It has been widely recognized that poor health is an important cause of poverty, especiallyamong the low- and middle- income countries. One of the reasons is the absence of publicfinancial protection against the medical consumption risk in these countries. This Phd dissertationis dedicated to discern the role that health insurance could play in the organization of healthfinancial protection system. The dissertation is composed of two parts. The first part discusses theproblems linking to the financing to medical consumption from a global point of view. Chapter 1brings theoretical discussions on three topics: 1) the specialties of medical consumption risks andthe difficulties in using private health insurance to manage medical consumption risks. 2) Therole of government and market in the distribution of health resources. 3) The options for theorganization of health financing system. Chapter 2 conducts a statistical comparison on theperformance of health financing systems in the countries of different social-economic background.The discussion is carried out around three aspects of health financing: the availability of resources,the organization of health financing, and the coverage of financial protection. The second part ofthe dissertation studies the evolution of heath financing system in a specific country: China. Threechapters are assigned to this part. Chapter 3 introduces the history of Chinese health financingsystem since 1950s. It helps us to understand the challenges in health financing brought byeconomic reform. Chapter 4 carries out an empirical study on the distribution of health financingburden in China in the 1990s. It illustrates the direct results of the decline of public financing andincrease of direct payment. Chapter 5 presents health insurance reform that launched by thegovernment since the end of 1990s. An impact analysis is conducted on an original dataset of 24township hospitals in Weifang prefecture in the north of the China. The objective is to estimatethe impact of the implementation of New Rural Medical Cooperation System (NRMCS) on theactivities and financial structure of township hospitals. At last, we conclude that social healthinsurance (SHI) permits a sharing of health financial responsibilities between the service provider,the patient-consumer, and the service purchaser. It can not only involve both public and privateagents into the collection of funds for health financing system, but also make each party moreaccountable due to the risks they bear from the result of medical consumption. Meanwhile it isnecessary to note that SHI is just one option among others to organize health financing system.The implementation of SHI requires a certain level of social-economic development. SHI does notsystematically bring better performance on health financing if it is not accompanied by thereforms on provider payment or on service delivery system. Government commitment andinstitutional capacity are also key factors for the good function of the system.

With the aim of increasing practitioner competence, this dissertation provides marriage and family therapists and mental health service providers with insight into the experiences of legally married same-sex couples. Specifically, the inquiry's objective was to elicit narratives of strength and agency from these couples who navigated the oppressive circumstances of an anti-gay amendment campaign situated within the debate over the extension of marriage rights to same-sex couples. Fourteen couples were interviewed in order to respond to the dissertation's overriding question: How do the lesbian and gay couples and families who are among those who were legally married in California before the passage of Proposition 8 narrate their experiences of their marriages? Through portraiture (Lawrence-Lightfoot & Davis, 1997), a method of inquiry situated within a postmodern, social constructionist framework, a narrative was produced which evolved through five emergent themes: 1) Our Commitments Have Rich Histories -- the symbolic and legal ways in which these couples commemorated and brought definition to their commitments, in the absence of a nationally-sanctioned and collectively-recognized state of legal marriage; 2) Not a Simple Matter: The Complexities of Language Choice -- their contextual language choices, which reflected the absence of representative and collectively-recognized language options for their relationships after their legal marriages; 3) The Battle Metaphor -- the couples' experiences of California's political debate over the extension of marriage rights to same-sex couples; 4) Support Shaped Lived Experiences -- the impact of support from friends, family, and community; and lastly, 5) Legal Marriage Shaped Individual, Relational, and Social Identities -- individual, relational and social shifts that occurred for the couples through the experience of being legally married. A follow-up focus group further validated the theme Support Shaped Lived Experiences, and examined more deeply the tensions that occurred when important persons were silent about and/or did not recognize the legitimacy of the couples' legal marriages, and/or the discriminatory context in which their legal marriages were situated. In addition to its contribution of the experiences of legally married same-sex couples to the family therapy literature, the dissertation concludes with important implications for affirmative therapeutic practice, research, education, training, advocacy, and social policy.

