This dissertation examines the factors and combinations of factors that affect the performance of continuum of care homeless service networks, applying the configurational approach of contingency theory to data sets drawn from federal sources. The study accepts the two key assumptions from the theory: (1) that there are multiple paths to high performance and (2) key conditions have a joint influence on network performance. The data analysis in this study has two parts. The first employs OLS regression to examine the causal relationship between independent variables and the performance of permanent supportive housing (PSH) programs. This study also applies fuzzy set qualitative comparative analysis (fsQCA) to identify multiple combinations of factors that influence the performance of PSH programs. The results identify key factors and multiple combinations of factors that lead to high and low network performance. Federal CoC funding emerges as a core condition for high and low performance, but all relevant conditions can be critical factors depending on how they interact with other relevant conditions. This analysis helps expand the utility of existing contingency theory by using it to explain the dynamic interactions between factors in the context of public service networks. Ultimately, this dissertation confirms that fsQCA can be a useful method for evaluating the performance of public service networks and helping them provide more services more effectively.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-05-10T12:54:50Z No. of bitstreams: 1 Deborah Sereno.pdf: 1138373 bytes, checksum: ddd7dd74183a3f6e776cf6bd033b047e (MD5) / Made available in DSpace on 2018-05-10T12:54:50Z (GMT). No. of bitstreams: 1 Deborah Sereno.pdf: 1138373 bytes, checksum: ddd7dd74183a3f6e776cf6bd033b047e (MD5) Previous issue date: 2018-03-21 / Pontifícia Universidade Católica de São Paulo - PUCSP / This research is based on the unquietness related to the field of therapeutic accompaniment (TA), more precisely on the training of workers in this function and seeks to contribute to the schooling of mental health workers in the territorial care devices created after the Brazilian Psychiatric Reform (RPB) and National Policy of Mental Health (PNSM). The research traces the clinical-political trajectories of mental health in Brazil, going through the prehistory of the TA in the 1960s, to focus on the second half of the 1970s, a time of political effervescence and a struggle for the country's redemocratization, and when the Day-Hospital A Casa was founded, where we place, at the beginning of the 80's, the emergence of the TA in São Paulo. From this trajectory, it was possible to situate the TA, from its origins linked to the opening movements, as of resistance to hegemonic, homogenizing, silencing, excluding powers and also its transdisciplinary disposition. With this, it is affirmed that the theorization of the TA makes use of different conceptual tools to be able to perform its clinic in the city, in the territory, and of the demands that arise from the RPB. In proposing the scene as a conceptual tool of the TA, we sought to contribute to the construction of subsidies for the TA clinic, the scene as the clinic's own method, the way the TA works and also as a transmission device of the TA clinic and on duty training. The division of the scene into four constituent elements - the open frame, the presence / body, the transference / listening of the subject and the city served as a clipping for reading of different authors committed to theorize the TA clinic, this division being purely methodological, once that these terms are linked. The discussion of the scenes of an TA presented in an open supervision shows the scene operating in its multiplier effects of senses. At the end of the course, it is considered that, from the perspectives of the networks, from its role as a war machine and from the contagion to the insurgent movements, from what the city is not allowed to dominate, the TA can operate in resistance to the control processes and automation of life / Esta pesquisa parte de inquietações referentes ao campo do AT, mais precisamente em relação à formação de trabalhadores nessa função, e busca contribuir para a formação de trabalhadores de saúde mental nos dispositivos de cuidado territoriais, criados a partir da Reforma Psiquiátrica Brasileira (RPB) e da Política Nacional de Saúde Mental (PNSM). A pesquisa faz um percurso sobre as trajetórias clínico-políticas da saúde mental no Brasil, passando pela pré-história do AT nos anos de 1960, para focalizar a segunda metade dos anos 1970, momento de efervescência política e de luta pela redemocratização do país, e quando se dá a fundação do Hospital-Dia A Casa, onde situamos, no início dos anos 1980, o surgimento do AT em São Paulo. A partir deste percurso, foi possível evidenciar o AT, desde suas origens, ligado aos movimentos de abertura, de resistência aos poderes hegemônicos, homogeneizantes, silenciadores, excludentes, bem como sua disposição transdisciplinar. Com isso, afirma-se que a teorização do AT faz uso de diferentes ferramentas conceituais para dar conta de sua clínica na cidade, no território, e das demandas que surgem a partir da RPB. Ao propor a cena como ferramenta conceitual do AT, buscou-se contribuir para a construção de subsídios para esta clínica: a cena como o próprio método da clínica, do modo fazer do AT, e também como dispositivo de transmissão da clínica do AT e de formação pelo trabalho. A divisão da cena em quatro elementos constituintes 􀂱 o enquadre aberto, a presença/corpo, a transferência/escuta do sujeito e a cidade 􀂱 serviu como recorte para a leitura de diferentes autores comprometidos em teorizar a clínica do AT. A discussão das cenas de um AT apresentadas em uma supervisão aberta mostra a cena operando em seus efeitos multiplicadores de sentidos e afirma sua função de transmissão. Ao final do percurso, considera-se que, a partir das perspectivas das redes, de sua atuação como máquina de guerra e do contágio com os movimentos insurgentes, com aquilo que a cidade não se deixa dominar, o AT pode operar na resistência aos processos de controle e de automação da vida

