Le Plan d’action en santé mentale institué en 2005 marque le début d’une période de changements profonds qui auront un impact significatif sur les équipes de première ligne qui assurent la plupart des services au Québec. Le changement se manifestera sur deux fronts distincts. En premier lieu, le passage de services historiquement ancrés dans un modèle biomédical vers des services centrés sur le rétablissement. En second lieu, l’adoption de processus administratifs s’inscrivant dans une philosophie de gestion axée sur les résultats qui ont pour objectif de mesurer et d’assurer l’efficacité des services. L'objectif de cette étude est d’explorer le statu du développement des pratiques axées sur le rétablissement au niveau des travailleurs sociaux de première ligne dans le contexte administratif mentionné ci-haut. Le travail de recherche qualitatif et exploratoire est construit sur l’analyse de 11 interviews semi structurés avec des travailleurs sociaux et des gestionnaires dans des équipes de première ligne en santé mentale. Les entretiens m’ont non seulement permis d’identifier et d’examiner des actions concrètes s’inscrivant dans l’effort d’implantation du Plan d’action mais aussi de sonder et d’explorer la signification qui est donnée au rétablissement par les travailleurs sociaux de première ligne. Les résultats indiquent que certains facteurs relatifs à l'organisation du travail tels que la flexibilité, l'autonomie, la réflexivité et l’interdisciplinarité peuvent favoriser une pratique orientée vers le rétablissement. Aussi, les résultats démontrent que le modèle du rétablissement et la profession du travail social partagent des valeurs fondamentales mais que la signification et l'expression du rétablissement ont été profondément influencés par les modèles organisationnels et obligations administratives en vigueur. Il appert que les travailleurs sociaux sont confrontés, dans leur pratique, à des contraintes qui dépassent leur mandat professionnel et, à certains égards, leur savoir-faire. En somme, les résultats obtenus indiquent que le passage avec succès vers la pratique de services basés sur le rétablissement est compromis par les exigences d’un modèle de gestion axé sur les résultats. / Following the 2005 Mental Health Action Plan most mental health services are offered in primary care teams. This policy called for a paradigm shift away from a biomedical model of care toward a process-focused ‘recovery’ orientation in mental health. Concurrently, it called for the use of a results-orientation that is outcome-focused in order to ensure efficiency. The objective of this research project was to explore the development of recovery-oriented practices among social workers in first line mental health teams in Québec. To do this, I investigated the microprocesses of implementing recovery-oriented services and practices alongside results-oriented management techniques. In addition, this project explored the saliency of a recovery orientation specifically for first line mental health social workers. This qualitative, exploratory study consisted of 11 semi-structured interviews with social workers and managers in first line mental health teams. The results indicate that certain aspects of work organization, such as flexibility, autonomy, reflexivity, training, and interdisciplinarity can foster a practice that is recovery-oriented. In addition, the results show that the foundations of both the recovery orientation and the social work profession share common values. However, social workers face constraints to practice that go beyond their know-how and professional base. Our exploratory study leads us to contemplate the influence of work organization on changing practice. The results suggest that practicing from a recovery orientation was a shared ideal among the participants but that the meaning and expression of this ideal was profoundly shaped by practice contexts. The implications of these results are that recovery-oriented systems will be difficult to develop in a result-oriented paradigm.