Made available in DSpace on 2018-06-04T19:14:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-06-26 / Introdução: Esta investigação teve como foco a gestão do trabalho na Atenção Básica realizado em duas unidades básicas de saúde gerido por duas Organizações Sociais em Saúde distintas. Objetivo: analisar a gestão de duas UBS do município de São Paulo administradas por OSS. Método: pesquisa qualitativa, do tipo estudo de casos múltiplos, de natureza cartográfica, feita por meio de observação participante em duas UBS do município de São Paulo, com produção de diários de campo, com registros de cenas observadas no cotidiano do trabalho. Utilizou-se também os dois seminários compartilhados realizados com os atores das UBS estudadas. Para a análise do material foi utilizado o conceito de “planos de visibilidade”, qual seja, aquilo que vai se destacando ou que vai se tornando visível/dizível, a partir das conexões das cenas de “natureza” semelhante registradas nos diários. O estranhamento das pesquisadoras pela equipe foi utilizado como um analisador das relações da equipe com as OSS. Resultados: os trabalhadores demonstram uma relação bem marcada com a OSS, que parte de um grande incômodo com as pesquisadoras de campo, e preocupam-se constantemente com a possibilidade das pesquisadoras serem parte de uma estratégia de controle e avaliação. Demonstram desconhecimento das estratégias de gestão aplicadas pelas OSS, e o gerencialismo fica evidente. Um mal-estar institucional fica exposto. Mesmo assim, os trabalhadores defendem este modelo de gestão e por isso ficam entre o medo e a confiança na relação com a empresa. Eles também apontam que a acentuada racionalização das práticas coloca o cuidado e o cumprimento dos números e metas em posições antagonistas. Contudo, apreciam o uso de ferramentas gerencialistas, na ilusão de que estas possam dar contorno a questões estruturais do trabalho em saúde. Isso os coloca num paradoxo: entre a autonomia e as metas permanentemente. Também pudemos observar que as gerentes, porta-vozes das OSS, possuem um discurso de valorização dos números, e fazem a gestão das UBS baseada nas metas de produtividade impostas pelos instrumentos de gestão da relação OSS/Prefeitura Municipal. Dada a intensa utilização de ferramentas gerencialistas o trabalho se assemelha à lógica empresarial, e assim os porta-vozes apresentam um discurso que não vai além do senso comum sobre o SUS, e também certa externalidade. Além de uma identificação e pertencimento maior com o ente privado que em relação ao ente público, se posicionam e disputam o modelo de gestão por OSS. Também pudemos identificar singularidades e regularidades entre as OSS, pois se assemelham na gestão gerencialista, e no aprofundamento do empresariamento, mas se diferenciam naquilo que representam para seus trabalhadores. Ficam em aberto questionamentos a respeito da legitimidade desse SUS produzido nas UBS geridas por OSS e das possíveis iniquidades em saúde a partir de estruturas organizativas tão matizadas. / Introduction: This research focuses the work management in primary care in two basic healthcare units (UBS) done by two different Social Health Organizations (OSS). Objective: analyze the management of two UBS in the municipality of São Paulo managed by OSS. Method: qualitative research, multiple case study type, of a cartographic nature made through participant observation in two UBS in the municipality of São Paulo that resulted in a field journal composed by registers of scenes observed in everyday work. Two shared seminaries held with the subjects of the UBS that are the study object were also adopted. For the material analysis, it was used the “visibility plans” concept, which is something that becomes more prominent or visible/sayable from the scene connections of similar “nature” registered in the journals. The researchers’ estrangement from the team was used as an analyzer of team relations with OSS. Results: the professionals show a well-established relationship with OSS which starts from a big disturbance related the field researchers, and constantly worry about the possibility of the researchers to take part of a control and evaluation strategy. Those professionals are