Entre o Direito de Reclamar e o Direito à Saúde: Serviço Social em Gabinetes do Cidadão do SNS

As políticas de saúde e o direito à saúde em Portugal sofreram profundas transformações nas últimas décadas, muito contribuíram para estas transformações a crise económica e financeira mundial e a influência de políticas neoliberais. O interesse por esta temática surge de uma prática profissional num Gabinete do Cidadão do Serviço Nacional de Saúde e, pela falta de debate e posicionamento público dos Assistentes Sociais sobre as competências do Gabinete do Cidadão e, do papel dos Assistentes Sociais nesse serviço. Com este trabalho, pretende-se contextualizar: as principais transformações nas políticas de saúde e suas repercussões no direito à saúde nos últimos anos; analisar as alterações legislativas que ocorrem entre a criação do Gabinete do Utente e o Gabinete do Cidadão; analisar o trabalho que os Assistentes Sociais têm vindo a desenvolver no âmbito das competências do Gabinete do Cidadão e do direito à saúde. A investigação de cariz exploratório e qualitativo contou com os contributos de Assistentes Sociais que trabalham em Gabinetes do Cidadão da região norte do país e, que participaram através de inquérito por questionário. Da investigação efetuada concluiu-se que o Gabinete do Cidadão apenas garante o direito a reclamar e não o direito à saúde. As possibilidades que se abrem ao trabalho do Assistente Social no Gabinete do Cidadão, em prol da efetivação do direito à saúde parte do trabalho coletivo. As competências e habilidades do Serviço Social devem ter o intuito de promover a consciência crítica dos indivíduos. / Health policies and the right to health in Portugal underwent profound changes in recent decades, greatly contributed to these transformations the global economic and financial crisis and the influence of neoliberal policies. The interest in this subject arises from a professional practice in the Gabinete do Cidadão National Health Service, and by the lack of public debate and placement of Social Workers on the powers of the Gabinete do Cidadão and the role of social workers in this service. This work aims to contextualize: major changes in health policies and their impact on the right to health in recent years; consider legislative changes that occur between the creation of the Gabinete do Utente and the Gabinete do Cidadão; analyze the work that Social Workers have been developing within the competence of the Gabinete do Cidadão and the right to health. The exploratory research and qualitative nature featured contributions from Social Workers who work in Gabinetes do Cidadão of the northern region of the country, who participated via questionnaire survey. Research conducted it was concluded that the Gabinete do Cidadão only guarantees the right to complain and not the right to health. The possibilities that open to the Social Work Assistant in the Gabinete do Cidadão, for the sake of ensuring the right to health of the collective work. The skills and abilities of Social Work must have in order to promote critical awareness of individuals.

Pontes para a (Des)inserção: inserção pelo trabalho no Concelho de Stª Mª da Feira

