While health authorities have administered licensed residential care facilities for years, in the last two decades, health authorities have increasingly contracted with nonprofit organizations to house persons diagnosed with mental illness in the community in "supported" projects. Services may include medical and/or social supports such as medication, addiction services, case-management and life skills training. While flexible supports customized to meet the needs of service users may sound encouraging, numerous questions remain. This thesis generates a basis from which to explore how services might shift to better meet the needs of tenants. To do so, I examine meanings of support from a tenant perspective and consider the environment in which tenants experience support in supported housing. The analysis involves semi-structured, one-on-one interviews with two female and four male tenants who had been previously homeless, currently living in one supported housing project in a mid-sized city in British Columbia, Canada. The study draws on love ethic and neoliberal theory in an effort to frame mental health service user understandings and mainstream models of support. The tensions between support services employing principles of love ethic theory and mainstream models raise the question of whether the two models can co-exist, and if so, how and where compromises are made and at whose expense. These tensions are evident in the data and in turn are taken up within the analysis. Tenant meanings of support include relationships and resources that increase safety, security and independence, understood as the freedom to identify your own goals and maintain control over the support you receive. The findings point to a vital need to ensure tenants are included in decision-making with regard to support practices and policies. Utilizing tenant knowledge would go a long way toward addressing many of the concerns and dilemmas which surface in the research.

Background: Worldwide one in twelve people are living with diabetes and one in two people do not know they have diabetes. Currently large numbers of the older people live in residential care homes in the UK, and up to one in four older people living in residential care homes present with diabetes. Low vision is one of the complications associated with diabetes in older people. In those aged 75 and over, one in five, and in those aged over 90, one in two people are affected by low vision and they are at an increased risk of developing other eye diseases. Within 20 years of diagnosis nearly all people with Type 1 and almost two thirds of people with Type 2 diabetes (60%) have some degree of diabetic retinopathy. Aims and Objectives: This study aimed to investigate the issues and problems faced by older people living in residential care homes with low vision and diabetes; to evaluate health professionals’ knowledge and understanding of the impact of low vision associated with diabetes in older people living in residential care homes; and to develop an educational toolkit which aimed to educate health care assistants about low vision and diabetes. Methods: This study is an exploratory investigation of older people living in residential care homes with low vision and diabetes. Adopting an open-ended qualitative approach using focus groups, interviews and a health professional’s survey, 116 participants were involved. These included GPs, ophthalmologists, nurses, optometrists, health care assistants and older people with low vision and diabetes. The data was analysed thematically. The educational toolkit was developed in the second part of this study, and 20 healthcare assistants were trained using this toolkit. Their knowledge was tested before the training, immediately after the training and one month after the initial training. Following Kirkpatrick’s model, the skills and practical use of the educational toolkit was assessed using an open-ended qualitative approach. Results: The results found that many older people and the health care assistants had the perception that low vision was a normal ageing process and could not be rectified. The study found that there was evidence to suggest that eye health was not considered to be a priority; instead, it was considered to be a natural part of the ageing process. The results found that 82% of the HCAs had not had any training in the area, and more than half of the nurses and GPs did not have sufficient knowledge of low vision and diabetes. After training, however, their knowledge was increased. This suggested that low vision and diabetes toolkit training could be used to educate healthcare assistants on a regular basis. The study also found that knowledge does decline over time, and therefore regular training for HCAs is required in order to maintain eye health and diabetes in older people, as well as improving their quality of life. Conclusion: In the research findings it was found that 50% to 70% of low vision was preventable or treatable if detected in its early stages and could be avoided by simply wearing appropriate spectacles, or possible surgery. However, in order to identify these 50% to 70% with low vision, everyone concerned should be able to recognise the signs and symptoms of preventable low vision, particularly health care assistants, as according to this study, health care assistants spent large amount of time in the residential care homes compared to the other health professionals.

