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Submitted by Maicon Juliano Schmidt (maicons) on 2015-07-17T13:50:54Z No. of bitstreams: 1 Miria Trentin Cargnin_.pdf: 3021619 bytes, checksum: ff4937858c71c1020f0674ace1809dcf (MD5) / Made available in DSpace on 2015-07-17T13:50:54Z (GMT). No. of bitstreams: 1 Miria Trentin Cargnin_.pdf: 3021619 bytes, checksum: ff4937858c71c1020f0674ace1809dcf (MD5) Previous issue date: 2015-03-09 / Nenhuma / Esta tese tem o objetivo de problematizar a relação saúde e educação no Programa Saúde na Escola (PSE) e o entendimento da escola como espaço de difusão de práticas de saúde na população. Esta pesquisa foi desenvolvida com base na implantação do Programa Saúde na Escola (2007), política que se desenvolve na educação escolar pública. A pesquisa analisou os seguintes documentos relativos ao Programa: Orientações sobre o Programa Saúde na Escola para a Elaboração dos Projetos Locais (2008); Agenda – Educação e Saúde (2010); Passo a Passo PSE – Tecendo Caminhos da Intersetorialidade (2011); Orientação para Elaboração do Projeto Municipal PSE (2011); e Manual Instrutivo – PSE (2013). Como metodologia analítica, foi utilizado o referencial teórico dos estudos foucaultianos, com os conceitos ferramenta de governamento e de discurso. As análises empreendidas sobre os materiais de pesquisa permitiram mostrar que o Programa Saúde na Escola é uma estratégia de disseminação de saúde, principalmente para a população mais vulnerável socialmente. Por meio do PSE, é possível, além de promover a saúde, prevenir os riscos de doenças, sendo um importante instrumento para conhecer, vigiar e controlar o educando e, consequentemente, a população como um todo. Neste estudo, demonstro que a disseminação de saúde é facilitada por meio de intersetorialidade (educação e saúde), capacitação dos recursos humanos, distribuição de recursos humanos e materiais, ampliação do número de instituições escolares, participação popular, atuação que envolve desde educandos até a comunidade local, produção de desejo por saúde e mudança de condições de vida. Constato que o PSE é uma estratégia de governamento que propõe determinados comportamentos para fazer com que o educando assuma os investimentos na sua própria condução de saúde, ou seja, para que desenvolva competências a fim de tornar-se gestor dos riscos de sua saúde e também multiplicador para a sua família e comunidade. / This thesis aims to problematize the relationship between health care and education in the School-Based Health Care Program (PSE) and the understanding of school as a place to spread health care practices among the population. This research is based on the implantation of the School-Based Health Care Program (2007), a policy that takes place in public schools. The research analyzes the following documents related to the Program: Guidelines of the School-Based Health Care Program for Local Projects (2008); Agenda - Education and Health Care (2010); PSE Step by Step - Opening Ways towards Inter-Sectoriality (2001); Guidelines for PSE Municipal Project (2011); and Instruction Handbook - PSE (2013). The theoretical reference of Foucauldian studies has been used as analytical methodology, by employing the tool concepts of government and discourse. The analyses of the research materials hasled to the understanding that the School-Based Health Care Program is a strategy to spread health care, particularly among socially vulnerable populations. Besides promoting health care, PSE allows the prevention of risk of diseases, and it is an important tool to know, oversee and control students and, consequently, the population as a whole. In this study, I have shown that spreading health care has been facilitated by inter-sectoriality (education and health), human resources qualification, material and human resources distribution, increased number of schools, popular participation, action involving students and the local community, production of a desire for health, and change of living conditions. I have found that PSE is a governing strategy that proposes certain behaviors in order to have students to invest in the conduction of their own health care, i.e. for them to develop skills to manage their health risks and spread such knowledge among their families and communities.

