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The objective of this study was to identify usage of foodservice performance measures, important activities in foodservice benchmarking, and benchmarking attitudes, beliefs, and practices by foodservice directors. The design of this study included two parts: (1) eleven expert panelists involved in a Delphi technique to identify and rate importance of foodservice performance measures and rate the importance of benchmarking activities, and (2) a national mail survey of 247 randomly selected foodservice directors from college/university, correctional, health care, and school foodservice operations to identify attitudes, beliefs, and practices about benchmarking and usage of performance measures. Statistical analyses of the expert panel data included frequencies of importance rating of performance measures and benchmarking activities. The expert panel identified 89 performance measures, which were subsequently consolidated into 19 generic performance measures. Regarding the national survey, a χ² analysis was conducted on: usage of types of benchmarking compared with knowledge and importance of benchmarking, and experience with benchmarking outcomes; foodservice directors' category of foodservice operation compared with usage of performance measures, type of benchmarking and benchmarking partner(s); and foodservice directors' knowledge of benchmarking compared to importance of benchmarking. According to the national survey, the most commonly used performance measures were: food cost percentage, cost per unit or area of service, and meals per labor hour. Usage of internal, external, and functional/generic benchmarking was associated with foodservice directors' knowledge about benchmarking, importance of benchmarking, and general experience with benchmarking outcomes. Foodservice directors' category of foodservice operation was associated with usage of types of benchmarking partners, and with some performance measures and types of benchmarking, while not others. Foodservice directors' knowledge about benchmarking was related to perceived importance of benchmarking. Sixty-one percent of respondents reported needing knowledge and skills about benchmarking. This research provides insight into performance measures that are or could be used in foodservice benchmarking. It also suggests that benchmarking has at least some importance, particularly to those with knowledge about benchmarking. It could be a useful management tool to foodservice directors, regardless of category of foodservice operation. Research results were used to develop a benchmarking guide for foodservice directors. / Graduation date: 1998

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The aim of the current study was to develop and test a methodology that could be applied to the evaluation of the complaints processes of regulatory bodies of health professionals in Australia including mental health regulatory bodies such as the board that the Council of Australian Governments (COAG) are planning to set up to regulate the psychology profession. The methodology was applied to the evaluation of the complaints process at the Office of the Health Services Commissioner of Victoria (HSC). There were four main research questions. The first research question related to the extent to which the methodology was able to determine how well the HSC was performing in their role of resolving health complaints. The second research question explored the implications of the findings of the evaluation of the HSC complaints process for the management of health complaints in general. The third research question related to the strengths and limitations of the methodology when applied in a practical setting and the final research question related to further improvement of the methodology for future applications. Questionnaires and telephone interviews were used to examine the experiences of 133 providers and 150 complainants whose complaints had been reviewed and closed in one year. The methodology proved successful in assessing the performance of the complaints process at the HSC. The findings of the evaluation indicated that complainants and providers were generally satisfied with the process by which their complaints were managed. However, they were in general less satisfied with the outcome. In particular the evaluation highlighted the unintended negative consequences that complaints processes can have on the complainants and respondents. It was concluded that these maladaptive behavioural responses to complaints most probably have their origins in the negative emotional overlay attached to health complaints which has the potential to lead to unrealistic expectations of the process and outcomes on the part of complainants, and maladaptive post-complaint practices for health service providers. The findings highlight the importance of providing advocacy and support for the parties involved in health complaints as a means of minimising these maladaptive responses. Finally, it is acknowledged that these findings are specific to Australian health regulatory systems.

M.A. (Social Work) / In terms of recent changes in Government policy, the posts of social workers are currently being subsidised on the basis of the effectiveness of the service programmes conducted by welfare organisations. Consequently, programme evaluation has lately become the subject of increasing attention. An increased sense of responsibility and an awareness of a need for greater efficiency and cost effectiveness is emerging. This suggests a need for a scientifically based evaluation process i.e. programme evaluation with a view to improving existing programmes or developing new programmes. However uncertainty prevails in welfare organisations with regard to the nature and content of programmes and consequently where and when programme evaluation should be applied. In order to verify this impression, questionnaires were mailed to welfare organisations in Johannesburg who are members of the Family care Liason Committee. A sampling group of five directors, seven supervisors and ten social workers, based on nonprobability quota sampling, were identified. A response of three directors, four supervisors and seven social workers were received and after the results were analysed a verification of the impression, that uncertainty prevails in welfare organisations with regard to programme evaluation, could be noted. Programme evaluation would therefore be less likely utilised in social work as a method and model in rendering services unless the uncertainty is minimised and an atmosphere is created in which social workers will want to apply programme evaluation.