ignorant of the management strategies adopted by OSS, and managerialism is evident. An institutional malaise is exposed, even so professionals support this management model that is why are placed between fear and trust in the relationship with the company. Those professionals also point out that a pronounced rationalization of the practices places care as well as numbers and goals accomplishments in antagonistic positions. However, the professionals estimate the managerialism tools with the illusion they will get past structural issues of health work. This situation constantly places those professionals in a paradox between autonomy and goals. It was also possible to observe managers, the OSS’s spokespeople, having a discourse of valuing numbers and managing UBS based on productivity goals imposed by management instruments of the relationship between OSS and city council. Due to intense adoption of managerialism tools, work is like business logic so the spokespeople support a discourse which does not go beyond common sense about Sistema Único de Saúde (SUS) as well as certain externality. In addition to an identification and greater belonging with public entity they take a position and dispute the OSS management model. It was also possible to identify singularities and regularities among OSS because they are similar when it comes to managerial management and deepening of the entrepreneurship, however they differ in what they represent for their workers. Questionings about the legitimacy of that SUS produced in UBS managed by OSS and possible iniquities related to health from very complex organizational structures are now open. / BV UNIFESP: Teses e dissertações

Este trabalho consiste de uma análise exploratória sobre municípios do Sudeste com população acima de 100mil habitantes abordando dois problemas: a violência e a educação. Na violência abordaremos índices de homicídios na adolescência trabalhando com a faixa de adolescentes de 12 a 18 anos. Na educação trabalharemos com o Índice de Desenvolvimento Educacionail Brasileiro referenciado ao último ano do ensino fundamental. Trabalhando com os indicadores citados, abordaremos esses problemas gerando um Índice de Saúde social do Adolescente utilizando a lógica Fuzzy, conjunto nebuloso. Classificando os municípios do Sudeste visando identificar municípios com qualidade de vida melhor para esses adolescentes, expectativa de vida e melhoria na educação. Baixos índices de homicídios e altos índices educacionais desenvolvendo uma ferramenta útil para auxiliar na tomada de decisões no tocante a políticas públicas nos Municípios e Estados gerando um indicador de municípios com qualidade de vida para os adolescentes! Trabalhamos com dados do ano de 2007 tanto para o homicídio quanto para a educação, os valores apresentados nos índices foram divididos em quintis, processados via o software MATLAB utilizando lógica nebulosa (fuzzy), classificados e apresentados nas formas de valores alfanuméricos em tabelas espaciais com o software Quantum Gis através de mapas temáticos das regiões estudadas. / This work aims to analyze Southeastern Brazils municipalities with more than one hundred thousand inhabitants by approaching two main problems: violence and education. Initially, it copes with teen homicide rates taking into account adolescents between the ages of 12 and 18 years. After that, it considers the Brazilian educational development index for the last grade of high school. Based on those indices, this work proposes a Teen Social Health index using fuzzy logic sets in order to identify municipalities with the best quality of life, life expectancy and educational opportunities for teens. Low homicide rates and high levels of education are crucial to develop a useful tool for making decisions concerning the municipalitys public policies, and for making a quality of life index for teens within the municipality. As to both homicide and education, the data collected for this work refers to the year 2007. The index values are divided into quintiles processed on MATLAB software by fuzzy logic and grouped inside Quantum Gis Software spatial tables in the form alphanumeric values through thematic maps of the analyzed regions.

