Дисертації: "Service to health"

1

Sheppard, Lorraine. "Service quality in professional health services /." Title page, contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09PH/09phs5495.pdf.

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Thesis (Ph. D.)--University of Adelaide, Graduate School of Management, 1999.
Includes one computer disk in Work 6 format. System requirements for accompanying computer disk: Mackintosh or IBM-compatible computer. Other requirments: Microsoft Word 6 or compatible Word Processor. Includes bibliographical references (leaves 241-270).

2

Bell, Louise. "Developing service quality and auditing in health services." Thesis, University of Kent, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310272.

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3

Oppong-Odiseng, Amma C. K. "Adolescent health : problems, needs, services and service providers." Thesis, Keele University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339846.

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Introduction There is a paucity of knowledge regarding adolescent's preferences for care. The health related problems they face have implications for individuals and nations. Objectives To determine the health problems and needs of adolescents, their knowledge, use of, and preferences for health related services and service providers. Study design A descriptive study involving a two-stage probability sample. An interview schedule was designed for data collection. Setting Eight randomly selected main-stream high schools in Stoke-on-Trent, England. Subjects One hundred and eleven males and 142 females aged 14 and 15 years between 1 st April and 30th June 1994. Results The adolescents had unmet problems and needs relating to lifestyle and risk-taking behaviour, sexual and reproductive health, and emotional problems, influenced by socio-economic and legislative factors. Services were used primarily for physical problems. Knowledge of the location and opening times of two local contraceptive services for adolescents was poor (10/253,4%). Factors they associated with confidentiality were identified. Preferences for service providers varied with the nature of the problem. The girls were more likely to give advice to peers regarding substance abuse, and issues relating to sexual and reproductive health, and expressed a greater preference for advice from peers on these issues. The services the adolescents wanted to see provided were appropriate to their needs and reflected a holistic concept of health. Conclusions • The Health of the Nation targets will not be met unless these problems and needs are addressed. • Potential intervention points for health promotion are being missed. • Local services must be widely advertised. • Adolescents need specific reassurance from service providers that their care will be confidential. • Positive actions adolescents are prepared to take need reinforcing. • Peer counselling programmes might be expected to have a greater positive impact on girls. • Adolescents' opinions regarding service provision must be taken into account.

4

Jones, Andrew Peter. "Health service accessability and health outcomes." Thesis, University of East Anglia, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296338.

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5

Peltomaa, M. (Miira). "User-centric service design in mobile health care services." Master's thesis, University of Oulu, 2019. http://jultika.oulu.fi/Record/nbnfioulu-201906052408.

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Abstract. The growing age of populations brings widespread problems for a range of services, including health care services. Another challenge is the areas of dispersed settlement and decreasing population in rural areas. Urbanization and movement to the larger cities after employment, education, and services has led to decreasing the services in the remote areas even further. In the changing needs of the requirements and challenges of health care entities the use of mobile health care services may provide many benefits to the systems to develop flexible and adjustable health services to citizens. With the help of mobile health care services, the requirements of ever-changing service needs may be responded more efficiently than traditional onsite health care centers. The purpose of this study is to understand the opportunities of user-centric service design and practices in the design processes of mobile health care services. In the future, mobile health care services may potentially be a medium for implementing the health and social service delivery as one of the standard mediums in order to reduce inconsistencies between habitant areas in Finland. By designing user-centric services with methods that leave room for ongoing development and improvement of mobile health care services. The nature of the study is a qualitative case study. The research phenomenon is approached by semi-structured interviews, to define practicalities in the planning of a mobile health care services. The target group of the interview is particularly chosen participants from representative organizations from both private and public health sector. The results of the study confirm the adaptability of user-centric service design in mobile health care services. It also reveals many practical aspects regarding the design process and the possibilities in co-design activities. More precisely, this study suggests that the user of the service can be included in all stages of service design process of mobile health care services in several ways — from defining the need to the implementation and ongoing development. The user-centricity in the context of this study means the users of the service that are involved in the service operations along its way — including employees and other encounters to the service. The results of the study contribute to the model of service design by assessing its suitability to designing mobile health care services with user-centric approach, and gathering concrete practices of those methods.

6

Tilmon-Kellum, Rosemary. "RTK Home Health Service." Thesis, California State University, Long Beach, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10599915.

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Home health care is heavily utilized to assist homebound clientele with a variety of medical needs. Home health services greatest population is the baby boomers. This population has multiple chronic medical problems that requires surgical intervention, disabilities that limit mobility, many suffer from a loss of mental capacities, or they suffer from depression which affects their physical and mental well-being. Because this population will continue to grow over the next several years, there will continue to be a growing need for home health care. RTK Home Health Services proposes to improve the home care delivered to this population by introducing a new psychological concept that is currently helpful in Psychiatry. The goal is to introduce this service during therapy sessions to decrease the emotional perception of pain by meditating. The full name of this service is Mindfulness Based Stress Reduction Techniques. It is accomplished by instituting meditation prior to therapy to convince the client to control and manipulate their perception to pain during therapy.

7

Baker, Stephanie. "Staff and service user experiences of forensic mental health services." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/90135/.

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This thesis consists of three chapters. Chapter one is a systematic review of the qualitative literature examining the experiences of clinicians working in mental health services with forensic service users (FSU). Following systematic searches and a process of quality assessment, a total of 14 articles were included and their findings were systematically compared. Staff members experienced both positive and negative emotional responses to their work, there are conflicting aspects to their role and additional challenges within the organisational context. Implications for clinical practice and further research are discussed. Chapter two uses Interpretative Phenomenological Analysis (IPA) to consider the experiences of FSUs diagnosed with Personality Disorder (PD) in Forensic Services and the meaning given to recovery within their accounts. The findings discuss the disempowered position of FSU participants and suggest that feeling safe within relationships in their environment is important for those with this diagnosis. There was evidence in their accounts of attempts to establish new identities but there also appeared to be multiple barriers to this. Chapter three offers a reflective account of the researcher’s experience of carrying out this study. It demonstrates the reflexive strategies used that allowed the competing subjective roles alongside that of ‘researcher’, to be examined and their influence on the research process explored.

8

Greene, Joseph Harrison. "Development of a social service program for college health services." CSUSB ScholarWorks, 2001. https://scholarworks.lib.csusb.edu/etd-project/1869.

