No / he development, pilot and evaluation of a brief psychosocial training intervention (BPTI) for staff working with people with dementia in an acute hospital setting are described. The project had two phases. Phase one involved adapting an existing competency framework and developing the BPTI using focus groups. For the pilot and evaluation, in phase two, a mixed methods approach was adopted using self-administered standardised questionnaires and qualitative interviews. Qualitative analysis suggested that delivering skills-based training can develop communication, problem-solving and self-directed learning skills; benefit staff in terms of increased knowledge, skills and confidence; and be problematic in the clinical area in terms of time, organisation and the physical environment. These factors must be taken into consideration when delivering training. These changes were not reflected in the quantitative results and measures were not always sensitive to changes in this setting. Definitive conclusions cannot be drawn about the efficacy of the intervention, due to the contradictory outcomes between the quantitative and qualitative data. Further developments and research are required to explore how staff and organisations can be supported to deliver the best possible care.

Yes / Many interventions that are delivered within public health services have little evidence of effect. Evaluating interventions that are being delivered as a part of usual practice offers opportunities to improve the evidence base of public health. However, such evaluation is challenging and requires the integration of research into system-wide practice. The Born in Bradford’s Better Start experimental birth cohort offers an opportunity to efficiently evaluate multiple complex community interventions to improve the health, wellbeing and development of children aged 0–3 years. Based on the learning from this programme, this paper offers a pragmatic and practical guide to researchers, public health commissioners and service providers to enable them to integrate research into their everyday practice, thus enabling relevant and robust evaluations within a complex and changing system. Using the principles of co-production the key challenges of integrating research and practice were identified, and appropriate strategies to overcome these, developed across five key stages: 1) Community and stakeholder engagement; 2) Intervention design; 3) Optimising routinely collected data; 4) Monitoring implementation; and 5) Evaluation. As a result of our learning we have developed comprehensive toolkits (https://borninbradford.nhs.uk/whatwe-do/pregnancy-early-years/toolkit/) including: an operational guide through the service design process; an implementation and monitoring guide; and an evaluation framework. The evaluation framework incorporates implementation evaluations to enable understanding of intervention performance in practice, and quasi experimental approaches to infer causal effects in a timely manner. We also offer strategies to harness routinely collected data to enhance the efficiency and affordability of evaluations that are directly relevant to policy and practice. These strategies and tools will help researchers, commissioners and service providers to work together to evaluate interventions delivered in real-life settings. More importantly, however, we hope that they will support the development of a connected system that empowers practitioners and commissioners to embed innovation and improvement into their own practice, thus enabling them to learn, evaluate and improve their own services. / Big Lottery Fund as part of the A Better Start programme. The Big Lottery Fund. NIHR CLAHRC Yorkshire and Humber.

O objeto deste estudo é a Unidade de Redução de Danos (URD) da Secretaria Municipal de Saúde de Santo André, compreendida como instrumento do trabalho em saúde, que tem por finalidade transformar a situação de saúde de sujeitos, que fazem parte de um grupo social marginalizado; são indivíduos que circulam ou trabalham nas ruas - usuários de drogas, michês, mulheres profissionais do sexo, homens que fazem sexo com homens, adolescentes em situação de exploração sexual, transexuais, travestis, lésbicas e mulheres que trabalham em casas de programas. O objetivo geral foi: avaliar a URD sob a ótica dos sujeitos que são alcançados pelo programa. Partindo da compreensão de que a \"questão social\" tomou na contemporaneidade novas feições, advindas do processo de reestruturação produtiva, que em maior ou menor grau repercutem na vida dos sujeitos alcançados pelo programa, e partindo do pressuposto de que a URD vai além da distribuição de insumos e orientações para prevenir doenças transmissíveis, procurando assegurar aos indivíduos o direito à saúde e apoiar o acesso a outros direitos sociais, esta pesquisa buscou compreender a situação familiar, de trabalho e de vida dos usuários, verificar como eles avaliam o programa e analisar as repercussões do trabalho da URD em suas vidas. Trata-se de uma pesquisa estratégica de natureza avaliativa que utilizou um método qualitativo para apreensão do objeto. Foram realizadas 19 entrevistas semi-estruturadas com usuários dos diferentes segmentos atendidos pelo programa. Os entrevistados mostraram que: encontram-se em composições familiares muito diversas; trabalhar nas ruas é conseqüência de uma trajetória marginal e da impossibilidade de acessar outros tipos de trabalho; almejam uma vida melhor. Como potencialidades da URD foram apontadas: melhora do cuidado com a saúde e do uso de preservativos; diminuição do consumo de