Orientador: Sueli Terezinha Ferreira Martins / Banca: Elen Rose Lodeiro Castanheira / Banca: Maria Dionísia de Amaral Dias / Banca: Flávia Gonçalves da Silva / Banca: Marina Peduzzi / Resumo: Práticas grupais são usualmente desenvolvidas por trabalhadores envolvidos na implantação de ações e serviços de saúde pública. Porém, frequentemente, tais práticas são realizadas com base em referenciais teórico-metodológicos que promovem análises mais restritas à instância imediata das relações intragrupais. As ações e serviços de atenção primária à saúde (APS) têm dentre suas diretrizes organizativas o trabalho em equipe, no qual se expressam processos grupais. Foram investigadas as manifestações da dialética cooperação-trabalho coletivo no processo de trabalho das equipes de APS, recorrendo ao processo grupal como unidade de análise. Foi sistematizada uma proposta histórico-dialética de análise concreta dos processos grupais, particularizada, posteriormente, para o caso do trabalho em equipe na APS. Inicialmente, examinaram-se as mediações constitutivas da formação do ser humano enquanto ser social. Foi apresentada a formulação da dialética cooperação-trabalho coletivo: o primeiro pólo (cooperação) se remete aos fundamentos histórico-ontológicos do trabalho na constituição do ser social do ser humano e o segundo (trabalho coletivo) trata das diversas formas históricas com que se vale da cooperação, constitutiva da sociabilidade do ser humano, na divisão técnica e social do trabalho. A seguir, investigou-se acerca da viabilidade teórica de que, como mediadores da existência social do ser humano, os processos grupais consistam na unidade de análise da dialética cooperaçãotrabalho coletivo. Posteriormente, particularizou-se essa formulação para o processo de trabalho em saúde com base no referencial teórico-metodológico marxiano. Observou-se que o trabalho em equipe de saúde se apresenta de forma contundente nas propostas de APS... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract:Group practices are usually performed by agents involved in public health actions and services deployment. However, these practices are frequently based on theoretical and methodological approaches that promote analysis restricted to the immediate dimensions of intragroup relations. The organization of public primary health care (PHC) actions and services include teamwork as an organizational directive, and group processes are part of it. The expressions of the cooperation-collective work dialectic in the work process of PHC teams were investigated, employing the group process as an analysis unit. A historicaldialectical proposition of a concrete analysis of group processes was systematized and, subsequently, particularized to the case of PHC teamwork. First, constitutive mediations regarding the formation of human being as a social being were examined. The cooperation-collective work dialectic formulation was presented: the first pole (cooperation) is related to the historical-ontological foundations of work in the constitution of the social being of human being and the second pole (collective work) is related to the diverse historical forms that cooperation, as a part of human being's sociability, is used as means to the technical and social division of labour. After that, it was investigated the theoretical viability that group processes, as mediations of human being's social existence, consist on the analysis unit of cooperation-collective work dialetic. Thereafter, this formulation was particularized to the health care work process grounded on marxian theoretical-methodological referential. It was observed that health care teamwork shows up substantially in PHC and health care model changing proposals developed in Brazilian Unified Health System. This presence is regardless... (Complete abstract click electronic access below) / Doutor

This thesis examines contemporary popular and news media representation of motherhood and labour in Canada and the United States. I explore what texts about motherhood and maternal labour suggest about gendered responsibilities to citizenship in neoliberal conditions. Building on important feminist research in the fields of citizenship, care, and the welfare state, I ask how are mothers being socially responsibilized toward multiple forms of labour simultaneously and to what effect? By engaging feminist theories of citizenship and bridging this field with feminist theories of science, media, and affect, I demonstrate how, under neoliberal conditions and in precarious circumstances, the ways in which women appear to juggle their commitments to paid and unpaid labour, determines how mainstream discourses reflect their value as citizens. This dissertation uses feminist critical discourse analysis to assess how, as women are responsibilized toward unpaid intimate work in newly empirical ways at the same time that they are encouraged to pursue career success in full-time paid employment, contemporary women in Canada and the United States are encouraged to rise above welfare retrenchment and inadequate provision by juggling “it all.” My thesis is an intersectional feminist project that interrogates questions of gendered citizenship and maternal affect, and I join feminist political theorists in applying pressure to the field of citizenship studies to centre reproduction in discussion of gendered welfare.