Este trabalho teve por objetivo investigar e discutir as imagens sociais atribuídas às instituições de acolhimento e aos jovens institucionalizados, a partir de dois estudos empíricos exploratórios. O estudo I investigou as imagens sociais atribuídas às instituições de acolhimento. Participaram da pesquisa 202 adultos selecionados por conveniência, com idades entre 16 e 69 anos (M=32,76, DP=11,67), sendo a maioria do sexo feminino (79,2%), solteiro (51%), com ensino médio (48%) ou curso superior (37,6%). Os participantes responderam a um questionário aberto utilizando até cinco palavras para descrever uma instituição de acolhimento. O estudo II investigou as imagens sociais atribuídas aos jovens em acolhimento institucional. Participaram 224 adultos selecionados por conveniência, com idades entre 18 e 71 anos (M=33,97, DP=11,42), sendo que 68,4% já tiveram contato com adolescentes em situação de vulnerabilidade e risco. Foi utilizado um questionário fechado, com 37 palavras para descrever os jovens típicos e em acolhimento, com itens em escala Likert. Os resultados do primeiro estudo indicam que as imagens sociais sobre as instituições de acolhimento, em geral, são positivas e que predominam as percepções relacionadas ao acolhimento/proteção e à organização. Os resultados do segundo estudo apontam que as palavras consideradas negativas foram significativamente mais associadas aos jovens em acolhimento institucional, indicando haver uma imagem social negativa desta população. Embora as mudanças legais e políticas referentes à proteção infantojuvenil venham contribuindo para a qualificação dos serviços de acolhimento, permanecem os estigmas que classificam os jovens inseridos nesse contexto. É importante que se faça uma reflexão social coletiva sobre essa realidade a fim de que se encontrem estratégias de modificação do imaginário social que ainda rotula e discrimina essa população. / This study aimed to investigate and discuss the social images associated to the residential care institutions and the young people in care through two exploratory empirical studies. The first study investigated the social images assigned to the residential care institutions. The participants were 202 adults selected by convenience, aged 16 to 69 years old (M=32.76, SD=11.67), mostly female (79.2%), single (51%), with high school (48%) or higher education (37.6%). The participants answered an open questionnaire using up to five words to describe a residential care institution. The second study investigated the social images assigned to young people in care. The participants were 224 adults selected by convenience, aged 18 to 71 years old (M=33.97, SD=11.42), 68.4% of them have already had contact with teenagers in vulnerability and risk situations. The instrument was a Likert scale questionnaire with 37 words used to describe young people in general and in care. The results of the first study indicated that social images are generally positive, prevailing perceptions related to care/protection and organization. The results of the second study indicated that the negative words were significantly more associated with young people in care, indicating that there is a negative social image related to this population. Although legal and political changes concerning children and youth protection have been contributing to the qualification of residential care institutions, the stigmas that classify young people inserted in this context remain. It is important to make a collective social reflection about this reality in order to find strategies to modify the social imaginary that still labels and discriminates this population.

Esta tese investigou fatores de risco e proteção ao desenvolvimento de adolescentes em medida de proteção de acolhimento institucional, através de três estudos. No primeiro estudo, verificouse a exposição a fatores de risco entre 113 adolescentes, por meio de um questionário. Além do excessivo tempo de institucionalização, foram identificados fatores de risco ao desenvolvimento como repetência escolar e exposição à violência intra e extrafamiliar. No segundo estudo, foram investigados, de forma transversal, indicadores de ajustamento psicossocial entre os adolescentes. Através de escores das variáveis autoestima, expectativa de futuro, repetência, comportamento infrator, uso de drogas e tentativas de suicídio, compôs-se um Índice de Ajustamento Psicossocial. Foi observado que o número de eventos estressores, a faixa etária e a exposição à violência extrafamiliar estavam independentemente associadas ao ajustamento psicossocial, tendo explicado 48% da variância do índice. No terceiro estudo, longitudinal, analisou-se o ajustamento psicossocial de 69 adolescentes acolhidos institucionalmente, comparando-se a estabilidade das variáveis em dois tempos, T1 e T2. Além disso, buscou-se identificar preditores do ajustamento psicossocial em T2. O modelo com maior poder explicativo (46,3%) para o ajustamento psicossocial em T2 envolveu o ajustamento em T1 e o apoio familiar. A convivência entre irmãos na mesma instituição revelou-se estatisticamente significativa para um melhor ajustamento psicossocial em T2, o que reforça a necessidade de preservar os laços familiares. Os resultados dos três estudos demonstram a necessidade de ações mesossistêmicas de políticas públicas, a fim de que a convivência familiar e comunitária seja incentivada, o que pode trazer impacto no ajustamento psicossocial dos adolescentes, além de auxiliar na tomada de decisão de cuidadores e operadores do direito. / This work investigated risk and protection factors regarding adolescent development in the context of residential care through three studies. In the first study, the exposure to risk factors among 113 adolescents was verified using a questionnaire. Besides the excessive institutionalization period, other risk factors to development found were school failure and exposure to intra- and extra-familial violence. In the second study, indicators of psychosocial adjustment among adolescents were investigated, in a cross-sectional design. A Psychosocial Adjustment Index was proposed through scores of the variables self-esteem, future expectation, school failure, antisocial behavior, drug use and suicide attempt. The number of stressor events, age range and exposure to extra-familial violence were independently associated to psychosocial adjustment, explaining 48% of the variance of such index. In the third study, characterized as longitudinal, psychosocial adjustment of 69 adolescents in residential care was analyzed, comparing variables stability at time 1 (T1) and time 2 (T2). Moreover, predictors of psychosocial adjustment were identified at T2. The model with greater explanation power (46.3%)concerning psychosocial adjustment at T2 involved adjustment at T1 and family support. Living with siblings in the same institution revealed to be statistically significant regarding improved psychosocial adjustment at T2, highlighting the need to preserve family bonds. Results of the three studies demonstrate the need of mesosystemic actions as concerns public policies, so that family and community living may be encouraged, possibly causing an impact in the psychosocial adjustment of adolescents, and supporting the caregivers' and law professionals' decision-making process.