drogas; melhora da procura e do acesso a serviços de saúde; diminuição do compartilhamento de material para uso de drogas; melhora da capacidade de decisão; a URD foi considerada um espaço humanizado, que dispõe de um trabalho regular e contínuo, o que dá aos usuários uma sensação de segurança e de proteção; a ação da URD perpassou a prevenção de danos à saúde, promovendo transformações mais amplas como a consciência de direitos sociais em geral e de saúde em particular, bem como ações no sentido de fazer valer esses direitos; os usuários sentem-se mais fortalecidos para a vida, procurando estudo, trabalho e moradia. Entre as fragilidades da URD estavam: presença inconstante e demora do programa em retornar em alguns dos campos; falta de profissionais de psicologia para acompanhamento dos usuários. Os serviços de saúde do município foram bastante criticados, sendo relatados vários episódios de preconceito e até mesmo de negligência na atenção à saúde. Sugeriu-se: expandir e divulgar o trabalho desenvolvido, agregando ações de RD nas unidades básicas de saúde; apoiar a implementação de associações para reunir as reivindicações dos que trabalham nas ruas ou nas casas de programas; um local mais adequado para o atendimento, entre outros / The subject of this study was the Harm Reduction Unit (HRU) of the Municipal Health Department of Santo André, taking it to be a working tool for healthcare that has the purpose of transforming the health situation of individuals forming part of socially marginalized groups. These are individuals who spend their lives or work on the streets: drug users, prostitutes, female sex workers, men who have sex with men, sexually exploited adolescents, transsexuals, transvestites, lesbians and women working in brothels. The general objective was to evaluate the HRU from the viewpoint of individuals that the program reaches. This study started from the understanding that the \"social question\" has now taken on new features coming from production restructuring processes that, to a greater or lesser degree, impinge on these individuals\' lives, and from the presupposition that the HRU goes beyond distributing supplies and guidance for preventing transmissible diseases, through seeking to ensure individuals\' rights to health and support their access to other social rights. It sought to understand the users\' family, work and life situations, find out how they rated the program and analyze the repercussions of the HRU\'s work on their lives. This was a strategic study of evaluative nature using a qualitative method to grasp this subject. Nineteen semi-structured interviews were held with users in the different segments attended by the program. The interviewees showed that: they were in a wide variety of family setups; working on the streets was consequential to their marginalized path through life and their impossibility of accessing other types of work; and they craved a better life. The HRU\'s potential benefits were indicated to be: improved healthcare and condom use; decreased drug use; improved seeking and access to healthcare services; and decreased material sharing for drug use; improved decision-making capacity. The HRU was deemed to be a humanized space performing regular and continuous work that gave users a sense of security and protection. The HRU\'s actions went beyond prevention of damage to health, through promoting broader transformations such as awareness of social rights in general and health rights in particular, along with actions towards making these rights apply. The users felt strengthened for life and for seeking education, work and housing. Among the weak points of the HRU were: non-constant presence and delay in program response in some of the fields; lack of psychology professionals to follow up users. The municipal health services were greatly criticized, and various episodes of prejudice and even negligence in healthcare attendance were reported. The following suggestions are made: expansion and dissemination of the work developed, adding the HRU\'s actions to primary healthcare units; support for the implementation of associations to bring together the demands of those who work on the streets or in brothels; and provision of a more suitable place for attendance, among others

Nesta dissertação analiso o desafio de avaliar o cuidado em serviços de Saúde Mental, utilizando o contar no sentido de contar histórias e, também, o contar no sentido de quantificar. Parto de uma questão que é como se conta (numera, quantifica) o cuidado que acontece no cotidiano dos serviços de Saúde Mental, situações estas, que muitas vezes não são registradas, mas que são tecnologias de cuidado. Durante este trabalho relato cenas que vivi como trabalhadora e gestora na Saúde Mental que vão contribuir para exemplificar, contrapor, construir os conceitos que apresento no decorrer da dissertação. No contexto brasileiro ainda há uma disputa na lógica do cuidado em Saúde Mental, embora tenha-se uma legislação que deveria garantir Reforma Psiquiátrica. Percebe-se a carência de dados e informação que possam ser indicadores nesta área, existem muitas formas de “cuidar” de alguém, algumas fomentam autonomia, o protagonismo do usuário na sua própria vida, possibilitando que ele experencie seus conflitos, medos, sintomas no convívio da comunidade, familiares, rede social em que está inserido outras formas de “cuidar” prendem, limitam, alienam, sendo assim, é necessário saber que concepção de saúde e de cuidado compõe um indicador e a quem interessa produzir este conhecimento. A partir destas reflexões, realizei uma pesquisa