This study, which is part of a research project conducted to explore the experiences of quality of life of older people living in a residential facility, focuses specifically on the psychosocial needs of these residents. Psychosocial needs refer to the innate psychological nutriments that prompt older people to take purposeful, self-directed action in an attempt to satisfy these needs and ultimately foster well-being. These may include needs for mastery, acknowledgement, social interaction and care. In this study the term “older people” refers to individuals aged 60 years and older. The group of older people who participated in this study all live in a residential facility for older people. “Residential facility” refers to premises or a building where older people are provided with accommodation and access to 24-hour care. Previous research concerning the needs of older people focused mainly on their physical care, in the context of deteriorating health. Considering that many older people are leading healthy, vigorous lifestyles, however, it is also important to explore the psychosocial needs of the more functional older people in residential facilities. Psychosocial needs were initially described by Maslow, within a hierarchical system, whereby psychosocial needs emerge only when biological needs have been satisfied. In view of the exceptions described in the literature of older people who overcome the inevitable physical strains that accompany ageing, Maslow’s bottom-up approach is seen as restrictive in its view of older people. In the present study self-determination theory (SDT) has been found to be applicable in exploring psychosocial needs, because of its holistic and adaptive view of people possessing the potential to address their needs within a social environment. SDT views people as motivated to gratify their needs for competence, autonomy and relatedness. A qualitative approach was used to describe the psychosocial needs of the older people studied. The research was conducted in a residential facility for older people in Johannesburg, Gauteng. The older participants comprised 16 residents, including 3 males and 13 females, aged 65 and older. Data-gathering was conducted by using the Mmogo-method®. This required each participant to use a lump of clay, sticks and beads to make something that represents their experiences of life in the residential facility. Prompting questions were asked and each participant was given an opportunity to describe his or her visual presentation. Group discussions allowing for confirmation or revision of perspectives of experiences followed. Data were analysed by means of secondary, thematic and visual analysis. Trustworthiness was ensured by carefully applying specific guidelines which were produced by considering different models aimed at ensuring rigour in qualitative research. These guidelines included clear and coherent writing; conceptual coherence; ensuring a trustworthy procedure through member-checking, multiple perspectives and clarification, as well as the researcher’s attentiveness to her own biases. The research was approved by the ethical committee of North-West University. The researcher applied ethical guidelines as prescribed by the Health Professions Council of South Africa while the research was conducted, and afterwards. Findings revealed four psychosocial needs, namely a need for autonomy, interpersonal interaction within a specific context, a sense of safety, and transcendental needs. The need for autonomy included freedom of personal preference, independent living and active participation. On the interpersonal level, there was a need for general relationships, in which sharing, acknowledgement and caring were present (both instrumental and emotional), as well as close family and friendship relationships. The need for safety covers both physical and organisational safety. On the transcendental level, there is a need for space and opportunities to express and address spiritual needs. These findings may be used to facilitate the development of policies and programmes which aim to address the psychosocial needs of older people in residential facilities as well as in other living arrangements. / MSc (Clinical Psychology), North-West University, Potchefstroom Campus, 2015

This study, which is part of a research project conducted to explore the experiences of quality of life of older people living in a residential facility, focuses specifically on the psychosocial needs of these residents. Psychosocial needs refer to the innate psychological nutriments that prompt older people to take purposeful, self-directed action in an attempt to satisfy these needs and ultimately foster well-being. These may include needs for mastery, acknowledgement, social interaction and care. In this study the term “older people” refers to individuals aged 60 years and older. The group of older people who participated in this study all live in a residential facility for older people. “Residential facility” refers to premises or a building where older people are provided with accommodation and access to 24-hour care. Previous research concerning the needs of older people focused mainly on their physical care, in the context of deteriorating health. Considering that many older people are leading healthy, vigorous lifestyles, however, it is also important to explore the psychosocial needs of the more functional older people in residential facilities. Psychosocial needs were initially described by Maslow, within a hierarchical system, whereby psychosocial needs emerge only when biological needs have been satisfied. In view of the exceptions described in the literature of older people who overcome the inevitable physical strains that accompany ageing, Maslow’s bottom-up approach is seen as restrictive in its view of older people. In the present study self-determination theory (SDT) has been found to be applicable in exploring psychosocial needs, because of its holistic and adaptive view of people possessing the potential to address their needs within a social environment. SDT views people as motivated to gratify their needs for competence, autonomy and relatedness. A qualitative approach was used to describe the psychosocial needs of the older people studied. The research was conducted in a residential facility for older people in Johannesburg, Gauteng. The older participants comprised 16 residents, including 3 males and 13 females, aged 65 and older. Data-gathering was conducted by using the Mmogo-method®. This required each participant to use a lump of clay, sticks and beads to make something that represents their experiences of life in the residential facility. Prompting questions were asked and each participant was given an opportunity to describe his or her visual presentation. Group discussions allowing for confirmation or revision of perspectives of experiences followed. Data were analysed by means of secondary, thematic and visual analysis. Trustworthiness was ensured by carefully applying specific guidelines which were produced by considering different models aimed at ensuring rigour in qualitative research. These guidelines included clear and coherent writing; conceptual coherence; ensuring a trustworthy procedure through member-checking, multiple perspectives and clarification, as well as the researcher’s attentiveness to her own biases. The research was approved by the ethical committee of North-West University. The researcher applied ethical guidelines as prescribed by the Health Professions Council of South Africa while the research was conducted, and afterwards. Findings revealed four psychosocial needs, namely a need for autonomy, interpersonal interaction within a specific context, a sense of safety, and transcendental needs. The need for autonomy included freedom of personal preference, independent living and active participation. On the interpersonal level, there was a need for general relationships, in which sharing, acknowledgement and caring were present (both instrumental and emotional), as well as close family and friendship relationships. The need for safety covers both physical and organisational safety. On the transcendental level, there is a need for space and opportunities to express and address spiritual needs. These findings may be used to facilitate the development of policies and programmes which aim to address the psychosocial needs of older people in residential facilities as well as in other living arrangements. / MSc (Clinical Psychology), North-West University, Potchefstroom Campus, 2015