Recent changes in the Centers for Medicare and Medicaid Services (CMS) reimbursement programs resulted in $1 billion in payments to hospitals based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Approximately 50% of the 3,000 hospitals currently receiving Medicare supplements may receive increases in reimbursement payments while 50% will receive decreases in payments. This case study explored how one hospital team in North Texas achieved high HCAHPS scores. The primary provider theory, Deming's model of plan-do-study-act (PDSA), and disruptive innovation theory framed the study. The data collection process included administrator interviews (n = 7), hospital document analysis (n = 13), and observations of staff conducting care (n = 8). Through method triangulation, themes emerged on the constructs required to achieve high HCAHPS scores. Themes included caregiver-patient interactions, hospital services, hospital environment, hospital technology, and hospital governance. Although this was a single case study, other healthcare leaders may explore the findings to determine how the information contained within might transfer to other healthcare organizations. Improved patient outcomes resulting from education, communication, and technology in the continuum of care might enhance the patient experience and patients' overall health and wellness.

Military cultural competence has gained attention due to the past 15 years of military conflict and ongoing deployment of troops around the globe. Returning veterans, particularly those who go on to experience homelessness, have reported negative experiences and adverse treatment from programs that were designed to support them. Those experiences have resulted in perceived barriers to access or use of such services. Researchers have established the need for increased levels of military cultural competence to develop rapport with veterans and their families when delivering community-based social and healthcare services. Bandura's self-efficacy theory was the theoretical framework of this study. This study examined the relationship between military cultural competence, socialization tactics, and perceived self-efficacy of service providers employed with Continuum of Care Program member organizations that served veterans experiencing homelessness. Data were collected utilizing a cross-sectional web-based survey. After conducting a bivariate correlation, a statistically significant relationship was found between military cultural competence levels, socialization tactics, and self-efficacy levels. After conducting multiple linear regression, it was found that socialization tactics did not moderate the relationship between military cultural competence levels on self-efficacy levels. Though moderation was not found, leadership of organizations that support veterans may want to consider these factors to inform onboarding and training decisions. Addressing behaviors and attitudes of service providers may support social change by reducing adverse treatment that creates barriers to access and use of programs and services.

The purpose of this study was to explore what makes the interorganizational referral process effective and efficient from the perspectives of acute care referral senders and post acute care referral receivers. The referral process was conceptualized as the classic communication model involving a sender, receiver, information, a communication channel and contextual factors such as formalization and relationships. The hypotheses proposed that the relationships between each of the variables information usefulness, communication channel richness, and degree of formalization affected each of perceived referral process effectiveness and efficiency through the variable ‘relational coordination’. Key informants who either sent referrals from acute care settings or who received them in post acute care inpatient settings were asked to discuss each variable. These results were combined with those of a literature review to develop questionnaires containing a scale with acceptable Chronbach alpha for each. Surveys were disseminated through networks and associations involved in acute and post acute stroke and hip fracture care and in discharge planning and Long Term Care. Useable responses included 114 surveys from referral senders and 171 from referral recipients. Baron and Kenny’s four step test for mediation was used to test the hypotheses. For senders, each of channel richness (adjR2 = 10% p= 0.001), information usefulness (adjR2 = 16% p= 0.000), and formalization (adjR2 = 10% p= 0.000) were significantly related to perceived effectiveness. For channel richness, the relationship with perceived effectiveness was partially mediated by relational coordination (adjR2 = 19% p= 0.001). This was also the case for the relationship between information usefulness and perceived effectiveness (adjR2 = 0.20; p=000). For receivers, channel richness is related to perceived effectiveness through relational coordination (adjR2 = 12% p= 0.003). This was also the case for information usefulness (adjR2 = 13% p= 0.000). In neither group were any of the variables significantly related to efficiency. We may conclude that in the referral process, channel richness and information usefulness are related to perceived effectiveness for both senders and receivers. These may provide an important return on investment if chosen as an areas for referral process improvement, if accompanied by concurrent investments in relational coordination.