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The initial development of a social services program in a college health setting is presented, with discussion regarding causes, methods, and outcomes. Both empirical and anecdotal data which were influential in the initial formation of the program are reviewed, in the context of an examination of the research literature relating to this area. The actual development and implementation of the program is followed through its first year of existence. Outcomes are presented in the form of qualitative data analysis and case studies. Discussion of the results and recommendations for both future research and improvements to the program are presented.

9

Price, Juliet. "Socioeconomic position and the National Health Service orthodontic service." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/socioeconomic-position-and-the-national-health-service-orthodontic-service(b4b4d25b-826a-4efe-83ae-50c18fafcf6a).html.

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Background: The National Health Service (NHS) aims to achieve maximum health gains with its limited resources, while also ensuring that it provides services according to need, irrespective of factors such as socioeconomic position (SEP). Aim: The aim of this thesis is to explore the relationships between SEP and various aspects of the NHS orthodontic service, including need, demand, supply, and outcomes. Methods: Three main data sources were used: two population-based surveys (the 2003 United Kingdom (UK) Children’s Dental Health Survey (CDHS) and the 2008-2009 NHS Dental Epidemiology Programme for England Oral Health Survey (OHS) in the North West) and an administrative data set (containing 2008-2012 North West NHS orthodontic activity data). The data were used to investigate levels of need and willingness to have orthodontic treatment, treatment utilisation, assessment procedures, and treatment outcomes, and the costs associated with the service. Subsequently, regression analyses were carried out to explore the associations between SEP and the various orthodontic variables. Results: Over a third of 12-year-olds had normative need for orthodontic treatment and over half had patient-defined need. Those in the most deprived groups in the North West tended to have lower levels of treatment compared to those in the least deprived group (despite the fact that normative need was not shown to vary by SEP), and they were more likely to discontinue treatment and have residual post-treatment need (RPTN). There was a great deal of variation among practices/orthodontic clinicians in terms of the percentages of patients with repeated assessments, treatment discontinuations, and RPTN. The major sources of potential inefficiency costs in the NHS orthodontic service in the North West are treatments that result in discontinuations (which cost £2.4 million per year), RPTN (which cost £1.8 million per year), and unreported treatment outcomes (which cost £13.0 million per year). Discussion: The NHS is not delivering orthodontic care equitably between SEP groups in the North West, as those from more deprived groups are more likely to fail to receive treatment, and to have poor outcomes if they do receive treatment. In addition, the wide range of process and outcome indicators between practices/orthodontic clinicians raises issues about quality of the overall service. In particular, treatment outcomes are frequently unreported, which highlights the need to improve the outcome monitoring systems in the NHS orthodontic service.

10

Thomas, Karen Anne. "The National Health Service contract for pharmaceutical services 1995 to 1998." Thesis, University of Portsmouth, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368471.

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11

Goldberg, Looney Lisa. "Military Service Members’ and Veterans’ Preferred Approach to Mental Health Services." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3608.

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Mental health services are greatly underutilized by military service members and veterans. Among the reasons for this underutilization is that the services offered may not be a good fit for the specific problems facing service members/veterans and/or their families. The current study presented service members with descriptions of several approaches to treatment and asked them to indicate the likelihood of using each. Service members indicated the highest likelihood for using self-directed services, followed by individual treatment with a professional. They reported being least likely to use group approaches. These results may inform decisions about the implementation and dissemination of information about existing and new services.

12

Dixon, Decia Nicole. "Mental health service delivery systems and perceived qualifications of mental health service providers in school settings." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0002991.

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13

Lawlor, Mary Ann C. "Predictors of Health Service Use in Persons with Heart Failure." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1619702345236178.

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14

Hammer, Joakim, and Olle Lind. "Scalable platform for health service integrations." Thesis, KTH, Data- och elektroteknik, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-123584.

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This thesis was performed at the company ShapeUp Club located in Stockholm, Sweden. ShapeUp Club offers a digital calorie counter service for the web, iOS and Android with data synchronization across the platforms. ShapeUp Club wants to provide their users with the option to synchronize data between ShapeUp Club and external health services. The objective for this thesis has been to develop an extension to ShapeUp Clubs current backend platform where new external health services can be plugged-in quickly and scalable. External partner APIs will be examined and implemented in the system to validate the functionality of the system. The amount of code needed to plug-in a service should be as minimal as possible for a developer to quickly add another service. To allow for scalability the platform also needs to adapt logic for how often users should be allowed to poll for data from their connected services, to minimize the database load for all parts. To handle these demands, an extension to ShapeUp Club’s current backend solution was built using the Django framework for Python. By providing a generic base class that new services inherit from, the amount of code necessary for implementing a new service is reduced to methods for API- requests, authorization and serialization of data. To reduce the number of redundant poll requests, users are placed into groups. Each group is a cluster of users with similar frequency of updates. Django’s cache framework is used to handle the concurrency of the sync tasks, which locks a user from syncing the same partner in parallel.
Detta examensarbete har utförts hos företaget ShapeUp Club i Stockholm. ShapeUp Club erbjuder en digital kaloriräknare för webben, iOS och Android med synkronisering av data mellan dessa plattformar. ShapeUp Club vill kunna erbjuda sina kunder möjligheten att synkronisera data mellan ShapeUp Club och andra externa hälsotjänster. Målet med detta projekt har varit att implementera en ny tjänst till ShapeUp Clubs nuvarande backend-lösning där externa hälsotjänster snabbt och skalbart kan implementeras. Externa hälso-API:er har utvärderats och implementerats i samband med utvecklingen av den nya backendtjänsten, för att validera dess funktionalitet. Mängden kod som behövs för att implementera en hälsotjänst bör vara så minimal som möjligt för att utvecklare snabbt ska kunna lägga till ytterligare tjänster. För att systemet ska vara skalbart måste logik finnas för hur ofta användare ska tillåtas att fråga efter data mot de tjänster de har valt att synkronisera mot. För att tillfredställa dessa behov har en utökning av ShapeUp Clubs nuvarande backend-lösning byggts med ramverket Django för Python. Genom att ha en större, generisk klass som nya implementeringar ärver från så har mängden nödvändig kod för varje hälsotjänst-implementering minskats till metoder för API-anrop, autentisering och serialisering av data. För att minska antalet “onödiga” poll-anrop så placerar vi användare i olika grupper beroende på om deras poll-anrop frekvent återvänder utan någon ny information. De olika grupperna bestämmer sedan hur länge användarna måste vänta innan de tillåts göra nya poll-anrop.