O presente relatório visa a obtenção do grau de Mestre em Serviço Social pelo Instituto Superior Miguel Torga. Motivada pela preocupação nascida na prática profissional quotidiana, no acompanhamento aos cidadãos beneficiários do Rendimento Social de Inserção (R.S.I.), procurámos compreender a relação entre a pobreza e o mercado de trabalho. Criado no ano de 1996 pela Lei nº 19-A/96 de 29 de Junho, como prestação de rendimento mínimo garantido, o R.S.I. tem introduzido formas cada vez mais apuradas de seleção das suas clientelas, quer através da redefinição do conceito de agregado e avaliação dos seus rendimentos, quer da contratualização da prestação, pelo reforço crescente das penalizações ao incumprimento relativo ao emprego e à formação. Objetivo geral é perceber como se efetiva o processo de colocação no mercado de trabalho e que oportunidades de (des)inserção social dai resultam para os beneficiários. Procurámos também analisar a configuração das propostas oferecidas, no âmbito do contrato de inserção, aos homens e às mulheres, aos “velhos” e “novos” pobres. Assim, foram efetuadas entrevistas exploratórias aos técnicos do Centro de Emprego e Formação Profissional Entre Douro e Vouga (CEFP-EDV); Gabinete de Inserção Profissional (GIP) e Núcleo Local de Inserção (NLI) de Stª Mª da Feira e aplicado um inquérito por questionário aos beneficiários do R.S.I. com Contrato de Inserção para colocação no mercado de trabalho. Os técnicos do CEFP-EDV e do GIP expressaram dificuldades no acompanhamento e gestão de carreira dos beneficiários, devido à sobrecarga e à natureza burocrática das tarefas exigidas nos seus organismos. Os beneficiários consideram igualmente que o CEFP-EDV não é eficiente nem eficaz, para a colocação no mercado de trabalho não cumprindo portanto a função que legalmente lhe está atribuída. Os homens são amplamente beneficiados na relação com o Centro de Emprego, comparativamente com as mulheres, porque recebem mais propostas de emprego e formação. A “velha pobreza” aparece instalada no desemprego e na prestação durante mais tempo que os “novos” pobres. Estes raramente são convocados pelo CEFP-EDV. São as redes informais que têm um papel mais ativo e preponderante no processo de inserção laboral. Na população inquirida a inserção pelo trabalho por si só não constituiu a solução para a saída da pobreza. / The present report aims to obtain a Master’s degree in Social Work from the Instituto Superior Miguel Torga. Motivated by concern aroused from the day to day professional practice, while monitoring citizens on social income benefits, “Rendimento Social de Inserção” (R.S.I.) (Social Insertion Income), we have sought to understand the relationship between poverty and the labour market. Introduced in the year 1996 by Law nº 19-A/96 of 29th June, as the provision of income support, the R.S.I. has introduced increasingly more refined forms of selection of its clientele, either by redefining the concept of aggregate and assessmento of their income, or the contractual provision, by increasingly strenthening the penalties for failure in relation to employment and training.The overall goal is to understand how the process of entering the work market is made and the opportunities of (un)inclusion arising from it for the beneficiaries. It was also sought to analyse the configuration of the proposals offered under the insertion contract to men and women, to the “old” and the “new” poor.Consequently, exploratory interviews were made to the technicians of Centro de Emprego e Formação Profissional Entre Douro e Vouga (CEFP-EDV) (Emloyment and Training Centre); Gabinete de Inserção Profissional (GIP) (Professional Insertion Office) and Núcleo Local de Inserção (Local Insertion Group) (NLI) of Stª Mª da Feira. The survey was carried out through a questionnaire to the beneficiaries of the R.S.I. with Insertion Contracts for placement in the labour market.The CEFP-EDV and GIP technicians expressed diffficulties in monitoring and career management of the benefeciaries due to overhead and bureaucratic nature of the tasks recquired in their institutions. The beneficiaries also considered that CEFP-EDV is neither efficient nor effective in placing people in the work market thus not fulfilling the function for which they are legally assigned. Men are largely benefitted in relation to the Job Centre, compared to women, because they get more job offers and training. The “old poverty” appears to be installed in unemployment and provision for longer than the “new” poor. These are rarely called up by CEFP-EDV. It is the informal networks that have a more active and leading role in the process of job placement. For the questioned population entering the job market does not itself constitute a solution to ending poverty.

Cuidados Paliativos em Portugal na Perspectiva de Assistentes Sociais

O contexto demográfico e epidemiológico hodierno traz à luz a fulcral relevância dos cuidados paliativos de qualidade acessíveis para todos. Pela importância que o serviço social assume na defesa da garantia dos direitos humanos, com uma ação direta nestes cuidados, o presente estudo pretendeu analisar os cuidados paliativos na perspectiva de assistentes sociais, tendo em conta o atual contexto das políticas sociais e de saúde. Optou-se por uma investigação quanti e qualitativa, através de um inquérito por questionário dirigido a todas as unidades/equipas de cuidados paliativos identificadas no território nacional (Portugal Continental e Regiões Autónomas), com assistentes sociais. A amostra foi constituida por 17 profissionais de serviço social, na sua maioria mulheres (94,1%), com idades entre os 25 e os 57 anos, a exercer a profissão há 5,5 anos, em média, na área dos cuidados paliativos. Os resultados do estudo mostram-nos que os assistentes sociais estão inseridos em 86,36% das unidades/equipas, sendo estas maioritamente de natureza pública. Os profissionais mais frequentes na constituição das equipas são o médico, enfermeiro, assistente social e psicólogo. Todos ou quase todos têm formação específica na área, tendo a maioria apoio para formação continuada. As condições de trabalho atuais foram alvo de uma avaliação desfavorável por parte da amostra. Estes profissionais perspectivam o acesso a estes cuidados como sendo pouco equitativos, apontam a falta quer de estruturas que cubram geograficamente todo o país, quer de recursos humanos adequados, não esquecendo a ausência de regulamentação da atividade laboral dos profissionais nos cuidados paliativos. É exigido ao assistente social uma intervenção baseada no cumprimento de objetivos que apresentem resultados rápidos, o que tem vindo a dificultar uma intervenção eficaz desde a admissão até ao encaminhamento do doente para continuidade de cuidados. A presente investigação oferece um contributo para a produção de conhecimento capaz de evidenciar as transformações que têm vindo a ocorrer na prática dos profissionais permitindo contribuir para a reflexão sobre os contextos e processos de intervenção, assim como sobre a promoção do direito aos cuidados paliativos de qualidade em Portugal. / The current demographic and epidemiological context highlights the crucial importance of quality palliative care accessible for all. The importance that social work assumes in the defense of human rights guarantees, with a direct action on these care, this study aims to analyze the palliative care from the perspective of social workers, taking into account the current context of social and health policies. We chosed a quantitative and qualitative research through a questionnaire addressed to the universe of the palliative care institutions identified in the national territory (Portugal’s mainland and the Autonomous Regions), with social workers. The sample has 17 social work professionals, mostly women (94.1%), aged between 25 and 57 years. They work as a social worker for 5.5 years on average in the area of care palliative. The results of the study show us that social workers are included in 86.36% of the units / teams, wich are mostly public services. The most frequent professionals in the teams are the doctor, nurse, social worker and psychologist. All or almost all have specific training in the area, and the majority has institutional support for continuing training. Current conditions of work have received an unfavorable evaluation by the participants. The inquired considered access to palliative care as being inequitable, or point to a lack of structures that geographically cover the whole country, whether adequate human resources, not to mention the lack of regulation of the activity of professionals working in palliative care. An intervention based on the achievement of goals that have quick results, which have been a difficulty for an effective intervention from the admission to the referral of the patient for continuity of care is required of the social worker. This research offers a contribution to knowledge production, able to highlight the changes that have taken place in professional practice, allowing to contribute to the reflection about the contexts and processes of intervention as well as on the promotion of the right to quality palliative care of in Portugal.

