e assistentes sociais judiciários. Para isso, a dissertação foi composta por dois artigos. O primeiro apresentou os critérios levados em consideração, durante as entrevistas com postulantes à adoção, concluindo que, para os profissionais, a única motivação adequada é o desejo de ter filho e ser pai e mãe. O segundo mostrou as implicações de novos modelos e configurações familiares nos processos de habilitação para adoção, compreendendo as peculiaridades na avaliação de diferentes perfis de candidatos. Tendo em vista os dois estudos, foi possível analisar mais cuidadosamente os processos de habilitação para adoção no estado e pensar que ele poderia se configurar como um espaço de reflexão acerca do projeto adotivo e de parentalidade dos adotantes. Espera-se que este trabalho tenha contribuído para dar voz aos profissionais, voltar o olhar para os postulantes à adoção e aproximar uma área de estudo ainda incipiente no contexto acadêmico. / Adoption is an exceptional measure that aims at giving a family to children and teens that were deprived of in-family living, hence the candidates for adoption must go through a process psychological and judicial preparation guided by personnel from the Court of Infancy and Youth. The lack of a basal criterion in the evaluations brings a difficulty to the professionals involved that have to evaluate complex contexts surrounding adoption and parenting. The present study aimed at clarifying the functionalities and minutia of the process of habilitation for adoption in the state of Rio Grande do Sul through the accounts of psychologists and social workers allotted in the judiciary system. This dissertation is composed of two articles: the first one presented the criteria taken in consideration during the interview with the adopting candidates. It concludes that for the professionals involved in the screening process the main motivation should be the desire to have a child and to be a parent. The second article aimed at presenting the implications regarding the new configurations of family in the process of habilitation for adoption. It touches the details in the evaluation of different profiles of the candidates. Considering the two studies, it was possible to analyze more carefully the process of habilitation for adoption in the state and think the habilitation process can be itself as a ground to ponder upon adoptive and parental projects of the candidates. It is hoped that this study gave a voice to the professionals involved in the adoption process, emphasized the context of the candidates and bridged this still incipient field of research.

A preocupação com a inclusão social da pessoa com deficiência é crescente. Especificamente quanto ao deficiente auditivo, o rol normativo está em desenvolvimento, porém ainda não supre todas as necessidades da sociedade. No contexto do serviço de implante coclear o Centro de Pesquisas Audiológicas (CPA) do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) da Universidade de São Paulo (USP), popularmente conhecido como Centrinho, que já realizou mais de 1.500 cirurgias de implante coclear (IC), constatou-se um grupo de pacientes implantados que não realizam a (re)habilitação auditiva por meio da terapia fonoaudiológica após a cirurgia do IC, ou ainda, não respeitam a periodicidade desse processo, comprometendo o desenvolvimento do deficiente auditivo. A falta ou negligência com o processo de terapia fonoaudiológica da (re)habilitação auditiva enseja na consequente violação de direitos fundamentais do deficiente. Toda equipe interdisciplinar de profissionais responsáveis pela indicação e adaptação do IC assumem papel fundamental no processo de (re)habilitação do deficiente auditivo, devendo acima de tudo zelar pela ética e humanização com o paciente e seus familiares. Como o IC é de elevado custo (tecnologias duras) incluso no procedimento de alta complexidade contemplado pelo Sistema Único de Saúde quem paga é a própria sociedade (através dos recursos públicos), por esse motivo é fundamental que o beneficiário dessa intervenção não apenas reivindique seus direitos, mas também cumpra com seus deveres. Apesar dos recentes avanços normativos do IC, a regulamentação existente é vulnerável frente à complexidade do processo de habilitação e reabilitação auditiva por meio do IC, deixando margem para violações, omissões e abusos. Diante desse cenário todos acabam sendo prejudicados, o Estado, a sociedade e o próprio beneficiário da prótese auditiva. O escopo do presente estudo é analisar criticamente o panorama jurídico em nível nacional das regulamentações voltadas ao implante coclear no processo de (re)habilitação auditiva. Os materiais e métodos utilizados serão os de levantamento bibliográfico, jurídico-doutrinário e revisão jurídica. / Concern about the social inclusion of people with disabilities is growing. Specifically regarding the hearing impaired, the normative roll is in development, but it still does not supply all the needs of society. In the context of the cochlear implant service, the Center for Audiological Research (CAR) of the Hospital of Rehabilitation of Craniofacial Anomalies (HRCA) of the University of São Paulo (USP), popularly known as Centrinho, which has already performed more than 1,500 cochlear implant surgeries, a group of implanted patients who did not perform auditory (re)habilitation by means of phonaudiologic therapy after cochlear implant surgery were found, or did not respect the periodicity of this process, compromising the development of the hearing impaired. Failure or negligence with the audiological (re)habilitation process leads to a consequent violation of the fundamental rights of the handicapped. Every interdisciplinary team of professionals responsible for the indication and adaptation of the cochlear implant assume a fundamental role in the process of (re) habilitation of the hearing impaired, and above all must care for the ethics and humanization with the patient and their relatives. Since the cochlear implant is of high cost hard technologies included in the procedure of high complexity contemplated by the Unified Health System who pays is the company itself (through public resources), for this reason it is fundamental that the beneficiary of this intervention not only claim their rights, but also fulfill your duties. Despite the recent normative advances in the cochlear implant, the existing regulations are vulnerable to the complexity of the process of habilitation and auditory rehabilitation through the cochlear implant, leaving room for violations, omissions and abuse. Faced with this scenario, all of them end up being harmed, the State, society and the beneficiary of the hearing aid itself. The scope of the present study is to critically analyze the legal framework at the national level of the regulations aimed at the cochlear implant in the (re)habilitation process. The materials and methods used will be those of bibliographical, legal-doctrinal and legal review.