15

Evans, Keith Edward. "Contracts and the National Health Service." Thesis, University of Leicester, 1996. http://hdl.handle.net/2381/35481.

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16

Scott, Janet M. "The role of the service manager in the National Health Service." Thesis, University of Kent, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.342142.

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17

Gibson, P. Joseph. "Access to health care : Medicaid fee-for-service versus capitation /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/10882.

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18

Brickel, Molly Ashworth. "Service Seeking Behaviors among Service Members and Spouses of Service Members: Facilitating and Inhibitory Factors." Thesis, Virginia Tech, 2012. http://hdl.handle.net/10919/76950.

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While previous research has explored the relationship between combat exposure and mental health disorders, the effects of mental health disorders on attrition rates of Service members, the discrepancy between mental health counseling services available and utilized by Service members, and barriers to seeking mental health counseling services, the majority of studies thus far have only been conducted with Service members and have been quantitative in nature. While researchers have begun to explore the experience of deployment on Service member spouses, little research has focused specifically on their service seeking behavior regarding accessing mental health services. This is unfortunate given that multiple studies have indicated the importance of including Service member's spouses in future research. This qualitative study included both Service members and spouses of Service member's in an attempt to capture their mental health counseling service seeking behaviors. Thematic analysis was employed to develop a model of mental health seeking behavior among Service members and their spouses. The resulting model is unique in that it attempts to account for the influence of multiple contextual and ecological factors. Limitations of the study, future research and clinical implications are also discussed.
Master of Science

19

Beatty, Kate, Michael Meit, Tyler Carpenter, Amal Khoury, and Paula Masters. "Clinical Service Delivery Disparities along the Urban/Rural Continuum." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6847.

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background: Rural communities face numerous health disparities related to health behaviors, health outcomes, and access to medical care. LHDs serving rural communities have fewer resources to meet their community needs. The number and types of community organizations (hospitals, health clinics, not-for-profits), available to partner with may be limited geographically. These factors may affect availability of clinical services in rural communities. This study will assess LHD clinical service delivery levels based on rurality. data sets and sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area (RUCA) Both “micropolitan” and “rural” categories are considered rural by the Federal Office of Rural Health Policy. analysis: Bivariate analysis for 25 clinical services offered by rurality . For each service, we compared the proportions of LHDs that: 1) directly performed, 2) contracted with organizations, and 3) reported that the service was provided independently by organizations in the community. principal findings: Analyses show significant differences in patterns of clinical services offered, contracted or provided by third parties based on rurality. LHDs in micropolitan areas provided more services directly than urban and rural LHDs (p≤0.001). Urban LHDs were more likely to contract with other organizations (p≤0.001). conclusions: Rural LHDs are less likely to offer, contract, or have services provided by another organization in the community, whereas larger rural (i.e., micropolitan) jurisdictions are more likely to directly provide these services. implications for public health practice and policy: Lower levels of clinical service delivery by rural LHDs may contribute to the access issues facing rural communities. Health care reform brings threats and opportunities for LHD clinical service delivery. Further analyses to assess impacts on rural LHDs and identify strategies to ensure access to clinical services is encouraged.

20

Asaria, Miqdad. "The economics of health inequality in the English National Health Service." Thesis, University of York, 2016. http://etheses.whiterose.ac.uk/16189/.

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This thesis explores the economics of health inequalities in the English National Health Service (NHS). It consists of five applied economic studies that explore different questions regarding socioeconomic inequalities and the NHS. It is bound together by an integrative chapter that provides the historical background to, and draws conclusions across, the body of work. The first of the five applied studies examined the financial costs that socioeconomic inequalities exact on the NHS, the second looked at socioeconomic inequalities in access to primary care, the third looked at socioeconomic inequalities in health outcomes attributable to the NHS, and the final two studies extended the established methods for the economic evaluation of health care programmes to explicitly value minimising socioeconomic health inequalities as well as maximising population health. These extended methods were termed distributional cost-effectiveness analysis. The studies found that dealing with the excess morbidity associated with socioeconomic inequalities cost the NHS approximately a fifth of its annual budget. Socioeconomic inequalities in access to and quality of primary care significantly improved from 2004 to 2011 in response to government policy to tackle these. However, socioeconomic inequalities in health outcomes stubbornly persisted over this period, by 2011 socioeconomic inequality was still associated with over 158 000 patients experiencing one or more preventable hospital admissions and almost 40 000 patients dying from causes amenable to health care. Distributional cost-effectiveness analysis methods were shown to be practically applicable in an NHS setting. This was demonstrated using a case study comparing population health programmes in which trading off between health maximisation and health inequality minimisation was necessary. The thesis provides an evidence base and practical new methods that should serve as a foundation to better understand the role of the NHS in tackling socioeconomic inequalities in health. In so doing, it also outlines an exciting programme of further research.

21

Zamora, Laura. "Azura digital health| Scheduling application and prescription service for women's health." Thesis, California State University, Long Beach, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10260903.

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In recent years, the financial barrier to access for prescription contraceptives has been lifted due to the Affordable Care Act. However, there is still a barrier to access because those who want it still need to get a prescription from a provider. This business plan proposes the establishment of Azura Digital Health, a scheduling tool that obstetricians and gynecologists can use to schedule their appointments, while also offering patients convenience for birth control prescriptions and assistance with finding the women’s health provider that is right for them. Allowing patients to choose their provider can increase quality for their health, since they can choose the doctor they feel is best for them. Additionally, the convenience of getting their birth control prescription helps patients get a simple prescription for what they need in a timely manner. The scheduling tool allows providers to market themselves and broaden their patient base, as Azura Digital Health would do that work for them. Azura Digital Health hopes to improve women’s healthcare quality, breaking the barrier to prescriber access.

22

Aschan, Lisa. "Health inequalities and mental health service use in mental-physical comorbidity." Thesis, King's College London (University of London), 2015. https://kclpure.kcl.ac.uk/portal/en/theses/health-inequalities-and-mental-health-service-use-in-mentalphysical-comorbidity(6f2c678e-1d94-40c0-9622-333539e46c4b).html.