Políticas de Austeridade, Serviço Social e Direitos das Crianças: o Serviço Social nas CPCJ do Distrito de Leiria

Objetivo. Este estudo reflete sobre o impacto das políticas neoliberais e a austeridade na vida das famílias e das suas crianças, no sistema de promoção e proteção de crianças e jovens em perigo e na prática profissional dos assistentes sociais que nele trabalham na defesa dos direitos devidos a essas crianças. Partiu-se da análise do enfraquecimento do estado social, para se perceber o desmonte das políticas públicas e as suas implicações na carreira profissional e nas condições de trabalho do assistente social. Assiste-se à transição de responsabilidades da esfera pública para a sociedade civil, no caso específico das políticas de proteção à infância. Participantes. Existindo necessidade de constituir uma amostra para a realização do estudo, optámos por uma amostra não-probabilística de informadores estratégicos. O critério de inclusão foi ser assistente social a desempenhar funções na CPCJ do distrito de Leiria. Com este critério responderam ao questionário 10 Assistentes Sociais, num total de 16 solicitações às CPCJ do distrito de Leiria. A recolha de informação através da aplicação dos inquéritos decorreu entre o mês de maio e junho de 2015. Material e métodos. A recolha de dados, para poder responder à questão em análise, foi feita com a aplicação de um inquérito por questionário online, com perguntas fechadas e abertas. Resultados. O Neoliberalismo atinge a prática profissional do assistente social, pela redução de recursos para o estudo diagnóstico das crianças e suas famílias e pela redução de técnicos superiores especializados na intervenção. Os Direitos das Crianças no sistema de promoção e proteção não se encontram devidamente asseverados, na medida em que estas comungam do sucessivo empobrecimento das suas famílias, sendo privadas da satisfação das necessidades básicas para o seu saudável desenvolvimento. Implicações. Os resultados deste estudo compelem a uma clara necessidade de lhe dar continuidade de âmbito nacional, para entender e melhorar as expressões do trabalho do assistente social desenvolvido com as crianças e suas famílias, no sistema de promoção e proteção. É necessário construir e consolidar uma manifestação de espírito crítico na classe profissional, no sentido de pugnar pelo projeto ético – político, bem como atribuir ao Serviço Social o estatuto de disciplina especializada. Nesta qualidade, a profissão deve participar na análise e na discussão das políticas para a infância, para assim colocar as necessidades das crianças, no centro das obrigações públicas. / Objective: This study concerns the impact of the neoliberal and austerity policies in the life of the families and their children, in the protection system of children and young people at risk and in the professional practice of the social workers, who work to defend the rights owed to those children. It started with the analysis of the weaknesses of the social state to understand the deconstruction of the public policies and the implications in the professional career and working conditions of the social worker. It can be noticed that there is a transition of responsibilities from the public sphere to the civil society in the specific case of the childhood protection policies. Participants: Due to the need to build a sample to perform the study, we chose a nonprobabilistic sample of strategic informers. The inclusion criterion was being a social worker performing duties in the CPCJs in the District of Leiria. 10 social workers answered the questionnaire with this criterion, out of a total of 16 requests to the CPCJs of the District of Leiria. The gathering of the information through the use of the questionnaires was done between the months of May and June 2015. Material and Methods: The gathering of data, to be able to answer the question under analysis, was done through the use of online questionnaires, with both open and closed questions. Results: The Neoliberalism affects the professional practice of the social worker, by reducing the resources, in the diagnostic study of the children and their families, by reducing specialized superior technicians in the intervention. The rights of the children in the protection system are not properly secure as they are affected by the continuous impoverishment of their families, being deprived of satisfying their basic needs, which are essential to their healthy development. Implications: The results of this study indicate a clear necessity to give it some continuity at a national level, to understand and improve the expressions of the social worker’s job being developed with the children and their families, in the promotion and protection system. It is necessary to build and consolidate some form of critical mind in the professional class, as to fight for the ethical-political project, as well as to give to the social service the statute of specialized discipline. Therefore, the profession should participate in the analysis and discussion of the policies concerning the childhood, being then able to place the needs of the children, in the centre of the public obligations.