The purpose of this study was to explore what makes the interorganizational referral process effective and efficient from the perspectives of acute care referral senders and post acute care referral receivers. The referral process was conceptualized as the classic communication model involving a sender, receiver, information, a communication channel and contextual factors such as formalization and relationships. The hypotheses proposed that the relationships between each of the variables information usefulness, communication channel richness, and degree of formalization affected each of perceived referral process effectiveness and efficiency through the variable ‘relational coordination’. Key informants who either sent referrals from acute care settings or who received them in post acute care inpatient settings were asked to discuss each variable. These results were combined with those of a literature review to develop questionnaires containing a scale with acceptable Chronbach alpha for each. Surveys were disseminated through networks and associations involved in acute and post acute stroke and hip fracture care and in discharge planning and Long Term Care. Useable responses included 114 surveys from referral senders and 171 from referral recipients. Baron and Kenny’s four step test for mediation was used to test the hypotheses. For senders, each of channel richness (adjR2 = 10% p= 0.001), information usefulness (adjR2 = 16% p= 0.000), and formalization (adjR2 = 10% p= 0.000) were significantly related to perceived effectiveness. For channel richness, the relationship with perceived effectiveness was partially mediated by relational coordination (adjR2 = 19% p= 0.001). This was also the case for the relationship between information usefulness and perceived effectiveness (adjR2 = 0.20; p=000). For receivers, channel richness is related to perceived effectiveness through relational coordination (adjR2 = 12% p= 0.003). This was also the case for information usefulness (adjR2 = 13% p= 0.000). In neither group were any of the variables significantly related to efficiency. We may conclude that in the referral process, channel richness and information usefulness are related to perceived effectiveness for both senders and receivers. These may provide an important return on investment if chosen as an areas for referral process improvement, if accompanied by concurrent investments in relational coordination.

Esta pesquisa teve como objetivo geral: compreender a ação clínica dos Acompanhantes Terapêuticos (Ats), em suas diferentes possibilidades, nas redes sociais da cidade de Recife-PE e, como objetivos específicos: descrever a atividade dos Acompanhantes terapêuticos como modalidade de ação clínica; descrever as diferentes possibilidades de ação clínica dos Acompanhantes terapêuticos e compreender a experiência dos Acompanhantes terapêuticos em sua ação clínica. Realizamos um estudo de natureza qualitativa, de cunho fenomenológico existencial. Como instrumento metodológico foi utilizada a narrativa colaborativa. Em um primeiro momento, individualmente, cada participante se expressou livremente. Em um segundo momento, realizamos um encontro grupal com os mesmos participantes, onde foi solicitado a estes que se dispusessem à conversação sobre suas experiências uns com os outros, favorecendo uma possibilidade de encontro entre eles. Participaram 5 (cinco) Ats que têm experiência, em Recife-PE, com pessoas em sofrimento psíquico, físico ou ambos com dificuldade de inserção social. No processo de interpretação dos dados fizemos uso da hermenêutica filosófica de Gadamer, a qual fundamentou toda a trajetória desta pesquisa e que consiste no entendimento que toda compreensão do homem é uma interpretação das condições históricas advindas da tradição, da qual ele faz parte. Deste modo, chegamos a uma narrativa final que foi construída a partir do diálogo entre os participantes, a pesquisadora e os textos dos teóricos que embasaram esta pesquisa. Como resultados, a partir das narrativas, trouxemos a clínica do Acompanhamento Terapêutico em suas diferentes possibilidades de ação clínica com as especificidades inerentes ao seu campo de atuação, a partir da experiência de quem a pratica. Nessa direção, percebemos que os Ats estão inseridos nos seguintes seguimentos de ação clínica: acompanhamento clínico a clientes, particular ou institucional, formação, supervisão e pesquisa. No entanto, constatamos que eles estão operacionalizando ações segregadas, com trabalhos desenvolvidos em pequenas equipes. Por outro lado, os Ats demonstraram almejar uma organização, através de uma vivência grupal, que objetiva incluir e agregar a classe de profissionais que estão atuando no campo. Essa perspectiva aponta para a busca de um lugar cada vez mais delimitado, o que inclui organização, institucionalização, formalização e profissionalização dos Ats.