Magister Curationis - MCur / Caring for people with intellectual disability is stressful as they have a reduced ability to cope independently. The stress may be exacerbated by the challenging behaviours intellectually disabled people display and by the lack of social support that care workers may experience. The aim of this study is to explore and describe care workers’ experience of stress and social support whilst caring for intellectually disabled residents with challenging behaviour. A qualitative, exploratory, descriptive phenomenology study was utilised to answer the research question: “What are the experiences of stress and social support of care workers caring for intellectually disabled residents with challenging behaviour at a residential facility in the Western Cape?” A purposive sampling technique was utilised to select ten care workers working at a residential facility for intellectually disabled residents with challenging behaviour in the Western Cape. Lazarus and Folkman’s transactional model of stress and coping has been used to guide the study. Data were collected by means of semi-structured interviews. Colaizzi’s method of data analysis was used to analyse the data. The four main themes that emerged are: (1) acceptance of abuse as a working condition, (2) interpersonal relationships with colleagues, residents and residents’ families, (3) the selfimpacted by an array of emotions and (4) social support and coping strategies used to deal with the stress experienced. The study concluded that care workers’ training does not prepare them to understand and manage residents with challenging behaviour adequately. Formalised training as well as interpersonal skills building is necessary for them to cope with the stress they experience while working with intellectually disabled residents.

Many Supported Residential Facility (SRF) residents express a desire to live in more independent accommodation, however relatively few achieve this. Two of the issues preventing this are a lack of housing alternatives and support. This study examines the relevant literature and legislation, to gather documentary evidence and demographic data about South Australian SRFs and their residents. This is augmented by interviews with five key informants, to discover what other factors inhibit SRF residents from moving on to alternative accommodation. Findings indicate that recovery and rehabilitation are inhibited in SRFs and that current standards are barely sustaining people. Data suggests that legislation has a negative impact on residents and service delivery. This research recommends that the South Australian Government take up its legislative and ministerial responsibility to SRFs and their residents as a matter of urgency, especially in relation to fire safety. Secondly, that there is a review of The Legislation to incorporate citizenship rights and individualised care. And lastly, that in the interim, funding tied to service agreements is made available to SRFs, so that they become a place to recover and not the end of the line.

Cooper, Heron and Heward define maintenance as the extent to which a learner continues to perform a target behavior after the intervention has been terminated. Testing for maintenance allows the trainer to see if gains were sustained following the termination of a treatment program. In addition, once it is shown that a learner's skills have remained in the repertoire, assessment of generalization is possible. Previous literature in behavior skills training have assessed maintenance in a variety of settings for a variety of skills. Following maintenance assessments, booster sessions are commonly used to re-train skills that did not maintain at criterion levels. The current project assessed the maintenance of caregivers' skills following a training package used to teach three behavior management techniques (use reinforcement, pivot, protect-redirect) at a large, residential care facility. Procedures were developed to assess caregivers' maintenance of the three behavior management techniques using a pre-test- post-test design. If needed, skills were re-established using 5-20 minute booster sessions. The results showed that time between post-test and maintenance did not seem to have a strong effect on maintenance scores. In general, post-test scores were somewhat indicative of maintenance scores, and patterns were most apparent across tools.