Previous research reveals the existence of social distance between the social policies that govern care work and human services that make up child welfare systems and their front-line implementation by direct service workers. The authors suggest that the nature of child welfare and human services requires discretion and flexibility that is not built into governing social policies. Our study uses qualitative ethnographic methods including participant observation, informal interviewing, and content analysis to determine the extent to which front-line barriers persist to implementing child welfare and related types of human services social policies and legal mandates. A comparison of different human services settings is presented along with a social policy analysis. A discussion of implications for front-line care work and ongoing research goals will be included.

付記する学位プログラム名: グローバル生存学大学院連携プログラム / 京都大学 / 0048 / 新制・課程博士 / 博士(地域研究) / 甲第22561号 / 地博第264号 / 新制||地||100(附属図書館) / 京都大学大学院アジア・アフリカ地域研究研究科東南アジア地域研究専攻 / (主査)教授 速水 洋子, 准教授 中村 沙絵, 教授 Hau Caroline Sy, 准教授 安里 和晃 / 学位規則第4条第1項該当 / Doctor of Area Studies / Kyoto University / DFAM

The COVID-19 crisis in Ontario’s long-term care (LTC) sector has brought unprecedented public attention to long-established systematic weaknesses in funding, staffing, and working conditions that have rendered both workers and residents highly vulnerable to infection. This study seeks to understand why unions have been unable to better protect long- term care workers from vulnerability to COVID-19 by exploring the effectiveness and limitations of unionization and assessing the challenges that unions have faced in safeguarding workers. Eight union representatives amongst SEIU, CUPE, and OPSEU were selected as participants for hour-long semi-structured interviews. Interviews were thematically analyzed for challenges to union power as well as workplace attributes related to COVID protection. Twelve collective agreements were examined to assess the relative strength and weakness of clauses relating to health and safety, paid sick leave, disability benefits, wages, and job security in relation to part-time PSWs. Collective agreements offered limited and varying degrees of protection to workers as unions faced constraints in bargaining within a largely privatized sector under the arbitration- based Hospital Labour Disputes Arbitration Act. The ubiquity of precarious, part-time PSW positions was identified as a major risk factor of COVID vulnerability. Unions also faced four challenges to their effectiveness: the structure of bargaining; challenges in member engagement; the neglect of long-term care and privatization of health-care; and labour relations with the Ford government. In addition to legislative reform concerning staffing and funding, this study suggests that unions engage in deeper forms of worker organizing to develop and exercise labour power beyond the legal confines of the strike-prohibiting HLDAA, as job action elsewhere by feminized healthcare workers has been met with public support and contributed to changes in conditions of care and work. / Thesis / Master of Arts (MA)

高齡化社會的來臨，增加了台灣的長期照顧需求。在華人家庭傳統上，照顧一直是女性的責任，社會規範與對性別角色的期待也都將照顧工作賦予女性。但隨著婦女勞參率的增加，許多有經濟能力的女性也開始試圖透過將照顧工作「外包」的方式，來移轉自己的照顧責任。從台灣逐年攀升的外籍看護工人數，即可看出此一趨勢發展。在過往母職外包的文獻中，母親將照顧小孩的責任外包出去的同時，會透過各種手段來維持其原有家庭的完整性，以及合理化這些作為，並重新詮釋這些原本被認為該由自己承擔的責任。而這樣的情況，是否同樣會發生在「孝道外包」的情況中？子女／媳婦會怎麼樣去詮釋自己的行為？他們如何定義照顧工作外包後「孝」的意義？ 本研究發現，家庭成員選擇外包照顧工作的過程中，受到子女輩成員間的經濟能力、角色與長輩的情感關係等各種因素所影響，主要的決策者與執行者會由不同的家庭子女輩成員擔任。對於將奉養工作外包給外籍看護的子女／媳婦來說，他們透過將自己的角色轉換成「監督者」或「主導者」，以確保外籍看護維持高品質照顧的方式，來重新定義自己的孝道實踐。「父母在家終老」以及「主導照顧過程」成為孝的核心條件。此外，透過敘述外籍看護的「專業」與「像對待家人」般的良好照顧，來證明他們將長輩的孝道外包是對長輩「有利的」。同時這個利益並不只是對於長輩，聘請外籍看護還有許多對其他家庭成員有利的外溢效果；例如整理家務，煮飯等等。對子女輩成員來說，聘請外籍看護是一個多方考量後，在現今照顧工作逐漸走向市場化下，對整體家庭最具利益的選擇。 / The need for long-term care increases with Taiwan’s aging population. According to the Chinese tradition as well as current social norms and expectations, care work is considered women’s responsibility. However, with women’s increasing participation in the labor force, many financially-abled women started to outsource care work to relieve their responsibility. The rise in the rate of hiring foreign caregivers in Taiwan manifests this trend. Current literature on outsourcing maternal care work has pointed out the ways mothers maintain family intactness and justify their behavior of outsourcing maternal care. Does the same situation happen in outsourcing filial piety? How do sons, daughters and daughter-in-laws justify such behavior? How would they reinterpret the meaning of ‘filial piety’ after sourcing parental care? The study found that the choice of outsourcing parental care work was affected by factors such as children's financial conditions, roles in the family, and relationship with parents. Sons, daughters and daughters-in-law often played different roles of decision makers and managers in outsourcing parental care. For those who outsourced parental care work to foreign caregivers, their roles were changed from 'primary caregiver' to 'supervisor' or 'manager' to ensure that their parents would obtain high quality care. In this way, the meaning and practice of filial piety were redefined. 'Parents living at home till the end of life' and 'quality control of parental care' became the core considerations of filial piety. By emphasizing foreign caregivers' professionalism and their family-like relationship with foreign caregivers, those children who outsourced parent care work justified their choice of outsourcing and claimed that such arrangement was beneficial to parents who were cared for. In addition, the care work provided by foreign caregivers often generated 'spillover effects' for the whole household; not only parents but other family members could also obtain benefits from hiring foreign caregivers. For example, foreign caregivers helped cleaning house, cooking and so on. Consequently, the choice of outsourcing parental care work to foreign caregiver was considered most appropriate for the whole family.