Developing and Delivering L&D Solutions for International Markets

In Chapter 8, ‘Developing and delivering L&D solutions for international markets’, Sa’ad Ali and I examine how different dynamics within and amongst countries can impact the development and delivery of L&D. We build upon the previous chapters, in particular Chapters 5 to 7 that discussed how L&D solutions may be developed in consideration of enhancing engagement, the digital world, and collective and social learning. In doing so, we examine how the effectiveness, and even appropriateness of the concepts discussed in these chapters, may be contingent on country-specific factors such as culture.

Understanding the Context of L&D

Chapter 2 recognises the important role that context plays in shaping the new directions of L&D professionals. In this chapter, Robin Bell and I discuss how L&D’s role is significantly influenced by contextual factors such as the external environment, organizational life-cycle and size, business/ industry of the organization, organizational goals and senior management’s view of strategy. Irrespective of L&D’s influence on organizational strategy, which varies amongst organizations e.g. whether L&D is a ‘scope maker’ (involved in helping to set direction) or ‘scope taker’ (involved in implementation after the direction has been set), understanding the context they operate within is crucial. This chapter discusses the sources and nature of change, and its impact on industry and organizations’ business model. We also discuss how this has influenced the general nature of work, the workforce, and ultimately, their learning and development.

Developing and Using Consultancy Skills

In Chapter 4, ‘Developing and using consultancy skills’, Ruth Sacks and I discuss what it means to be a consultant and what is it that consultants do. This is presented in the order of stages in a project; starting, ‘doing’ and ending, with specific sections dedicated to examining each stage. Adopting a consulting approach helps L&D professionals to ‘demonstrate’ the value they bring, and may be undertaken through projects that have been articulated and justified through a business case.

Using Information, Metrics and Developing Business Cases for L&D

The second theme of this book concerns L&D’s ‘Contributions’, specifically how L&D professionals articulate, communicate and demonstrate value that it brings to the organization. Specifically, Chapter 3, titled ‘Using information, metrics and developing business cases for L&D’, discusses how L&D professionals can do this using the business case as a vehicle. The business case is a tool that L&D professionals can use to show how new L&D initiatives can benefit the organization and its stakeholders. The value of such benefit can be ‘articulated’ quantitatively and qualitatively. Chapter 3 adopts a holistic approach in developing a business case. L&D professionals must be competently knowledgeable about accounting and finance but without the need to be experts – as their expertise lies in L&D. Therefore to successfully complete a business case, L&D professionals need to form teams comprising the right members (depending on what the business case is about). The political realities that are associated with the development of a business case can be important considerations. How well L&D is able to ‘sell’ a business case depends on how well it is framed, usually either as a problem or opportunity. We then discuss the information, data and metrics required to build a typical business case, specifically in terms of identifying the benefits and costs. The chapter concludes with some suggestions on how the findings from the business case can be presented in infographics-inspired form.

