AIM AND OBJECTIVES: The aim of this study was to evaluate perceptions on quality of care delivered by service providers to families of children with disabilities, attending the cerebral palsy (CP) clinic at Dr George Mukhari hospital. The objectives of this study were to 1) determine the demographic and socio-economic profile of the caregivers; 2) establish how the caregivers perceive the provision of care as identified by the subscales of the Measure of Processes of Care-South African (MPOC-SA version), by Saloojee (2007); and 3) determine the overall perception of caregivers with regard to their satisfaction from the service they received. METHODS: A correlation study design using structured interviews was used. Purposive sampling technique was used to recruit participants who gave informed consent to participate in the study (n=67). Caregivers completed the demographic and the MPOC-SA version questionnaire through structured interviews conducted by two trained assistants. The researcher completed the Gross Motor Function Classification System (GMFCS) for each child diagnosed with cerebral palsy guideline and eliciting developmental and functional abilities of the child using the Neurodevelopmental therapy (NDT) clinical approach. RESULTS: Ninety-nine percent of caregivers were females, and approximately 45% of them were 30 years old and younger. Just over forty percent of them were married, with 34.33% married to the father of the child. Thirteen percent of caregivers were exposed to tertiary education, and 34.33% of families were receiving less than R500 per average month. Caregivers perceived that the MPOC-SA domains of Respectful and Supportive Care together with Providing Specific Information to have been experienced to a great extent at 5.34 (±0.61) and 5.09 (±0.82) respectively. The weak domains were perceived to be Providing General Information, Enabling and Partnership and 2.34 (±0.95) and 3.26 (±1.10) respectively. Satisfaction with services rendered was at an average of 5.33 (±1.00). There was a positive correlation between Satisfaction and of the all the MPOC-SA domains. CONCLUSION: Service providers need to improve on the interpersonal aspects of service delivery to ensure healthcare provision of high quality with better outcomes and higher satisfaction for users. The identified aspects that need immediate improvement are ‘Providing General Information’ and ‘Enabling and Partnership’ respectively. Providing General Information focuses on activities that meet caregivers’ general information needs such as grant applications, accessing assistive devices, and other resources that may support the family of a child with cerebral palsy such as non-governmental organization. Enabling and Partnership focus on activities where caregivers are involved in decision-making about the appropriate treatment for the child, and in giving input, sharing their concerns and opinions about services they receive.

Thesis (Ph.D.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 182 pages. Includes Vita. Includes bibliographical references.

Made available in DSpace on 2015-05-08T14:47:42Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 4451394 bytes, checksum: 931774754daf350a64611d3a30a270e8 (MD5) Previous issue date: 2014-02-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The presence of attributes of the Primary Health Care qualifies the services of basic attention ensuring a higher effectiveness of the developed actions. The general objective was to evaluate the guidance degree related to the child´s Primary Health Care in the Family Health Strategy and the specific ones were to identify the presence and scope of Primary Care attributes concerning the child´s health; to verify the association between the user´s characteristics and the quality of child´s health care in the Family Health Strategy; and to analyze the effectiveness of the child´s health care by means of the association among the Primary Care attributes. It is an evaluative and cross-sectional study of quantitative approach. A total of 344 children´s family members in Family Health Units took part in the research. Data collection occurred from October 2012 to January 2013 by using the Primary Care Evaluation Tool, child´s version, and a tool structured for collecting the families´ socio-demographic data. Data were analyzed in the light of descriptive statistics, distribution of absolute/relative frequencies, calculation of average and construction of scores for the measured attributes, following the guidance contained in the tool´s manual issued by the Health Ministry. In order to analyze the association among the variables, univariate statistical tests and the adaptation of a logistic regression model were used. The study followed the guidelines of the Resolution number 466/12 of the National Council of Health, and obtained favorable