Esta é uma pesquisa cartográfica que conta a análise e intervenção institucional produzidas com trabalhadores de saúde de uma Unidade Básica do município de Ribeirão Preto que também dispõe de trabalhadores do Programa de Saúde da Família. Propõe-se a delimitar as linhas em produção molares, moleculares e de fuga, os “marcos" acerca do trabalho produzido na Unidade e também da produção da equipe de saúde nesse cotidiano. O referencial teórico metodológico utilizado é o da análise institucional, especialmente da linha esquizoanalítica. O método é o da bricolagem em que diversos objetos, idéias, fragmentos de texto de autores de diferentes orientações teóricas são colocados lado a lado sem a pretensão da permanência ou da totalidade. A intervenção teve por norte a produção da auto-análise e da auto-gestão. Realizamos encontros grupais semanalmente, ora no período da manhã, ora à tarde, para facilitar a participação voluntária dos trabalhadores. Os encontros grupais foram gravados, transcritos e analisados. A equipe é definida como máquina a ser construída desmontando referências da totalização e da equipe grande-família, raspando superfícies de registro e controle. Na equipe é necessário que ocorram distintas articulações de saberes e fazeres para a produção de cuidados diferenciados para os usuários e para as famílias, uma vez que suas necessidades são diferentes. Daí a terminologia engenhoca mutante: uma permanente produção e que pode ser agenciada pela supervisão externa. Construímos três territórios de análise: Agenda, Paranóia e Aprenderes. Em cada território buscamos demarcações, ares, levezas, pesares, afetos... Agenda traz o modo como os trabalhadores se relacionam entre si e com a população para incluir ou excluir os usuários do serviço. O imprevisto próprio do trabalho em saúde faz os trabalhadores procurarem as certezas, as lógicas instituídas como o número de vaga por trabalhador médico, e resulta em diversos contornos e delineamentos no trabalho. Paranóia desenha as relações dos trabalhadores, traz momentos de resistência à mudança e de crise da equipe. Aprenderes conflui as possibilidades de transversalizar a equipe pelo seu encontro com o trabalhador agente comunitário de saúde, alguns aprendizados da própria equipe sobre si mesma, sobre o trabalho e ainda aprendizagens da equipe de análise e intervenção. / This is a cartographic research presenting institutional analysis and intervention produced with health professionals at a Basic Health Care Unit in the city of Ribeirão Preto, where there also are Family Health Care Program professionals. It is an invitation for taking the reader to a different future, multiplying senses, searching for "line" and "between-the-line" meaning. It attempts to outline molar, molecular, and escape production, "landmarks" surrounding the work produced within the unit and health care team production as to such routine. The methodological theoretical reference used is based on institutionalist writers, especially the schizoanalytical line. The method is bricolage, where a number of objects, ideas, text passages from writers with different theoretical guidance are placed together with no permanence or totality purpose: it is a performance with rhythm, color, and intensity produced upon researching/intervening. The analysis/intervention aims at producing self-analysis and self-management, professionals analyzing their work and lives, creating their own processes, and building their own responses. The analysis/intervention started as professionals asked for help with their relationships as they were not "getting along well" since the Family Health Care team arrived at the Unit. We has weekly team meetings, mornings and afternoons, in order to facilitate professional volunteer participation. Team meetings were recorded, transcribed, and analyzed. Team work is defined as a machine to be mounted unmounting totalization and large-team-family references, scraping record and control surfaces. The team is a mixture that does not blend, complete inclusion of difference, a net of institutions defines, according to Baremblitt (1994), as a set of said and unsaid rules and regulations that regulate people behavior. The thesis we advocate is that the team needs to be built as a changing device where know`s and do`s articulation takes place for different care production for users and families as they have different needs. The changing device term: a permanent production that may be managed through external supervision - taking care of who cares. We have built three analysis territories: Agenda, Paranoia, and Learning. We search for boundaries, atmospheres, lightness, pain, affection for each territory... Agenda brings the way professional relationships are among themselves and the population for including or excluding users to/from service. Health work unexpectation make professionals look for certainties, logic in the number of positions for medical professional, and it also provides several work outlines and standards. Paranoia outlines professional relationship, provides resistance to modification, and team crises. Learning brings team transversal possibilities through meeting health care community agents, team learning about itself, the work, and the analysis/intervention team.

