The disproportionate burden of disease in the Aboriginal population in Canada has become so great that it is now being referred to as a health ‘crisis’. Evidence suggests that the answer to these ills lies not in the western biomedical model of heath care, but within the Aboriginal traditions of self-determination and holism (RCAP, 1996; O’Neil, Lemckuk-Favel, Allard & Postl, 1999; Romanow, 2002; CIHI, 2004; Maar, 2004; First Nations & Inuit Regional Health Survey, 2004). To this end, First Nations communities have been negotiating with the federal government and transferring responsibility for their community-based health services since 1986, despite the limitations of the federal Health Transfer Policy (Gregory, Russell, Hurd, Tyance & Sloan, 1992; Lavoie, et al, 2005; RCAP, Vol 3, Chp 3, 1996; Speck, 1989). These self-determination initiatives in health attempt to improve the health status of community members. Thus, determining an approach to health service delivery that contributes to positive health outcomes is of particular significance. Examining Island Lake’s evolving model of health service delivery indicates the success of the intergovernmental, interdepartmental, and intersectoral partnership approach they have taken; as evidenced by the Regional Renal Health Program, with dialysis treatment services, that has been established, perhaps for the first time in the country, in a remote First Nations community without existing hospital services. There remains work to be done in creating a holistic system of health service delivery that reflects their unique worldview within a context of health promotion and self-determination; however, their accomplishments to date, established processes, willingness to put their dreams into action and build what has not been built before demonstrate a potential to improve community health and well-being. / October 2006

The disproportionate burden of disease in the Aboriginal population in Canada has become so great that it is now being referred to as a health ‘crisis’. Evidence suggests that the answer to these ills lies not in the western biomedical model of heath care, but within the Aboriginal traditions of self-determination and holism (RCAP, 1996; O’Neil, Lemckuk-Favel, Allard & Postl, 1999; Romanow, 2002; CIHI, 2004; Maar, 2004; First Nations & Inuit Regional Health Survey, 2004). To this end, First Nations communities have been negotiating with the federal government and transferring responsibility for their community-based health services since 1986, despite the limitations of the federal Health Transfer Policy (Gregory, Russell, Hurd, Tyance & Sloan, 1992; Lavoie, et al, 2005; RCAP, Vol 3, Chp 3, 1996; Speck, 1989). These self-determination initiatives in health attempt to improve the health status of community members. Thus, determining an approach to health service delivery that contributes to positive health outcomes is of particular significance. Examining Island Lake’s evolving model of health service delivery indicates the success of the intergovernmental, interdepartmental, and intersectoral partnership approach they have taken; as evidenced by the Regional Renal Health Program, with dialysis treatment services, that has been established, perhaps for the first time in the country, in a remote First Nations community without existing hospital services. There remains work to be done in creating a holistic system of health service delivery that reflects their unique worldview within a context of health promotion and self-determination; however, their accomplishments to date, established processes, willingness to put their dreams into action and build what has not been built before demonstrate a potential to improve community health and well-being.

The disproportionate burden of disease in the Aboriginal population in Canada has become so great that it is now being referred to as a health ‘crisis’. Evidence suggests that the answer to these ills lies not in the western biomedical model of heath care, but within the Aboriginal traditions of self-determination and holism (RCAP, 1996; O’Neil, Lemckuk-Favel, Allard & Postl, 1999; Romanow, 2002; CIHI, 2004; Maar, 2004; First Nations & Inuit Regional Health Survey, 2004). To this end, First Nations communities have been negotiating with the federal government and transferring responsibility for their community-based health services since 1986, despite the limitations of the federal Health Transfer Policy (Gregory, Russell, Hurd, Tyance & Sloan, 1992; Lavoie, et al, 2005; RCAP, Vol 3, Chp 3, 1996; Speck, 1989). These self-determination initiatives in health attempt to improve the health status of community members. Thus, determining an approach to health service delivery that contributes to positive health outcomes is of particular significance. Examining Island Lake’s evolving model of health service delivery indicates the success of the intergovernmental, interdepartmental, and intersectoral partnership approach they have taken; as evidenced by the Regional Renal Health Program, with dialysis treatment services, that has been established, perhaps for the first time in the country, in a remote First Nations community without existing hospital services. There remains work to be done in creating a holistic system of health service delivery that reflects their unique worldview within a context of health promotion and self-determination; however, their accomplishments to date, established processes, willingness to put their dreams into action and build what has not been built before demonstrate a potential to improve community health and well-being.

Philosophiae Doctor - PhD / Since the advent of South Africa‘s democracy in 1994 there have been several changes in the policy and legislative arena specifically promoting public-private-partnerships in the health sector. These initiatives have given rise to opportunities for inter-sectoral policy transfer under the rubric of ―best practices‖. This exploratory study examines the character, obstacles and contested nature of a selection of policy transfers between private and public health institutions in a single province of South Africa. The study looks at the dynamics at play around envisaged, current and past transfers of policies and organisational practices in relation to administrative systems and technologies used in four different hospital settings – two public and two private hospitals in the Eastern Cape Province of South Africa. This thesis explores the views of managers and labour organisations about policy transfer focusing on local contexts, and how various parties construct policy transfer, hence providing a perspective of policy at the ―plant‖ level. In this research, special focus is placed on different agents‘ role and understandings of their contexts and how and why policies move and contradictions of these developments. In-depth interviews were conducted at four major Eastern Cape hospitals. The thesis argues that in practice, policy transfer is messy, politicized and traversed by power and vested interests and that organised labour plays a key role in policy transfer process. The thesis focuses on the different philosophical/ideological underpinnings, socio-political values and operational environments in each sector. This study is designed to contribute to existing knowledge on practices particularly between the public and private sectors in order to widen the understanding of the complexity of transferability.

