RESUMEN
PURPOSE: To identify facilitators and barriers to service reorganization, how they evolved and interacted to influence change during the implementation of a new service delivery model of paediatric rehabilitation. METHODS: Over 3 years, different stakeholders responded to SWOT questionnaires (n = 139) and participated in focus groups (n = 19) and telephone interviews (n = 13). A framework based on socio constructivist theories made sense of the data. RESULTS: Facilitators related to the programme's structure (e.g. funding), the actors (e.g. willingness to test the new service model) and the change management process (e.g. participative approach). Some initial facilitators became barriers (e.g. leadership lacked at the end), while other barriers emerged (e.g. lack of tools). Understanding factor interactions requires examining the multiple actors' intentions, actions and consequences and their relations with structural elements. CONCLUSIONS: Analysing facilitators and barriers helped better understand the change processes, but this must be followed by concrete actions to successfully implement new paediatric rehabilitation models.
Asunto(s)
Servicios de Salud del Niño/organización & administración , Medicina Estatal/organización & administración , Actitud del Personal de Salud , Niño , Grupos Focales , Humanos , Entrevistas como Asunto , Innovación OrganizacionalRESUMEN
This article presents results of a research conducted in Québec City between 2004 and 2006. The objective of this study was to examine services to families in which the mother suffers from a mental disorder. The authors examine the experiences and perspectives of parents with a mental disorder, spouses and children on the services offered to families ; the study also examines the organisation, the basis and the context of actions and interactions between stakeholders of various sectors of services to families with a parent with severe mental illness. The authors conclude that despite Quebec's good intentions, members of families in which the mother suffers from a mental disorder do not benefit from a truly comprehensive family-focused approach.
Asunto(s)
Relaciones Familiares , Trastornos Mentales/terapia , Servicios de Salud Mental , Madres/psicología , Femenino , Humanos , QuebecRESUMEN
This essay takes its support on the study of concepts of intentionality and life projects and their use in the rehabilitation of people with borderline personality disorder (BPD). It considers that these people are dis-concerted and disconcerting and the pertinence of envisaging new ways of helping them reconstruct a sense of their existence. Inspired by constructivist approaches that recognize the constant interaction of the subject with his environment and the duality of things, this reflection leads to the necessity of exploring the intentionality of people with BPD and develop their reflexive capacity in order to allow the progressive emergence of a life project. This recovery process is part of an approach where hope and mobilization of the person's strengths take an important place.