The work deals with the specifics of interactions between mentally disabled clients in the residential facilities providing institutional care, in particular with the relations between clients and social workers/carers. It analyses the role of interpersonal relations for individual´s inherent dignity, describes cultural and religious sources which recognise dignity of the mentally disabled in the contemporary society. It also strives to explain healthy ways of communication as an important and integral part of social interactions and how such methods can help to prevent conflicts in residential facilities. There is identification of risks of asymmetric relations between clients and carers due to the organisational hierarchy and the relevant changes brought about in the course of the deinstitutionalisation process. It provides various aspects of the relationship between employees and clients in traditional and alternative forms of residential facilities which in this particular case are represented by the Arch and Camphill communities. The Conclusions provide a summary of risks and benefits resulting from friendly attitude to mentally disabled clients and risks posed by the unequal and unnatural relations in residential facilities.

Contexte. La majorité des adultes autistes vivent avec leur famille ou dans des établissements résidentiels. Cependant, les ressources résidentielles sont limitées et peu d’entre elles sont spécifiquement conçues pour répondre aux besoins des adultes autistes. Peu d’études ont systématiquement examiné les différentes facettes du bien-être de l’individu, y compris la qualité de vie, l’anxiété et le fonctionnement adaptatif, avant et après la transition du domicile familial à l’établissement résidentiel. La construction de résidences adaptées à l’autisme (c’est-à-dire, avec approches architecturales et cliniques spécifiques) et l’identification des facteurs entourant une transition positive pourraient favoriser la transition et l’expérience de vie des adultes autistes dans leur propre maison. Objectifs. Les objectifs de cette étude sont (1) d’évaluer l’impact de la transition vers une résidence adaptée à l’autisme sur le bien-être, en particulier sur la qualité de vie, le niveau de fonctionnement adaptatif et l’anxiété ; et (2) d’identifier les facteurs, tels que perçus par les parents, associés à une transition positive vers une résidence adaptée aux personnes autistes. Méthodologie. Il s’agit d’une recherche à devis mixte (qualitatif et quantitatif) s’inscrivant dans le cadre d’une étude longitudinale auprès de 12 adultes autistes (21-49 ans ; 8F : 4 M), résidant tous dans la même résidence adaptée. La majorité des participants (92 %) viennent d’un milieu familial et tous requièrent un niveau de soutien léger à modéré. Les résidents ont été suivis pendant 13 mois : trois mois avant leur entrée dans la résidence (T1) et 10 mois après leur arrivée (T2). La collecte de données a combiné des informations provenant (a) des questionnaires remplis par les parents, mesurant la qualité de vie (Échelle San Martin — Échelle d’Évaluation de la Qualité de vie de personnes ayant des déficiences significatives), le bien-être émotionnel et comportemental (Emotional Problem Scales), et le niveau de fonctionnement adaptatif (Système d’évaluation des comportements adaptatifs — 2e édition), (b) des entretiens semi-structurés avec les parents des adultes autistes après la transition dans la résidence. Les analyses sont basées sur une série de cas multiples et comprennent des analyses thématiques qualitatives. Résultats. Objectif 1. Les résultats démontrent que les niveaux de qualité de vie, de fonctionnement adaptatif et d’anxiété du groupe sont restés relativement stables à travers la transition. Cependant, lorsque les résultats sont examinés individuellement, ils montrent qu’au T2, 50 % des parents ont signalé une augmentation de la qualité de vie des résidents et 83 % ont noté un maintien ou une augmentation du fonctionnement adaptatif. Les résultats de la sous-échelle d’anxiété du questionnaire EPS montrent que 25 % des résidents semblent présenter une diminution de l’anxiété, 8 % une augmentation, tandis que 67 % restent inchangés. Objectif 2. Trois thèmes clés ont été associés à une transition favorable du domicile familial vers le nouvel environnement résidentiel : (a) la préparation en amont avec le futur résident permet de réduire l’incertitude associée à un nouveau milieu de vie et d’augmenter le sentiment de contrôle du résident sur la situation ; (b) les caractéristiques individuelles de l’adulte autiste aident à son intégration dans la résidence ; (c) la communication entre les différents acteurs permet le partage d’informations sur le résident. Conclusion. La transition vers une résidence conçue spécifiquement en fonction des besoins d’adultes autistes semble faciliter l’adaptation et accroître le bien-être de certains résidents. Malgré les limites de cette étude (p. ex. : la taille de l’échantillon, l’absence de contribution directe des adultes autistes), ces résultats comblent une lacune dans les connaissances sur les impacts de la transition entre le milieu familial et une résidence adaptée aux besoins autistiques. D’autres analyses viseront à identifier la contribution de composantes architecturales et cliniques aux résultats actuels. / Background. A majority of autistic adults stay with their families or in residential facilities. However, residential resources are limited, and few are specifically built to meet the needs of autistic adults. Few studies systematically investigated the various facets of the individual's well-being, including quality of life, adaptive functioning, and anxiety before and after transitioning from family home to residential facility. Building autism-friendly residence facilities (i.e., specific architectural and clinical approaches), and identifying factors surrounding a positive transition, might support the transitioning and living experience of autistic adults into their own home. Objectives. The aims of this study are to (1) assess the impact of transitioning to an autism-friendly residence on well-being, specifically on quality of life, level of functioning and anxiety; and (2) identify factors, as perceived by parents, associated with a positive transition to an autism-friendly home. Methods. This is a mixed-methods (quantitative and qualitative) longitudinal study of 12 autistic adults (21-55 years; 8F:4M), all residing in the same autism-friendly residence. The majority of participants (92%) comes from a family setting, and all require a mild to moderate level of support. Residents were followed for 13 months: three months before entering the residence (T1) and 10 months after their arrival (T2). Data collection combined information from (a) questionnaires completed by parents, measuring quality of life (San Martin Scale — Quality of life Assessment for People with significant disabilities), emotional and behavioral well-being (Emotional Problem Scales), and level of adaptive functioning (Adaptive Behavior Assessment System – 2nd edition), (b) semi-structured interviews with autistic adult parents before and after integration. Analyses are based on a multiple-case design series and include qualitative content thematic analyses. Results. Objective 1. Results showed that levels of quality of life, adaptive functioning, and anxiety remained relatively stable during the transition. Although, when the results are individually looked at, they show that at T2, 50% of parents reported an increase in the residents' quality of life and 83% noted a maintenance or an increase in adaptative functioning. Distinctly, results on the anxiety subscale of the emotional problem scales questionnaire show that 25% of residents appear to show a decrease in anxiety, 8% show an increase, while 67% remain unchanged. Objective 2. Three relevant key themes were associated with a positive transition from the family home to the new residential environment: (a) upstream preparation with the future resident helps reduce the uncertainty associated with a new living environment and increase the resident’s feeling of control over the situation; (b) the individual characteristics of the autistic adult facilitated integration into the residence; and (c) communication among the various stakeholders allowed for sharing informations about the resident. Conclusion. The transition to a residence designed specifically in accordance with autistic needs seems to ease their adaptation and increase their well-being. Despite limits of this study (e.g. sample size, absence of direct input of autistic adults), these results fill a knowledge gap about the impacts of the transition from a family setting to an autism-friendly residence facility. Further analyses will aim to identify the contribution of specific architectural, clinical and lifestyle components to the current results.