To advance social work practice and decrease the research practice gap, this dissertation followed a model development paradigm consisting of several phases. Based on the task-centered model of social work practice and motivational interviewing, a new combined model was construed. The two underlying models were analyzed and synthesized, using technical eclecticism as the integrative approach. The resulting combined model was described by guidelines and manualized. To test the combined model in an applied setting, a study was designed in collaboration with social workers at a substance abuse counseling center. There, the combined model intervention was implemented in an outpatient medication assisted treatment program dispensing methadone and buprenorphine to a mainly African-American population. The agency program aimed at detoxification, but also provided methadone maintenance. It offered additional groups and acupuncture. Ten clients and four social work practitioners participated in the intervention study. The study used a mixed-method approach in data collection and analysis. Client practitioner verbal interaction was recorded using digital audio recording. The digital audio files were loaded directly into Atlas.ti software to be used for analysis. Qualitative data analysis with Atlas.ti was performed for two research tasks, a) assessing implementation fidelity of the manual based intervention and b) exploring model development aspects to improve model guidelines. Treatment fidelity was analyzed through deductive coding and frequency counts. Model development analysis was performed similar to a grounded theory model and used content analysis and constant comparison methodologies. Addiction Severity Index and Readiness Ruler, urine drug screens, problem change, and task accomplishment ratings were used as quantitative outcome measures to produce time series data in order to chart individual case progress in a single system design. After testing the intervention, a focus group with participating practitioners was conducted. Overall beneficence with clients improving and progressing successfully in the program was found. The integration of the underlying models was deemed successful. Their elements were found to be complementary and intricately linked. Crucial for successful implementation is that the program environment supports and accepts client choices. Model guidelines were reviewed and improved for further field testing.

In this study, the researchers explored child welfare workers’ perceptions on placement changes for youth in foster care and the impact these changes had on youths’ overall outcomes. Using a Post Positivist paradigm, qualitative research was completed using snowball-sampling procedures. The researchers conducted in-depth interviews with sixteen members from their personal networks of child welfare social workers that have direct contact with foster youth. The research participants included current child welfare social workers from two counties in Southern California. The study’s findings suggest that children’s behaviors and foster parents’ reactions to those behaviors impacted placement changes. Further, participants felt that these changes significantly impacted youths’ educational outcomes. Participants identified a variety of interventions they used to try to mitigate placement changes, some with more or less success. Finally, workers identified barriers within the child welfare system, including communications and compensation, that might have an impact on placement changes. Implications for social work practice, policy and research are discussed.

Le Plan d’action en santé mentale institué en 2005 marque le début d’une période de changements profonds qui auront un impact significatif sur les équipes de première ligne qui assurent la plupart des services au Québec. Le changement se manifestera sur deux fronts distincts. En premier lieu, le passage de services historiquement ancrés dans un modèle biomédical vers des services centrés sur le rétablissement. En second lieu, l’adoption de processus administratifs s’inscrivant dans une philosophie de gestion axée sur les résultats qui ont pour objectif de mesurer et d’assurer l’efficacité des services. L'objectif de cette étude est d’explorer le statu du développement des pratiques axées sur le rétablissement au niveau des travailleurs sociaux de première ligne dans le contexte administratif mentionné ci-haut. Le travail de recherche qualitatif et exploratoire est construit sur l’analyse de 11 interviews semi structurés avec des travailleurs sociaux et des gestionnaires dans des équipes de première ligne en santé mentale. Les entretiens m’ont non seulement permis d’identifier et d’examiner des actions concrètes s’inscrivant dans l’effort d’implantation du Plan d’action mais aussi de sonder et d’explorer la signification qui est donnée au rétablissement par les travailleurs sociaux de première ligne. Les résultats indiquent que certains facteurs relatifs à l'organisation du travail tels que la flexibilité, l'autonomie, la réflexivité et l’interdisciplinarité peuvent favoriser une pratique orientée vers le rétablissement. Aussi, les résultats démontrent que le modèle du rétablissement et la profession du travail social partagent des valeurs fondamentales mais que la signification et l'expression du rétablissement ont été profondément influencés par les modèles organisationnels et obligations administratives en vigueur. Il appert que les travailleurs sociaux sont confrontés, dans leur pratique, à des contraintes qui dépassent leur mandat professionnel et, à certains égards, leur savoir-faire. En somme, les résultats obtenus indiquent que le passage avec succès vers la pratique de services basés sur le rétablissement est compromis par les exigences d’un modèle de gestion axé sur les résultats. / Following the 2005 Mental Health Action Plan most mental health services are offered in primary care teams. This policy called for a paradigm shift away from a biomedical model of care toward a process-focused ‘recovery’ orientation in mental health. Concurrently, it called for the use of a results-orientation that is outcome-focused in order to ensure efficiency. The objective of this research project was to explore the development of recovery-oriented practices among social workers in first line mental health teams in Québec. To do this, I investigated the microprocesses of implementing recovery-oriented services and practices alongside results-oriented management techniques. In addition, this project explored the saliency of a recovery orientation specifically for first line mental health social workers. This qualitative, exploratory study consisted of 11 semi-structured interviews with social workers and managers in first line mental health teams. The results indicate that certain aspects of work organization, such as flexibility, autonomy, reflexivity, training, and interdisciplinarity can foster a practice that is recovery-oriented. In addition, the results show that the foundations of both the recovery orientation and the social work profession share common values. However, social workers face constraints to practice that go beyond their know-how and professional base. Our exploratory study leads us to contemplate the influence of work organization on changing practice. The results suggest that practicing from a recovery orientation was a shared ideal among the participants but that the meaning and expression of this ideal was profoundly shaped by practice contexts. The implications of these results are that recovery-oriented systems will be difficult to develop in a result-oriented paradigm.