<p>The purpose of this qualitative study is to investigate how the welfare officer who works in the child and youth<strong>-</strong> habilitation is documenting in boys and girls journals. We also want to see if there are any differences or similarities in the journals on the basis of a gender perspective? The investigation is made from ten journals, five boys and five girls in the ages from 13 -18 years. The analysis which proceeds from prior research made on this area and from a number of gender theories and gender perspectives is based on a hermeneutic nature. The results show that the welfare officers make more documentation about the boys´ school situation than the girls´. Although is the documentation made more detailed about the girls´ feelings and general health. In the girls’ journals the family’s health gets more attention than in the boys´ ones where there is more focus on the boy himself. Further the results show that the girls altogether have had almost double as much contact whith the welfare officers than the boys had. Concerning documenting sparetimes interests the result show that three of the girls like riding while two of the boys do sports in their sparetime.</p>

The purpose of this qualitative study is to investigate how the welfare officer who works in the child and youth- habilitation is documenting in boys and girls journals. We also want to see if there are any differences or similarities in the journals on the basis of a gender perspective? The investigation is made from ten journals, five boys and five girls in the ages from 13 -18 years. The analysis which proceeds from prior research made on this area and from a number of gender theories and gender perspectives is based on a hermeneutic nature. The results show that the welfare officers make more documentation about the boys´ school situation than the girls´. Although is the documentation made more detailed about the girls´ feelings and general health. In the girls’ journals the family’s health gets more attention than in the boys´ ones where there is more focus on the boy himself. Further the results show that the girls altogether have had almost double as much contact whith the welfare officers than the boys had. Concerning documenting sparetimes interests the result show that three of the girls like riding while two of the boys do sports in their sparetime.

This study determined whether a pre-operative cardiac “pre-habilitation” (Prehab) program improves the health of elective coronary artery bypass graft (CABG) surgery patients to a greater extent than standard care (StanC). Seventeen elective CABG patients were randomized to StanC (n= 9) or Prehab (n= 8) at Baseline and were followed at 1-2 weeks pre-operatively (Preop) and Three months post-operatively. Functional walking ability was assessed using the 6-Minute Walk Test (6MWT) and 5-meter Gait Speed Test. Baseline data was not different between groups. Patients in StanC did not improve 6MWT scores; whereas Prehab patients improved 6MWT distance by 35% and 39% at Preop and Three months post-operatively, respectively (p<0.05). Gait speed scores were 25% and 27% lower in Prehab patients at Preop and Three months post-operatively, respectively, as compared to StanC (p<0.05). These data suggest that Prehab is an attractive intervention for enhancing functional walking ability before and after elective CABG surgery.

This study determined whether a pre-operative cardiac “pre-habilitation” (Prehab) program improves the health of elective coronary artery bypass graft (CABG) surgery patients to a greater extent than standard care (StanC). Seventeen elective CABG patients were randomized to StanC (n= 9) or Prehab (n= 8) at Baseline and were followed at 1-2 weeks pre-operatively (Preop) and Three months post-operatively. Functional walking ability was assessed using the 6-Minute Walk Test (6MWT) and 5-meter Gait Speed Test. Baseline data was not different between groups. Patients in StanC did not improve 6MWT scores; whereas Prehab patients improved 6MWT distance by 35% and 39% at Preop and Three months post-operatively, respectively (p<0.05). Gait speed scores were 25% and 27% lower in Prehab patients at Preop and Three months post-operatively, respectively, as compared to StanC (p<0.05). These data suggest that Prehab is an attractive intervention for enhancing functional walking ability before and after elective CABG surgery.

