This study is aimed at looking at the relationship experiences between the adolescent with visual impairment in institutional care and his family. A lack of sufficient guidelines in this field has been identified in the relevant literature. Experts working with these adolescents have confirmed this shortcoming. In order to reach the required goal, a number of objectives were set. By means of a literature study and consultation with experts in the field of blindness as a symptom (in terms of the degree of visual impairment that is experienced), a theoretical framework was set up with regard to the following: adolescence as part of life; the adolescent's relationship with his family; institutional care and institutionalization; as well as play therapeutic assessment and play therapeutic techniques. An empirical study where semi-structured interviews were used as a method of data collection, was undertaken to assess the relationship of the adolescent with visual impairment in institutional care with his family. The following aspects were handled specifically: the way the adolescents with visual impairment in institutional care experience holidays and weekends with their families; their view of their families' perception of them coming home for holidays or weekends; their opinion with regard to family chores and responsibilities that are allocated to them; their experience of participating in the decision making process in the family; their perception of the treatment that they receive from their parents – does it differ in any way from that of their siblings?; their view with regard to “feeling part of” the family as an equal and complete family member; their opinion with regard to things that they would have liked to be done differently during their growing up process; as well as advice that they would give to parents who have children with the same disabilities. Individual semi-structured interviews were used with the ten respondents. Applied research was undertaken as the researcher aimed at establishing solutions for problems that occur with the adolescent with visual impairment in institutional care with regard to his relationship with his family. The researcher used a qualitative approach as research procedure in order to get qualitative empirical data. Considering that in this study a relatively unknown field was researched, a phenomenological strategy within an exploratory study was used to explore, understand and interpret the research question, which is not well known. The research question formulated for this study was: What are the experiences of the adolescent with visual impairment in institutional care with regard to his relationship with his family? Empirical data, which was obtained by using an interview schedule and a play therapeutic technique, showed that: § Adolescents with visual impairment in institutional care are experiencing ambivalent feelings (positive and negative) with regard to spending holidays and/or weekends with their families. There are a variety of factors influencing this experience, whether positively or negatively. § The way adolescents with visual impairment in institutional care view their families' perception with regard to them coming home for holidays or weekends, is mainly influenced by three factors, namely: special activities that are organized during the time that the adolescent is at home, as well as verbal and non-verbal behavior that is communicated towards the adolescent. § Adolescents with visual impairment have a specific opinion with regard to chores and responsibilities that were allocated to them since they were younger. This includes aspects like the adolescents' willingness and ability to complete chores, as well as their willingness to ask for help. They intimated that they are willing to accept chores and responsibilities as they experience positive feelings when they are able to complete such tasks successfully. § Adolescents with visual impairment in institutional care have a specific opinion about their participation in the decision making process in the family. This includes emotions that are experienced with regard to the decision making process (positive emotions are experienced when their opinions are asked in family decisions), their involvement in the decision making process, as well as the influence of decision making on the atmosphere in the house. § Adolescents with visual impairment have a fixed perception with regard to the treatment that they receive from their parents. This perception includes the following aspects: a need for normal treatment, the consequences of preference treatment from their parents, strict treatment (overprotective treatment) from their parents, as well as the emotions they experience about the type of treatment that they are exposed to. § The way adolescents with visual impairment view themselves as “part of” the family - as equals to all household members - is influenced by the following aspects: the influence of institutionalization on the feeling of “belonging to“ (adolescents are away from home for long periods of time and the only contact they have are telephone calls); family events (special activities in which both the family and the adolescent participate during holidays or weekends); family