ABSTRACT Model housing like a part of self-contained rehabilitation of children with combinated handicap In my thesis I deal with the following subject: Model housing like a part of self-contained rehabilitation of children with combinated handicap. The model housing is totally new project which Children´s Centre ARPIDA in České Budějovice ( hereinafter {\clqq} DC ARPIDA ``) took up as part of its services.The project has been running for two years and its implementation is realized in the second grade of vocational tranining school of DC ARPIDA in the building of The model protected housing. The aim of the project is to teach children with physical and combined handicap predefined activities.These predefined model activities should enlarge their independence from other persons and increase the extent of their self-sufficiency in common and extended daily activities connected with housing. The model protected housing is designed for children who attend the two-year vocational tranining school in DC ARPIDA where they go through three month´s course of the model protected housing.At the beginning of the course the children go through ergo-therapeutical examination to determine the rate of their independence and self-sufficiency. After finishing the course they are reviewed to find out whether they have improved their results and how they have profited from passing through the course. The main goal of my thesis is to investigate whether The model protected housing contributes to the increasing of the client´s level of seff-sufficiency and why it has a great importance in the system of education and physiotherapy. Another goal which should be followed is to show how the children´s parents see the project as a whole, whether they want their children to take part in this project, if they support the idea of a separate living and how they want their children to live in the future. I used the questionnaire method and the secondary data analysis to verify the given hypotheses. The interviewed group was made up of the parents of children clients of DC ARPIDA. My main aim was to investigate how much they are informed about the possibilities of integration of their children to the society, in what ways the parents are able to support them, their willingness to assist in this proccess and what is their idea of their children´s future life.The proccess of integration is not only the result of school classes or experts´ and school staff´s effort but first of all it is the parents who are supposed to be the most important link in the proccess of integration . Their position in the proccess of successful integration is irreplaceable. The input and output physiotherapy results were used for the secondary analysis. On the basis of data obtained from this analysis it is possible to claim that the model activities which the children performed in the model protected housing help to increase the rate of independance from an other person and of everyday self-sufficiency. With respect to explicit results of the research it is possible to draw the conclusion that in all cases the course of model protected housing increases the function rate of self-sufficiency and independence from the others in the model activities. Thereby the basis hypothesis has been clearly confirmed.