After nine years of working in the field of social work, this including counselling, training and supervision, the researcher became aware of the need to develop a tool by which social workers could identify how they work. This study is for the social workers. It will review theory and techniques and then will go one step further. It will offer a new product to the social worker, a product whereby he or she can internally reflect on, investigate, argue about, integrate and finally, within the relationship the social worker has with his or her own working self, developed a personal practice model. Developmental research was selected as the research design. The tool to achieve the goal of developing a personal practice model was a workshop. A pilot study was undertaken at Family Life Centre. / Social Work / M.A. (Social Science (Mental Health))

Background: In recent years Acceptance and Commitment Therapy (ACT) has gained increasing status as a promising approach to treating chronic pain physical functioning and psychological well-being. The basic premise of ACT as applied to chronic pain is that while pain hurts, it is the struggle with pain that causes suffering. This approach aims to restore effective and adaptive functioning for an individual within a context of continuing pain so that the individual can live a more vital and meaningful life. There is a growing empirical support for the effectiveness of ACT however research has relied on self-reported quantitative outcomes, focused on addressing changes in pain intensity and the physical and psychological impact of chronic pain. There appears to be a gap in the literature on the exploration of the experience of attending an ACT programme for chronic pain from the patient’s perspective. Aim: This study sought to explore the experience of attending an ACT programme for chronic pain within an outpatient NHS hospital setting. Furthermore the study sought to explore the modulating factors influencing clients learning and understanding of the construct of acceptance from the perspective of the participants. Additionally, the experience of attending a group based ACT intervention was explored. Methodology: A qualitative methodology was chosen for the project. The study used a purposive sample of twelve participants, who had all attended the Luton & Dunstable Hospital ACT 8 week outpatient programme for chronic pain. The participants were interviewed through the use of a semi structured interviews, and the transcripts were transcribed and then analysed using Thematic Analysis. Identified themes were further organised using the tool of Thematic Network Analysis. Results: Three global themes emerged from the analysis of the data. The first global theme encompassed the participant’s pre-programme expectations and this theme highlighted the participant’s feelings of hope and hopelessness prior to attending the programme. The second global theme demonstrated the on-going process of living with chronic pain and highlighted the benefits and barriers to adopting and ACT based approach to chronic pain. Finally the third global theme addressed the experience of a group based intervention and included the positive and negative aspects of this experience for the participants. Clinical Implications & Conclusion: Based on the results of this study a number of clinical implications were highlighted in relation to the future development of ACT programmes for chronic pain. These included suggestions in relation to engaging participants in such programmes. Notably, timing issues, validation of physical symptoms, and consideration of the potential barriers to acceptance and understanding of the benefits of adopting and ACT group based pain management approach were discussed.

Call number: LD2668 .T4 1986 R53 / Master of Science / Hospitality Management and Dietetics

