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This study analyzes effective service delivery in organizations serving the mentally retarded. Qualitative organizational analyses of three community care facilities were compared to assess effectiveness. Data were gathered by systematic observations, field notes, documents, and employee interviews. Program analysis, the funding system of service delivery, and staff attitudes best indicated effective service. I concluded that effectiveness would improve by focusing on individual consumer needs and further defining service delivery.

This study explores mental health advocacy among individuals with psychiatric disabilities in the New York State (NYS) adult home system. This system has garnered longstanding public concern over the unsafe and unjust conditions in which its residents live. In New York City (NYC) a unique organization, Adult Home Advocates (AHA), supports a group of residents (called peer advocates) to advocate for their rights. I integrate literature on health and mental health advocacy and movements with the concept of mental health recovery to consider how AHA participation may impact recovery for peer advocates and others living in the adult home system. I use Brown et al.'s (2010) policy ethnography approach to study sociolegal, organizational, and individual contexts in which peer advocates work and live. From May 2013 to August 2017 I conducted peer advocate (n=36) interviews and member checks, participant observations (n=154), archival document research, and initiated policy advocacy work. This study is guided by four research questions: 1) How may the sociolegal and organizational environments - - including an unfolding shift in the sociolegal environment - - influence mental health advocacy among individuals with psychiatric disabilities? (Chapter 3, p.41) 2) How may individual characteristics - - specifically, mental health recovery characteristics - - influence mental health advocacy among individuals with psychiatric disabilities? (Chapter 4, p.90) 3) What are the motivations for mental health advocacy among individuals with psychiatric disabilities? (Chapter 5, p.134) 4) What are the impacts of mental health advocacy among individuals with psychiatric disabilities? (Chapter 6, p.182) I use conventional content analysis (Hsieh & Shannon, 2005), with mental health recovery as a sensitizing concept, to organize and analyze data. I report on findings from the sociolegal to individual levels. First, the sociolegal environment includes patterns of unsafe, unhealthy, and socially isolating conditions within adult homes; even as a legal settlement (O’Toole v. Cuomo) helps residents move out, troubling implementation practices perpetuate these unjust conditions. AHA enters this environment with a commitment to help adult home residents advocate for themselves, though it is a small organization in terms of budget, staffing, and scope. Its size is both a key strength and limitation, as it furthers its mission-driven work, yet impedes training and support for peer advocates. I also report on findings specific to peer advocate participants (n=36). I use six mental health recovery domains - - including a sociolegal domain I develop to explore justice and rights issues - - to describe recovery as heterogeneous and dynamic across both individual domains and individual participants. Participants’ motivations for advocacy are also heterogeneous, with three types salient: 1) self-advocacy, 2) purpose, and 3) identity. Further, these motivations lead to four types of advocacy activities: 1) self-advocacy, 2) self-help, 3) advocate leader, and 4) advocate activist. Finally, I find that advocacy involvement does impact participants, both positively and negatively. I return to the six recovery domains used above to discuss how mental health advocacy brings into relief potential means of furthering mental health recovery for individuals with psychiatric disabilities.

During World War Two, approximately 400 to 450 Ausländerkinder-Pflegestätten, or foreign child-care facilities, were established across the German Reich as collection centers for the infants born to Polish and Soviet civilian laborers employed in the German war economy. My thesis examines two such foreign child-care facilities, the Volkswagen and Velpke children’s homes, where over 450 Polish and Soviet infants perished. Three themes provide the framework for an analysis of these two facilities: the conflict between two of the main goals of the Third Reich—racial cleansing and the exploitation of forced labor; the question of whether the establishment of the facilities and treatment of the children depended on orders from upper-level or local-level authorities; and the issue of whether the children’s deaths stemmed from intent to cause their deaths or indifference toward their fate. This thesis addresses the following questions: In terms of racial ideology and economic pragmatism, was one factor more significant in the establishment and use of the Volkswagen and Velpke children’s homes? Who, among upper-level and lower-level Nazi officials, ordinary Germans, medical professionals, and factory executives, was responsible for the children’s deaths? Were the children’s deaths intentional? What do these two facilities tell us about the other foreign child-care facilities that existed across the Third Reich? The research for this thesis draws upon two British war crimes trials held in Braunschweig and Helmstedt, Germany in 1946, the “Velpke Baby Home Case” and the “Rühen Baby Farm Case,” as well as records from the United States Holocaust Memorial Museum Archives in Washington, DC, the National Archives at College Park in College Park, MD, and digital records from the International Tracing Service Archives. Ultimately, this thesis highlights the connections between the three conflicting—and often opposing—themes. First, the trial records revealed that both facilities were exclusively established, managed, and operated by local-level officials and personnel. Second, upper-level Nazi authorities deemed alleged racial enemies a threat to the German “master race,” and were intent on enforcing a racial hierarchy in the German Reich; however, the local-level officials and staff responsible for these two children’s homes were far more concerned with maintaining productivity from the Polish and Soviet workforce, remaining indifferent toward the fate of the children at the homes. Third, while both the need for economic efficiency from workers and the belief in Nazi racial ideology influenced the establishment, management, and operation of the Volkswagen and Velpke children’s homes, there is minimal evidence that local authorities and personnel prioritized racial ideology over economics. Since both facilities were controlled locally, this thesis reveals that rather than putting racial ideological into practice and intentionally killing the children, local officials prioritized economic production. This left the fate of the children somewhere between extermination and child-rearing—between being left to die, murdered, or raised.