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009

The drastic readjustments brought on by the ending of a love relationship make divorce one of the most stressful events that divorced persons may face. Divorced persons often experience the negative consequences of divorce including, amongst others, an increased level of unhappiness, greater physical and psychological distress, less support systems, lower life satisfaction, elevated risk of suicide, asocial behavioural problems, and a decline in the standard of living. Therefore, expounding on the nature of social work services to divorced persons and determining divorced persons’ needs with regard to social work services were of critical importance in order to develop guidelines that would inform social work practice and social welfare policies. A qualitative research approach was employed, guided by an explorative, descriptive, and contextual research design. A sample of 20 participants, comprising10 divorced persons (males and females) from different ethnic groups and 10 social workers employed at different organisations (including governmental, non- governmental and private practice) in the Gauteng Province of South Africa, was drawn through purposive and snowball sampling. Data was collected by means of semi-structured interviews and analysed following Tesch’s eight steps (in Creswell 2009:186) framework. Guba’s model (Krefting 1991:215-222) was applied for data verification. Amongst others, the study found that divorced persons experience loneliness, stigma, financial hardships, lack of support, loss of self-esteem and companionship, loss of trust in the opposite sex, anger, regret, suicidal thoughts, rejection, challenges related to children, and post-divorce adjustments. Most of the divorced persons did not know about the social work services available to them. There are social workers employed at different organisations who provide mediation and parenting plan services to divorced persons, but most of them do not deal with cases related to divorced persons. Although there are social workers who believe that the counselling services provided to divorced persons are helpful, most of them were not entirely satisfied and feel that they could do more by involving group work and community work methods of social work practice. Based on the research findings, recommendations pertaining to social work practice, social work training and education, social welfare policy, and further research were put forward. / Social Work / PhD. (Social Work)

Social workers in private practice / Social work in South Africa appears to have low status and a negative ”welfare” image. The general public seems to regard social workers and the profession with disdain and for the most part is ignorant of what social workers do apart from handing out grants and removing children from their families. This exploratory research focuses on social workers in private practice - how they view their professional selves, the factors that contribute to the development of their professional selves and the factors that hinder or facilitate this development. The impact of public opinion on social workers in private practice is explored and possible solutions to problems experienced by these private practitioners are sought. Modern and postmodern paradigms are summarised as a background to the Rogerian theory, constructivist philosophy and social constructionist theory that underlie this research. The researcher explores the perceptions of each respondent who shares his/her particular reality with the researcher through the meanings he/she attributes to his/her experiences. / Social work / M.A (Social Science (Mental Health))