Submitted by Bruna Rodrigues (bruna92rodrigues@yahoo.com.br) on 2016-09-14T14:08:51Z No. of bitstreams: 1 DissCCJ.pdf: 1945636 bytes, checksum: e489a805f9b33e827f7456a2f91b86ea (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-15T13:54:15Z (GMT) No. of bitstreams: 1 DissCCJ.pdf: 1945636 bytes, checksum: e489a805f9b33e827f7456a2f91b86ea (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-15T13:54:26Z (GMT) No. of bitstreams: 1 DissCCJ.pdf: 1945636 bytes, checksum: e489a805f9b33e827f7456a2f91b86ea (MD5) / Made available in DSpace on 2016-09-15T13:54:35Z (GMT). No. of bitstreams: 1 DissCCJ.pdf: 1945636 bytes, checksum: e489a805f9b33e827f7456a2f91b86ea (MD5) Previous issue date: 2015-02-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The Doctor-Patient Relationship has been identified as an important variable in Health Care’s adherence, efficiency, and effectiveness; The Doctor’s Social Skills, seem to be essential components in its establishment. The general aim of this study was to evaluate doctors’ social skills who works in social and private health systems, examining the relations between these skills and patient satisfaction with regard to the medical consultation. The Study 1 describes the Matched-Pair Instrument (MPI)’s translation and cultural adaptation; the instrument assesses doctor’s social skills during a consultation. Nineteen (19) individuals were involved in the translation and adaptation process. Psychometric analyzes showed satisfactory internal consistency for the patients version (Cronbach's alpha: α= 0,893), presenting similar properties to the original version. The Study 2 aimed to evaluate the social skills of doctors in both Social and Private Health System, considering the self-perception of the professional and the patient’s perceptions, and, examining how the interaction of these variables influence on patient satisfaction. The participants were 195 patients and 30 physicians, distributed in both health systems. The instruments used in the study were: the translated and validated version of the Matched-Pair Instrument (MPI), a Partial Version of the Social Skills Inventory (HIS-Del-Prette), and the Medical Care’s Patient Satisfaction Evaluation Questionnaire (QASPAM). The overall average scores in the MPI for both Patients (M = 77.5, SD = 12.3) and Physicians (M = 76.5, SD = 11.8) showed low, positive and statistically significant correlation (r = 0.16, p = 0.030); The Patients showed significantly higher ratings than the Doctors’ one. The professionals of social health system evaluated themselves as less skilled (M=69,93; SD=13,55) than the participants of private system (M=76,5; SD = 10.1). These data were similar to those obtained in the analysis of the patient’s questionnaires, since the overall average of public system patients (M=72.31; SD= 12.25) was significantly lower than the average of the private system (M=80.80; SD= 10.59). The professionals who worked in both health systems rated themselves, and were rated by their patients, as significantly (p <0.000) more skilled in the private system consultation than in the social one. Patients showed satisfaction with the service offered in both social and private health systems; however, private attended patients presented higher satisfaction’ scores. The scores levels of discontentment in the socials’s attended patients were relatively higher than those of the private system, especially in the following items: The Waiting Time in the office, before the consultation; the duration of the medical consultation and Medical Sensitivity. Future research have been suggested to increase the validity of the instruments used for the investigation. The results of this study seem to show that physicians who work in the private service evaluated up and received more satisfactory evaluations of their patients, in relation to social skills and satisfaction with care, than those who work in the public service. The data obtained in this study emphasized the relevance of both evaluation and training social skills for health professionals. / A Relação Médico-Paciente tem sido identificada como uma variável importante na adesão, eficiência e eficácia do tratamento em saúde. As habilidades sociais do médico parecem ser componentes essenciais no estabelecimento