Thesis advisor: Rebecca Lowenhaupht / Abstract Purpose and Research Questions: To understand central office leadership, it is necessary to examine how language grounds leaders’ actions, and influences their effectiveness among themselves and with stakeholders, including other central office leaders, building principals, teachers, community and students. This study explores the relationship between central office administrators’ language and their support of historically marginalized students. Looking closely at how language shows commonality or disconnect in understanding and action, this study is guided by the following research questions: (1) What language do leaders use to talk about their work with marginalized populations? (2) How does this language influence practice? Methods: This qualitative case study analyzes with the use of discourse analysis the language of central office administrators and their work in support of historically marginalized populations, using semi-structured interviews, and document review to answer the aforementioned research questions. This is one section of a larger research project studying how central office administrators organize their work in support of marginalized populations. Findings: Turnaround districts such as the district in this case study face complex and urgent issues, which seem to influence the language central office administrator’s use. In this study, central office administrators expressed language of frustration to talk about lack of time. Second, central office administrators used language that either recognized or demonstrated implicit bias in what marginalized populations heard or saw. Third, central office administrators relied on expressions of mandated language when they communicated about their work in support of marginalized populations, and lastly, central office administrators used language of care to talk about why they worked in a turnaround district. Significance: Given the importance of communication in district leadership, practitioners should work to establish and integrate consistent language into practice. Researchers will find it a valuable contribution to examine the outcomes of central office administrators’ language use in supporting traditionally marginalized student populations, as research is limited. / Thesis (EdD) — Boston College, 2018. / Submitted to: Boston College. Lynch School of Education. / Discipline: Educational Leadership and Higher Education.

There are many populations poorly served by the current Canadian approach to health and illness care. These populations include members of ethnic minority groups, those with poor socio-economic status, those who are homeless, working in the sex trade or affected by mental illness. One way of potentially improving the health of communities or populations is through policy. In addition, a deeper understanding of the health needs of underserved populations could facilitate expeditious solutions mindful of resource challenges. In spite of copious research, health inequities and disparities persist. My hypothesis was that the conscious use of specific lenses to examine policies or interview data was a useful device to both better visualize and understand actions related to policy development and community member input. Thus, this thesis research was comprised of two major components. The first was an exploration of two policies of an academic tertiary health care centre through the lenses of feminist, critical social and systems theory. The objective was to determine if viewing policy development using different lenses might influence thinking about issues related to underserved populations. The second component used the same three lenses to conduct a grounded theory analysis of eleven photo-elicitation and six photo-voice interviews with North End Halifax Community members. The focus of these interviews was on contributions to health found in the community of North End Halifax. The results clearly show that examination of policies through the three theoretical lenses serves to highlight hidden assumptions and to broaden the view and comprehension of implications and potential impacts of policies. A better way to formulate policies is one step towards achievement of improved health outcomes. The use of three lenses in the grounded theory analysis significantly enhanced the depth of interview analysis: the feminist lens accentuated the concept of caring and relationships and the extent of the White-middle-class male perspective; the critical social lens crystallized the power disparities at play; and the systems lens stressed the need to examine root causes. The conscious use of specific lenses could facilitate a more comprehensive and comprehended view of the health needs of underserved populations.

Afro-descendant communities in Central America have recently made important legal strides by enshrining their right to equal treatment under the law and in some cases their ability to claim a distinct group status in national constitutions. The United Nations recently issued a draft resolution declaring that access to water and sanitation is a universal right, furthering the tools available to marginalized afro-descendant peoples in their battles against poverty and underdevelopment. Unfortunately, implementation of these measures has been slow in some areas and non-existent in others. Though there have been some advances, the situation for Afro-descendant communities remains largely unchanged and the availability of the basic requirements of life for Afro-descendant populations remains among the lowest in the region. Increased attention to the political, social, and especially the material situation of Afro-descendant communities is needed in political circles, as well as in the academic community. There is a lack of scholarly work on the material well-being of Afro-descendent populations in Central America. An important initial contribution in this area would be the compilation, and accumulation of statistical information as a primary step in developing the literature. The focus of this study then is on the Atlantic Coast Afro-descendant populations in Nicaragua. This document will outline the current material circumstances of Nicaraguan Afro-descendant communities using data gathered from a variety of sources, identify the causes of inadequate access to water and sanitation, and suggest strategies to improve the situation of these communities. It is my sincere hope that, at the very least, increased attention will be brought to the situation. / text