opinion of the Research Ethics Committee number 044/2012 and CAAE number 01295412.2.1001.0107. High scores for the access attribute were verified in their procedural component, use and longitudinality which highlight that the service is reference for infantile care and it has been used as regular source of care. Longitudinality is favored by the existence of a suitable information system, procedural component of the coordination. Nevertheless, it was observed commitment of the structural dimension of access accessibility, of the integrality attribute in both evaluated dimensions available and offered services, which consequently resulted in the low family and community guidance. From the user´s characteristics associated to the satisfactory evaluation of the service, the affiliation degree was highlighted which was presented as possibility for a better evaluation of the Family Health Strategy. Probably, the bond is the factor related to the satisfactory evaluation once it provides favorable conditions for the offer of measured attributes. This result emphasizes the importance of the bond for the quality of primary care services in the child´s health. It can be concluded that the Family Health Strategy still is not directed to the child´s Primary Health Care in the investigated context, but it focuses on attaining satisfactory levels for the evaluated attributes, highlighting the need for improving aspects of the service process and structure, especially related to the access accessibility and integrality attributes, in addition to the attributes derived from family and community guidance with the purpose of qualifying the developed actions. / A presença dos atributos da Atenção Primária à Saúde qualificam os serviços de atenção básica garantindo maior efetividade das ações desenvolvidas. O objetivo geral foi avaliar o grau de orientação à Atenção Primária à Saúde da criança na Estratégia Saúde da Família e os específicos identificar a presença e a extensão dos atributos da Atenção Primária relacionados à saúde da criança; verificar a associação entre características do usuário e a qualidade da atenção em saúde da criança na Estratégia Saúde da Família; e analisar a efetividade do cuidado à saúde da criança por meio da associação entre os atributos da Atenção Primária. Estudo avaliativo, transversal de abordagem quantitativa. Participaram 344 familiares de crianças em Unidades de Saúde da Família. A coleta de dados ocorreu no período de outubro de 2012 a janeiro de 2013 utilizando-se o Instrumento de Avaliação da Atenção Primária versão criança e um instrumento estruturado para coleta dos dados sociodemográficos das famílias. Os dados foram analisados a luz da estatística descritiva, distribuição de frequências absolutas/relativas, cálculo de médias e construção dos escores para os atributos mensurados, seguindo as orientações contidas no manual do instrumento divulgado pelo Ministério da Saúde. No intuito de analisar a associação entre variáveis foram empregados testes estatísticos univariados e adaptação de um modelo de regressão logística. O estudo seguiu as orientações da Resolução nº 466/12 do Conselho Nacional de Saúde, obteve parecer favorável do Comitê de ética em Pesquisa nº 044/2012 e CAAE nº 01295412.2.1001.0107. Verificou-se escores elevados para os atributos acesso em seu componente processual, utilização e longitudinalidade, os quais evidenciam que o serviço é referência para o atendimento infantil e vem sendo utilizado como fonte regular de atenção. A longitudinalidade é favorecida pela existência de um sistema de informação adequado, componente estrutural da coordenação. No entanto, observou-se comprometimento da dimensão estrutural do acesso-acessibilidade, do atributo integralidade em ambas as dimensões avaliadas - serviços disponíveis e serviços prestados, consequentemente resultaram a baixa orientação familiar e comunitária. Das características do usuário associadas à avaliação satisfatória do serviço sobressaiu-se o grau de afiliação, o qual se apresentou como possibilidade para uma melhor avaliação da Estratégia Saúde da Família. Registra-se que, provavelmente o vínculo é o fator relacionado à avaliação satisfatória, pois fornece condições favoráveis à oferta dos atributos mensurados. Esse resultado reforça a importância do vínculo para qualidade dos serviços de atenção primária na saúde da criança. Conclui-se que a Estratégia Saúde da Família ainda não está orientada à Atenção Primária à Saúde da criança no contexto investigado, mas caminha na direção de alcançar patamares satisfatórios para os atributos avaliados, destacando-se a necessidade de melhorar aspectos de estrutura e processo do serviço, especialmente relacionados aos atributos acesso-acessibilidade e integralidade, além dos atributos derivados orientação familiar e comunitária, no sentido de qualificar as ações desenvolvidas.