Philosophiae Doctor - PhD / Since the advent of South Africa's democracy in 1994 there have been several changes in the policy and legislative arena specifically promoting public-private-partnerships in the health sector. These initiatives have given rise to opportunities for inter-sectoral policy transfer under the rubric of ―best practices‖. This exploratory study examines the character, obstacles and contested nature of a selection of policy transfers between private and public health institutions in a single province of South Africa. The study looks at the dynamics at play around envisaged, current and past transfers of policies and organisational practices in relation to administrative systems and technologies used in four different hospital settings – two public and two private hospitals in the Eastern Cape Province of South Africa. This thesis explores the views of managers and labour organisations about policy transfer focusing on local contexts, and how various parties construct policy transfer, hence providing a perspective of policy at the ―plant‖ level. In this research, special focus is placed on different agents' role and understandings of their contexts and how and why policies move and contradictions of these developments. In-depth interviews were conducted at four major Eastern Cape hospitals. The thesis argues that in practice, policy transfer is messy, politicized and traversed by power and vested interests and that organised labour plays a key role in policy transfer process. The thesis focuses on the different philosophical/ideological underpinnings, socio-political values and operational environments in each sector. This study is designed to contribute to existing knowledge on practices particularly between the public and private sectors in order to widen the understanding of the complexity of transferability.

Paper 1 - Consultation is a widely used model of practice amongst Educational Psychology Services (EPS) in the United Kingdom (UK) as evidenced in the amount of research carried out on this practice (Leadbetter, 2006, p. 246). This paper attempts to supplement the limited evidence on how and why consultation is used. This paper provides an account of Educational Psychologists (EPs) perceptions of using consultation in a Welsh Educational Psychology Service (EPS). The study uses a thematic analysis of interviews with EPs and 3 accounts of the practice of consultation are provided as examples of how consultation is used. Data analysis revealed that EPs’ practice is dominated by the influence of Wagner’s model of consultation, which is a result of both university, and service based training and not because they feel it is necessarily the best way of working and were vague about their reasons for using this approach. Evidence emerged to suggest EPs were only aware of one model of consultation, which is the Wagner model. Evidence also emerged to suggest that EPs confused service delivery models with models of consultation and that EPs are unclear about their unique skills and role when using consultation and feel that schools do not understand the work they are trying to achieve when working in this way. EPs also considered that schools want more time with them, but burdensome bureaucracy hinders this. These findings are discussed in more detail at the end of Paper 2 where the overall findings suggest there is a systemic problem in Pantysgawn EPS, where the dominance of the EP role to provide statutory assessments prevents EPs from working in a truly consultative way. The paper ends by discussing the key element of the EP’s role, whether a consistent and rigid adherence to one practice model is practicable or desirable, and the various ways that EP services can monitor outcomes to alleviate some of the bureaucratic processes. Paper 2 - Paper 1 of this study looked at EPs’ perceptions of using consultation. Very few studies have looked at service users experiences in consultation based EP services. Paper 2 therefore looks at schools’ perceptions of the EP service and considers the benefits and barriers to effective service delivery using a thematic analysis of interviews with staff from 5 primary and 3 secondary schools. Findings suggest that schools continue to regard the expertise of the EP as being a provider of individual assessments, but they also revealed an awareness of the wider systemic role that EPs can provide. This traditional view of the role of the EP is discussed in terms of a wider systemic pressure for schools to seek this kind of EP intervention due to the Local Authority’s (LA) focus on statutory assessments. Schools appreciated a greater continuity of EPS staff as this helped them to develop more productive working relationships and they wanted more time with the EP. The findings suggest that the level of bureaucracy and the statutory assessment requirements to gain access to targeted resources were a barrier to working more effectively with schools. The paper ends by integrating these findings with the paper 1 findings and discussing the key element of the EP’s role, whether a consistent and rigid adherence to one practice model is practicable or desirable, and the various ways that EP services can monitor outcomes to alleviate some of the bureaucratic processes.

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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.

In order to address the managerial leadership challenge of the educational psychologist cohort, it seems fundamentally superficial to make direct use of conventional management theories, scientific data, and empirical evidence from managers’ work practices in other contexts. The current research explored the influence of managerial leadership on the professional performance of educational psychologist in relation to service delivery models, management appointments, workload management and educational psychologists’ engagement in clinical supervision. Managers need to gain better understand of the influence of managerial leadership on the professional performance of educational psychologists and use contemporary empirical and scientific data to guide their managerial leadership practice. The explanatory sequential mixed-methods research approach was best suited to the early stages of research in this arena. The research findings elucidated the influence of service delivery models, described the ideal management appointment, proposed a formal structured workload management system and provided activities for managers to encourage educational psychologists’ engagement in clinical supervision. / Educational Leadership and Management / D. Ed. (Education Management)