documental a respeito dos discursos de como a avaliação vem se constituindo na área da Saúde Mental no Brasil e no Mundo. No Brasil no ano de 2005 há a Política Nacional de Monitoramento e Avaliação da Atenção Básica, onde o Ministério da Saúde coloca- se como indutor do exercício de avaliação nos serviços de saúde. Na área da Saúde Mental, quando se busca números, indicadores, dados de qualidade do cuidado, poucas são as referências, não encontrei um consenso nos pesquisadores e trabalhadores da área em relação a indicadores de qualidade de serviços de Saúde Mental. O que encontrei nas produções científicas são diferentes maneiras de avaliar os serviços e a cada pesquisa, utiliza-se indicadores, metodologia e públicos diferentes. No material de divulgação nacional, o que encontrei foram taxas de cobertura e valor de investimento financeiro. No ano de 2013, foi proposta pela Coordenação Nacional de Saúde Mental do Ministérios da Saúde a aplicação do QualityRigths no Brasil. Em 2015, o instrumento já havia sido traduzido e estava em fase de aplicação do projeto piloto. Na perspectiva mundial, a Organização Mundial da Saúde (OMS) tem um Plano de Ações com metas para serem alcançadas até 2020, uma outra estratégia da OMS é a aplicação do QualityRigths para avaliar e qualificar a atenção em saúde Mental nos países colaboradores, no entanto, não encontrei dados e informações dos resultados da avaliação nos países que já aplicaram o instrumento. A partir desta pesquisa pude perceber que a avaliação de serviços de saúde visa qualificar a atenção, no entanto, elas podem ser apenas uma forma de protocolar procedimentos, pouco ou nada informando sobre a realidade dos serviços e muito menos dos sujeitos. A OMS tem uma série de documentos como o Atlas de Saúde Mental e o Plano de Ação 2013-2020, porém não é uma informação difundida no Brasil. Um dos entraves pode ser atribuído a diversos destes documentos da OMS estarem disponível somente na língua inglesa. Portanto, a institucionalização da avaliação com questionários e indicadores comuns, que sejam aplicados em diferentes serviços, demonstra ter pouca capacidade de registrar as potências e fragilidades dos serviços de saúde. / In this research I analize at the challenge of evaluating care in Mental health services, using the count in the sense of storytelling and, also, the count in order to quantify. Beginning of an issue which is how to count (numbers, quantifies) that happens in the everyday care of Mental health services, these situations, which are often not recorded, but they are care technologies. During this work report scenes that lived as employee and Manager on Mental health that will contribute to exemplify, counteract, build the concepts present in the course of the dissertation. In the Brazilian context there is still a dispute on logic Mental health care, although a legislation that should ensure psychiatric reform. There is a lack of data and information that may be indicators in this area, there are many ways to "take care" of someone, some promote autonomy, the role of the user in his own life, enabling him to experencie their conflicts, fears, symptoms in the midst of community, family, social network in which is inserted other forms of "caring" holding, limited, alienate, therefore, It is necessary to know which health conception and care make a bookmark and who cares to produce this knowledge. From these reflections, I ran a documentary research, with speech analysis as has been done in Mental Health service evaluation in Brazil and in the world. In Brazil in the year 2005 for the National Policy of monitoring and evaluation of the basic attention, where the Ministry of health places as the inducer evaluation exercise at health services. In the area of Mental health, when search numbers, bookmarks, data from quality of care, there are few reference ~ encias, did not find a consensus on researchers and workers in relation to quality indicators of Mental health services. What I found in scientific productions are different ways to evaluate the services and each search using indicators, methodology and different audiences. National disclosure material, what I found were coverage rates and investment value. In the year 2013, was proposed by the national coordination of Mental Health of the Ministry of health the application of QualityRigths in Brazil. In 2015, the instrument had already been translated and was in the process of implementation of the pilot project. Global perspective, the World Health Organization (WHO) has a plan of Action with goals to be reached until 2020, another who's strategy is the implementation of QualityRigths to evaluate and qualify the attention in Mental Health in countries employees, however, have not found data and information of the results of the assessment in the countries that have already applied the instrument. From this research could tell that the evaluation of health services aims to qualify the attention, however, they can be just a form of Protocol procedures, little or nothing stating about the reality of the services, and less of the subject. The WHO has a series of documents such as the Atlas of Mental Health and the 2013-2020 Action Plan, but it is not a widespread information in Brazil. One of the barriers can be assigned to several of these documents are available from the who only in the English language. Therefore, the institutionalization of evaluation with questionnaires and common indicators that are applied at different services, demonstrates have little ability to record the powers and weaknesses of health services.