interaction (the families communicational patterns during holidays or weekends); as well as the private space of the adolescents (bedrooms). § Adolescents with visual impairment have a specific opinion with regard to things that they would have liked to be done differently during their process of growing up. They feel that their families should have more insight into the world of people who are visually impaired. They also have the need to be treated in the same way as other family members – they do not want to be overprotected. § Adolescents with visual impairment want to give relevant advice to parents of children who have the same disability. The advice that they suggested are: The child must function more independently; parents must be honest with their child at all times; the child must be treated normally; a feeling of unconditional, positive acceptance must be revealed to the child; no unnecessary restriction must be imposed on the child. They also gave advice with regard to general information (to expand parents' knowledge). The study revealed the experience of the adolescent with visual impairment in institutional care of his relationship with his family, which holds further research possibilities. The desired information was acquired and can be used in further studies of the adolescent in a similar situation. / Dissertation (MSD (Play Therapy))--University of Pretoria, 2006. / Social Work and Criminology / Unrestricted

L’obiettivo generale del progetto di ricerca è valutare la percezione della qualità dei servizi offerti in due RSA del Nord Italia e proporre interventi di miglioramento. Nel primo capitolo della tesi sono stati descritti i principali modelli teorici della qualità dei servizi. La letteratura riconosce la mancanza di scale validate che esplorano la percezione della qualità dei servizi nelle RSA Italiane. Per questo motivo, è stato realizzato uno studio di validazione e adattamento della versione italiana della scala SERVQUAL. Nel secondo capitolo della tesi è stato presentato uno studio qualitativo retrospettivo. Partendo dagli eventi critici che si sono verificati nella RSA, sono stati analizzati i principali episodi positivi e negativi ricordati dai famigliari degli anziani. I risultati sono stati utilizzati per ipotizzare nuovi percorsi di intervento e per fornire strategie organizzative per migliorare la gestione degli eventi problematici. La letteratura riconosce l’importanza del coinvolgimento dei famigliari per il benessere degli anziani. Per questo motivo, in questo progetto di ricerca sono state delineate le basi concettuali per l’applicazione di un modello collaborativo di assessment all’interno delle RSA. Nello specifico, il terzo capitolo della tesi ha esplorato l'efficacia dell’Assessment Terapeutico attraverso una meta-analisi multilivello e nell'ultimo capitolo della tesi è stata applicata una componente del modello di Assessment Collaborativo e Terapeutico nelle RSA. / The general aim of the present research project was to broaden the knowledge and understanding of the ways in which elderly’s family members perceive the quality of service and propose interventions to improve services. To lay the ground for discussion about the quality of services offered by nursing homes, Chapter 1 provides a historical overview of the models of the quality of services. Given the lack of validated measures of the quality of services in Italian nursing homes, I presented data regarding the validation and adaptation of the Italian version of the SERVQUAL Scale. Chapter 2 introduced a retrospective qualitative study. Starting from critical events that occurred in nursing homes, I analyzed family members’ observations of the incidents. The results were used to generate new paths for interventions to improve the family members’ evaluation of services and to provide organizational strategies to improve the management of problematic events. Given the effect of family involvement on elder people’s well-being, I presented the conceptual underpinnings and the applicability of a collaborative model of assessment in nursing homes. Chapter 3 explored the effectiveness of the Therapeutic Assessment model through a multilevel meta-analytic study. From these results, a component of the Collaborative and Therapeutic Assessment model was applied in nursing homes, as described in the last chapter.

Nous avons initialement réalisé une étude prospective évaluant l’intérêt de la TEP-TDM au FDG pour le diagnostic de récidive infra-clinique des carcinomes épidermoïdes des voies aéro-digestives supérieures. Nos résultats ont montré d’excellentes performances de l’examen en surveillance systématique, permettant notamment le diagnostic de récidive chez environ 1/3 des patients cliniquement asymptomatiques 1 an après la fin du traitement. Nous avons ensuite étudié le bénéfice d’une évaluation thérapeutique précoce par TEP-TDM au FDG à 2 cures d’une chimiothérapie néoadjuvante par TPF précédant une radiochimiothérapie sur une cohorte de sujets porteurs d’un cancer localement avancé (stade IIIIVA). Nos résultats ont montré une corrélation statistiquement significative entre la réponse métabolique et la survie sans récidive, suggérant l’intérêt d’un examen intermédiaire pour cibler de façon