<p>Det är viktigt att skolan kan bemöta barn och elever som uppvisar psykisk ohälsa.</p><p>Skolhälsovården är uppbyggd på team vilka har medlemmar som samarbetar med andra team</p><p>från andra professioner. Det är av vikt att detta samarbete fungerar på ett effektivt sätt. Syftet</p><p>med denna studie var att undersöka vilken teoretisk utgångspunkt barn- och elevhälsoteamets</p><p>kuratorers arbete utgår ifrån och om kuratorsgruppen har en samsyn gällande den teoretiska</p><p>utgångspunkten. Syftet konkretiserades genom följande frågeställningar: 1. Vilken teoretisk</p><p>utgångspunkt är vägledande för barn- och elevhälsoteamets kuratorer och finns det någon</p><p>enighet eller oenighet i samsynen gällande den teoretiska utgångspunkten? 2. På vilket sätt</p><p>framkommer den teoretiska utgångspunkten i det praktiska arbetet? 3. Framkommer hinder</p><p>och möjligheter i samarbetet internt och externt? 4. Framkommer i resultatet omständigheter</p><p>som kan leda till att verksamheten utvecklas? Studien har en kvalitativ metodansats där fyra</p><p>intervjuer och en observation genomförts med kuratorer inom barn- och elevhälsoteamet. Det</p><p>framgår att kuratorsgruppen har en samsyn gällande systemperspektivet i sitt arbete. Det</p><p>framkommer både hinder och möjligheter i samarbetet och även faktorer som kan komma att</p><p>utveckla verksamheten. I diskussionen förs resonemang angående samarbete, kompetens,</p><p>dokumentation och tidsbrist.</p> / <p>It is of great relevance that School staff can answer pupils that shows mental illness. School</p><p>based health care has teams who collaborate with teams in other professions. It is of</p><p>importance that the collaboration works in an effective way. The purpose of this study is to</p><p>examine what theoretical position the school based health care teams counsellors work starts</p><p>from and if they have a unanimous way considering the theoretical position. The purpose was</p><p>made more specific by following questions: 1. What theoretical position is guiding the school</p><p>based health care team counsellors and is there any disagreements regarding to the theoretical</p><p>positions? 2. In what way does the theoretical position become apparent in the practical</p><p>work? 3.Which prominent problems an possibilities comes to light in the collaboration</p><p>internal and external? 4. Does circumstances in the results occur which would develop the</p><p>team? The study include a qualitative approach whereas four interviews and one observation</p><p>has taken place among the counsellors in the school based health team. It appears that the</p><p>counsellors overall are unanimous concerning the system perspective in their work. Also it</p><p>emerged both obstacles and possibilities in the collaboration and factors that might develop</p><p>the organisation. The central aspects of the discussion are the collaboration, competence,</p><p>documentation and lack of time.</p>

Det är viktigt att skolan kan bemöta barn och elever som uppvisar psykisk ohälsa. Skolhälsovården är uppbyggd på team vilka har medlemmar som samarbetar med andra team från andra professioner. Det är av vikt att detta samarbete fungerar på ett effektivt sätt. Syftet med denna studie var att undersöka vilken teoretisk utgångspunkt barn- och elevhälsoteamets kuratorers arbete utgår ifrån och om kuratorsgruppen har en samsyn gällande den teoretiska utgångspunkten. Syftet konkretiserades genom följande frågeställningar: 1. Vilken teoretisk utgångspunkt är vägledande för barn- och elevhälsoteamets kuratorer och finns det någon enighet eller oenighet i samsynen gällande den teoretiska utgångspunkten? 2. På vilket sätt framkommer den teoretiska utgångspunkten i det praktiska arbetet? 3. Framkommer hinder och möjligheter i samarbetet internt och externt? 4. Framkommer i resultatet omständigheter som kan leda till att verksamheten utvecklas? Studien har en kvalitativ metodansats där fyra intervjuer och en observation genomförts med kuratorer inom barn- och elevhälsoteamet. Det framgår att kuratorsgruppen har en samsyn gällande systemperspektivet i sitt arbete. Det framkommer både hinder och möjligheter i samarbetet och även faktorer som kan komma att utveckla verksamheten. I diskussionen förs resonemang angående samarbete, kompetens, dokumentation och tidsbrist. / It is of great relevance that School staff can answer pupils that shows mental illness. School based health care has teams who collaborate with teams in other professions. It is of importance that the collaboration works in an effective way. The purpose of this study is to examine what theoretical position the school based health care teams counsellors work starts from and if they have a unanimous way considering the theoretical position. The purpose was made more specific by following questions: 1. What theoretical position is guiding the school based health care team counsellors and is there any disagreements regarding to the theoretical positions? 