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Although mental and physical health are likely to share common social causes, most mental-physical comorbidity research has focused on immediate mechanisms between mental and physical illness. This thesis takes a social epidemiological approach to mental-physical comorbidity, where social disadvantage and the disproportionate availability of resources are central. The amplified burden of comorbidity in terms of poor health and functioning may have implications for the relationship between comorbidity and mental health service use (MHSU). Whilst much research examines the impact of comorbidity on physical health services, MHSU is under-researched. Furthermore, comorbidity inequalities may be perpetuated through processes of cumulative disadvantage. For example, barriers to social participation may deplete resources over time, thus leading to worse health outcomes and more adverse social circumstances. This project therefore aims to: 1. Estimate the prevalence of comorbidity, and describe inequalities in mental-physical comorbidity by key socio-demographic and socioeconomic factors 2. Describe and explain the association between comorbidity and mental health service utilisation and quality 3. Describe the trajectories of social functioning by comorbidity Analyses make use of survey data from the South East London Community Health Survey (SELCoH) phases 1 (N=1698) and 2 (N=1052) (73% response among those approached at follow-up). Statistical methods used include weighted cross-sectional and longitudinal regression analyses. The results indicate that comorbidity is associated with distinct socio-economic inequalities (most consistently by household income), increased MHSU over time, and persistent social exclusion. This suggests that comorbidity reflects a process of cumulative disadvantage, which has important implications for comorbidity and health inequality research, and local services and policy makers. Altering the downward spiralling trajectories of health and social disadvantage among those with mental-physical comorbidity may be addressed through integrated care models, while interventions aimed at reducing social inequalities may effectively 3 prevent comorbidity and interrupt its downward spiralling course of disadvantage.

23

Blakey, Heather. "Participation¿why bother?: The views of Black and Minority Ethnic mental health service users on participation in the NHS in Bradford. Report of a community research process undertaken by the International Centre for Participation Studies, University of Bradford and Sharing Voices (Bradford)." International Centre for Participation Studies, 2005. http://hdl.handle.net/10454/3798.

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Yes
The International Centre for Participation Studies and Sharing Voices Bradford (for information on these organisations, see Appendices 3 and 4) maintain that participation is an important part of a healthy democracy, with benefits for all. However, participation can be anything from empowering to tokenistic, and must be critically examined if we are to understand how to use it effectively. This paper considers the contribution of participation to improved service delivery in the health service. For beneficiaries, participation can be about ownership and responsibility for the services we use, as well as rights and the chance to express what we want from them. For service providers, participation is widely recognised as an effective way of tailoring services to the needs of the different communities they serve. The NHS and other service providers have made great strides in developing mechanisms for participation by service users. However, these do not always reach all sections of the community. Many individuals feel sceptical about getting involved, unconvinced that their contribution could make a real difference. Through the Participation ¿ Why Bother? workshops, we set out to explore these feelings, to reflect on perceived barriers and identify changes that might help overcome them. The aim was not to look at the substance of service delivery issues, but to try and work out how the process of involving people in decision-making in the NHS could be improved, to make it easier for voices from Black and Minority Ethnic (BME) communities to be heard.
Bradford District Care Trust; South and West PCT; City tPCT

24

Wang, Yu. "A geospatial analysis of the community health service in Jinan City, China : access to services and health outcomes." Thesis, University of Cambridge, 2014. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708124.

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25

Crepaz-Keay, David. "Effective mental health service user involvement : establishing a consensus on indicators of effective involvement in mental health services." Thesis, Middlesex University, 2014. http://eprints.mdx.ac.uk/13932/.

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Mental health service user involvement had been UK government policy since the early 1990s. This dissertation explored the current state of policy and practice in mental health service user involvement by reviewing peer reviewed literature. A number of potential indicators of effective involvement were drawn from the literature. A discrepancy was found between policy and practice and the concept of indicators of effective involvement was proposed to support the process of enabling practice to develop to match policy expectations. A number of approaches to developing indicators were explored, with the explicit aim of introducing greater mental health service user ownership of the concept of effective involvement. In order to ensure both broad engagement and a degree of consensus, the Delphi process was chosen. An expert panel of mental health service users from England was recruited against a person specification co-developed with the National Survivor User Network (NSUN, an England wide, national network led by and for mental health service users). The 38 panel members represented a spread of ages and came from every region of the country. They have experience of and expertise in involvement at a strategic, operational and individual level. The panel completed two rounds of a Delphi process using an online tool. The panel reached consensus on 21 indicators of effective mental health service user involvement. There was a clear preference for collaborative involvement where service users and professionals worked together in a partnership that was as equal as possible. The chosen indicators have already influenced a number of international, national and local initiatives and have been used to support the development national standards for service user involvement in England.

26

Fossum, Bjöörn. "Communication in the health service : two examples /." Stockholm : Karolinska inst, 2003. http://diss.kib.ki.se/2003/91-7349-667-7/.

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27

Tucker, Ian. "Deterritorialising mental health : unfolding service user experience." Thesis, Loughborough University, 2006. https://dspace.lboro.ac.uk/2134/5445.

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Mental health has a long history of proving to be a tough concept to define. Multiple forms of knowledge and representation seek to inform as to the nature of mental health, all contributing to the production of immense complexity as to the experience of living with mental health difficulties. This thesis sets out to explore this, by getting as close as possible to mental health service users' actual experiences. A range of forms of knowledge that pertain to inform as to service users' experiences are explored, prior to analysing a corpus of interviews with service users. These are analysed through the development of a Deleuzian Discourse Analysis. Service users' experiences are analysed in terms of the relation between discursive and non-discursive factors, which include forms of mainstream psychiatric discursive practice, such as the application of diagnostic criteria and administration of treatments, along with how such practices are experienced in non-discursive dimensions of service user embodiment and space. The challenges facing service users are seen to operate around identity and control in relation to forms of psychiatric knowledge, along with presenting particular problems with regard to how user embodiment is felt, primarily in relation to psychiatric medication, and how these are driven into the production of service user spaces, i.e. day centres. Finally, a politics of affectivity is offered, as a way to unfold the complexity of service user experience, and to emphasise the existence and potential for change that can be gained through deterritorialising mental health.

28

Jain, Swati. "PsychWeb online mental health service| Business plan." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10124519.