Familiares cuidadores de usuários de serviço de saúde mental têm sido chamados a participar cada vez mais ativamente como provedores de suporte e cuidados às pessoas em situação de sofrimento mental. Neste contexto, a avaliação do serviço mostra-se central em se considerando a mudança de paradigma na assistência em saúde mental. O presente estudo objetivou avaliar a sobrecarga e a satisfação com o serviço de familiares cuidadores de pessoa em sofrimento mental, verificando sua relação com estresse, estressores do cuidado, qualidade de vida e enfrentamento. Participaram 54 familiares de usuários que frequentavam um serviço substitutivo de saúde mental em cuidado intensivo e semi-intensivo de uma cidade de médio porte do interior paulista. Os instrumentos utilizados foram: Escala de Sobrecarga dos Familiares de Pacientes Psiquiátricos (FBIS-Br); Escala de Avaliação da Satisfação dos Familiares em Serviços de Saúde Mental (SATIS-Br); Inventário de Sintomas de Stress para Adultos de Lipp (ISSL); Inventário de Estratégias de Coping de Folkman e Lazarus; Escala de Qualidade de Vida versão abreviada (WHOQOL-Bref) e Roteiro Complementar. Os dados foram tratados por meio de estatística não-paramétrica e se adotou valor p<=0,05. Verificaram-se moderada sobrecarga objetiva e de moderada a elevada sobrecarga subjetiva. Entre participantes com estresse, foi maior a sobrecarga objetiva (p=0,000) e subjetiva (p=0,04). As mulheres apresentaram maior sobrecarga objetiva devido à supervisão aos comportamentos problemáticos comparativamente aos homens (p=0,04). Foi encontrada maior sobrecarga objetiva entre participantes cujos usuários possuíam o diagnóstico de esquizofrenia (p=0,01). Verificou-se correlação positiva entre sobrecarga objetiva devido à assistência na vida cotidiana e tempo de diagnóstico (p=0,01) e tempo de tratamento (p=0,03). Observou-se correlação negativa entre sobrecarga objetiva e os domínios físico (p=0,04) e social (p=0,03) da qualidade de vida. Foi encontrada correlação positiva entre sobrecarga subjetiva e uso da estratégia de resolução de problemas (p=0,05). Em sua maioria, os cuidadores encontraram-se satisfeitos com o serviço frequentado pelo usuário. Verificou-se correlação negativa entre satisfação com resultado do tratamento e idade do usuário (p=0,006). Observou-se correlação negativa entre sobrecarga objetiva e satisfação com serviço (p=0,05). Dados descritivos apontaram para baixa participação do familiar cuidador no serviço e no tratamento do usuário. Concluiu-se que os familiares cuidadores apresentaram dificuldades no cuidado ao usuário. A sobrecarga apresentou impacto negativo na qualidade de vida dos participantes. O serviço de saúde mental não foi avaliado como possuindo recursos de alívio à sobrecarga do cuidador. Os dados apontam para a necessidade de maior articulação entre serviço substitutivo em saúde mental e rede básica, bem como elaboração e desenvolvimento de programas de intervenção que possam ajudar esses cuidadores no que diz respeito ao cuidado ao usuário e ao manejo de situações estressantes. (FAPESP). / Family caregivers of mental health service users have been called on to participate more actively in providing support and care to people with mental suffering. In this setting, service evaluation becomes central, considering the paradigm change that is taking place in mental health care. The goal of the present study was to evaluate family caregivers of individuals with mental suffering in terms of their overload and satisfaction towards the service, analyzing the relationship with stress, care stressors, quality of life, and coping. Participants were 54 relatives of individuals who attended a substitutive mental health service for intensive and semi-intensive care in a medium sized city in the state of Sao Paulo. The following instruments were used: Family Burden Interview Scale for Relatives of Psychiatric Patients (FBIS-Br); Satisfaction Assessment Scale for Relatives of Psychiatric Patients (SATIS-Br); Lipp\'s Inventory of Stress Symptoms for Adults (ISSL); Coping Strategy Inventory by Folkman and Lazarus; Quality of Life Scale, shorter version (WHOQOL-Bref) and a Complementary Script. Data were treated using non-parametric statistics and considering p<=0.05. It was found that objective burden was moderate and subjective burden was moderate to high. Participants with stress had higher objective (p=0.000) and subjective (p=0.04) burdens. Objective burden was greater among women, because of the supervision of problematic behaviors, compared to men (p=0.04). Participants who were caregivers of users diagnosed with schizophrenia showed greater objective burden (p=0.01). A positive correlation was found between objective burden due to everyday life care and time of diagnosis (p=0.01) and time of treatment (p=0.03). A negative correlation was observed between objective burden and the physical (p=004) and social (p=0.03) domains of quality of life. A positive correlation was found between subjective burden and using the problem solving strategy (p=0.05). Most caregivers were satisfied with the service attended by the user. A negative correlation was observed between satisfaction towards the treatment outcome and user\'s age (p=0.006). There was also a negative correlation between objective burden and satisfaction towards the service (p=0.05). Descriptive data pointed at the poor participation of family caregivers in the service and in the treatment of the user. In conclusion, family caregivers face difficulties in providing care to the user. The burden had a negative impact on the participants\' quality of life. The mental health service did not have resources to relieve caregiver burden. The data show that there is a need to improve the articulation between substitutive mental health services and the primary care level, as well as to design and develop intervention programs that could help those caregivers in terms of providing care to users and managing stressful situations. (FAPESP).