de tal relação. O objetivo geral do presente trabalho foi avaliar as habilidades sociais de médicos que atuam em serviços público e privado de saúde, examinando a relação entre a percepção de tais habilidades e a satisfação do paciente com o atendimento do profissional. O Estudo 1 descreve a tradução e adequação cultural do Matched-Pair Instrument (MPI), instrumento que afere as habilidades sociais do médico durante uma consulta. Participaram dezenove (19) pessoas nos processos de tradução e adaptação do instrumento. Análises psicométricas mostraram consistência interna satisfatória, para a versão dos pacientes (α= 0,886), com propriedades similares ao instrumento original. O Estudo 2 visou avaliar as habilidades sociais do médico, através da auto-percepção do profissional e a percepção de seus pacientes. Além disso, foi investigado como a interação destas variáveis influenciavam na satisfação do paciente, nos serviços público e privado de saúde. Participaram 195 pacientes e 30 médicos distribuídos em ambas as redes de atendimento (público/privado). Os instrumentos utilizados foram: Versão Traduzida e Adaptada do Matched-Pair Instrument (MPI), Versão Parcial do Inventário de Habilidades Sociais (IHS-Del-Prette), e o Questionário de Avaliação da Satisfação do Paciente com o Atendimento Médico (QASPAM). Os resultados desse estudo indicaram que os pacientes (M=77,55; DP=12,3) possuíram uma percepção mais positiva das habilidades sociais dos médicos (M=76,5; DP=11,8), que os próprios profissionais, uma vez que apresentaram médias significativamente maiores no MPI; a correlação entre as percepções dos membros dessa díade mostrou-se baixa, porém estatisticamente significativa (r=0,16; p=0,030). No que se refere à avaliação das habilidades sociais dos médicos nos serviços de saúde, pode-se verificar que os profissionais (M=76,49; DP=10,11) e pacientes (M=80,80; DP= 10,59) do sistema privado realizaram avaliações significativamente mais elevadas que os profissionais (M=69,93 ; DP=13,55) e pacientes (M=72,31; DP=12,25) do serviço público. Corroborando com esses dados, os profissionais que participaram da pesquisa em ambos os serviços de saúde se auto-avaliaram, e foram avaliados por seus pacientes, com escores significativamente (p<0,005) mais elevados no serviço privado. Já, no que se refere à avaliação de satisfação, pode-se verificar que pacientes de ambas as redes demonstraram-se satisfeitos com o atendimento médico; todavia, usuários do setor privado apresentaram maiores escores de satisfação. Os níveis de insatisfação foram mais elevados no setor público, e estavam relacionados a questões como: Tempo de espera, Duração do Atendimento e Sensibilidade do médico. Os resultados desse estudo parecem mostrar que médicos que atuavam no serviço privado avaliaram-se e receberam avaliações mais satisfatórias de seus pacientes, no que se refere à disposição de habilidades sociais e satisfação com o atendimento, que aqueles que atendiam no serviço público. Pesquisas futuras foram sugeridas para aumentar a validade dos instrumentos utilizados. Os dados obtidos no estudo enfatizam a relevância da avaliação e da capacitação em habilidades sociais em profissionais de saúde.

This project presents dance as treatment for Orthorexia Nervosa, an eating disorder defined as an unhealthy obsession with healthy eating. Eating disorders disconnect body, mind, and spirit of an individual, and dance therapeutically connects these aspects. The specific effects of orthorexia on the body, mind, and spirit are analyzed; supported by evidence from research sources such as literature of books and scholarly journals, videos, an interview with board-certified dance/movement therapist Rachel Gonick-Mefferd, and a series of interviews with Dr. Thomas Doyle, in which he supplied a case study exemplifying dance as treatment for orthorexia. Conclusively, eating disorders and specifically orthorexia affect one’s entire being — physical, mental, emotional, social, spiritual health — and interfere with one’s entire life and daily functioning. Dance, as a holistic therapeutic approach, is effective in addressing and remedying every single one of these elements, healing one’s whole self. Therefore, it is suggested that dance may be an effective treatment for orthorexia.