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Over the past several years, mental healthcare system in United States has evolved tremendously, however majority of people are still struggling with various forms of mental illness and find it difficult to get appropriate treatment at the right time due to barriers like lack of providers, poor access, high cost and, social stigma. This business plan proposes an online mental health service company PsychWeb, offering telemental health services, with the aim of improving access to mental healthcare in the comfort of one’s own living environment.

Chapter 1 of this business plan is about complete market analysis for the online mental health industry along with the business overview for PsychWeb and its services. It also sheds light on business target population, competitors, growth strategies and proposed future milestones. Chapter 2 shows an in depth feasibility analysis using SWOT that ensures business viability and success. In chapter 3, we have discussed the legal and regulatory issues, along with company formation, and laws around provider and patient use of PsychWeb services laying stress on HIPAA and provider licensure requirements at the state and federal level. Lastly, chapter 4 explains the financial analysis conducted to ensure the business profitability. It gives a detailed breakdown of monthly and yearly expenditures, revenues generated and profit margin projections. All financial statements generated in the process are provided in the appendix of this business plan.

29

Kelly, James Miller. "The Dairy Herd Health and Productivity Service." Thesis, University of Edinburgh, 2001. http://hdl.handle.net/1842/29828.

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The veterinary input to many dairy farms is at best routine fertility visits confirmed to examination of the reproductive tract, and at worst occasional emergency calls. The Dairy Herd Health and Productivity Service (DHHPS) was established to provide the opportunity for veterinary surgeons to lead a multidisciplinary team which can monitor health, fertility and production and can plan remedial action, when necessary. Over a period of twenty years it has continued to identify infertility, mastitis and lameness as the main reason for the involuntary disposal of dairy cows, although on some farms BSE has been a major factor. The trend in the last few years has been for an increase in culling for reasons of disease rather than or age or yield. The average disease rates have remained consistently high with over 100 treatments per 100 cows each year. Infertility, mastitis and lameness are the most common disease problems on DHHPS farms. Blood profiling and condition scoring have demonstrated that at least a third of cows tested were mobilising excessive fat during the transition from the dry period to early lactation. The DHHPS found 34.3% of 9,235 dry cows, sampled 0-14 days before calving and 28 per cent of 20,502 cows between 5-40 days post calving, had raised BHB blood concentrations. 30.6 per cent of the same dry cows and 21.9 per cent of the early lactation animals had elevated NEFA results. Blood urea was measured to reflect the current protein intake and the protein/energy balance of the ration. 14 per cent of 9325 dry cows and 9.5 per cent of 20502 of early lactation cows had low urea N (<17 mmol/l). 25 per cent of the cows sampled between 5-40 post partum had blood urea nitrogen concentrations above 3.3mmol/l. Low magnesium levels were detected throughout the year. 9.2 per cent of 9235 dry cows and 7 per cent of 19,738 early lactation cows between 5-40 days calved had blood magnesium concentration <0.8 mmol/l.

30

Lund, Crick. "Mental health service norms in South Africa." Doctoral thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/10620.

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Bibliography: p. 297-335.
This thesis includes four main aspects. Firstly, a situation analysis was conducted of current national public sector mental health services in South Africa, using nine service indicators. Secondly, a model was developed for estimating the mental health service needs of people with psychiatric conditions in a local South African population. Thirdly, a set of service norms was proposed for each of the nine service indicators, informed by data from the situation analysis. Fourthly, a practical user-friendly planning manual was developed, using the situation analysis, model and norms to provide guidelines for the planning of mental health services by local and provincial planners.

31

Cameron, Nancy G. "Health Officer’s Service in Civil Air Patrol." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/7066.

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32

Macpherson, Elinor Carol. "Manpower substitution in mental health service delivery." Thesis, University of British Columbia, 1988. http://hdl.handle.net/2429/27988.

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The study developed a model for projecting potential economies from manpower substitution among the four core mental health professions and applied the model to a proposed substitution situation which would substitute psychologists for psychiatrists in the delivery of a proportion of present private practice (fee-for-service) psychiatry services in British Columbia. The model identifies three controlling variables: treatment substitutability (TS), practice privilege constraints (PPC), and relative payment rates (RR). In the model, TS and PPC are conceptualized as determining the estimated substitutable share of costs (SSC%); RR, in combination with the values derived for SSC%, is then used to estimate potential cost savings (CS%). Two conditions were defined for each of the three controlling variables in order to provide a range of possible values for SSC% and CS%. For reasons of data availability, data were obtained from the Manitoba Health Services Commission for private practice psychiatry services for FY 1984 and estimates of SSC% calculated. These estimates were then applied to B.C. Medical Services Commission data for FY 1984, and projected values of CS% calculated. Calculations were made both for all services and for the subset of psychotherapy services, which accounted for 80 percent of the larger set of services. The results of the study indicated considerable possibilities for manpower substitution, ranging from 35 to 70 percent for all services and 40 to 75 percent for psychotherapy services. However, the study also found that while salaried psychologists offered the possibility of substantial cost savings, a fee-for-service arrangement suggested virtually no potential savings. Projected values of CS% for the salaried alternative were 20 to 40 percent for all services and 15 to 30 percent for psychotherapy services but in the fee-for-service alternative, only 4 to 8 percent for all services and 4 to 7 percent for psychotherapy services. Licensure and market rigidities which might pose barriers to implementation were evaluated and a review of professional training standards (TS), licensure standards (PPC), and funding alternatives (RR) indicated that the projected economies could be achieved with no necessity for modifications in existing arrangements. PPC appear to present almost no barriers to economies from the proposed manpower substitution and those barriers which are presented by TS and RR limitations still allow considerable potential for economies. Thus, the greatest opportunities for intervention in achieving and enhancing the projected, economies appear to be in the exploration of relative payment rates and relative effectiveness of treatment methods (e.g., psychotherapy vs. pharmacotherapy). The study concludes with a discussion of factors lying outside the boundaries of the model but which impinge, nonetheless, upon the feasibility of the proposed substitution and fall, necessarily, to policy makers to address. The existing network of B.C. community mental health centres was suggested as a possible mechanism for the delivery of the substitutable share of private practice psychiatry services.
Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate

33

Riddington, Megan. "Rethinking rehabilitation : the lived-experience of service users in mental health rehabilitation services." Thesis, University of East London, 2009. http://roar.uel.ac.uk/3736/.