précoce les patients réfractaires au traitement. Nous avons ensuite analysé prospectivement l’impact pronostique de la TEP-TDM au FDG réalisée en situation préthérapeutique dans le but de sélectionner encore plus précocement cette population à risque de récidive. Les résultats de nos 2 études ont prouvé que l’utilisation de paramètres volumétriques ou cinétiques de la captation intra-tumorale du FDG était prédictive de la survie globale, avec une valeur pronostique indépendante et supérieure à celle du SUVmax. Cette thèse ouvre ainsi des perspectives de nouvelles indications de la TEP-TDM au FDG dans la prise en charge des carcinomes épidermoïdes des VADS, soulève des problématiques de recherche avec notamment l’émergence des nouveaux traceurs permettant de caractériser au mieux la cellule tumorale et s’inscrit dans une volonté actuelle d’une médecine préventive et prédictive personnalisée. / We initially conducted a prospective study evaluating diagnostic interest of FDG PET-CT for head and neck squamous cell carcinomas subclinical recurrence. Our results showed FDG PET-CT high performance in systematic monitoring, especially for the diagnosis of recurrence in about one third of clinically asymptomatic patients 1 year after the end of treatment. Secondly, we studied the benefits of early treatment evaluation by FDG PET-CT after 2 cycles of neoadjuvant chemotherapy by DCF (docetaxel, cysplatin, 5-fluorouracil) before chemoradiotherapy in a cohort of patients with locally advanced cancer (stage III-IVA). Our results showed a statistically significant correlation between metabolic tumor response and recurrence-free survival, suggesting the interest of an interim PETscan to early target patients refractory to treatment. Then, we prospectively analyzed the prognostic impact of FDG PET-CT performed at initial staging in order to select earlier this population at risk for recurrence. The results of our two studies proved that the use of volumetric or kinetic parameters of intratumoral FDG uptake was predictive of overall survival, with an independent prognostic value and a higher performance to SUVmax. Thus, this thesis opens new perspectives indications of FDG PET-CT in the management of head and neck squamous cell carcinoma, raises research issues such as the emergence of new tracers to characterize at best the tumor cell and falls within a current commitment to move towards a personalized preventive and predictive medicine.

Inledning: Syftet med studien var att ta reda på hur en metod för neuropsykiatriska utredningar upplevdes av de föräldrar som deltagit i den. Utredningsmetoden kallas TA-C, eng. Therapeutic Assessment with Child. I den sätts särskilt värde till delaktighet och den terapeutiska potentialen. Frågeställningar: 1: Vad var föräldrarnas anledning att söka utredning? Hur beskrev föräldrar sig delaktiga i den neuropsykiatriska utredningen av deras barn? Hur var utredningen till hjälp att förstå sitt barn? Metod: Kvalitativ metod, semistrukturerad intervju, 10 föräldrar som genomgått en form av neuropsykiatrisk utredning för deras barn. Resultat: Resultatet visar att föräldrarna har upplevt betydande delaktighet och förståelse för sitt barn, och kopplar ofta ihop begreppen, som att de har en ömsesidig påverkan. Det upplevdes i huvudsak under arbetet med frågeställningar som blev kopplade till vardagen, i att de deltog i utredningens samtliga delar, i att de fick vara med, uppmuntra och observera, samt att de löpande kunde resonera och delta med barnet och utredarna. Några uppfattade minskad delaktighet och förståelse i samband med återgivningen av resultatet. Diskussion: I diskussionen används begreppen delaktighet och förståelse i samverkan, samspel, intersubjektivitet, anknytning och mentalisering. Studien synliggör den terapeutiska effekten med den sortens utredning. / Introduction: The aim of this study was to find out how a particular method for neuropsychiatric assessments was experienced by the parents who participated in it. The Assessment method is called Therapeutic Assessment with Child, which add particular value to participation and the therapeutical potential. Questions: What was the parents’ need to seek assessment? How did parents describe their involvement in the neuropsychiatric assessment of their child? How was the assessment helping to understand the child? Metod: Qualitative method, semi-structured interview, 10 parents of children who have undergone a certain neuropsychiatric assessment. Resultat: The results show that parents have experienced significant involvement and understanding of their child, and often link together those concepts, as they have a mutual influence. It was felt mainly during work on issues that were related to everyday life, in that they participated in the assessment in all the parts, in that they could be involved, encourage and observe, and that they continously could discuss and engage with the child and the assessors. Some perceived reduced participation and understanding in relation to the presentation of the result. Diskussion: The discussion uses the terms participation and understanding collaborating, interaction, intersubjectivity, attachment and mentalization. The study reveals the therapeutic effect of the kind of assessment.