Este trabalho consiste de uma análise exploratória sobre municípios do Sudeste com população acima de 100mil habitantes abordando dois problemas: a violência e a educação. Na violência abordaremos índices de homicídios na adolescência trabalhando com a faixa de adolescentes de 12 a 18 anos. Na educação trabalharemos com o Índice de Desenvolvimento Educacionail Brasileiro referenciado ao último ano do ensino fundamental. Trabalhando com os indicadores citados, abordaremos esses problemas gerando um Índice de Saúde social do Adolescente utilizando a lógica Fuzzy, conjunto nebuloso. Classificando os municípios do Sudeste visando identificar municípios com qualidade de vida melhor para esses adolescentes, expectativa de vida e melhoria na educação. Baixos índices de homicídios e altos índices educacionais desenvolvendo uma ferramenta útil para auxiliar na tomada de decisões no tocante a políticas públicas nos Municípios e Estados gerando um indicador de municípios com qualidade de vida para os adolescentes! Trabalhamos com dados do ano de 2007 tanto para o homicídio quanto para a educação, os valores apresentados nos índices foram divididos em quintis, processados via o software MATLAB utilizando lógica nebulosa (fuzzy), classificados e apresentados nas formas de valores alfanuméricos em tabelas espaciais com o software Quantum Gis através de mapas temáticos das regiões estudadas. / This work aims to analyze Southeastern Brazils municipalities with more than one hundred thousand inhabitants by approaching two main problems: violence and education. Initially, it copes with teen homicide rates taking into account adolescents between the ages of 12 and 18 years. After that, it considers the Brazilian educational development index for the last grade of high school. Based on those indices, this work proposes a Teen Social Health index using fuzzy logic sets in order to identify municipalities with the best quality of life, life expectancy and educational opportunities for teens. Low homicide rates and high levels of education are crucial to develop a useful tool for making decisions concerning the municipalitys public policies, and for making a quality of life index for teens within the municipality. As to both homicide and education, the data collected for this work refers to the year 2007. The index values are divided into quintiles processed on MATLAB software by fuzzy logic and grouped inside Quantum Gis Software spatial tables in the form alphanumeric values through thematic maps of the analyzed regions.

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No. of bitstreams: 1 Dissertação Paulo Viol - Versão Final.pdf: 869270 bytes, checksum: da6b1af81d75d8726abda99dd5a0e398 (MD5) Previous issue date: 2018-06-20 / Nos últimos 15 anos a administração de unidades de saúde públicas por Organizações Sociais de Saúde (OSS) vêm crescendo e se consolidando como excelente alternativa para o aumento da eficiência dos serviços prestados. O modelo de gestão de serviços de saúde por OSS já está presente em mais de 23 Estados e 220 municípios do país (SOUZA, 2017). De acordo com o estudo elaborado pela Secretaria de Saúde do Estado de São Paulo, o modelo de gestão de serviços de saúde por OSS apresenta melhor custo-benefício sob diversos indicadores, quando comparados à gestão direta de hospitais gerais, apontando maior produtividade e menor custo, concluindo-se que a gestão por OSS consegue ser até 52% mais produtiva e 32% mais barata para o Estado de São Paulo em comparação ao sistema de administração direta (SOUZA, 2017). No entanto, este modelo ainda apresenta variabilidade nos resultados das unidades conforme retratado pelo Tribunal de Contas da União (TCU), apontando referências não tão positivas, destacando as dificuldades na fiscalização quanto ao cumprimento de cláusulas e metas estabelecidas no contrato de gestão por parte dos contratantes (WERNECK, BOTTARI, 2016). Visando a possibilidade de promover um modelo de gestão que permita maior competitividade, o estudo se aprofundou nos fatores influenciadores no desempenho das unidades de saúde administradas pela OSS, de modo a permitir desdobramentos futuros em ações para mitigar as variabilidades evidenciadas e alavancar a performance dos equipamentos analisados. Por se tratar da análise sobre a metodologia de avaliação de desempenho criada por uma determinada Organização Social de Saúde (OSS), optou-se por um formato de estudo de caso. Os resultados encontrados mediante a aplicação do estudo, demonstram que um dos fatores de maior relevância para assegurar o melhor desempenho das unidades de saúde administradas por uma OSS correspondem à interação entre os contratantes, cumprindo as obrigações contratuais, fluxos de repasses financeiros e parceria de médio para longo prazo, de modo a sedimentar a cultura da melhoria contínua. / Over the last 15 years, the administration of public health units by Social Health Organizations (OSS) has been growing and consolidating as an excellent alternative to increase the efficiency of services provided. The model of health services management by OSS is already present in more than 23 states and 220 municipalities in the country (SOUZA, 2017). According to the study prepared by the Health Department of the State of São Paulo, the health services management model by OSS is more cost-effective under several indicators, when compared to the direct management of general hospitals, pointing to higher productivity and lower cost, and concluded that OSS management can be up to 52% more productive and 32% cheaper for the State of São Paulo than the direct administration system (SOUZA, 2017). However, this model still presents variability in the results of the units as portrayed by the Federal Court of Audit (TCU), pointing out not so positive references, highlighting the difficulties in monitoring compliance with clauses and targets established in the management agreement by the contractors (WERNECK, BOTTARI, 2016). Aiming at the possibility of promoting a management model that allows greater competitiveness, the study deepened the factors influencing the performance of health units administered by the OSS, in order to allow future actions in actions to mitigate the variability and leverage equipment performance analyzed. Because it is the analysis of the methodology of performance evaluation created by a certain Social Health Organization (OSS), we chose a case study format. The results obtained through the application of the study demonstrate that one of the most relevant factors to ensure the best performance of health units administered by an OSS is the interaction between the contractors, fulfilling contractual obligations, financial onlending flows and medium partnership for the long term, in order to sediment the culture of continuous improvement.