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Introduction: Community-based mental health rehabilitation is increasingly viewed as occupying a central position within the spectrum of care available to people with 'severe mental illness' (DH, 1999, pp.5). The definitions of rehabilitation informing this care primarily originate from service providers; service user understandings and experiences of rehabilitation have been inadequately explored, and the relationship between it and the potentially related concept of 'recovery' has not been examined. This study begins to address these issues by exploring the lived-experience in mental heath rehabilitation services, with specific attention to understandings and experience of rehabilitation. In doing so, it seeks to promote a fuller understanding of rehabilitation, benefiting the development and delivery of services, whilst providing a foundation from which the desirability of a unified definition of rehabilitation can be considered. Method: Semi-structured, audio-recorded interviews were undertaken with eight participants (seven men and one woman) recruited from 24-hour nurse-supported community mental health rehabilitation provisions. Interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis (Smith & Osborn, 2003). Results: Analysis yielded the three master themes of (i) 'Positioning of Power'; (ii) 'Moving Forward' and (iii) 'A Conducive Setting'. Within these themes respectively, the six subordinate themes of (i) 'Control' and 'Meeting Standards', (ii) 'Being Involved in a Process' and 'Independence through Skills' and (iii) 'Relationships, Re-engagement and Togetherness' and 'Nurturing Environment' were identified. Discussion: The analysis is discussed in relation to the extant literature base, with particular focus on relationships, power, independence, and moving on through services. Implications are identified and recommendations for clinical practice and research are considered. Critical review: The study is reviewed with specific attention to its limitations, quality and control, and the impact of researcher factors on the research process.

34

Ford, Tasmin Jane. "Services for children with mental health disorders : rates and predictors of service use." Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.412482.

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35

Powell, Alison. "Examining the implementation of acute pain services in the UK National Health Service." Thesis, University of St Andrews, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.667194.

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36

Cook, Jacqueline S. "With good intentions: Appalachian service providers in human services and community mental health." Diss., Virginia Polytechnic Institute and State University, 1986. http://hdl.handle.net/10919/76485.

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This study is a self-assessment of a small group of Appalachian face-to-face service providers in human services and community mental health. It has evolved from their daily experiences. The purpose of the study has been to reflect back to these providers information about themselves. That reflection has been given in the form of an Adlerian life style analysis, a psychological assessment for individuals modified as assessment of a group. The reflected impression provided its own image for change and an opportunity for the participants to assess what impact, if any, their jobs might be having on other aspects of their lives. In the process of informing the participants about themselves, there has been the intent to give that same information to the people who come for services, supervisors, administrators, policy makers, and ultimately the community of academics and scholars. The author of this study functioned as a co-worker with the other participants, becoming a part of that system which she was observing. The job gave wide access for observation and work with the participants in a variety of settings. The primary interactions took place in the homes of families referred for alleged child abuse and neglect, to include sexual abuse. The methodology allowed the research effort to be one of exploration and evolution. Based on the notion expressed by Carol Ehrlich that people can do research for and about themselves rather than having others do it for them, it drew from several theorists, described in order of their use in the study: H.T.Wilson, Brian Fay, Alfred Adler, Stephen Fawcett, and George Gazda. Presenting one subjective view of reality, conclusions of the study pointed to unconscious guilt on the part of participants with respect to system inadequacies, marked by a desire to feel superior in the helping relationship or in the relationship with those perceived to have authority over them. Unaware of these feelings, and in the simple performance of their jobs, the participants help to perpetuate the systems in which they work and often purport to deplore.
Ph. D.

37

Mowbray, Derek. "Decision making in the Management Advisory Service to the National Health Service." Thesis, University of Bath, 1991. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.306735.

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38

Woodbridge-Dodd, Kim. "A discursive study of how mental health social workers constructed their professional selves within the context of National Health Service mental health services." Thesis, University of Northampton, 2017. http://nectar.northampton.ac.uk/9721/.

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Since the 1990s there have been continued drives in England to integrate National Health Services and Local Authorities’ social care within a single mental health service, with the aim of bringing about improvements in health and social care (Local Government Association et al., 2016). This is underpinned by the belief that through bringing the different professional health (such as psychiatrists and mental health nurses) and social care disciplines together, people in need will have a single point of access to a range of skills and knowledge, that no one system could deliver alone (Cooper, 2017). However, the very unique professional approaches that have been stated as the reason to place social workers in NHS Mental Health Services have been the ones that mental health social workers have struggled to hold onto in this setting (Allen et al., 2016). This is a thesis of how mental health social workers constructed a professional self within the context of the NHS mental health services. I used a Foucauldian approach and the notion that professional identity is a socially constructed sense of self, produced from discourses, subject positions and a process of subjectification. Twelve social workers were interviewed; seven mental health social workers and five social workers who held positions as managers or educationalists. I asked social workers questions about their professional identity, their answers provided a rich source of ‘talk’ that I could analyse using Parker’s steps to discourse analysis. The findings discuss the nature of social work as a profession, generic and specialist social work, and suggests a typology of subject positions drawn from the mental health social workers’ discourses. These findings provide a useful resource to support critical social work practice, both as an example of how Foucauldian theory and concepts can be a rich toolbox for understanding practice in complex settings, and through the use of the typology of subject positions as a source to prompt self-reflection for mental health social workers’ practice.

39

Meit, Michael, Kate E. Beatty, and Megan Heffernan. "Exploring Service Composition and Financing Among Rural LHDs." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6836.

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40

Chomi, Eunice Nahyuha. "Service provider's perceptions of the quality and accessiblity of health services under social health insurance in Dar-Es-Salaam." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/489.

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Social health insurance is a form of health care financing that has gained increased attention in African countries in the past decade. Tanzania introduced social health insurance by the establishment of the National Health Insurance Fund (NHIF) in 1999 with, inter alia, the objective of improvement of the quality and availability of health services. The goal of this study was to determine the perceptions of services providers on the quality and accessibility of health services following the introduction of social health insurance. A qualitative approach was used to gain an insider's perspective from the service providers of how the services have changed following the introduction of the scheme. Individual interviews, observation and field notes were used to gather information on the quality and accessibility of health services under the policy of social health insurance. Data were analysed using Tesch's method of data analysis. The health workers generally perceived the fund as being beneficial to its members as it reduced the financial barriers to receiving health care. However, the objectives of the NHIF as a health financing mechanism were not adequately understood by the health workers. Although they perceived the quality of health services as having improved compared to previous years, they did not associate this improvement with the NHIF. The health workers also perceived accessibility of health services as having improved for insured patients but not for non-insured patients.