2. In what way does the theoretical position become apparent in the practical work? 3.Which prominent problems an possibilities comes to light in the collaboration internal and external? 4. Does circumstances in the results occur which would develop the team? The study include a qualitative approach whereas four interviews and one observation has taken place among the counsellors in the school based health team. It appears that the counsellors overall are unanimous concerning the system perspective in their work. Also it emerged both obstacles and possibilities in the collaboration and factors that might develop the organisation. The central aspects of the discussion are the collaboration, competence, documentation and lack of time.

This thesis explores the concept of family engagement in education and school-based rehabilitation services and contributes to practice and policy implications. / In pediatric occupational therapy, family-centered service is an essential part of practice. Working with families, occupational therapists facilitate capacity-building to enable parents to participate in their child’s occupational therapy services and make informed choices to best support their child. Family engagement can be particularly challenging in the school-based context, but without this engagement, services are at risk of being less meaningful and impactful for children. In this thesis, I explore the unique nature of the educational context, contribute to the conceptual development of ‘family engagement’, provide an in-depth analysis of family engagement in school-based occupational therapy, and generate stakeholder-informed solutions for occupational therapy practice. The first manuscript depicts a concept analysis that critically analyzes the concept of family engagement as discussed in the education literature. I suggest implications for professionals working with families and children in educational settings, including a proposed definition to contribute to further concept development. In the second manuscript, I present a qualitative description study exploring occupational therapists’ experiences on the development of family-therapist relationships using the Partnering for Change service delivery model. Through analysis of the data, I identify several factors influencing family-therapist relationships and recommend strategies to improve relationship-building. In the last study, I present an interpretive description study exploring family engagement in school-based occupational therapy services from the perspectives of both occupational therapists and families. Based on the findings, I recommend service transformation to improve family engagement, and to increase the value of these services for children and their families. Specific strategies for therapists, organizations, schools, regulatory colleges, and professional practice groups are outlined in this thesis to facilitate family engagement in school-based occupational therapy practice. Ensuring families are able to engage in services may lead to more individualized and impactful services in the school setting. / Thesis / Doctor of Philosophy (PhD) / Pediatric occupational therapists aim to partner with the family in all aspects of a child’s service. However, this is difficult for school-based occupational therapists. Families are not typically present at the school when therapists provide services for children, making it difficult to build relationships. This thesis explores factors that impact on how families are able to engage in the school-setting, and on how to provide families with better support. The first study examines how families engage in children’s education, and what this means for school-based therapists. The second study explores therapists’ views of what influences family-therapist relationships in a school-based service delivery model called Partnering for Change. The final study explores family engagement in school-based occupational therapy from the perspective of both families and therapists. Findings from all three studies contribute to a better understanding of what family engagement means in the school-setting, and how to build stronger family-therapist relationships in school-based occupational therapy services.