A Política Nacional de Humanização (PNH) objetiva promover a Reforma Sanitária considerando como centrais as relações estabelecidas no cotidiano. Apesar de sua complexidade, a humanização, muitas vezes, é banalizada no cotidiano, mantendo-se como foco apenas a qualidade das relações entre profissionais de saúde e usuários. O âmbito da gestão, incluindo as relações de trabalho, é debatido no campo teórico, mas pouco explorado empiricamente. Esta pesquisa tem como objetivo compreender como a humanização da gestão, a partir do modelo adotado pela política (Cogestão), é considerada e praticada pelos profissionais no cotidiano da Atenção Básica. Delineamos como contexto de análise duas unidades de saúde, uma tradicional (Unidade Básica de Saúde - UBS) e uma com Estratégia Saúde da Família (Núcleo de Saúde da Família - NSF). A construção do corpus foi realizada em duas etapas. Na primeira, imersão no campo, realizamos observações registrando em notas de campo aspectos importantes do contexto e da interação entre os profissionais. Esta imersão nos forneceu subsídios para a segunda etapa, entrevistas grupais ou individuais, e para análise geral do corpus. Utilizamos roteiro semiestruturado nas entrevistas, construído a partir da análise dos diários de campo para abarcar as especificidades de cada contexto. As conversas foram gravadas em áudio e transcritas na íntegra. A análise dos diários objetivou descrever o modo de funcionamento de cada unidade, e a análise das entrevistas, descrever os sentidos sobre humanização da gestão e os sentidos sobre as práticas que os profissionais identificam como sendo humanização da gestão. Os resultados são apresentados para cada unidade a partir de três focos: o contextual, a dinâmica relacional e a produção de sentidos. Esses aspectos são analisados separadamente, embora na prática estejam imbricados e se retroalimentem. Descrevemos elementos contextuais e relacionais que contribuem ou dificultam a construção (no caso da UBS) ou manutenção (no caso do NSF) de uma cultura participativa e gestão compartilhada. Quanto aos sentidos, em ambos os contextos, a participação na tomada de decisões, o trabalho em equipe e a resolutividade das ações são identificados como sendo gestão humanizada, porém difere o que significam esses aspectos e suas práticas em cada unidade. Concluímos que, para haver uma gestão compartilhada, é necessário trabalhar as relações e o modo como os profissionais constroem sentido sobre elas. Somente criar momentos de conversa coletiva não geram, necessariamente, a participação e a gestão compartilhada, pois o modo como esses espaços irão funcionar depende diretamente da maneira como a equipe compreende e constrói a si mesma. Nossa tese descreve a cultura participativa, aspecto central da gestão compartilhada, como uma construção social, algo que se dá nas relações e na linguagem. Portanto, para se desenvolver um modelo de gestão compartilhada, é necessário trabalhar com os profissionais o processo grupal. A Psicologia Social, os estudos sobre grupos, e, em especial, a epistemologia construcionista social podem oferecer recursos para este trabalho de construção da cultura participativa. Assim, esperamos, com essa pesquisa, contribuir para o incremento da literatura e para a prática da cogestão no contexto da Atenção Básica. / The National Humanization Policy (NHP) goal is to promote the Sanitary Reform focusing the centrality of daily relationships. Despite its complexity, humanization is often understood only as the quality of relationships between health professionals and users, thus undermining its potential. Management issues, including work relations, are debated in the theoretical field but little explored empirically. This research aims to understand how the humanization of management - based on the model adopted by the policy, the Co-management - is considered and practiced by health professionals in the daily work of Primary Care context. Two health units were included in the research, one traditional (Basic Health Unit - BHU) and one with the Family Health Strategy (Family Health Nucleus - FHN). The corpus construction was carried out in two stages. During the first one, immersion in the field, we observed some context aspects and the interaction of health professionals, which were written as field notes. This immersion provided subsidies for the second stage, group or individual interviews, and for general analysis of the corpus. A semi-structured script, which was constructed from the analysis of the field notes to cover each contexts specificities, guided the interviews. The conversations were audio-recorded and full transcribed. The analysis of field notes describes the way each health unit works, and the analysis of interviews describes the meanings about management humanization and the practices identified as such by health professionals. The results are separated for each unit, from three focuses: the contextual, the relational dynamics and the meaning-making process. These aspects are analyzed separately, although in practice they overlap. We describe contextual