41

Xu, Fang, and 徐方. "Self-rated health, chronic diseases and health service utilisation in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2015. http://hdl.handle.net/10722/212607.

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Introduction Self-rated health (SRH) is a widely used indicator of health service utilisation and reflects self-perceived objective health condition. Poorer non-comparative SRH was shown to be related to higher inpatient and outpatient utilisation in Western and elderly populations. Little is known about how healthcare utilisation relates to SRH in non-Western settings, such as Hong Kong and in adult populations. The association of age- and time- comparative SRH with healthcare utilisation is also unclear. This study aimed to assess the association of three types of SRH (non-, age- and time- comparative SRH) with inpatient and outpatient utilisation in Hong Kong‟s general populaion. Methods Data were derived from 2011 Thematic Household Survey (THS), covering 23,892 non-institutional residents aged 20 and above. The study adopts Andersen‟s Behavioral Model of Health Service Use for the analytical framework. Healthcare utilisation was measured by inpatient use during the past year and outpatient use (including General Outpatient Clinic (GOPC) and Specialist Outpatient Clinic (SOPC)) during the past month, in terms of ever-use and the amount of use (bed-days and number of outpatient visits). SRH was measured with a 5-point Likert Scale: non-comparative SRH from “Excellent” to “Poor”; age- and time- comparative from “much worse” to “much better”. Logistic regression and zero-truncated negative binomial/ Poisson regression were applied to examine the association of SRH and chronic diseases with healthcare utilisation in the public and private sector separately as per the Andersen behavioral model. Results “Fair/ poor” non-comparative SRH was associated with higher inpatient and outpatient utilisation. The association was not significant for hospital bed-days. Similarly, age-comparative SRH was associated with inpatient (except private bed-days) and outpatient utilisation (except the number of SOPC visits). “Worse/ much worse” time-comparative SRH was associated with higher healthcare utilisation, but the relationship was less clear for private hospitalisation. The presence of cancer, cardiovascular diseases, diabetes, lower respiratory diseases, and musculoskeletal diseases were associated with higher healthcare utilisation, with stronger association observed for ever-use than the amount of use. The relationships between musculoskeletal diseases and inpatient utilisation, between cardiovascular diseases and diabetes and the number of private outpatient visits, and between lower respiratory diseases and GOPC utillisation were not significant. Conclusions The present study suggests SRH to be a useful health indicator of health service utilisation. All three SRH measures were associated with health service utilisation and no marked differences were observed between different measures. Poorer SRH were strongly related to higher public inpatient utilisation, with stronger association observed for ever hospitalisation than bed-days. Poorer SRH measures were also related to higher outpatient uilisation in both sectors during the past month. All the selected chronic conditions were related to increased healthcare use. The associations were less clear for hospital bed-days and the private sector. Future studies should focus on the predictive validity of SRH on future healthcare utilisation.
published_or_final_version
Public Health
Master
Master of Philosophy

42

Yalahow, Abdiasis. "Exploring the Reproductive Health Education of Health Service Professionals in Mogadishu, Somalia." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36709.

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Somalia has recently come out of a two decade long civil war and is currently in a post-war and rebuilding phase. The national health system, largely crippled during years of conflict, is faced with a significant maternal mortality ratio and the debilitating effects of a high fertility rate. To combat these issues, the new Somali government is working toward creating a strong national health system that addresses some of these key indicators. With a lack of human resources in healthcare and the need for better reproductive health services, the need to invest in educating a new generation of health service professionals is evident. To address this gap in education, many educational institutions with health science faculties have opened in the last decade but the quality and accuracy of their curricula has yet to be examined. My thesis addresses this gap in knowledge. Through a multi-methods study that included reviewing curricula and curricular materials, conducting key informant interviews, and facilitating focus group discussions, I was able to learn about the quality and comprehensiveness of reproductive health topics in health service professionals‟ education and training. Religion, culture, logistical issues, and lack of oversight shape the way reproductive health is taught to health students. This study provides an important foundation to help inform key stakeholders working to improve the Somali health system.

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Jallow, M., Melanie Haith-Cooper, Jae Hargan, and M.-C. Balaam. "A systematic review to identify key elements of effective public health interventions that address barriers to health services for refugees." Springer, 2021. http://hdl.handle.net/10454/18444.

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Yes
Aim: Refugees often face barriers to accessing health services, especially after resettlement. The aim of this study is to identify key elements of effective public health interventions that address barriers to health services for refugees. Methods: Key online databases were searched to identify studies published between 2010 and 2019. Six studies met the inclusion criteria: two qualitative, one quantitative and three mixed-methods studies. An adapted narrative synthesis framework was used which included thematic analysis for systematic reviews. Results: Five themes were identified: peer support, translation services, accessible intervention, health education and a multidisciplinary approach. Conclusion: These key elements identified from this review could be incorporated into public health interventions to support refugees’ access to health services. They could be useful for services targeting refugees generally, but also supporting services targeting refugee resettlement programmes such as the Syrian resettled refugees in the UK. Future research is needed to evaluate the impact of public health interventions where these elements have been integrated into the intervention.
The full-text of this article will be released for public view at the end of the publisher embargo on 23 Mar 2022.

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Aristidou, Angela. "Theorizing service user transitions through a relational practice perspective : insights from a study in the context of mental health services." Thesis, University of Cambridge, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708965.

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45

Beatty, Kate. "Clinical Service Delivery Disparities along the Urban/Rural Continuum." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6853.

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46

Roberts, Nicola. "Using attachment theory within mental health community services to improve patient outcomes and reduce service utilisation costs." Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/using-attachment-theory-within-mental-health-community-services-to-improve-patient-outcomes-and-reduce-service-utilisation-costs(78a9832e-0e8f-4d2b-a6a4-8d7ffdf5aa6d).html.