In this exploratory study, several conditions are identified as facilitative to a mandate of accountability to the welfare service users premised on a social process of cooperative inquiry. Firstly, constructive pressure from an extraneous surveillance power is necessary to instigate the structural inclusion of the welfare service users, without which the prevalent power asymmetry between the welfare service users and the professional service providers cannot be easily rocked. Secondly, enhanced social encounter and sustained interaction between the welfare service users and the service providers is the basis for emergent trust and alliance facilitative to an eventual power sharing that a mandate of accountability to the welfare service users demands. Thirdly, an ideological allegiance to the liberatory orientation of social work professionalism is imperative to nurturing the service providers' political commitment to the course of partnership with the service-using principal that a mandate of accountability to them requires. Realization of the service providers' accountability to the welfare service users invariably lies in the dialectic interaction between managerialism and professionalism. / Meanwhile, the study identifies different manifestation of the user involvement rhetoric between service units serving the elderly and the disabled persons (the "frail" group) and those serving clienteles with psychosocial or moral deficiency (the "deviant" group). It is the contention of this thesis that the greater strength and wider scope of user involvement as featured in the institutional structure of service units in the "frail" group does not necessarily correspond to a state of power symmetry that allows authentic argumentation between the professional service providers and the welfare service users in their discursive encounter. Given the multifarious strategies enabling the service providers to exert control over the welfare service users, the service providers' attitude in their relationship with the welfare service users is crucial for effecting change in the prevailing power position of the welfare service users. Materialization of a mandate of accountability to the welfare service users is hence premised on the prevalence of a cultural code that can embrace a more egalitarian relationship with the welfare service users among the service providers. / The last decades have seen a wide-reaching quest for reforms in the Hong Kong public sector. Among the multifarious managerial changes imposed on the Hong Kong welfare sector, the Service Performance Monitoring System instigated in 1999 embraces the irrefutable rhetoric of accountability that subjugates welfare service units in Hong Kong to a renewed mandate of managerial control premised on performance measurement and the enhanced involvement of the welfare service users. It is this policy context that revitalizes the user participation ethos that the profession of social work has always been supporting. By the mixed methodology of survey and case study, the research on which this thesis is based endeavours to locate the structural properties of the commonly incepted user involvement mechanism among the Hong Kong welfare service units, and to discern the processual dynamics in the discursive space enabled by the structural inclusion of the welfare service users. This is meant to advance our understanding on the ways by which user involvement enables a mandate of accountability premised on a cooperative inquiry with the welfare service users. / The study identifies a generally limited strength and scope in the user involvement initiatives adopted by the welfare service units. The discursive encounter between the service-using principal and the service-providing agent was also fused with tension. The tension was manifested in the service providers' unease at the accountability discourse, which legitimized the authority of the welfare service users in the management structure of the service units. In a service environment where the managerial discourse and the professional discourse used to compete for dominance, both the managerialist and professional tenets were employed by the service-providing informants to confront the tension and neutralize the implied power of the welfare service users, however meager it was. Whilst structural inclusion of the service users is a necessary condition for tackling the management risk arising from necessary entrustment to the service-providing agent, this thesis contends that structural re-engineering by itself is insufficient to ensure the advancement of the service-using principal's influence in their accountability relationship with the professional service providers. / Leung Tse Fong, Terry. / "November 2005." / Adviser: Bong-ho Mok. / Source: Dissertation Abstracts International, Volume: 67-11, Section: A, page: 4336. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 301-315). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