This dissertation examined students‘ experience with school assessment infused with Therapeutic Assessment (TA) techniques. Nine assessors from the school district were assigned to one of two groups, TA-infused group and the assessment-as-usual group. Those in the TA-infused group were trained in collaborative assessment practices based on Finn‘s model of TA with children (TA-C), specifically collaborative interviews, extended inquiries, and collaborative oral and written feedback (Finn, 2007). Thirty-three students from a medium sized public school district in central Texas completed the study in its entirety. It was hypothesized that those in the TA-infused group, compared with the assessment-as-usual group, would report learning more about themselves, experiencing a more positive relationship with the assessor, feeling more positive about the assessment process, feeling more collaborated with, and having greater perceptions of parental understanding. It was also hypothesized that those in the TA-infused group would report an increase in positive feelings and a decrease negative in feelings about themselves and their challenge when compared with the assessment-as-usual group. Additionally, it was hypothesized that those in the TA-infused group would report an increase in positive attitudes toward school after the intervention when compared with the assessment-as-usual group. Outcomes were measured by the Child‘s Experience of Assessment Survey (CEAS), the Children‘s Positive and Negative Affect Scale (CPNE-S), and the Attitude to School (ATS) subtest of the BASC-2-SRP. A descriptive discriminate analysis was conducted using the five subscales of the CEAS to measure the first hypotheses. RM ANOVAs were run on the CPNE-S and the ATS to analyze the second and third hypotheses. Additionally, a qualitative interview was conducted with participants. Analyses yielded no statistically significant results between the groups. Qualitative interviews indicated that both groups were satisfied with the assessment process. Additionally, those in the TA-infused group all reported positive reactions to the collaborative written feedback. Specifically, those that received a fable reported liking the fable and feeling that it related to their lives. Those that received a letter reported learning more about themselves, appreciating a written record of the feedback, and feeling positively about their relationship with the assessor. Further research is needed to understand the effects of collaborative techniques within school assessments, particularly the effects of the different forms of written feedback. / text

This research was aimed at the lack of knowledge with regards to the nature, causes and disruptive behavioural patterns as a consequence of adolescents with self-destructive behaviour, and the way in which it limits effective intervention. A lack of research and literature, especially within the South-African context, contributes to this lack of knowledge. As a result, therapists tend to distance themselves, misinterpret and even ignore this behaviour. Some therapists, especially social workers, fear this behaviour, are frustrated by and even disapprove of clients who present self-destructive behaviour. The goal of this study was to address the lack of knowledge with regards to self-destructive behaviour in adolescents within a social work perspective. A knowledge framework has been developed by investigating the nature, causes and disruptive behavioural problems as a consequence in adolescents, which will serve as a reference for therapists. In order to reach the required goal, a number of objectives were set. This included the development of a knowledge framework by means of a literature study as well as consultation with experts in the field of self-destructive behaviour in adolescents. An empirical study was undertaken during which a collective case study was utilised as strategy for the gathering of data. During these interviews, the researcher tried to gather information about the nature, causes and disruptive behavioural problems as a consequence in adolescents who demonstrate with this behaviour. Three participants took part and the three case studies were compared. Applied research was used as the researcher aimed to explore the problem (namely adolescents with self-destructive behaviour) scientifically in order to develop a knowledge framework. The researcher used a qualitative research approach and in this way, qualitative empirical information was gathered. This study embraced research of a relatively unknown research field. This led to the researcher utilising an exploratory study design in order to investigate a research question, which comprises of limited information. The research question that was formulated for the means of this research was: What are the nature, causes and disruptive behavioural problems as a consequence of self-destructive behaviour in adolescents? Empirical data was gathered by means of case studies and led to the development of a research framework which contains the following information: 1. The nature of self-destructive behaviour 2. The causes of self-destructive behaviour 3. The link between self-destructive behaviour and suicide 4. The “therapeutic value” of self-destructive behaviour Thus, the research indicated that adolescent self-destructive behaviour is a common problem which therapists must face without appropriate knowledge and skills. Therefore, it is of outmost importance that social workers be trained accordingly in order to handle the problem of self-destructive behaviour in a constructive manner. / Dissertation (MSD (Play Therapy))--University of Pretoria, 2006. / Social Work / unrestricted