The diploma thesis deals with finding optimal size for model of residential facilities providing social services. The thesis is divided into two parts. The first part deals with social services in general context, presents actual legislation and publishes the view of experts who handle with issues in providing social services. The second research part is focused on data analysis and quantitative survey of social services users. Quantitative research is made by interrogation method through questionnaire. Secondary data analysis is specified on financial costs those facilities and its differences. The aim of diploma thesis is to create optimal model of residential facilities providing social care services. Diploma thesis works with two hypotheses. Hypothesis 1 is : ?The capacity of residential facility providing social services for more than 70 clients do not guarantee providing better services than facilities with lower capacity of clients. ? This hypothesis was confirmed. Hypothesis was statistically tested through working hypotheses and shown in contingency tables and also graphically by descriptive statistics. Hypothesis 2 is : ?Operating costs of residential facility providing social services for less than 70 clients are higher than residential facility providing social services for more than 70 clients.? This hypothesis was also confirmed. Hypothesis was statistically tested by statistic tests and summarized in charts. Results were statistically processed by using multi-scale classification of data in contexts with obtained nominal, ordinal, and cardinal variables. To analyse categorical data were used two statistical tests ? chi square test of independence and t-test. Questionnaires were distributed to the registered providers of social services after their written agreement. Total of 290 questionnaires were sent out and 214 of them returned. Return the sample reached 74%. Importance of this thesis is to get a better insight into the optimal size of residential facility providing social services from the perspective of clients and operating costs. The gathered data from quantitative survey could be useful for students, social workers and in general for all people profesionally focused on the area of building, providing and improving residential facilities providing social services.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This research aimed to know the teenagers point of view about experiences during the period of residential care and family reintegration. We conduct a qualitative study and used the case study. Study participants were two teenagers who had gone through the residential care process and family reintegration and their mothers. The teens were into child protective services, in one specific institution in a city of Rio Grande do Sul. That data were analyzed using Content Analysis. The study results suggest a number of fragilities faced by families that experience a measure of protection, which end up weakening affective bonds and hindering an effective family reintegration. It was also observed that the modifications brought to Law 12.010 were perceived and reported by both teenagers who experienced the residential care as by their mothers, showing, and greater involvement of the technical teams of the host institution, a link between the child protective services and adolescents. In conclusion, beyond what is written, Law 12.010 has been felt by the actors involved in the protection measure. It is known that we cannot, and neither was sought, to generalize, but it is understood that some aspects pointed out by teenagers certainly are present in other cases and are the everyday reality of residential care. / Esta dissertação teve como objetivo conhecer o ponto de vista de adolescentes reintegrados acerca das experiências vividas durante o período de acolhimento institucional e reinserção familiar. Foi realizada uma pesquisa de caráter qualitativo e utilizou-se o estudo de caso. Participaram do estudo duas adolescentes que haviam passado pelo processo de acolhimento institucional e reintegração familiar e suas mães. As adolescentes estavam vinculadas a uma instituição de acolhimento de uma cidade do interior do RS. Os dados foram analisados através da Análise de Conteúdo proposta por Bardin (1977). Os resultados do estudo sugerem uma série de fragilidades enfrentadas pelas famílias que vivenciam a medida de proteção, as quais acabam enfraquecendo os laços afetivos e dificultando uma reintegração familiar efetiva. Também foi possível observar que as modificações trazidas com a Lei 12.010 foram percebidas e relatadas tanto pelas adolescentes que vivenciaram a medida quanto pelas suas mães, demonstrando, além de um maior envolvimento das equipes técnicas da instituição de acolhimento, uma articulação entre a rede de atendimento à criança e ao adolescente. Conclui-se que, para além do que está escrito, a Lei 12.010 vem sendo sentida pelos atores envolvidos na medida de proteção. Sabe-se que não se pode, e nem se buscou, fazer generalizações, mas entende-se que alguns aspectos apontados pelas adolescentes certamente se encontram presentes em outros casos e são o cotidiano da realidade do acolhimento institucional.