O presente estudo tem como principal objetivo avaliar o impacto de aspectos contingenciais no modelo básico do efeito da espera na avaliação geral de um serviço. Com base em estudos referentes à espera já realizados, o presente trabalho definiu o “modelo básico do efeito da espera na avaliação geral do serviço” que consiste no impacto negativo da espera na avaliação geral do serviço por meio da suscitação de emoções negativas. A influência de fatores contingenciais sobre o modelo é a principal contribuição do estudo, dado que essa abordagem não havia sido ainda estudada. Inicialmente, foi realizada uma etapa exploratória, qualitativa, para investigar as relações propostas no modelo teórico, assim como para compreender melhor os serviços de saúde, campo de estudo da pesquisa. Na sequência, a influência do envolvimento do consumidor, da singularidade do serviço, da pressão do tempo e do relacionamento interpessoal no modelo central foi investigada através da realização de uma survey com 382 pacientes As hipóteses foram testadas por meio de modelagem de equações estruturais, com o software LISREL 8.51. Os resultados indicam que o envolvimento do consumidor tem impacto positivo no seu tempo de espera aceitável. Já o efeito da singularidade do serviço sobre essa mesma variável não foi confirmado. A pressão do tempo apresentou impacto positivo no tempo de espera percebido e o efeito moderador do relacionamento interpessoal na relação entre as respostas afetivas negativas e a avaliação geral do serviço também foi confirmada. Além das hipóteses propostas, foi realizado um teste exploratório segundo o qual se confirmou o efeito moderador da variável gravidade sobre as relações que compõe o modelo básico do efeito da espera da avaliação geral do serviço. No final, os resultados são discutidos, e as limitações do estudo e sugestões para futuras pesquisas são apresentadas. / The most important objective of the present study is to evaluate the impact of the contingency aspects on the basic model of the waiting effect in the overall service evaluation. Based on studies in reference to the wait already carried out, this study defined the "basic model of the waiting effect on the general evaluation of the service" as being the negative impact of waiting in the general evaluation of the service because of the rise of negative emotions. The influence of contingency factors over the model is the most important contribution of the study as this approach has never been studied before. Iniatially, there was a qualitative exploratory to investigate the proposed relations in the theoretical model, as well as to have a better understanding of health care services, the field study of the research. Following that, the influence of the consumer involvement, the uniqueness of the service, the time pressure and the interpersonal relationship in the central model was investigated through a survey conducted among 382 patients The hypotheses were tested using structural equation modeling with LISREL 8.51 software. The results showed that the consumer involvement have a positive impact in the acceptable waiting time. On the other hand the effect of the uniqueness of the service over the same variable was not confirmed. The time pressure indicated a positive impact on the perceived waiting time and the moderate effect of the interpersonal relationship of the connection between negative affective reactions and the overall service evaluation was also confirmed. Beyond the proposed hypotheses, it was performed a exploratory test whereby it was confirmed the moderator effect of the gravity variable on the relations that form the basic model of the waiting effect on the overall service evaluation. In the end the results are discussed, and the limitations of the study and suggestions for future surveys are presented.

<p>The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time.</p><p>We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care.</p><p>A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large.</p><p>In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.</p>

The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time. We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care. A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large. In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.