The aim of the study on which this thesis is based was to gain an understanding of the life situation of street children in Kenya and to investigate how caring institutions care for these children.  A reflexive ethnographic approach was used to facilitate entry into the children’s sub-culture and the work contexts of the caregivers to better understand how the children live on the streets and how the caregivers work with the children. A fundamental aim of the research was to develop interventions to care; one of the reasons why we also used the interpretive description approach. Method and data source triangulation was used. Field notes, tape, video, and photography were used to record the data.  Participant observation, group discussions, individual interviews, home visits, key informant interviews, participatory workshops and clinical findings were used for data collection in Studies I and II.  In addition to observation, interviews were conducted with caregivers for study III, while written narratives from learners attending adult education developed and implemented during the research period provided data for study IV.  Study I indicated that food, shelter and education were the main concerns for the children and that they had strong social bonds and used support networks as a survival strategy.  Study II provided a deeper understanding of the street culture, revealing how the boys are organised, patterns of substance use, home spaces in the streets and networks of support. The boys indicated that they wanted to leave the streets but opposed being moved to existing institutions of care. A group home was therefore developed in collaboration with members of the category “begging boys”.  Study III indicated how the caregivers’ interactions with the children were crucial in children’s decisions to leave the streets, to be initiated into residential care, undergo rehabilitation and to be reintegrated into society.  Caregivers who attempted to use participatory approaches and took time to establish rapport were more successful with the children.  Study IV suggested that the composition of learners, course content grounded on research, caregivers’ reflections and discursive role of researchers and facilitators, all contributed to adult learning that transformed the learners’ perspectives and practice.

A adoção é uma medida excepcional que visa à possibilidade de dar uma família às crianças e adolescentes privados da convivência familiar. Por isso, candidatos à adoção devem passar por um processo de preparação psicossocial e jurídica, orientado pelas equipes técnicas dos Juizados da Infância e Juventude. A falta de um critério norteador nas avaliações pode ser um trazer dificuldades para os profissionais que devem avaliar questões complexas como a adoção e a parentalidade. A partir disso, a presente dissertação teve como objetivo conhecer o funcionamento dos processos de habilitação para adoção no Rio Grande do Sul através de relatos dos psicólogos e assistentes sociais judiciários. Para isso, a dissertação foi composta por dois artigos. O primeiro apresentou os critérios levados em consideração, durante as entrevistas com postulantes à adoção, concluindo que, para os profissionais, a única motivação adequada é o desejo de ter filho e ser pai e mãe. O segundo mostrou as implicações de novos modelos e configurações familiares nos processos de habilitação para adoção, compreendendo as peculiaridades na avaliação de diferentes perfis de candidatos. Tendo em vista os dois estudos, foi possível analisar mais cuidadosamente os processos de habilitação para adoção no estado e pensar que ele poderia se configurar como um espaço de reflexão acerca do projeto adotivo e de parentalidade dos adotantes. Espera-se que este trabalho tenha contribuído para dar voz aos profissionais, voltar o olhar para os postulantes à adoção e aproximar uma área de estudo ainda incipiente no contexto acadêmico. / Adoption is an exceptional measure that aims at giving a family to children and teens that were deprived of in-family living, hence the candidates for adoption must go through a process psychological and judicial preparation guided by personnel from the Court of Infancy and Youth. The lack of a basal criterion in the evaluations brings a difficulty to the professionals involved that have to evaluate complex contexts surrounding adoption and parenting. The present study aimed at clarifying the functionalities and minutia of the process of habilitation for adoption in the state of Rio Grande do Sul through the accounts of psychologists and social workers allotted in the judiciary system. This dissertation is composed of two articles: the first one presented the criteria taken in consideration during the interview with the adopting candidates. It concludes that for the professionals involved in the screening process the main motivation should be the desire to have a child and to be a parent. The second article aimed at presenting the implications regarding the new configurations of family in the process of habilitation for adoption. It touches the details in the evaluation of different profiles of the candidates. Considering the two studies, it was possible to analyze more carefully the process of habilitation for adoption in the state and think the habilitation process can be itself as a ground to ponder upon adoptive and parental projects of the candidates. It is hoped that this study gave a voice to the professionals involved in the adoption process, emphasized the context of the candidates and bridged this still incipient field of research.