The search for new identity factors and shared values in the post-Soviet region has given rise to a process of reevaluation of the role of religion in society. Not least the Central Asian countries are struggling with these issues in their nation building processes. They share important parts of their history with other Muslim dominated nations, but the Soviet heritage sets them apart. The focus of this study lies on the way religion as a general concept and Islam in particular are treated in four textbooks used in Kazakhstan’s school education. The contents of the textbooks are analyzed within a historical and societal context as well as a framework of contemporary secularity theory. The results elucidate a contrast between the discourse on religion found in the textbooks and the official legal status of religion in Kazakhstan today, which is taken as an indication of an ongoing reevaluation of religion leading away from the staunch Soviet secularity and possibly towards a situation where religion is seen as a natural part of societal developments. At the same time, however, the normative effect of official discourse is a double-edged sword, which, while shaping ideas of what religion is and ought to be, may also undermine the credibility and authority of a religion too closely associated with political authority.

The present study examined the subjective experiences of individuals living in the community with a severe or persistent mental illness receiving services from the Sunnybrook Program of Assertive Community Treatment (SunPACT). The researcher employed McCracken’s (1998) Long Interview Method to interview a sample of 8 clients from SunPACT. The aim of this research was to explore client perspectives on their experiences of SunPACT and their perception of its impact on their quality of life. The findings from this study overlapped with the literature, as well providing new and vital information in the implementation and monitoring of quality of care of an ACT model. This research demonstrated that clients experience the effects of their treatment differently, and therefore, understanding client feedback is imperative to understanding how to maximize treatment benefits and provide effective services. Specific details about their experiences are outlined. Implications for social work practice are discussed.

This thesis includes three empirical studies that have all aimed to increase the understanding of the interactions and connections between self-concepts, reading impairment, psychological health and Assistive Technology (AT). The use of applications in tablets as assistive technology to facilitate reading and compensate for reading impairment and its impact on the participants’ self-concepts and psychological health as well as on their reading abilities was also of interest. The first study included 67 pupils in school years 4-9. They were assessed by the Beck Youth Inventory (BYI) regarding self-image, anxiety and depression. The results showed no deviance from age-equivalent norm group scores. The second study included 35 pupils in school years 4-6. This study aimed at investigating the transfer effects on decoding and general reading ability after 20 intervention sessions where AT (applications in tablets) were used. Results showed that the decoding ability had progressed at the same rate as that of the norm group. The results also showed that using AT increased motivations to learn, as well as independence and improved family climate. The third study was a randomized control study (RCT) with 137 participants in school years 4, 8 and high school. The results showed that reading impaired children and adolescents to a great extent, but not completely unanimously, did not depict any different self-image or self-esteem than peers with an expected reading ability of the same age. Self-esteem was investigated by the Cultural Free Self Esteem Inventory (CFSEI-3). The CFSEI-3 scores showed no effect by interventions with AT. The results also showed that there were no signs of depression, assessed by BYI, in the investigated groups, but somewhat inconclusive results regarding anxiety where the school-year 4 group depicted higher levels of anxiety. The results generally showed a more positive depiction than what previous studies within the field have presented, which was interpreted as being due to the development of efficient pedagogical strategies and supportive attitudes in the school context, as well as among family members or peers.