Esse estudo teve como objetivo avaliar a evolução dos pacientes com síndrome de dependência de álcool nas dimensões sociais e de saúde. Metodologia: O desenho metodológico do estudo é do tipo longitudinal e a mensuração da evolução do tratamento ocorreu por meio da abordagem quantitativa. A amostra foi composta por 35 pacientes de ambos os sexos com diagnóstico de síndrome de dependência alcoólica em tratamento no CAPS - AD II de Ribeirão Preto-SP. A evolução do tratamento foi realizada por meio de duas avaliações, sendo a primeira consulta no primeiro mês e a segunda agendada para três meses posteriormente ao início do tratamento. Para a coleta de dados utilizouse o The Addiction Severity Index ASI, um questionário que possibilita mensurar a evolução do tratamento considerando seis áreas de maior importância da vida da pessoa. Resultados: identificou-se que os usuários em tratamento no CAPS - AD II são adultos, a maioria do sexo masculino, de cor branca, solteiros/separados, católicos, possui baixo nível de escolaridade, quase a metade está desempregado e os que trabalham recebem uma renda mensal entre R$380 a R$1000. Para a análise estatística das áreas do ASI, dos dados sociodemográficos e do padrão de uso utilizaram-se o modelo estatístico da análise linear de efeitos mistos. Desse modo, a idade, a escolaridade, o estado civil, a religião, o emprego, a renda, os anos de consumo de álcool, a freqüência de uso e o valor em dinheiro gasto com o uso foram as variáveis que influenciaram na evolução do tratamento em cada área. Os resultados indicaram que a evolução do tratamento foi positiva ao longo dos três meses nas Áreas Uso de Álcool, Legal, Relação Família/Social e nas Condições Psiquiátricas. Conclusão: A relação entre o consumo do álcool e as conseqüências sociais e de saúde são complexas e multidimensionais. Avaliar a evolução do tratamento de pacientes alcoolistas de um CAPS - AD possibilitou identificar as características sociais e de saúde que podem contribuir de maneira mais apropriada no norteamento e planejamento da assistência a essa população. / This study aimed to evaluate the evolution of patients with alcohol dependency syndrome in terms of social and health dimensions. Methodology: The methodological design is longitudinal and the measurement of the treatment evolution occurred through qualitative approach. The sample was composed of 35 patients, both genders, with diagnosis of alcohol dependency syndrome in treatment at CAPS-ad II in Ribeirão Preto - SP, Brazil. The treatment evolution was measured through two evaluations, the first consultation in the first month and the second one scheduled for three months after the beginning of the treatment. The Addiction Severity Index ASI, a questionnaire that measures the treatment evolution considering six areas of high importance in a persons life, was used for data collection. Results: It was identified that users at CAPS-ad II, in treatment for alcoholism, are adults, male in their majority, white, single, catholic, with low schooling, almost half of them are unemployed, and those who work have a monthly income ranging from R$ 380 to R$ 1000. For the statistical analysis of the socio-demographic data, pattern of use, and ASI areas, the linear mixed-effects statistical model was used. This way, age, schooling, marital status, religion, work, income, years of alcohol consumption, frequency of use, and amount of money spent in each area were the variables that influenced the treatment evolution in each area. Results indicate that the treatment evolution was positive over the three months in the areas of Alcohol Use, Legal, Family/Social Relation and Psychiatric conditions. Conclusion: The relation between the consumption of alcohol and social and health consequences are complex and multidimensional. Evaluating the treatment evolution of alcoholic patients in one of the CAPS-ad allowed the identification of social and health characteristics that can contribute in a more effective way in the planning and guiding the care delivered to the services users.