Social factors and social contexts have long been implicated in shaping/influencing behaviours, actions, and outcomes, including social and health inequities. The social determinants of health concept has shown that health and health inequities are shaped by a variety of socio-cultural factors including education, socio-economic status, gender, ethnicity, and the social and physical environments in which people live. Critical drug scholars have specifically sought to understand how contexts and environments shape drug use and related harms. The “risk environment” framework, for example, suggests that drug use, risky drug use practices (e.g., needle sharing), and drug use-related harms are shaped by social, physical, economic and policy environments. Yet while contexts are frequently implicated in framing and shaping behaviours, the specific mechanisms at play are rarely unpacked. I address this gap by further “opening up” contexts of drug consumption and social marginalization in order to extend our knowledge of drug use among marginalized people who use drugs (PWUD) My dissertation includes 3 analyses of my data in the form of published (2) and submitted (1) manuscripts. Two-stage interviews (a short quantitative survey and longer qualitative interview) were conducted with fifty PWUD in the Downtown Eastside (DTES) neighbourhood in Vancouver, Canada. Data were analyzed with conceptual and theoretical tools borrowed from Situational Analysis, as well as actor-network and assemblage theories. In my first paper, I explore reasons for using drugs, and suggest that, despite known negative consequences of drug use, substance use among marginalized PWUD can be meaningful and beneficial. Participant narratives revealed four main themes regarding positive aspects of drugs and drug use in their lives: (1) pain relief and management; (2) alleviating mental health issues; (3) fostering social experiences; (4) pleasurable embodied experiences. These findings draw attention to the fallacies of drug prohibition and much current drug policy which has fabricated boundaries between the acceptable and unacceptable, resulting in the criminalization and stigmatization of certain substances and the people that use them. In my second paper, I draw upon actor-network theory and event analysis to explore how contexts shape drug consumption practices. My findings illustrate how specific methods of drug consumption (e.g., smoking or injecting) are shaped by an assemblage of objects, actors, affects, spaces and processes. Rather than emphasising the role of broad socio-structural factors (e.g., poverty, drug policy) participant narratives reveal how a variety of actors, both human and non-human, assembled in unique ways produce drug consumption events that have the capacity to influence or transform drug consumption practices. In my third paper, I explore how spaces/places frequently used by PWUD in the DTES that are commonly associated with risk and harm (e.g., alleyways, parks) can be re-imagined and re-constructed as spaces/places of safety and wellbeing. Conceptualizing spaces/places as assemblages, I trace the associations among/between a host of seemingly disparate actants – such as material objects, actors, processes, affect, temporal elements, policies and practices – to better understand how experiences of harm, or conversely wellbeing, unfold, and shed light on how risky spaces/places can be re-constructed as places that enable safety and wellbeing. Taken together these 3 papers/analyses provide unique insight into not only drug use among marginalized PWUD, but our understanding of the ways in which contexts and environments shape behaviour and social phenomena. These findings have direct implication for harm reduction theory and drug policy. With greater insight into the contexts of drug use, drug policy and harm reduction strategies may be better tailored to prevent drug use-related harms. / Graduate / 2019-12-07

Performance policies propose to enhance the quality of services provided to vulnerable citizens. However, the ability to accomplish this goal is largely unsubstantiated. In the field of education, the No Child Left Behind Act outlined performance policy guidelines that held educators accountable for disadvantaged students outcomes and provided students with the option to seek the serves of alternative providers through a student transfer provision. This dissertation assesses the quality of states’ NCLB provisions that targeted minority and vulnerable student performance as well as utilization of the NCLB transfer provision allowing students to exit underperforming schools. It indicates that teachers’ union strength, minority student population, and past performance impacted the development of vulnerable student accountability provisions. The use of the transfer provision was limited by the strength of the accountability system implemented. As a result, the transfer provision is being poorly utilized and the states have negatively affected the educational opportunities of marginalized populations.