Background: Individuals with severe mental illness (SMI) have higher rates of physical comorbidities, such as cardiovascular disease and diabetes, which contribute to reduced life expectancy compared to the general population. Regular physical activity (PA) has proven efficacy at improving both physical and mental health outcomes in all persons. There is evidence that regular PA can also reduce the severity of psychiatric symptoms in individuals with SMI, including improvement of negative and neurocognitive symptoms in schizophrenia spectrum disorders. While currently available psychotropic medication is effective in managing positive symptoms, they have little or no effect on negative and neurocognitive symptoms, making regular PA a promising adjunctive treatment to pharmacological interventions. Despite the benefits of regular PA, individuals with SMI engage in PA at lower levels than the general population. Assertive Community Treatment (ACT) teams provide robust community-based support to individuals with SMI and are thus in a unique position to be able to provide support with PA engagement also. Purpose: To explore ACT team member perspectives and experiences with positive PA program implementation and visions for future program design and delivery for this population. Methods: A qualitative pragmatic a priori framework and implementation approach were used. Semi-structured interviews were conducted with ACT team members of various professional and paraprofessional designations. Interview questions were created using an appreciative inquiry lens and based on the Consolidated Framework for Implementation Research (CFIR) and focused on the CFIR domains of individuals involved, intervention characteristics, inner and outer settings. All interviews were recorded, and transcribed verbatim, and thematic analysis was conducted using QSR International’s Nvivo12® software. The CFIR was used to guide theming. Results: Eight participants with an average ACT experience of 6 years were interviewed. All participants believed PA to be important for physical and mental health, and all expressed enthusiasm and willingness to be involved in the development, implementation, and ongoing delivery of PA programs for ACT clients. However, most participants felt only somewhat or not at all confident in their own ability to deliver PA programming effectively and safely. Regarding intervention characteristics, participants unanimously identified adaptability and flexibility as necessary. Participants unanimously believed that the organizational culture was supportive of PA, but that few if any tangible supports existed. Interview questions related to the CFIHR outer setting revealed three main themes: necessary resources, organizational culture, and an expectation of implementation. Only two participants identified resources available within Island Health, and no participants were aware of any resources currently available within the ACT teams. However, all participants were able to identify some community resources available. Discussion: There was high motivation to deliver a PA program for ACT clients and positive beliefs about the benefits, but poor self-efficacy. To achieve successful implementation, additional training or supports, such as addition of a PA professional to the teams, should be considered. Participants resoundingly identified adaptability and flexibility as intervention characteristics necessary for implementation of a PA program in this setting. Fun, social connection, autonomy and incentive were identified as intervention characteristics that may improve client satisfaction. Some suggestions made by participants were the delivery of PA programming in a group format, and provision of choice in type of PA. In terms of inner setting, the structural characteristics of Island Health and the ACT teams include both strength and challenges to implementing new interventions. Island Health is a large organization with diverse knowledge, immense resources, longstanding and stable leadership structure, and organizational values of person-centred care and psychosocial rehabilitation that are congruent with implementation of a PA program for ACT clients. However, some participants believed the large size of the organization may create challenges to change and recommended a bottom-up team-based approach to implementation of a PA program. Resoundingly, participants in this study identified the need for dedicated time, space, funding, and staff to provide PA programs to ACT clients, and that including PA in program mandates would support the implementation of this. Greater connection with external organizations such as recreation centres, through personal connections or planned partnerships, was identified as an additional way to support implementation of PA programs. In terms of process, a dedicated group of staff or special committee may be a necessary part of the planning process in this setting, and planning should include consideration for the requisite time and staffing. As identified by one participant in this study, a “champion” can be a critical part of the engaging stage. A formalized execution plan may be most efficacious in this setting. Ongoing reflection and evaluation will be necessary to ensure the sustainability and quality of a newly implemented PA program. This study, by using an appreciative inquiry approach, has already initiated the process of engaging individuals. Island Health leadership can further engage individuals by continuing the conversations started in this study, providing education, and training, and supporting the importance of PA for ACT clients. / Graduate

With the method of conversation analysis, this study examines the level of adverseness in questions between members of parliament from different parties. The data consists of question – response sequences derived from a ministerial statement from the prime minister in the House of Commons. This study finds that, in question – response sequences between oppositional members of parliament and the prime minister, adversarial presuppositions in questions can be used as a strategy to project negative traits upon the respondent. Adversarial dimensions of hostility, assertiveness and directness can also be found in adversarial questions. In these instances, the respondent may adjust their answer to match the level of adverseness from the questioner through the use of certain lexis, creating counter sequences. Adversarial questions are the most common type of question from members of the oppositional party, and there are different adversarial strategies being used. Questions from members of the government party do not make use of adversarial strategies, and should not be described as adversarial.

Indiana University-Purdue University Indianapolis (IUPUI) / Assertive Community Treatment (ACT) is a widely implemented evidence-based practice for consumers with severe mental illness. However, fidelity to the model is variable and program drift, in which programs decrease in fidelity over time, can occur. Given substantial variability in fidelity and program drift in evidence-based practices, a study to examine how to re-implement ACT to high fidelity on established teams was warranted. The present study examined three teams providing moderate fidelity services prior to a state-wide policy change to the definition of ACT. Two of the teams attempted to implement ACT in accordance with state standards, while the third team served as a quasi-control for factors related to other state policy changes, such as a change to the funding mechanism. The implementation effort was examined using qualitative and quantitative measures over a 14-month period at a large, psychosocial rehabilitation center. Themes that were common across all three teams included the perceived negative impact of fee-for-service, ambiguity of stipulations and lack of guidance from the Department of Mental Health (DMH), difficulties with the managed care organization, importance of leadership within the agency, and familiarity with the services. Perceived barriers specific to the implementation of ACT standards included DMH stipulations, staff turnover, lack of resources, and implementation overload, i.e., too many changes at once. One team also had the significant barrier of a misalignment of requirements between two funding sources. Staff attitudes represented both a facilitator and a barrier to ACT implementation, while management being supportive of ACT was viewed as a major facilitator. One of the two teams seeking ACT status was rated at high fidelity within 6 months and maintained high fidelity throughout the study. The other team seeking ACT status never achieved high fidelity and decertified from ACT status after 6 months. The agency’s focus on productivity standards during the implementation effort hampered fidelity on the two teams seeking ACT status and greatly contributed to burnout on all three teams. The team achieving ACT status overcame the barriers in the short-term; however, DMH requirements may have threatened the long-term sustainability of ACT at the agency.