nÃo hà / Este estudo se inscreve no campo da avaliaÃÃo qualitativa de serviÃos de saÃde mental, tendo como objetivo compreender como as prÃticas de cuidado impactam no fortalecimento das pessoas com transtornos mentais acompanhadas pelo Movimento de SaÃde Mental ComunitÃria do Bom Jardim em Fortaleza-Ce. Esta instituiÃÃo à uma OrganizaÃÃo NÃo-Governamental criada em 1996 pelos missionÃrios combonianos e lideranÃas das Comunidades Eclesiais de Base, no municÃpio de Fortaleza-CearÃ. Nesta experiÃncia em saÃde mental que nasce do movimento popular, emergem os questionamentos que norteiam esta investigaÃÃo, pois encontro pessoas que entraram no Movimento com diagnÃstico de transtorno mental e passaram do papel de usuÃrio para o de cuidador. Para compreender esta mudanÃa de lugar social no estatuto da loucura, utilizo os aportes da psicologia comunitÃria, GÃis e Montero, e os pressupostos da Reforma PsiquiÃtrica brasileira, Amarante e Rotelli. Metodologicamente utilizo a perspectiva crÃtica da hermenÃutica, em um estudo de caso do Movimento de SaÃde Mental ComunitÃrio do Bom Jardim. A aproximaÃÃo do campo de pesquisa se deu no perÃodo de agosto de 2009 a marÃo de 2010 e a aplicaÃÃo das tÃcnicas de pesquisa ocorreu nos meses de junho e julho de 2010. Os participantes da pesquisa foram 8 pessoas que entraram no Movimento com diagnÃstico de transtorno mental e passaram para o papel de cuidadores e o presidente do Movimento de SaÃde Mental ComunitÃria do Bom Jardim. Utilizei como tÃcnicas de pesquisa o grupo focal, entrevista em profundidade e entrevistas mediadas pela autofotografia. ApÃs a produÃÃo e transcriÃÃo dos dados, foi construÃda uma rede interpretativa com dois temas, fortalecimento das pessoas com transtorno mental e cuidado. Os resultados apontam que a participaÃÃo das pessoas com transtornos mentais em uma diversidade de atividades de cuidado do Movimento favorecem o fortalecimento, ocorrendo a mudanÃa das crenÃas sobre si mesmo, sobre o mundo, experimentando a coragem de fazer diferente, superando atitudes fatalistas que promovem a passividade, acomodaÃÃo e desqualificaÃÃo. Hà o resgate do valor pessoal e poder pessoal, o desenvolvimento do sentimento de pertenÃa à comunidade e a capacidade de refletir e agir sobre a realidade. O Movimento apresenta caracterÃsticas inovadoras no cuidado em saÃde mental, quando inaugura um novo espaÃo social para a loucura, por meio do voluntariado. No desenvolvimento desta atividade sÃo diminuÃdos os sentimentos de isolamento, solidÃo, anomia e alienaÃÃo, favorecendo novos espaÃos de trocas na comunidade. Outra caracterÃstica inovadora no cuidado em saÃde mental à a dimensÃo espiritual reconhecida no Movimento como uma ligaÃÃo com o transcendente, em uma vivÃncia mais livre da institucionalizaÃÃo, ligada aos processos de desenvolvimento pessoal, mediados pela profunda implicaÃÃo com o Outro e com o desenvolvimento comunitÃrio. / This study falls within the field of qualitative assessment of mental health services, aiming to understand how care practices impact on the empowerment of people with mental disorders accompanied by the Movement for Mental Health Community in Bom Jardim. This institution is an NGO established in 1996 by the Comboni Missionaries and leaders of the Basic Ecclesial Communities, in Fortaleza-Ce. During this experiment in mental health, which comes from the popular movement, I met people who took part in the movement with a diagnosis of mental disorder, who are now caretakers. To understand this change in the social status of madness, I used the contributions from the community psychology, Gois and Montero, and the assumptions of the Brazilian Psychiatric Reform, Amarante and Rotelli. The methodology used was the perspective of hermeneutics in a critical case study of the Community Mental Health Movement in Bom Jardim. The field study took place from August 2009 to March 2010 and the application of the instruments occurred during June and July 2010. The participants were eight people who took part in the movement with a diagnosis of mental disorder, and now work as caretakers, as well as the president of the Community Mental Health Movement in Bom Jardim. The instruments used were focus groups, depth interviews and interviews mediated by the autodescriptions. After the production and transcription of data, an interpretive network was constructed. It concerned two issues: empowerment of people with mental illness and caretaking. The results indicate that the participation of people with mental disorders in a variety of caretaking activities favor the strengthening of the movement, leading to a change in beliefs about oneself and the world, experiencing the courage to do things differently, overcoming fatalistic attitudes that promote passivity, accommodation and disqualification. There