and relational elements that contribute to or hamper the construction (in the case of BHU) or maintenance (in the case of FHN) of a participatory culture and shared management. In regard of the meanings, in both contexts participation in decision-making, teamwork and actions focused in resolution of demands are identified as humanized management, but what these aspects and practices mean, differ in each context analyzed. We concluded it is necessary, in order to construct a co-management culture, to act on the stablished relationships, and, at the same time, on how professionals understand and signify their practices together. Moments of collective talk do not necessarily generate participation and shared management. It is how these moments work that matters and this will depend directly on how the team understands and builds itself. Our thesis describes participatory culture, a central aspect of co-management, as a social construction, something that occurs in relationships and language. Therefore, in order to develop a co-management model, it is necessary to work the group process involved in daily activities. Social Psychology, group studies, and especially social constructionist epistemology provide resources to work the group process in order to build participatory culture and comanagement. Therefore, we hope to contribute to increase the literature and the practice of co-management in Primary Care context.

A Política Nacional de Humanização (PNH) objetiva promover a Reforma Sanitária considerando como centrais as relações estabelecidas no cotidiano. Apesar de sua complexidade, a humanização, muitas vezes, é banalizada no cotidiano, mantendo-se como foco apenas a qualidade das relações entre profissionais de saúde e usuários. O âmbito da gestão, incluindo as relações de trabalho, é debatido no campo teórico, mas pouco explorado empiricamente. Esta pesquisa tem como objetivo compreender como a humanização da gestão, a partir do modelo adotado pela política (Cogestão), é considerada e praticada pelos profissionais no cotidiano da Atenção Básica. Delineamos como contexto de análise duas unidades de saúde, uma tradicional (Unidade Básica de Saúde - UBS) e uma com Estratégia Saúde da Família (Núcleo de Saúde da Família - NSF). A construção do corpus foi realizada em duas etapas. Na primeira, imersão no campo, realizamos observações registrando em notas de campo aspectos importantes do contexto e da interação entre os profissionais. Esta imersão nos forneceu subsídios para a segunda etapa, entrevistas grupais ou individuais, e para análise geral do corpus. Utilizamos roteiro semiestruturado nas entrevistas, construído a partir da análise dos diários de campo para abarcar as especificidades de cada contexto. As conversas foram gravadas em áudio e transcritas na íntegra. A análise dos diários objetivou descrever o modo de funcionamento de cada unidade, e a análise das entrevistas, descrever os sentidos sobre humanização da gestão e os sentidos sobre as práticas que os profissionais identificam como sendo humanização da gestão. Os resultados são apresentados para cada unidade a partir de três focos: o contextual, a dinâmica relacional e a produção de sentidos. Esses aspectos são analisados separadamente, embora na prática estejam imbricados e se retroalimentem. Descrevemos elementos contextuais e relacionais que contribuem ou dificultam a construção (no caso da UBS) ou manutenção (no caso do NSF) de uma cultura participativa e gestão compartilhada. Quanto aos sentidos, em ambos os contextos, a participação na tomada de decisões, o trabalho em equipe e a resolutividade das ações são identificados como sendo gestão humanizada, porém difere o que significam esses aspectos e suas práticas em cada unidade. Concluímos que, para haver uma gestão compartilhada, é necessário trabalhar as relações e o modo como os profissionais constroem sentido sobre elas. Somente criar momentos de conversa coletiva não geram, necessariamente, a participação e a gestão compartilhada, pois o modo como esses espaços irão funcionar depende diretamente da maneira como a equipe compreende e constrói a si mesma. Nossa tese descreve a cultura participativa, aspecto central da gestão compartilhada, como uma construção social, algo que se dá nas relações e na linguagem. Portanto, para se desenvolver um modelo de gestão compartilhada, é necessário trabalhar com os profissionais o processo grupal. A Psicologia Social, os estudos sobre grupos, e, em especial, a epistemologia construcionista social podem oferecer recursos para este trabalho de construção da cultura participativa. Assim, esperamos, com essa pesquisa, contribuir para o incremento da literatura e para a prática da cogestão no contexto da Atenção Básica. / The National Humanization Policy (NHP) goal is to promote the Sanitary Reform focusing the centrality of daily relationships. Despite its complexity, humanization is often understood only as the quality of relationships between health professionals and users, thus undermining its potential. Management issues, including work relations, are