Nesta dissertação analiso o desafio de avaliar o cuidado em serviços de Saúde Mental, utilizando o contar no sentido de contar histórias e, também, o contar no sentido de quantificar. Parto de uma questão que é como se conta (numera, quantifica) o cuidado que acontece no cotidiano dos serviços de Saúde Mental, situações estas, que muitas vezes não são registradas, mas que são tecnologias de cuidado. Durante este trabalho relato cenas que vivi como trabalhadora e gestora na Saúde Mental que vão contribuir para exemplificar, contrapor, construir os conceitos que apresento no decorrer da dissertação. No contexto brasileiro ainda há uma disputa na lógica do cuidado em Saúde Mental, embora tenha-se uma legislação que deveria garantir Reforma Psiquiátrica. Percebe-se a carência de dados e informação que possam ser indicadores nesta área, existem muitas formas de “cuidar” de alguém, algumas fomentam autonomia, o protagonismo do usuário na sua própria vida, possibilitando que ele experencie seus conflitos, medos, sintomas no convívio da comunidade, familiares, rede social em que está inserido outras formas de “cuidar” prendem, limitam, alienam, sendo assim, é necessário saber que concepção de saúde e de cuidado compõe um indicador e a quem interessa produzir este conhecimento. A partir destas reflexões, realizei uma pesquisa documental a respeito dos discursos de como a avaliação vem se constituindo na área da Saúde Mental no Brasil e no Mundo. No Brasil no ano de 2005 há a Política Nacional de Monitoramento e Avaliação da Atenção Básica, onde o Ministério da Saúde coloca- se como indutor do exercício de avaliação nos serviços de saúde. Na área da Saúde Mental, quando se busca números, indicadores, dados de qualidade do cuidado, poucas são as referências, não encontrei um consenso nos pesquisadores e trabalhadores da área em relação a indicadores de qualidade de serviços de Saúde Mental. O que encontrei nas produções científicas são diferentes maneiras de avaliar os serviços e a cada pesquisa, utiliza-se indicadores, metodologia e públicos diferentes. No material de divulgação nacional, o que encontrei foram taxas de cobertura e valor de investimento financeiro. No ano de 2013, foi proposta pela Coordenação Nacional de Saúde Mental do Ministérios da Saúde a aplicação do QualityRigths no Brasil. Em 2015, o instrumento já havia sido traduzido e estava em fase de aplicação do projeto piloto. Na perspectiva mundial, a Organização Mundial da Saúde (OMS) tem um Plano de Ações com metas para serem alcançadas até 2020, uma outra estratégia da OMS é a aplicação do QualityRigths para avaliar e qualificar a atenção em saúde Mental nos países colaboradores, no entanto, não encontrei dados e informações dos resultados da avaliação nos países que já aplicaram o instrumento. A partir desta pesquisa pude perceber que a avaliação de serviços de saúde visa qualificar a atenção, no entanto, elas podem ser apenas uma forma de protocolar procedimentos, pouco ou nada informando sobre a realidade dos serviços e muito menos dos sujeitos. A OMS tem uma série de documentos como o Atlas de Saúde Mental e o Plano de Ação 2013-2020, porém não é uma informação difundida no Brasil. Um dos entraves pode ser atribuído a diversos destes documentos da OMS estarem disponível somente na língua inglesa. Portanto, a institucionalização da avaliação com questionários e indicadores comuns, que sejam aplicados em diferentes serviços, demonstra ter pouca capacidade de registrar as potências e fragilidades dos serviços de saúde. / In this research I analize at the challenge of evaluating care in Mental health services, using the count in the sense of storytelling and, also, the count in order to quantify. Beginning of an issue which is how to count (numbers, quantifies) that happens in the everyday care of Mental health services, these situations, which are often not recorded, but they are care technologies. During this work report scenes that lived as employee and Manager on Mental health that will contribute to exemplify, counteract, build the concepts present in the course of the dissertation. In the Brazilian context there is still a dispute on logic Mental health care, although a legislation that should ensure psychiatric reform. There is a lack of data and information that may be indicators in this area, there are many ways to "take care" of someone, some promote autonomy, the role of the user in his own life, enabling him to experencie their conflicts, fears, symptoms in the midst of community, family, social network in which is inserted other forms of "caring" holding, limited, alienate, therefore, It is necessary to know which health conception and care make a bookmark and who cares to produce this knowledge. From these reflections, I ran a documentary research, with speech analysis as has been done in Mental Health service evaluation in Brazil and in the world. In Brazil in the year 2005 for the National Policy of monitoring and evaluation of the basic attention, where the Ministry of health places as the inducer evaluation exercise at health services. In the area of Mental health, when search numbers, bookmarks, data from quality of care, there are few reference ~ encias, did not find a consensus on researchers and workers in relation to quality indicators of Mental health services. What I found in scientific productions are different ways to evaluate the services and each search using indicators, methodology and different audiences. National disclosure material, what I found were coverage rates and investment value. In the year 2013, was proposed by the national coordination of Mental Health of the Ministry of health the application of QualityRigths in Brazil. In 2015, the instrument had already been translated and was in the process of implementation of the pilot project. Global perspective, the World Health Organization (WHO) has a plan of Action with goals to be reached until 2020, another who's strategy is the implementation of QualityRigths to evaluate and qualify the attention in Mental Health in countries employees, however, have not found data and information of the results of the assessment in the countries that have already applied the instrument. From this research could tell that the evaluation of health services aims to qualify the attention, however, they can be just a form of Protocol procedures, little or nothing stating about the reality of the services, and less of the subject. The WHO has a series of documents such as the Atlas of Mental Health and the 2013-2020 Action Plan, but it is not a widespread information in Brazil. One of the barriers can be assigned to several of these documents are available from the who only in the English language. Therefore, the institutionalization of evaluation with questionnaires and common indicators that are applied at different services, demonstrates have little ability to record the powers and weaknesses of health services.