People with serious mental illnesses (SMIs) (e.g., schizophrenia, major depressive disorder, bipolar disorder) receive inadequate medical care, which is associated with high rates of avoidable morbidity and premature mortality. Assertive Community Treatment (ACT) is an evidence-based service delivery model that provides intensive mental and social health support to clients with SMI. It has been suggested that ACT should provide primary care services to address client physical health, however, initiatives towards this and their implications are not well understood. I used a case study approach and semi-structured interviews to explore five ACT teams in the Ottawa region to discover team members’ mental models of primary care, relationships with external primary care providers, and the perceived impact COVID-19 has had on these mental models. I used Shared Mental Model (SMM) theory to frame data collection and a thematic analysis. The results showed that ACT team members similarly perceived primary care as important for the holistic health of their clients. They described ACT’s psychosocial scope and how they support clients’ access to external primary care services and their work to mitigate barriers. Teams did not share mental models about the basic primary care services they provided or which roles delivered them, due to differences in context and team members’ comfort. Team members also did not share beliefs about the future of ACT and primary care integration. Finally, the COVID-19 pandemic changed and challenged primary care delivery, with beliefs becoming more negative overall. This thesis provides insight into how primary care could be delivered to ACT clients and where challenges and improvements can be addressed.

Магистерская диссертация содержит теоретическую и эмпирическую часть. В теоретической части рассматривается формирование ассертивности у дошкольников, как целенаправленный процесс, способствующий более полному внутреннему раскрытию их личности, успешной социальной адаптации в среде сверстников и социуме в целом. Так как именно в дошкольном возрасте, встает необходимость формирования ассертивности, предпосылки мотивации в учебной деятельности, и мотивации достижений в дальнейшем. В эмпирической части диссертации представлена программа, направленная на закрепление полученных умений, навыков и знаний об особенностях ассертивного поведения дошкольников, подобранны упражнения, направленные на все компоненты ассертивного поведения средствами эмоционального наполнения. Таким образом, необходимость формирования ассертивности у дошкольников рассматривается как одна из актуальных проблем современного воспитания подрастающего поколения. В заключение диссертации сделаны соответствующие выводы по изучаемой проблеме. / Master's thesis contains theoretical and empirical part. The theoretical part deals with the formation of assertiveness in preschoolers as a purposeful process, contributing to a more complete disclosure of their inner personality, successful social adaptation among peers and society in general. Since it is in the pre-school age, there is a necessity of formation of assertiveness, motivation background in training activities, and achievement motivation in the future. In the empirical part of the dissertation presents a program aimed at consolidating the obtained skills and knowledge about the features of assertive behavior preschoolers podobranny exercises aimed at all components of assertive behavior by means of emotional content. Thus, the need to build assertiveness in preschool children is considered as one of the urgent problems of modern education of the younger generation. In conclusion, the thesis made the appropriate conclusions for the problem under study.