This study documented the history of the development and practice of the kinlein associate. Consumer dissatisfaction with health care, nursing unrest, and increased demand for long-term care-givers were the antecedents for a paradigm shift to "caring with" persons based upon the theory of esca developed by M. Lucille Kinlein. Interested people wanted to learn how to offer care from this perspective, and informal classes were held in several locations across the nation. The study focused on identifying the teaching methods used by the founder, Miss Kinlein. The methodology was deemed important in an attempt to assure that future kinlein associate teachers reflect the original educational processes and style when Miss Kinlein is no longer teaching. Her methods were considered important for kinlein associate teachers to prepare kinlein associates for practice. To determine Miss Kinlein's teaching methodology, qualitative research was conducted by observing her teaching, face to face interviews with students and kinleiners interested in teaching, and material gathered from the founder, Institute of Esca/Practice of Kinlein, and the Detente Homer, Alaska. Modeling, coaching, and directed inquiry were the primary methods used by Miss Kinlein and Mrs. Raymond, kinleiner of reference at the Homer Detente, in teaching kinlein associates. It was important to ground their teaching in educational theory and the contemporary interest in constructivism philosophy. Principles were extracted from several articles regarding constructivist philosophy/theory and were aligned with principles from the theory of esca used by Miss Kinlein. The parallels between the theory of esca and constructivism were striking. The study concluded by recommending Miss Kinlein and her student teachers examine the constructivism philosophy relative to the kinlein philosophy and theory of esca. The result of this examination may open kinleiner interest to explore similar, new ideas and serve as a spark for an intellectual/philosophical interchange among professional kinleiners and educators. Specific recommendations were given regarding immediate attention to kinlein associate curriculum, videotaping Miss Kinlein teaching various levels of courses, and developing a course on assisting students in moving in esca in learning. / Graduation date: 1998

Graduation date: 1994

The purpose of the present study was to examine the effect of environmental density on the behavior (Disruptive and Nondisruptive) of elderly residents with dementia living on a special care unit. A building project that led to relocation of residents from high density units to units that varied in density (low vs. high) provided a natural context for this study. Disruptive and Nondisruptive behavior are composite variables that together include the full range of behavioral responses. Both are composed of several subvariables. Data were collected using direct behavioral observation using the Environment-Behavior Interaction Code (Stewart & Hiscock, 1992b) and a hand-held computer. The first objective of the study was to examine behavior patterns in relation to density and privacy. This objective was addressed with a quasi-experimental design (Study 1), in which three hypotheses were tested. It was predicted that residents who moved from a high density unit to a low density unit would exhibit a greater reduction in rate of Disruptive behavior (Hypothesis 1) and a greater increase in rate of Nondisruptive behavior (Hypothesis 2), compared to residents in a constant high density condition. It was also predicted that use of Private Time (time spent alone in one's bedroom) would be greater on the low density unit, where residents had private rooms (Hypothesis 3). Results of Study 1 provided support for Hypotheses 1 and 2, in relation to comparisons with the External Comparison Group only. Within subjects analyses provided additional support for Hypothesis 1 (Disruptive behavior). Hypothesis 3 (Private Time) was also supported. The second objective of the study was to explore the perceptions of family and staff caregivers with regard to the effect of the environment on resident behavior. This study was addressed with a qualitative design (Study 2) using the grounded theory method. Participants in Study 2 described the needs of residents with dementia in relation to the physical and social environment, and the outcomes that occurred when these needs were met or not met. (Abstract shortened by UMI.)