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This thesis follows the paper-based format and papers one and two have been prepared for submission to Attachment and Human Development and the British Journal of Clinical Psychology, respectively. The relevant submission guidelines are included in the appendices (Appendix A and B).Attachment theory (Bowlby, 1977a) has prompted a wealth of empirical research in its contribution to adult attachment patterns and subsequent psychopathology in mental health (Holmes, 2001; Wallin, 2007). More recently, attachment theory has been proposed as a suitable framework by which to inform the organisation, design and delivery of mental health services (Goodwin, 2003; Seager et al., 2007) but it is unclear what this would look like in practice. Adopting an attachment-informed service model has key implications for individual and service outcomes and the two papers presented in this thesis aim to contribute to research in this area, followed by a critical review of the research, its relevance and future implications. Paper one is a narrative overview of the literature discussing the practice implications of services adopting an attachment-informed framework, and describes how this might be conceptualised in front-line service delivery. Articles reviewed described the influence of attachment theory in predominantly inpatient, secure forensic and/or psychiatric rehabilitation services, and its application within more generic community mental health services was explored. Paper two aimed to investigate the importance of individual attachment and service attachment to client psychopathology, quality of life, service utilisation and service costs in community-based mental health services. The final section, the Critical Review, critiqued the literature review and aimed to place the research within a wider context. This section considers the findings from the research and the limitations of the study, while also highlighting important issues for services, with implications for clinical practice and future research.

47

Thompson, Dawn Louise. "The National Health Service Breast Screening Programme in Sheffield : service delivery and uptake." Thesis, University of Sheffield, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.286514.

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48

Beatty, Kate E., Nathan Hale, Michael Meit, Paula Masters, and Amal Khoury. "Clinical Service Delivery along the Urban/Rural Continuum." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6870.

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Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities. Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities. Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting Area codes. Bivariate analysis for clinical services was conducted by rural/urban status. For each service, the proportions of LHDs that directly performed the service, contracted with other organizations to provide the service, or reported provision of the service by independent organizations in the community was compared. Results: Analyses show significant differences in patterns of clinical services offered, contracted, or provided by others, based on rurality. LHDs serving rural communities, especially large rural LHDs, tend to provide more direct services than urban LHDs. Among rural LHDs, larger rural LHDs provided a broader array of services and reported more community capacity for delivery than small rural LHDs- particularly maternal and child health services. Implications: There are capacity differences between large and small rural LHDs. Limited capacity within small rural LHDs may result in providing less services, regardless of the availability of other providers within their communities. These findings provide valuable information on clinical service provision among LHDs, particularly in rural and underserved communities.

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O'Lonargain, Diarmaid. "Experiencing health services and mentalisation-based treatment for borderline personality disorder : service user perspectives." Thesis, Lancaster University, 2014. http://eprints.lancs.ac.uk/70688/.

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This doctoral thesis begins with a literature review that explores how individuals who meet criteria for borderline personality disorder (BPD) experience health services. Following a comprehensive literature search, a metasynthesis of 14 papers was conducted utilising Noblit and Hare’s (1988) meta-ethnographic approach. Findings indicate that the attitudes of professionals are exceptionally important to service users but are often experienced by them as judgmental and dismissing. Service users highly value communication, consistency and input into their own treatment and sometimes search for containment and meaning within health services. Barriers to treatment are highlighted which include negative attitudes from professionals, lack of input into treatment and insufficient security and support for service users in the community. Implications for health services are explored. The research paper that follows this is an interpretative phenomenological analysis (IPA) study on the experience of mentalisation-based treatment (MBT) for BPD from the perspective of adult service users. Seven participants were interviewed and findings illustrate that the group component of MBT was experienced as challenging and unpredictable. Trust was identified as key to benefitting from MBT and was much more difficult to obtain in group sessions than in individual therapy. However, participants attending MBT for longer than three months appeared to make progress with this. The structure of MBT generally worked well for participants but individual therapy was identified as the most important component and specific challenges were highlighted. All participants learned to look on the world differently due to MBT which resulted in a positive shift in experience for them. Implications for MBT are discussed in this paper. The subsequent section in this thesis is a critical appraisal that highlights key learning points and reflections from conducting the research paper.

50

Holbrook, Hannah Mead. "Referral Patterns and Service Provision in Child Protective Services: Child, Caregiver, and Case Predictors." ScholarWorks @ UVM, 2019. https://scholarworks.uvm.edu/graddis/921.

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Child maltreatment, and recurrent maltreatment in particular, occurs at an alarmingly high rate. Frequency of reports to Child Protective Services (CPS) is associated with negative psychological outcomes, and children whose reports are unsubstantiated experience similar risk of behavioral, emotional, and substance use disorders as those whose reports are substantiated. Prior research has demonstrated that children with no CPS reports and children with one CPS report showed no significant differences in rates of maltreatment perpetration or substance use in adulthood, suggesting that prevention efforts after one report may have strong merit in reducing negative outcomes in adulthood. However, patterns and risk factors of unsubstantiated reports have been only minimally explored thus far, despite having been found to predict subsequent maltreatment. The current study extends upon previous research by (a) examining both substantiated and unsubstantiated reports to identify longitudinal patterns of timing and recurrence and (b) assessing the extent to which service provision mediates long-term recurrence after each type of report. Analyses were conducted using subsamples of a longitudinal national dataset from 2011-2015 containing data from CPS reports for 3,655,951 children. Measures included child, caregiver, and CPS case characteristics obtained at the time of first report in 2011. Latent class analysis of referral patterns indicated four classes of recurrence patterns: (1) 2011 unsubstantiation followed by moderate recurrence, (2) 2011 unsubstantiation followed by low recurrence, (3) 2011 substantiation followed by moderate recurrence, and (4) 2011 substantiation followed by low recurrence. Multinomial logistic regression with most likely class membership as the outcome variable indicated that domestic violence, caregiver substance abuse, and poverty were better predictors of initial substantiation status than of long-term recurrence. Prior victimization was predictive of initial substantiation status as well as long-term recurrence. Asian American race predicted low rates of recurrence. Latent class analysis of service provision revealed only two classes: a class of children who received services and a class of children who did not. Service provision partially mediated associations between initial substantiation status and five-year maltreatment recurrence, as measured by number of subsequent reports, number of subsequent substantiated reports, and number of subsequent years in foster care. Limitations are considered and implications of using predictive modeling to drive service prioritization are discussed.

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