O presente estudo tem como principal objetivo avaliar o impacto de aspectos contingenciais no modelo básico do efeito da espera na avaliação geral de um serviço. Com base em estudos referentes à espera já realizados, o presente trabalho definiu o “modelo básico do efeito da espera na avaliação geral do serviço” que consiste no impacto negativo da espera na avaliação geral do serviço por meio da suscitação de emoções negativas. A influência de fatores contingenciais sobre o modelo é a principal contribuição do estudo, dado que essa abordagem não havia sido ainda estudada. Inicialmente, foi realizada uma etapa exploratória, qualitativa, para investigar as relações propostas no modelo teórico, assim como para compreender melhor os serviços de saúde, campo de estudo da pesquisa. Na sequência, a influência do envolvimento do consumidor, da singularidade do serviço, da pressão do tempo e do relacionamento interpessoal no modelo central foi investigada através da realização de uma survey com 382 pacientes As hipóteses foram testadas por meio de modelagem de equações estruturais, com o software LISREL 8.51. Os resultados indicam que o envolvimento do consumidor tem impacto positivo no seu tempo de espera aceitável. Já o efeito da singularidade do serviço sobre essa mesma variável não foi confirmado. A pressão do tempo apresentou impacto positivo no tempo de espera percebido e o efeito moderador do relacionamento interpessoal na relação entre as respostas afetivas negativas e a avaliação geral do serviço também foi confirmada. Além das hipóteses propostas, foi realizado um teste exploratório segundo o qual se confirmou o efeito moderador da variável gravidade sobre as relações que compõe o modelo básico do efeito da espera da avaliação geral do serviço. No final, os resultados são discutidos, e as limitações do estudo e sugestões para futuras pesquisas são apresentadas. / The most important objective of the present study is to evaluate the impact of the contingency aspects on the basic model of the waiting effect in the overall service evaluation. Based on studies in reference to the wait already carried out, this study defined the "basic model of the waiting effect on the general evaluation of the service" as being the negative impact of waiting in the general evaluation of the service because of the rise of negative emotions. The influence of contingency factors over the model is the most important contribution of the study as this approach has never been studied before. Iniatially, there was a qualitative exploratory to investigate the proposed relations in the theoretical model, as well as to have a better understanding of health care services, the field study of the research. Following that, the influence of the consumer involvement, the uniqueness of the service, the time pressure and the interpersonal relationship in the central model was investigated through a survey conducted among 382 patients The hypotheses were tested using structural equation modeling with LISREL 8.51 software. The results showed that the consumer involvement have a positive impact in the acceptable waiting time. On the other hand the effect of the uniqueness of the service over the same variable was not confirmed. The time pressure indicated a positive impact on the perceived waiting time and the moderate effect of the interpersonal relationship of the connection between negative affective reactions and the overall service evaluation was also confirmed. Beyond the proposed hypotheses, it was performed a exploratory test whereby it was confirmed the moderator effect of the gravity variable on the relations that form the basic model of the waiting effect on the overall service evaluation. In the end the results are discussed, and the limitations of the study and suggestions for future surveys are presented.