The objective of this study is to test if the hypothesis of the environmental gerontology theory can be applied to a cross-cultural environment. This study examined the applicability and functionality of the Multiphasic Environmental Assessment Procedure (MEAP), a tool based on the environmental gerontology theory, and assessed the quality of elderly care facilities in Taiwan. Special emphasis was placed in examining the functionality of the MEAP from the cross-cultural standpoint and also in identifying the associations or potential impacting factors of care quality. This is the first study with the application of the MEAP to examine the quality of the two major care facilities in Taiwan. Results of this study provide not only an insight into the characteristics of the elderly care facilities ,and a reference for policy making and regulation, but also valuable data for cross-cultural comparisons. The study employed the MEAP to achieve the stated objectives and further evaluated the differences in the characteristics of the two major elderly care facilities, namely the nursing homes and assisted-living facilities in Kaohsiung city in Taiwan. This cross-sectional research was conducted with questionnaires by 687 employees (excluding foreign workers) and 429 residents in 35 nursing homes and 41 assisted living facilities in Kaohsiung city were interviewed. Participants were selected from residents who were conscious and without cognitive disorder for face-to-face questionnaire interviews. For facilities with ten or more residents, 50% of the eligible residents were selected for this interview. For facilities having less than ten residents, all those qualified residents were interviewed. Results were analyzed on the basis of institutional units rather than the individual basis. Results showed that the MEAP effectively evaluated the associations of the multiple environmental factors with the quality of life of the two major elderly care facilities in Kaohsiung city. Standardized multiple quality indexes mode showed that the assisted-living facilities have better overall quality than nursing homes do. The major findings are: 1.The major residents of elderly care facilities in Kaohsiung city were the socioeconomically less privileged residents, including house wifes, the disabled, and widowed. The service most needed was personal care such as bathing. 2.Based on the MEAP, a total of eight significant variables were compared between nursing homes and assisted living facilities. Among these variables, nursing homes were better in staff resource than that of the assisted living facilities. Assisted-living facilities were better in all other seven variables including functional abilities, activities in community, acceptance of problem behavior, physical amenities, social-recreational aids, and orientational aids and staff facilities. 3.The staff members of both nursing homes and assisted living facilities have better SCES than that of their residents. 4.Compared to assisted living facilities, the nursing homes were superior in staff level and staff resources but inferior in comfort, security, and control. No differences were observed in services, autonomy, rapport and morale. 5.The characteristics of organizational management, such as ownership, type and size, were important impacting factors of care quality. The nonprofit-nursing homes were better scored in six of the eight quality indexes than the ones owned by privately-for-profit. 6.Factors that influenced the quality of the nursing homes include number of workers, number of beds, number of residents, ownership, functional abilities, actively level, activities in community, occupancy rate and type of elderly care facility. 7.Factors that influenced the quality of assisted living facilities include occupancy rate, number of residents, number of workers, activity level and type of elderly care facility. 8.The regression model for the outcome of multiple environmental quality indexes with the structure and process indexes is related in nursing homes. The regression model indicates that the model significantly predicted outcome quality index (morale) (R2 = 49.4%). Both structure quality index (comfort and safety) and process quality index (autonomy and rapport) were significant predicting factors of outcome quality index (morale). Autonomy was a negative predicting factor. 9.Standardized multiple environmental quality index indicated that based on the MEAP, assisted living facilities had a little bit higher quality than that of nursing homes in Kaohsiung city. In conclusion, this study confirmed the hypothesis that the MEAP can be applied effectively to evaluate the quality of elderly care facilities in a cross-cultural environment. However, cultural differences do have an impact on the functionality of the tool. Results of this study indicate that the two major elderly care facilities in Kaohsiung city have relatively similar characteristics, but the assisted living facilities are slightly better in overall quality than that of nursing homes. The major factors that impact the quality of elderly care facilities are the operational characteristics and efficience. Results of this study indicate that the MEAP provides very useful indicators for assessing the quality of elderly care facilities in Taiwan, especially for nursing homes. The MEAP identified more structure and process-related impacting factors than outcome-related impacting factors in this study. Concerning cultural difference, the MEAP could be benefited from some modification in certain measurements, especially in facility atmosphere(SCES), when applied in Taiwan.

Thesis (M.S.W.) - Carleton University, 2009. / Includes bibliographical references (p.99-104). Also available in electronic format on the Internet.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2002. / Restricted until October 2003. Bibliography: leaves 127-136.