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Formålet: Psykiatriens udvikling er konstant præget af ønsket om effektive behandlings-metoder. Etablering af ACT (Assertive Community Treatment) -er skabt i erkendelse af, at psykiatrien i hospitalerne ikke i tilstrækkelig grad har evnet at helbrede. Med afsæt i de kronisk psykisk syge, vil dette MPH arbejde fokusere på denne gruppes sundhedstilstand, ved at studere arbejdsmetoden ACT. En arbejdsmetode som sundheds-og socialvæsenet i stigende grad accepterer som organisation og funktion til forebyggelse og sundhedsfremme. Der er i de sindslidendes liv brug for en arbejdsmodel, hvor en kompetent hjælper kan støtte den sindslidende i at begribe hverdagen, så der dannes et meningsfuldt grundlag for at håndtere livet. Formålet med studiet er, at få mere viden om, hvordan de danske ACT teams fungerer i en hektisk hverdag. Modellen har i udlandet vist, at have god effekt på reduktion af kompleksitet og sikre en bedre sammenhæng i det psykiatriske arbejde. Studiet er ligeledes en efterprøvning af, om der arbejdes modeltrofast overfor ACT i Danmark. Metode: Studiet belyser ACT interventionen ved hjælp af en struktureret elektronisk spørgeundersøgelse og efterfølgende kvalitativ indholdsanalyse. Efterfølgende fravalg af størstedelen af den indsamlede kvantitative data, grundet lav svarprocent. Resultat: I undersøgelsen deltog 72 respondenter fordelt på 31 respondenter fra Region Hovedstaden (43 %),12 respondenter fra Region Sjælland (17%), 11 respondenter fra Region Syddanmark (15 %), 2 respondenter fra Region Midtjylland (3%) og endelig 16 respondenter fra Region Nordjylland (22%). Antal ACT teams i Danmark er fordelt med 33 teams i Region Hovedstaden, et team i Region Sjælland, otte teams i Region Syddanmark, 11 teams i Region Midtjylland og endelig fire teams i Region Nordjylland. Danske ACT teams arbejder anderledes og med en anden sammensætning / funktion end den oprindelige model fra USA. ACT har vist sin funktionsdygtighed gennem mere end de sidste 10 år i Danmark. ACT teams indtænker salutogenitet i sin arbejdsform og fokuserer på ressourcer og på at forbedre sundhedstilstanden. ACT er opsøgende og assertivt i sin kontakt til klienterne. Konklusion: ACT har med sit indtog i Danmark vist,at tilgodese et behov hos både klienter, den arbejdende psykiatri og samfundet. Psykiatrien skal behandle klienterne, der hvor de er – i deres eget liv. Med tilbud som er tilgængelige, sammenhængende og meningsfulde for den enkeltes vej mod et godt liv uden eller på trods af sygdom. Arbejdsmetoden er effektiv i reduktion af sundhedsfaglig og socialfaglig kompleksitet og teammedlemmerne udtrykker stor arbejdstilfredshed ved metoden. Teammedlemmerne i danske ACT-teams evner at arbejde i teams. Det tværfaglige samarbejde opleves meningsfuldt og håndterbart. ACT arbejdet er attraktivt og kan rekruttere kompetente medlemmer. Kvaliteten af de ydelser som ACT teams leverer, inkluderer forebyggelse, pleje, behandling, rehabilitering samt en øget oplevelse af tilgængelighed, koordination, kontinuitet og reduktion af kompleksitet. De danske ACT teams er ikke modeltro mod ACT –men tilpasset danske forhold og begrænsninger. ACT team har ikke fuldstændig myndighedsfunktion. ACT som model er under udvikling og tillempes mere og mere i en dansk kontekst / Background: Inpsychiatry, development is characterized by a desire for efficient treatment. Establishment of Assertive Community Treatment (ACT) was created in recognition that psychiatric hospitals have not adequately been able to restore health. Based on the chronic mentally ill, this study focused on the Outreach Psychosis Team by studying the working method ACT. Health and social services are increasingly willing to accept ACT as an organized and functional method for prevention and health promotion. Mentally ill people need a working model in which a competent assistant can support the patient in comprehending everyday life and form a meaningful basis for dealing with life. Aim: This study aimed to gain more knowledge about how ACT teams in Denmark operate in a hectic schedule, and determine whether teams adhere to the ACT model. Method: The study highlighted ACT intervention using a structured electronic survey and subsequent qualitative content analysis. However, most of the collected quantitative data was rejected due to a low response rate . Results:The study included 72 respondents, 31 working in Region Hovedstaden, 12 in Region Sjælland 11 in Region Syddanmark, 2 in Region Midtjylland, and 16 in Region Nordjylland. ACT teams in Denmark include 33 teams in Region Hovedstaden, 1 in Region Sjælland, 8 in Region Syddanmark, 11 in Region Midtjylland, and 4 in Region Nordjylland. The teams work differently and with a different composition and function than the original US model, but they have proven their functionality for more than 10 years. ACT includes salutogenesis in its working methods, and focuses on resources and on improving health. Moreover, ACT is proactive and assertive in dealing with clients. Conclusion: Psychiatry must treat clients wherever they are intheir own lives with offers that are available, consistent, and meaningful to each person on his way to a good life without or in spite of illness. ACT in Denmark has shown that it considers the needs of both clients (i.e., working psychiatry and society), and the working method efficiently reduces the complexity of health care and social work. Team members appreciate the working method. Members of Danish ACT teams are capable of working in teams, and they experience interdisciplinary collaboration as meaningful and manageable. Because working in an ACT team is attractive, it is possible to recruit competent members. Services provided by ACT teams include prevention, care, treatment, rehabilitation, an increased sense of accessibility, coordination and continuity, and decreased complexity. The Danish ACT teams do not strictly adhere to the original ACT model, but rather have adapted to Danish conditions and limitations. Abroad, ACT reduces complexity and ensures greater consistency in mental health work. They do not have complete authority. Currently, ACT is being developed and adjusted to a Danish context / <p>ISBN 978-91-982280-3-6</p>