is the rescue of personal worth and personal power, developing a sense of community ownership and ability to reflect and act upon reality. The Movement presents innovative features in mental health care when it starts a new social space for madness, through volunteering. The development of this activity decreases isolation, loneliness, alienation and anomie, promoting new areas of trade in the community. Another innovative feature in mental health care is recognized in the spiritual dimension of the movement as a link with the transcendent, in a freer experience of institutionalization, linked to the process of personal development, mediated by the deep involvement with the Other and to community development.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-06-29T15:28:54Z No. of bitstreams: 1 kelynascimentosilvalouza.pdf: 1933846 bytes, checksum: c02764cbfdeb08cc146b9b4ce9f6afc9 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-07-03T13:57:45Z (GMT) No. of bitstreams: 1 kelynascimentosilvalouza.pdf: 1933846 bytes, checksum: c02764cbfdeb08cc146b9b4ce9f6afc9 (MD5) / Made available in DSpace on 2018-07-03T13:57:45Z (GMT). No. of bitstreams: 1 kelynascimentosilvalouza.pdf: 1933846 bytes, checksum: c02764cbfdeb08cc146b9b4ce9f6afc9 (MD5) Previous issue date: 2018-03-26 / O redirecionamento da saúde mental, marcado pela criação de uma rede de dispositivos substitutivos ao hospital psiquiátrico, conferiu aos Centros de Atenção Psicossocial papel central na organização e sustentação da rede. Em termos de cuidado em saúde, a instauração dos Centros de Atenção Psicossocial Álcool e Drogas (CAPS AD) representou um marco, visto que, durante muito tempo, a questão das drogas ficou associada a criminalidade e os tratamentos disponíveis pautados em modelos de exclusão/separação. Sabe-se que para garantir a qualidade e efetividade dos CAPS AD é importante que se preze por uma prática baseada em evidências. Nesse sentido, o presente estudo objetivou realizar uma avaliação com os serviços de CAPS AD de Minas Gerais, contemplando questões como a redução de danos, o tratamento, a inclusão social, a articulação dos serviços e os direitos humanos em saúde mental. Trata-se de um estudo descritivo desenvolvido online. Participaram da pesquisa 31 coordenadores responsáveis pelas unidades de CAPS AD do estado. O convite foi realizado através de e-mail e contato telefônico, utilizando-se a estratégia de censo. Para cada coordenador foi disponibilizado um questionário semi estruturado online de avaliação, elaborado através da ferramenta Google Forms. Os resultados preliminares indicam que todos possuem formação superior e que a maioria (80,6%) dos coordenadores teve alguma experiência profissional na área de drogas antes do atual cargo. Em relação às instalações e equipamentos adequados para atender as metas almejadas, 45,2% afirmam não possuir. Ademais, 51,6% afirmam não fornecer programa de treinamento e atualização periódica para profissionais. Espera-se, ao final, contribuir para fomentar as discussões na área. / The redirection of the mental health care system, marked by the creation of a network of substitutive devices to the psychiatric hospital, gave the Centers of Psychosocial Care a central role in the organization and support of the network itself. In terms of health care, the establishment of the Centers for Psychosocial Care - Alcohol and Drugs (CAPS AD) represented a milestone, since for a long time the drug issue had been associated with crime and the treatments available based on exclusion / separation. It is well known that in order to guarantee the quality and effectiveness of CAPSad it is important to pay attention to an evidence-based practice. Hence, the present study aimed to conduct an evaluation of the services of CAPS AD in Minas Gerais, addressing issues such as damage reduction, treatment, social inclusion, service management and human rights in mental health. It is an exploratory descriptive study developed online. 31 coordinators responsible for the state's CAPS AD units have taken part in the research. The invitations were made through e-mail and telephone, using the census strategy. For each coordinator, a semi-structured online evaluation questionnaire was made available through Google Forms. Preliminary results indicate that all have completed higher education and that the majority (80,6%) of the coordinators has had some professional experience in the area of drugs before taking over the current position. Regarding facilities and proper equipment to meet the intended goals, 45,2% say they do not have access to them . In addition, 51,6% said they do not provide training programs or eventual updating for their professionals. This study is expected, ultimately, to contribute and encourage the discussions in the area.

Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. To counteract this, attention tends to focus around access (equality) of services. Yet access may not equate with the meaningfulness (equity) of services for women from different socioeconomic backgrounds. Without understanding equity we are not in a position to plan appropriate and equitable care. This study aimed to determine pregnant women's perceptions of the current antenatal provision and to determine if women from the extremes of socioeconomic background perceived their antenatal care differently. Longitudinal interviews were undertaken with multiple, comparative antenatal case studies between January 2007 and April 2009. Cases were primigravida women from ‘least deprived’ (n=9) and ‘most deprived’ (n=12) geographical areas as identified by the Scottish Index of Multiple Deprivation (SIMD 2006). The data were analysed using case study replication analysis. Analysis of categorical data from the sample groups indicated they were less diverse than might have been expected in terms of age and education. However in the key variables of housing tenure, potential income and socioeconomic status based on area of residence, the groups were indicative of the SIMD target populations. The preliminary analysis showed that the sample groups considered the initial General Practitioner contact to be less than adequate and the subsequent utility of antenatal education to be based on self perceived relevance. The substantive analysis showed little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups but perception of care differed. A key difference concerned the level of ‘engagement’ (defined as personalisation and active involvement in care, power and relationships and health literacy). Using these concepts, engagement was present in most of the ‘least deprived’ group and almost none of the ‘most deprived’ group. In comparison with women from affluent areas, more deprived women described less evidence of: personal connection to their own care; shared decision making; and perceived value in relation to the written educational aspects of antenatal care. In terms of the preliminary analysis, the results suggest that utility of educational material may need to be reviewed to ensure it is relevant to specific needs. Without this relevance, key information may be missed. The substantive analysis suggests that for women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing quality of antenatal services. The lack of engagement perceived by those who are most deprived suggests that equity of service has yet to be attained for those who are most in need. Future research needs to be directed to the potential reasons that may undermine equity and engagement in women from lower socioeconomic areas.

Il lavoro di tesi ha come oggetto la valutazione della qualità relazionale dei servizi offerti dal Centro disabilità neuromotorie infantili della Fondazione Ariel e ha come obiettivi l’approfondimento teorico e metodologico dell’approccio relazionale riflessivo alla valutazione, con attenzione alle connessioni tra valutazione e dimensioni organizzative dei servizi alla persona e alla famiglia. Questo approccio multidimensionale e multivision della qualità fa riferimento ad alcune macro-dimensioni organizzative del benessere relazionale generato da un servizio sociale: l’efficienza, l’efficacia, la qualità integrativa, la qualità etica dei fini. Questa prospettiva riflessiva e partecipata di valutazione costituisce un’opportunità per cogliere, descrivere e giudicare il bene comune relazionale generato da un servizio alla persona e alla famiglia in un contesto di bisogni sociali in mutamento, dove strategiche sono personalizzazione e alla familiarizzazione dei servizi. Oltre al potenziale conoscitivo, la valutazione della qualità relazionale dedica particolare attenzione al potenziale trasformativo e morfogenetico della leva valutativa. Metodologicamente l’analisi condotta è stata di tipo quanto-qualitativo. Sono state realizzate interviste semi-strutturate con gli operatori del Centro e una dettagliata analisi della documentazione. Il lavoro partecipato ha condotto alla costruzione di questionario di 35 variabili che è stato esitato da 167 famiglie beneficiarie. Oltre ad un’analisi monovariata dei risultati del questionario sono stati costruiti alcuni indici sintetici su alcune dimensioni critiche della qualità relazionale. / The work relates to evaluation of relational quality of the services offered by Foundation Ariel’s childhood neuromotor disabilities Center . The objectives are the methodological and theoretical study of the relational reflexive evaluation approach, with attention to the connections between evaluation and organizational dimensions services to individuals and families. This multidimensional and multi-vision quality model refers to some macro-organizational dimensions of relational well-being generated by social services: efficiency, effectiveness, quality integration, the quality of ethical purposes. This reflective and participatory evaluation perspective is an opportunity to capture, describe and assess the common good relationship generated by a service to individuals and families, which are strategic to the familiarization and customization in a context of changing social needs. In addition, relational quality evaluation pays particular attention to the transformative and morphogenetic potential of evaluation. Methodologically, the analysis was quanto-qualitative. Semi-structured interviews were conducted with operators of the Centre and a detailed analysis of the documentation was done. The work led to the construction of a questionnaire of 35 variables, which 167 beneficiary families have responded to. Besides monovariata analysis of the results of the questionnaire, some synthetic indexes of some critical dimensions of relational quality were constructed.