Syftet med denna studie är att undersöka i vilken utsträckning ungdomar, ur personalens perspektiv, har möjlighet att vara delaktiga i sin vårdplacering. För att uppnå detta syfte har 11 individuella intervjuer med behandlingspersonal samt verksamhetschefer på HVB utförts. Med utgångspunkt i intervjumaterialet har sedan en tematisk analys genomförts. Resultaten visar att personalen arbetar för att delaktiggöra ungdomarna, dock inom vissa uppsatta ramar. Resultatet visar även att personalen motiverar ungdomarna för att få med dem ”på tåget”. Vidare framkommer det att personalen ofta verkar vara under intrycket av att de gör ungdomarna mer delaktiga än resultatet visar. Den tematiska analysen kommer även att kopplas till Arnsteins delaktighetsstege (1969) samt Shiers delaktighetsstege (2001). / The purpose of this study is to investigate to what extent young people, from the staff’s perspectives, are able to participate in their care placement. In order to reach the purpose, 11 individual interviews with treatment staff and institution managers at residential care homes have been conducted. Based on the interview material, a thematic analysis has been implemented. The results show that the staff work to involve young people, though within certain set limits. The result also shows that the staff motivates the youngsters to bring them ”on the same track". Furthermore, it appears that the staff often seems to be under the impression that they make the young people more involved than the results show. The thematic analysis will also be related to Arnstein's participation ladder (1969) and Shier's participation ladder (2001).

Esta tese investigou fatores de risco e proteção ao desenvolvimento de adolescentes em medida de proteção de acolhimento institucional, através de três estudos. No primeiro estudo, verificouse a exposição a fatores de risco entre 113 adolescentes, por meio de um questionário. Além do excessivo tempo de institucionalização, foram identificados fatores de risco ao desenvolvimento como repetência escolar e exposição à violência intra e extrafamiliar. No segundo estudo, foram investigados, de forma transversal, indicadores de ajustamento psicossocial entre os adolescentes. Através de escores das variáveis autoestima, expectativa de futuro, repetência, comportamento infrator, uso de drogas e tentativas de suicídio, compôs-se um Índice de Ajustamento Psicossocial. Foi observado que o número de eventos estressores, a faixa etária e a exposição à violência extrafamiliar estavam independentemente associadas ao ajustamento psicossocial, tendo explicado 48% da variância do índice. No terceiro estudo, longitudinal, analisou-se o ajustamento psicossocial de 69 adolescentes acolhidos institucionalmente, comparando-se a estabilidade das variáveis em dois tempos, T1 e T2. Além disso, buscou-se identificar preditores do ajustamento psicossocial em T2. O modelo com maior poder explicativo (46,3%) para o ajustamento psicossocial em T2 envolveu o ajustamento em T1 e o apoio familiar. A convivência entre irmãos na mesma instituição revelou-se estatisticamente significativa para um melhor ajustamento psicossocial em T2, o que reforça a necessidade de preservar os laços familiares. Os resultados dos três estudos demonstram a necessidade de ações mesossistêmicas de políticas públicas, a fim de que a convivência familiar e comunitária seja incentivada, o que pode trazer impacto no ajustamento psicossocial dos adolescentes, além de auxiliar na tomada de decisão de cuidadores e operadores do direito. / This work investigated risk and protection factors regarding adolescent development in the context of residential care through three studies. In the first study, the exposure to risk factors among 113 adolescents was verified using a questionnaire. Besides the excessive institutionalization period, other risk factors to development found were school failure and exposure to intra- and extra-familial violence. In the second study, indicators of psychosocial adjustment among adolescents were investigated, in a cross-sectional design. A Psychosocial Adjustment Index was proposed through scores of the variables self-esteem, future expectation, school failure, antisocial behavior, drug use and suicide attempt. The number of stressor events, age range and exposure to extra-familial violence were independently associated to psychosocial adjustment, explaining 48% of the variance of such index. In the third study, characterized as longitudinal, psychosocial adjustment of 69 adolescents in residential care was analyzed, comparing variables stability at time 1 (T1) and time 2 (T2). Moreover, predictors of psychosocial adjustment were identified at T2. The model with greater explanation power (46.3%)concerning psychosocial adjustment at T2 involved adjustment at T1 and family support. Living with siblings in the same institution revealed to be statistically significant regarding improved psychosocial adjustment at T2, highlighting the need to preserve family bonds. Results of the three studies demonstrate the need of mesosystemic actions as concerns public policies, so that family and community living may be encouraged, possibly causing an impact in the psychosocial adjustment of adolescents, and supporting the caregivers' and law professionals' decision-making process.