Made available in DSpace on 2017-06-01T18:08:41Z (GMT). No. of bitstreams: 1 dissertacao_ananda_kenney_cunha.pdf: 598167 bytes, checksum: 5c19731135d498ea84af9f919a3605b5 (MD5) Previous issue date: 2012-11-08 / This research had as general objective: understand the Therapeutic Accompaniments‟ (Ats) clinical action, in its different possibilities, in social networks of Recife-PE city, and as specific objectives: describe the activity of the Therapeutic Accompaniments as clinical action modality; describe the different possibilities of the Therapeutic Accompaniments‟ clinical action and understand the experience of the Therapeutic Accompaniments in their clinical action. We make a qualitative study with an existential phenomenological base. As instrument methodological was use the collaborative narrative. At the first moment, each participant expressed individually, themselves freely. In a second moment, were made a group meeting with the same participants, where they were requested to talk about their experiences with each other, favoring a chance of meeting between them. Five Ats who had experience in Recife-PE participated, with mental, physical or both suffering people with difficulty in social integration. When collecting and interpreting the data we used Gadamer's philosophical hermeneutics, which substantiate the whole trajectory of this research and that consists in the understanding that all human comprehension is an interpretation of the historical conditions stemming from the tradition of which he is part. Thus, we arrived at a final narrative that was constructed from the dialogue between the participants, the researcher and the texts of theorists who based this research. As results, from the narratives, bring the AT clinic in its different possibilities with the specificities inherent of their field, from the experience of those who practice it. In this direction, we realize that Ats are included in the following segments of clinical action: clinical accompaniment to clients, private or institutional, formation, supervision and research. However, we found that they are operationalizing segregated actions with works done in small teams. On the other hand, the Ats aim an organization, trough a group experience, wich aims to include and aggregate the class of professionals who are working in the field. This perspective points to the persuit of an even more delimited place wich includes organization, institutionalization, formalization and professionalization of Ats. / Esta pesquisa teve como objetivo geral: compreender a ação clínica dos Acompanhantes Terapêuticos (Ats), em suas diferentes possibilidades, nas redes sociais da cidade de Recife-PE e, como objetivos específicos: descrever a atividade dos Acompanhantes terapêuticos como modalidade de ação clínica; descrever as diferentes possibilidades de ação clínica dos Acompanhantes terapêuticos e compreender a experiência dos Acompanhantes terapêuticos em sua ação clínica. Realizamos um estudo de natureza qualitativa, de cunho fenomenológico existencial. Como instrumento metodológico foi utilizada a narrativa colaborativa. Em um primeiro momento, individualmente, cada participante se expressou livremente. Em um segundo momento, realizamos um encontro grupal com os mesmos participantes, onde foi solicitado a estes que se dispusessem à conversação sobre suas experiências uns com os outros, favorecendo uma possibilidade de encontro entre eles. Participaram 5 (cinco) Ats que têm experiência, em Recife-PE, com pessoas em sofrimento psíquico, físico ou ambos com dificuldade de inserção social. No processo de interpretação dos dados fizemos uso da hermenêutica filosófica de Gadamer, a qual fundamentou toda a trajetória desta pesquisa e que consiste no entendimento que toda compreensão do homem é uma interpretação das condições históricas advindas da tradição, da qual ele faz parte. Deste modo, chegamos a uma narrativa final que foi construída a partir do diálogo entre os participantes, a pesquisadora e os textos dos teóricos que embasaram esta pesquisa. Como resultados, a partir das narrativas, trouxemos a clínica do Acompanhamento Terapêutico em suas diferentes possibilidades de ação clínica com as especificidades inerentes ao seu campo de atuação, a partir da experiência de quem a pratica. Nessa direção, percebemos que os Ats estão inseridos nos seguintes seguimentos de ação clínica: acompanhamento clínico a clientes, particular ou institucional, formação, supervisão e pesquisa. No entanto, constatamos que eles estão operacionalizando ações segregadas, com trabalhos desenvolvidos em pequenas equipes. Por outro lado, os Ats demonstraram almejar uma organização, através de uma vivência grupal, que objetiva incluir e agregar a classe de profissionais que estão atuando no campo. Essa perspectiva aponta para a busca de um lugar cada vez mais delimitado, o que inclui organização, institucionalização, formalização e profissionalização dos Ats.

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Contends that poor discharge planning for elderly patients in American hospitals is the result of reduced lengths of stay which do not give medical social workers adequate time to assess patients' needs. A survey methodology was used to assess social service and community resource needs of hospitalized elderly patients and their family members at Riverside Community Hospital in California. Argues that the results of the survey can be used to improve discharge planning and lead to a more client-centered practice in hospitals.