School-based health centers (SBHCs) have faced challenges in securing adequate funding for operations and developing sound business systems for billing and reimbursement. Specifically, administrators often lack strategies to develop and sustain funding levels to support appropriate resources for business operations. The focus of this descriptive study was to explore best practice strategies to develop and sustain funding through the experiences of SBHC administrators. The conceptual framework included Elkington's sustainability theory, which posits that corporate social responsibility, stakeholder involvement, and citizenship improve manager's effect on the business system. Twenty full-time SBHC administrators working in separate locations throughout the state of Maryland participated in semistructured telephone interviews. The van Kaam process was used to cluster descriptive experiences in data analysis that resulted in the development of thematic strategies for implementing best practices relevant to developing and sustaining funding for SBHC business operations. Major themes provided by the participants were interagency communications, creating marketing plans, and disparities in the allocation of funding for programs and professional staff. Findings indicated SBHC administrators continue to face challenges in developing and sustaining adequate funding for operations in the state of Maryland. Suggestions for future research include how administrators can develop marketing plans and explore long-range funding for SBHC services. The findings in this study may contribute to positive social change by demonstrating to officials in the Maryland State Department of Education the significance of SBHCs, and the need to increase mental health services.

To date, few high school based interventions have been shown to have lasting effects on adolescents' health behaviors. The need for health interventions targeting adolescents is underscored by data showing that several health behaviors with significant short and long term adverse effects begin in early adolescence and become progressively more prevalent toward late adolescence. This project tested the efficacy of a novel anatomy based health education curriculum at increasing health knowledge. The course was taught by first year Yale medical students. The curriculum placed emphasis on nutrition, physical activity and infectious disease. Forty Juniors from Career High School visited Yale's anatomy lab once every two weeks for ten hour-long sessions. In addition to visits to the anatomy lab, students completed two class projects, one covered nutrition and the other focused on exercise. Four additional sessions at Career High School were dedicated to the class projects. Pre and post test analysis showed an improvement in health knowledge with a thirteen percentage point improvement on a standardized health knowledge survey. The students' performance was compared to a control cohort of thirty-one students who were not exposed to the curriculum. Students exposed to the curriculum had a nineteen percentage point advantage compared to control students who had not been exposed. Curriculum efficacy as demonstrated by this small cohort validate further testing with larger cohorts and more vigorous controls as well as separate testing to measure changes in health behavior attributable to curriculum exposure.

Walden University College of Management and Technology This is to certify that the doctoral study by Ingrid Hayes-Burrell has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Ify Diala, Committee Chairperson, Doctor of Business Administration Faculty Dr. Anne Davis, Committee Member, Doctor of Business Administration Faculty Dr. Yvette Ghormley, University Reviewer, Doctor of Business Administration Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 â?? School-based health centers (SBHCs) have faced challenges in securing adequate funding for operations and developing sound business systems for billing and reimbursement. Specifically, administrators often lack strategies to develop and sustain funding levels to support appropriate resources for business operations. The focus of this descriptive study was to explore best practice strategies to develop and sustain funding through the experiences of SBHC administrators. The conceptual framework included Elkington's sustainability theory, which posits that corporate social responsibility, stakeholder involvement, and citizenship improve manager's effect on the business system. Twenty full-time SBHC administrators working in separate locations throughout the state of Maryland participated in semistructured telephone interviews. The van Kaam process was used to cluster descriptive experiences in data analysis that resulted in the development of thematic strategies for implementing best practices relevant to developing and sustaining funding for SBHC business operations. Major themes provided by the participants were interagency communications, creating marketing plans, and disparities in the allocation of funding for programs and professional staff. Findings indicated SBHC administrators continue to face challenges in developing and sustaining adequate funding for operations in the state of Maryland. Suggestions for future research include how administrators can develop marketing plans and explore long-range funding for SBHC services. The findings in this study may contribute to positive social change by demonstrating to officials in the Maryland State Department of Education the significance of SBHCs, and the need to increase mental health services.