Sex offender community re-entry is a process fraught with many challenges. As jurisdictions face increasing demands from the public and legislative bodies for mandatory community supervision and treatment, those tasked with adequate risk management in our communities must often balance the needs of community safety and policy compliance with what is most beneficial and most realistic for the offender. Such challenges are more pronounced in rural communities with limited resources. Identifying clinicians who are willing to provide sex offender treatment services and able to communicate effectively with involved agents (e.g., offices of probation and parole), locating additional treatment services for offenders who struggle with other co-morbid issues like mental illness or addictions, and finding adequate residential and vocational placements, are some of the specific obstacles that clients face in any setting, but perhaps more so when returning to rural or isolated communities. Are such communities equipped for the needs of these clients? In this presentation, sex offender community reintegration within the context of rural treatment settings will be discussed. This will include a discussion of pilot research that has identified barriers to effective risk management, such as a need for intensive case management and follow-up, coordination with the courts and other responsible agencies, struggles with compliance with residency restrictions, stigma, and unique challenges in ensuring a good quality of life for sex offenders in small communities. Additional preliminary results from an ongoing survey of community and primary care providers describing knowledge, training, and experience related to offender treatment and working with clients involved in the forensic mental health and correctional systems will be included. Here, implications for provider training will be discussed, as well as future directions for more effective interaction between interdisciplinary providers in community settings to facilitate comprehensive risk management for this client population.

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<p>Community participation has been identified as a key facilitator of community health among marginalized populations in international health statements. However, knowledge gaps in the community participation literature regarding marginalized populations has been attributed to the lack of consistent definitions of community participation, ambiguity about the features of community participation initiatives (e.g., methods and strategies) that are appropriate for marginalized populations, and limitations of existing community participation frameworks in specifying the ways and means in which different marginalized populations might effectively participate, as well as in recognizing that community participation is highly contextual and situational. All of these factors have made it difficult to draw broader conclusions about the impact of participation methods and strategies for marginalized populations from evaluations of participation initiatives.</p> <p>The overall purpose of this thesis is to better understand how to involve marginalized populations in the planning and decision-making for local health services. First, a critical interpretive synthesis (CIS) was conducted to better understand the role of community development principles used in community participation initiatives with marginalized populations and the factors contributing to the influence of the principles in enabling the participation of these populations. Second, an in-depth comparative case study of four community participation initiatives in Ontario Community Health Centres (CHCs)—which are primary health care organizations serving 74 high-risk communities throughout the Province of Ontario—was conducted to identify the core features of participation initiatives with marginalized populations, and reflect on the particular challenges of engaging marginalized populations. Third, four focus groups were held at four Ontario CHCs to examine the role of frameworks as mechanisms for translating knowledge about community participation practice with marginalized populations. Overall, this thesis broadens our understanding of community participation with marginalized populations in the context of local health services planning and decision making. Specifically, this thesis contributes a theoretical basis for future research and provides practical knowledge for planning and evaluating community participation initiatives with marginalized populations.</p> / Doctor of Philosophy (PhD)

This thesis analyzes the Cuban medical adaptation in Venezuela called Misión Barrio Adentro (MBA) and seeks to answer the question of whether MBA shows promise as a health system that improves medical accessibility for impoverished and marginalized populations. In many cases MBA succeeds by: utilizing a free universal health care system; locating health centres in previously underserved areas; providing medical education scholarships to populations from non-traditional backgrounds; creating a catchment system based on medical accessibility; scaling up the medical workforce to 60,000 community doctors by 2019; and broadening the very praxis of what health means in a Latin American social medicine approach. However, some challenges remain including issues of corruption, fragmentation, and polarization. Issues regarding internal and external migration of Misión Sucre-trained physicians remain to be comprehensively evaluated. However, the capacitation of non-traditional medical personnel, imbued with conciencia, is significant and could well become an important example for other countries.