Este trabalho teve por objetivo investigar e discutir as imagens sociais atribuídas às instituições de acolhimento e aos jovens institucionalizados, a partir de dois estudos empíricos exploratórios. O estudo I investigou as imagens sociais atribuídas às instituições de acolhimento. Participaram da pesquisa 202 adultos selecionados por conveniência, com idades entre 16 e 69 anos (M=32,76, DP=11,67), sendo a maioria do sexo feminino (79,2%), solteiro (51%), com ensino médio (48%) ou curso superior (37,6%). Os participantes responderam a um questionário aberto utilizando até cinco palavras para descrever uma instituição de acolhimento. O estudo II investigou as imagens sociais atribuídas aos jovens em acolhimento institucional. Participaram 224 adultos selecionados por conveniência, com idades entre 18 e 71 anos (M=33,97, DP=11,42), sendo que 68,4% já tiveram contato com adolescentes em situação de vulnerabilidade e risco. Foi utilizado um questionário fechado, com 37 palavras para descrever os jovens típicos e em acolhimento, com itens em escala Likert. Os resultados do primeiro estudo indicam que as imagens sociais sobre as instituições de acolhimento, em geral, são positivas e que predominam as percepções relacionadas ao acolhimento/proteção e à organização. Os resultados do segundo estudo apontam que as palavras consideradas negativas foram significativamente mais associadas aos jovens em acolhimento institucional, indicando haver uma imagem social negativa desta população. Embora as mudanças legais e políticas referentes à proteção infantojuvenil venham contribuindo para a qualificação dos serviços de acolhimento, permanecem os estigmas que classificam os jovens inseridos nesse contexto. É importante que se faça uma reflexão social coletiva sobre essa realidade a fim de que se encontrem estratégias de modificação do imaginário social que ainda rotula e discrimina essa população. / This study aimed to investigate and discuss the social images associated to the residential care institutions and the young people in care through two exploratory empirical studies. The first study investigated the social images assigned to the residential care institutions. The participants were 202 adults selected by convenience, aged 16 to 69 years old (M=32.76, SD=11.67), mostly female (79.2%), single (51%), with high school (48%) or higher education (37.6%). The participants answered an open questionnaire using up to five words to describe a residential care institution. The second study investigated the social images assigned to young people in care. The participants were 224 adults selected by convenience, aged 18 to 71 years old (M=33.97, SD=11.42), 68.4% of them have already had contact with teenagers in vulnerability and risk situations. The instrument was a Likert scale questionnaire with 37 words used to describe young people in general and in care. The results of the first study indicated that social images are generally positive, prevailing perceptions related to care/protection and organization. The results of the second study indicated that the negative words were significantly more associated with young people in care, indicating that there is a negative social image related to this population. Although legal and political changes concerning children and youth protection have been contributing to the qualification of residential care institutions, the stigmas that classify young people inserted in this context remain. It is important to make a collective social reflection about this reality in order to find strategies to modify the social imaginary that still labels and discriminates this population.

This descriptive ethno-theatre case study explored the impact of intergenerational engagement through a reminiscence theatre arts initiative on the psychosocial quality of life for older adults with mild to moderate cognitive decline. Study participants were comprised of 11 adults 65 years and older residing in a dementia-specific residential care facility unit, and 13 University of Victoria Theatre students. Both qualitative and quantitative procedures were integrated into the case study. Qualitative processes consisted of older adult life history interview transcriptions, ethno-theatre field notes of theatre devising and performance processes, and post-program drama evaluations. Quantitative measures included pre- and post-administered instruments: CASP-19; Alzheimer’s Disease-related Quality of Life (ADRQL) – Revised; and older adult health perception surveys. Overall, it appears from the data that active engagement in reminiscence theatre (the process of creating and performing theatre from real life memories and stories) results in a positive impact on older adults’ well-being – increased self-esteem, elevated mood and social engagement, decreased isolation and boredom, and desire to continue with activities. This study’s findings suggest that the integration of reminiscence arts initiatives into residential care plans for older adults with mild to moderate cognitive impairment can substantially enhance psychosocial quality of life. These findings are consistent with reminiscence and life review theory in that intergenerational engagement in these processes promotes healthy aging. This study demonstrated that intergenerational connection between young and older adults through drama and storytelling activities occurred. The creative reciprocal initiatives of reminiscence arts in turn fostered a context for social and emotional engagement that appeared to reduce older adults’ isolation. / Graduate