The purpose of this study was to identify and describe from an ecological perspective the characteristics contributing to collaboration, empowerment and effectiveness of federally mandated Ryan White Title I and Title II planning councils and consortia within the State of Florida. A case study approach within two (2) community health planning partnerships, specifically those related to. HIV/AIDS consortia, was used to gather data over one and a half years. The methodology included a combination of qualitative and quantitative approaches, utilizing documents, administering several survey instruments, observing meetings, and conducting individual interviews. The interviews and surveys provided the primary sources of data, with the documents and observations providing supportive secondary sources of data. The data were analyzed to develop an ecological perspective of the collaboration, empowerment, and effectiveness of the partnerships. The findings indicate that both partnerships were collaborative, empowering, and effective in their fulfilling their responsibilities. Significant findings include those related to members' perceptions about the leader and the group, decision making, and conflict as well as the structure, processes, and outcomes of the partnerships. Suggestions were made for the improvement of each partnership and areas for further research and practical implications were identified.

CARVALHO , Maria Aparecida Alves Sobreira . Fortalecimento das pessoas com transtornos mentais: a experiência dos usuários do Movimento de Saúde Mental Comunitária do Bom Jardim. 2010. 127 f. Dissertação (Mestrado em Psicologia) – Universidade Federal do Ceará, Departamento de Psicologia, Programa de Pós-Graduação em Psicologia, Fortaleza-CE, 2010. / Submitted by moises gomes (celtinha_malvado@hotmail.com) on 2012-03-28T18:52:46Z No. of bitstreams: 1 2010_dis_MAASCarvalho.PDF: 2608309 bytes, checksum: 50894675494660418fba5dc755f2f3ab (MD5) / Approved for entry into archive by Maria Josineide Góis(josineide@ufc.br) on 2012-03-29T16:54:39Z (GMT) No. of bitstreams: 1 2010_dis_MAASCarvalho.PDF: 2608309 bytes, checksum: 50894675494660418fba5dc755f2f3ab (MD5) / Made available in DSpace on 2012-03-29T16:54:39Z (GMT). No. of bitstreams: 1 2010_dis_MAASCarvalho.PDF: 2608309 bytes, checksum: 50894675494660418fba5dc755f2f3ab (MD5) Previous issue date: 2010 / This study falls within the field of qualitative assessment of mental health services, aiming to understand how care practices impact on the empowerment of people with mental disorders accompanied by the Movement for Mental Health Community in Bom Jardim. This institution is an NGO established in 1996 by the Comboni Missionaries and leaders of the Basic Ecclesial Communities, in Fortaleza-Ce. During this experiment in mental health, which comes from the popular movement, I met people who took part in the movement with a diagnosis of mental disorder, who are now caretakers. To understand this change in the social status of madness, I used the contributions from the community psychology, Gois and Montero, and the assumptions of the Brazilian Psychiatric Reform, Amarante and Rotelli. The methodology used was the perspective of hermeneutics in a critical case study of the Community Mental Health Movement in Bom Jardim. The field study took place from August 2009 to March 2010 and the application of the instruments occurred during June and July 2010. The participants were eight people who took part in the movement with a diagnosis of mental disorder, and now work as caretakers, as well as the president of the Community Mental Health Movement in Bom Jardim. The instruments used were focus groups, depth interviews and interviews mediated by the autodescriptions. After the production and transcription of data, an interpretive network was constructed. It concerned two issues: empowerment of people with mental illness and caretaking. The results indicate that the participation of people with mental disorders in a variety of caretaking activities favor the strengthening of the movement, leading to a change in beliefs about oneself and the world, experiencing the courage to do things differently, overcoming fatalistic attitudes that promote passivity, accommodation and disqualification. There is the rescue of personal worth and personal power, developing a sense of community ownership and ability to reflect and act upon reality. The Movement presents innovative features in mental health care when it starts a new social space for madness, through volunteering. The development of this activity decreases isolation, loneliness, alienation and anomie, promoting new areas of trade in the community. Another innovative feature in mental health care is recognized in the spiritual dimension of the movement as a link with the transcendent, in a freer experience of institutionalization, linked to the process of personal development, mediated by the deep involvement with the Other and to community development. / Este estudo se inscreve