Designing and Developing Digital and Blended Learning Solutions

Chapter 6 concerns ‘Designing and developing digital and blended learning solutions’, however, despite its title, it is not aimed at developing L&D professionals to be technologists (in so much as how Chapter 3 is not aimed at developing L&D professionals to be accounting and financial experts). Chapter 6 is about developing L&D professionals to be technology savvy. In doing so, I adopt a culinary analogy in presenting this chapter, where the most important factors in creating a dish (e.g. blended learning), are the ingredients and the flavour each of it brings. The chapter first explores the typical technologies and technology products that are available for learning and development i.e. the ingredients. I then introduce the data Format, Interactivity/ Immersion, Timing, Content (creation and curation), Connectivity and Administration (FITCCA) framework, that helps L&D professionals to look beyond the labels of technologies in identifying what the technology offers, its functions and features, which is analogous to the ‘flavours’ of the ingredients. The next section discusses some multimedia principles that are important for L&D professionals to consider in designing and developing digital learning solutions. Finally, whilst there are innumerable permutations of blended learning, this section focuses on the typical emphasis in blended learning and how technology may support such blends.

Meeting the challenges of globalisation in legal education

The focus of this paper is a critical review of the impact of globalisation on international higher education at my own institution, the University of East London (UEL), where I am Programme Leader for LLB (Hons) Law, an undergraduate qualifying law degree. Globalisation, along with internationalisation, has been one of the forces that have most changed the educational landscape in this country over the last two decades. Although closely related to each other, globalisation and internationalisation are usually regarded as distinct forces – the former being defined as the economic, political, and societal forces pushing twenty-first-century higher education towards greater international involvement, while the latter describes the policies and practices of higher education developed to deal with this. Whilst these phenomena have wide implications for higher education as a whole, they present opportunities and challenges that are very specific both to an institution like UEL, which has a high proportion of students from international backgrounds, and to my own discipline, law, which has an increasingly global profile in terms of both legal education and professional practice.

Constructions of Clinical Psychology in Adult Mental Health: A Discursive Thematic Analysis

In face of the current economic-political changes facing the UK and its State institutions and of the new evidence about the impact of social inequality on human distress, this study attempts to understand the increasing practice of delivering psychological therapy by the British clinical psychology profession. A review of the critical histories of the profession in the UK identified the need for a more detailed study of the “history of the present” to reveal the discursive operations that construct professional practice. A discursive thematic analysis (DTA) based on the theoretical concepts of the late post-modern scholar Michel Foucault was used to explore public available documents produced by British clinical psychologists between 2010 and 2014. Two dominant professional discursive themes were identified: alternative and leadership. These themes were found to be supported by the discursive sub-themes of applied science, well-being, Cognitivism and therapy which align the aspiration of the profession with those of the State. The tension between the applied scientist and the therapist role - specifically the need to establish simultaneously the profession’s scientific credibility and its therapeutic abilities in order to respond to market pressures – showed recurrences of the conflicts of the early history of professionalization of clinical psychology. The positioning of clinical psychology against the use of functional psychiatric diagnosis and the challenges and opportunities identified by the opening of the NHS market to ‘any willing provider’ revealed how professional discourses operate to maintain the status quo. This study recommends that the socio-historical construction of the profession should be investigated further, in particular through the subjugated discourse identified here

An exploratory study of orthoptic student satisfaction in a blended learning environment

Purpose: To describe orthoptic student satisfaction in a blended learning environment. Methods: Blended learning and teaching approaches that include a mix of sessions with elearning are being used since 2011/2012 involving final year (4th year) students from an orthoptic program. This approach is used in the module of research in orthoptics during the 1 semester. Students experienced different teaching approaches, which include seminars, tutorial group discussions and e-learning activities using the moodle platform. The Constructivist OnLine Learning Environment Survey (COLLES ) was applied at the end of the semester with 24 questions grouped in 6 dimensions with 4 items each: Relevance to professional practice, Reflection, Interactivity, Tutor support, Peer support and Interpretation. A 5-point Likert scale was used to score each individual item of the questionnaire (1 - almost never to 5 – almost always). The sum of items in each dimension ranged between 4 (negative perception) and 20 (positive perception). Results: Twenty-four students replied to the questionnaire. Positive points were related with Relevance (16.13±2.63), Reflection (16.46±2.45), Tutor support (16.29±2.10) and Interpretation (15.38±2.16). The majority of the students (n=18; 75%) think that the on-line learning is relevant to students’ professional practice. Critical reflections about learning contents were frequent (n=19; 79.17%). The tutor was able to stimulate critical thinking (n=21; 87.50%), encouraged students to participate (n=18; 75%) and understood well the student’s contributions (n=15; 62.50%). Less positive points were related with Interactivity (14.13±2.77) and Peer support (13.29±2.60). Response from the colleagues to ideas (n=11; 45.83%) and valorization of individual contributions (n=10; 41.67%) scored lower than other items. Conclusions: The flow back and forth between face-to-face and online learning situations helps the students to make critical reflections. The majority of the students are satisfied with a blended e-learning system environment. However, more work needs to be done to improve interactivity and peer support.