Resiliency is an important characteristic of successful therapists (Aponte, 1991; Aponte & Carlsen, 2009; Aponte & Winter, 2000; Clark, 2009; Hamel & Laraway, 2004; Kuiper, 2012; Protinsky & Coward, 2001; Rosenburg & Pace, 2006; Wolgien & Coady, 1997), especially those in entry-level positions that tend to involve high stress and turnover (Acker, 2004; Clark, 2009; Davis, 2013; Greenson, Guo, Barth, Harley, & Sission, 2009; Grosch & Olsen, 1994; Gupta, Peterson, Lysaght, & Zweck, 2012; Horan, 2002; Maslach & Leiter, 1997; Negash & Sahin, 2011; Rosenburg &Pace, 2006; Skovolt &Trotter Mathison, 2011). This study explored the perspectives of six therapists providing in home services in community based agencies who succeeded and thrived in entry-level positions. The researcher inquired about how the therapists defined and maintained necessary resiliency. The participating therapists were recommended by their agency directors for their exemplary performance; they defined themselves as succeeding and thriving. The researcher used the qualitative research method of phenomenology (Kafle, 2011) to examine the participants’ lived experiences. The researcher derived five primary themes from the thematic analysis of the interviews: (1) In-home therapists should enjoy the freedom of their jobs; (2) In-home therapists should schedule their time creatively; (3) In-home therapists should understand the unique needs of their clientele; (4) In-home therapists should practice self-care; and (5) In-home therapists should vary their clientele. These themes represent methods by which the participants manage to become successful in-home therapists and prevent burnout.

Physical and social characteristics of neighborhoods are important to resident satisfaction for clinical and nonclinical populations. This study draws upon data collected from a sample of 172 individuals with psychiatric disabilities living in 16 supportive housing sites in the Portland, Oregon metropolitan area. Research questions explore the extent to which subjective and objective measures of neighborhood physical and social environments contribute to neighborhood satisfaction for this population. Mixed methods were employed to construct a detailed understanding of the factors that influence satisfaction with one's neighborhood of residence. Predictor variables were neighborhood social climate, neighborhood physical quality, perceptions of safety, crime reports, neighborhood diversity, and WalkScore data. This study found that aspects of the social environment collectively accounted for more variance in neighborhood satisfaction than physical environmental variables; further, subjective assessments of the environment were more predictive of neighborhood satisfaction than objective indicators. Qualitative data were collected on aspects of the neighborhood that residents liked and disliked. These data were analyzed using thematic content analysis to contextualize quantitative findings. Findings provide important information regarding neighborhood features that contribute to or detract from neighborhood satisfaction among individuals with psychiatric disabilities. Supportive housing programs aiming to improve residents' well-being and increase residential tenure may consider looking to features of the neighborhood that most impact resident experiences.