debated in the theoretical field but little explored empirically. This research aims to understand how the humanization of management - based on the model adopted by the policy, the Co-management - is considered and practiced by health professionals in the daily work of Primary Care context. Two health units were included in the research, one traditional (Basic Health Unit - BHU) and one with the Family Health Strategy (Family Health Nucleus - FHN). The corpus construction was carried out in two stages. During the first one, immersion in the field, we observed some context aspects and the interaction of health professionals, which were written as field notes. This immersion provided subsidies for the second stage, group or individual interviews, and for general analysis of the corpus. A semi-structured script, which was constructed from the analysis of the field notes to cover each contexts specificities, guided the interviews. The conversations were audio-recorded and full transcribed. The analysis of field notes describes the way each health unit works, and the analysis of interviews describes the meanings about management humanization and the practices identified as such by health professionals. The results are separated for each unit, from three focuses: the contextual, the relational dynamics and the meaning-making process. These aspects are analyzed separately, although in practice they overlap. We describe contextual and relational elements that contribute to or hamper the construction (in the case of BHU) or maintenance (in the case of FHN) of a participatory culture and shared management. In regard of the meanings, in both contexts participation in decision-making, teamwork and actions focused in resolution of demands are identified as humanized management, but what these aspects and practices mean, differ in each context analyzed. We concluded it is necessary, in order to construct a co-management culture, to act on the stablished relationships, and, at the same time, on how professionals understand and signify their practices together. Moments of collective talk do not necessarily generate participation and shared management. It is how these moments work that matters and this will depend directly on how the team understands and builds itself. Our thesis describes participatory culture, a central aspect of co-management, as a social construction, something that occurs in relationships and language. Therefore, in order to develop a co-management model, it is necessary to work the group process involved in daily activities. Social Psychology, group studies, and especially social constructionist epistemology provide resources to work the group process in order to build participatory culture and comanagement. Therefore, we hope to contribute to increase the literature and the practice of co-management in Primary Care context.

Courtesy stigma is the public disapproval evoked as a consequence of associating with a stigmatized individual or group. While there are few examples of research applying the concept of courtesy stigma to the professional associates of stigmatized persons, courtesy stigma has been shown to limit the social support and social opportunities available to family members who come to share some of the shame, blame and loss associated with their family member’s stigma(s). Research on the occupational health of persons performing frontline service work examines various sources of workplace demands and rewards, including the availability of public funding for the health and social service sectors, the devaluation of feminized forms of care-oriented work, and the downloading of responsibility for providing care to poorly paid or unpaid workers in the community and home. This research project blends the literatures on courtesy stigma and the occupational health of frontline service workers to understand the work experiences of those providing frontline social services to sex workers. A mixed methods design is used to study the workplace experiences of a small group of workers in a non-profit organization providing support and educational services to sex workers. The findings reveal that courtesy stigma is a discernable experience among this vulnerable group of service workers, affecting their work, community and family contexts. Courtesy stigma played a significant role in staff perceptions of others’ support for themselves and their work activities, leading to diminished opportunities for collaborative relationships, emotional exhaustion, altered service practices, and a low sense of workplace accomplishment. Thus, courtesy stigma forms part of the package of conditions that leads to high turnover, diminished workplace health, and a loss of service capacity in the frontline health and social service sector. The dissertation concludes with a consideration of the implications of the findings for the literatures on courtesy stigma and frontline service work, arguing that courtesy stigma is an underestimated determinant of occupational health for frontline service providers serving socially denigrated groups.