no campo da avaliação qualitativa de serviços de saúde mental, tendo como objetivo compreender como as práticas de cuidado impactam no fortalecimento das pessoas com transtornos mentais acompanhadas pelo Movimento de Saúde Mental Comunitária do Bom Jardim em Fortaleza-Ce. Esta instituição é uma Organização Não-Governamental criada em 1996 pelos missionários combonianos e lideranças das Comunidades Eclesiais de Base, no município de Fortaleza-Ceará. Nesta experiência em saúde mental que nasce do movimento popular, emergem os questionamentos que norteiam esta investigação, pois encontro pessoas que entraram no Movimento com diagnóstico de transtorno mental e passaram do papel de usuário para o de cuidador. Para compreender esta mudança de lugar social no estatuto da loucura, utilizo os aportes da psicologia comunitária, Góis e Montero, e os pressupostos da Reforma Psiquiátrica brasileira, Amarante e Rotelli. Metodologicamente utilizo a perspectiva crítica da hermenêutica, em um estudo de caso do Movimento de Saúde Mental Comunitário do Bom Jardim. A aproximação do campo de pesquisa se deu no período de agosto de 2009 a março de 2010 e a aplicação das técnicas de pesquisa ocorreu nos meses de junho e julho de 2010. Os participantes da pesquisa foram 8 pessoas que entraram no Movimento com diagnóstico de transtorno mental e passaram para o papel de cuidadores e o presidente do Movimento de Saúde Mental Comunitária do Bom Jardim. Utilizei como técnicas de pesquisa o grupo focal, entrevista em profundidade e entrevistas mediadas pela autofotografia. Após a produção e transcrição dos dados, foi construída uma rede interpretativa com dois temas, fortalecimento das pessoas com transtorno mental e cuidado. Os resultados apontam que a participação das pessoas com transtornos mentais em uma diversidade de atividades de cuidado do Movimento favorecem o fortalecimento, ocorrendo a mudança das crenças sobre si mesmo, sobre o mundo, experimentando a coragem de fazer diferente, superando atitudes fatalistas que promovem a passividade, acomodação e desqualificação. Há o resgate do valor pessoal e poder pessoal, o desenvolvimento do sentimento de pertença à comunidade e a capacidade de refletir e agir sobre a realidade. O Movimento apresenta características inovadoras no cuidado em saúde mental, quando inaugura um novo espaço social para a loucura, por meio do voluntariado. No desenvolvimento desta atividade são diminuídos os sentimentos de isolamento, solidão, anomia e alienação, favorecendo novos espaços de trocas na comunidade. Outra característica inovadora no cuidado em saúde mental é a dimensão espiritual reconhecida no Movimento como uma ligação com o transcendente, em uma vivência mais livre da institucionalização, ligada aos processos de desenvolvimento pessoal, mediados pela profunda implicação com o Outro e com o desenvolvimento comunitário.

Home First is an Ontario transition management approach that attempts to reduce the pressure on hospital and Long Term Care (LTC) beds through early discharge planning, the provision of timely and appropriate home care, and the delay of LTC placement. The purpose of this qualitative descriptive study was to obtain descriptions from South Eastern Ontario Home First clients and their family caregivers of their experiences with and thoughts about care transitions, the provision of care, and the Home First approach. The goal was to enable insight into the Home First approach, care transitions, and the provision of care through access to the perspectives of study participants. Nine semi structured interviews (and one or more follow-up calls for each interview) with Home First clients discharged from hospitals in South East Ontario and their family caregivers were conducted and their content analyzed. All participating Home First clients were pleased to be home from hospital and did not consider LTC placement a positive option. All had family involved with their care and used a mix of formal and informal services to meet their care needs. Four general themes were identified: (a) maintaining independence while responding (or not) to risks, (b) constraints on care provision, (c) communication is key, and (d) relationship matters. Although all Home First clients participating in the study were discharged home successfully, a sense of partnership between health care providers, families, and clients was often lacking. The Home First approach may be successfully addressing hospital alternative level of care issues and getting people home where they want to be, but it is also putting increasing demands on formal and informal community caregivers. There is room for improvement in how well their needs and those of care recipients are being met. Health professionals and policy makers must ask caregivers and recipients about their concerns and provide them with appropriate resources and information if they want them to become true partners on the care team. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-05-23 16:10:53.323