Bakgrund: Samband mellan motorisk utveckling, fysisk aktivitet och lärande finns väl dokumenterade. Processer för att utveckla implementeringen av fysisk aktivitet i skolan har påbörjats bland annat genom fysioterapi som en del av elevhälsan, ett relativt nytt verksamhetsområde. För fysioterapeuter innebär detta en etableringsprocess där samverkan i nya teamkonstellationer utvecklas. Syfte: Syftet med studien var att undersöka hur skolfysioterapeuter upplever sin professionella roll och teamarbetet inom elevhälsan. Metod: Tre semistrukturerade intervjuer utfördes via zoom eller telefon med skolfysioterapeuter som arbetade inom elevhälsan. Intervjuerna spelades in och materialet transkriberades för att sedan analyseras med hjälp av en kvalitativ innehållsanalys enligt Graneheim &amp; Lundman. Resultat: Studien resulterade i att tre kategorier kunde identifieras: Att samarbeta och vara spindeln i nätet,  Att utveckla och vara en ny kompetens på skolan, och Att förhålla sig till ett delat fokus på hälsa kontra prestation i skolan. Dessa kategorier delades även in i underkategorier. Studien visade att skolfysioterapeuterna upplevde att de spelade en viktig roll på skolan genom att bidra med en kompletterande, fysioterapeutisk syn på hälsa. Att implementera sina perspektiv på hälsa i skolan var dock en utmaning där skolans fokus ofta ligger på prestation. Informanterna hade till stor del själva fått utforma sin yrkesroll vilket varit både en möjlighet och en utmaning. Slutsats: Fysioterapeuter kan bidra med en kompletterande syn på hälsa i skolan och en ökad styrning från högre instanser krävs för att överkomma utmaningarna och för utveckling av verksamhetsområdet. / Introduction: The relationship between motor development, physical activity and academic achievement is well documented. Processes for developing the implementation of physical activity in schools have begun through physiotherapy, among other areas, as part of school based healthcare. This is a relatively new area of focus within the profession. For physiotherapists, this involves establishing a new professional role and developing interprofessional working relationships. Purpose: The purpose of the study was to investigate school physiotherapists experiences of their role and teamwork within school based healthcare. Method: Three semi-structured interviews were conducted via zoom or telephone with school physiotherapists working within student healthcare. The interviews were recorded, transcribed, and the data analyzed using a qualitative content analysis. Results: Three categories were identified: To cooperate and be “the person at the heart of things”, To develop and to have a new professional role in school, and To relate to a shared focus of health versus academic achievement in school.  These categories were further specified into subcategories. The subjects felt they played an important role in the school by providing a complementary, physiotherapeutic perspective on health. However, the schools focus on performance was perceived to be a challenge when implementing their views on health. The subjects were able to form the role themselves to a large extent which was deemed a challenge and an opportunity. Conclusions: Physiotherapists contribute a complementary perspective on health within schools. An increased involvement from governing bodies is required to overcome challenges and for development in the field.

Mental illness is not only the leading cause of disability among adults, but there is also an emerging public health crisis in childhood mental illness. A majority of parents do not recognize symptoms of psychological disorder in their children, and current policies and programs for mental health service delivery are not sufficiently responsive to the early help-seeking dynamics of families. Using a concurrent mixed methods design, this study explored how parents in the Pikes Peak region of Colorado learned to recognize their child's mental illness. Phenomenological interviews, augmented by poetic inquiry and quantitative measurements, were used to discover factors that inhibited or enhanced five mothers' recognitions. These factors were then evaluated using a frequency distribution analysis and a rank-order correlation. The phenomenon of recognition was, for these mothers, a process of waiting to hear that 'normal' had stopped, wherein they miscategorized symptoms as normal behaviors in a passing developmental phase. Prior experience with mental illness appeared to significantly decrease both the length of time and the level of distress necessary for recognition. Ultimately, recognition did not occur until someone in their social network validated their concerns and provided explicit confirmation, which galvanized them to seek treatment. Governance network collaborations can facilitate positive social change by standardizing guidance on how to differentiate symptoms of a disorder from normal childhood development. Public policies and programs such as universal mental health screening, mental health literacy, and more supportive and responsive school policies can foster dialogue for parental recognition in Colorado and throughout the country.