Using Constructivist Case Study Methodology to Understand Community Development Processes: Proposed Methodological Questions to Guide the Research Process

Often, research projects are presented as final products with the methodologies cleanly outlined and little attention paid to the decision-making processes that led to the chosen approach. Limited attention paid to these decision-making processes perpetuates a sense of mystery about qualitative approaches, particularly for new researchers who will likely encounter dilemmas and uncertainties in their research. This paper presents a series of questions that assisted one Ph.D. student in making key methodological choices during her research journey. In this study, a collective case study design informed by constructivist grounded theory data analysis methods was used to develop a framework of community development from an occupational therapy perspective. Ten methodological questions are proposed regarding research question development, research paradigm, design and analysis, and trustworthiness. Drawing on examples from this research project, these questions are used to explicate the decisions made “behind the scenes”, with the intention of providing both theoretical and practical guidance to others embarking on similar research journeys

Unpacking the foundational dimensions of work integration social enterprise: the development of an assessment tool

Purpose The aim of this exploratory, mixed methods study was to develop and test a tool that identifies foundational dimensions of work integration social enterprises (WISEs) for use in empirical studies and enterprise self-assessment. Construction of the initial prototype was based upon a review of the literature and prior qualitative research by the authors. Design/methodology/approach A 20-item question pool with a four-point response scale was constructed to explore WISE business and employment practices and strategies for worker growth and development. Three sequential field tests were conducted with the prototype – the first with 5 Canadian WISEs, the second with 14 WISEs in the UK and the third with 6 Canadian WISEs involved in an outcome study in the mental health sector. Each field test included completion of the questionnaire by persons with managerial responsibility within the WISE and evaluative feedback captured through questions on the applicability and interpretability of the items. Findings Testing of the prototype instrument revealed the inherent diversity in the field and the difficulty in creating questions that both embrace that diversity and produce unidimensional variables definable along a spectrum. A number of challenges with question structure were identified and have been modified throughout the iterative testing process. Research limitations/implications This study identified central domains for inclusion in a multi-dimensional WISE assessment tool. Further testing will help further refine scaling and establish psychometric properties. Originality/value This measure will provide a descriptive profile of WISEs across sectors and identify WISE core dimensions for research and organizational development. </jats:sec

A Conceptual Definition of Vocational Rehabilitation Based on the ICF: Building a Shared Global Model

Background The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF. Method We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models. Results Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary. Conclusions VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders' participatio

Social Enterprise as a Pathway to Work, Wellness, and Social Inclusion for Canadians with Mental Illnesses and/or Substance Use Disorders Social Enterprise as a Pathway to Work, Wellness and Social Inclusion for Canadians with Mental Illnesses and/or Substance-Use Disorders’

People with serious and persistent mental illnesses and/or substance use disorders are among the most economically and socially disenfranchised populations in Canada, and often present with long histories of labour market detachment and underemployment. Work engagement has the potential to improve social determinants of health while also harnessing productive capacity. This article re-ports on a five-year study examining the social, economic, and health impacts of Work Integration Social Enterprises (WISEs) in the mental health sector in Ontario, Canada. The findings shed light on the population that works in WISEs, its levels of social and labour market integration, and or-ganizational features that influence worker outcomes. Results highlight both the importance of WISEs as a means of supporting employment, and challenges to organizational sustainability

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Recovery Compromised: Tracing the Structural Conditions that Perpetuate and Maintain Social Exclusion in Assertive Community Treatment

Concerns have been raised regarding the extent to which the services provided through the Assertive Community Treatment (ACT) model are based on an understanding of recovery as primarily a clinical phenomenon rather than a journey that is fundamentally about self-determination, social inclusion, citizenship and civil rights. Until recently, the limited degree of social inclusion experienced by users of ACT has been assumed to result from individual functioning or inadequate practitioner training. These explanations negate the role of organizing conditions in shaping a systematic approach to everyday practice that diminishes opportunities for inclusion. The current study identifies key areas where practices consistent with the current recovery vision and theories of social inclusion are superseded by accepted and legitimized forms of practice that are aligned with a medical model approach. The study explicates both how and why this happens in the course of everyday practice.Des inquiétudes ont été soulevées à savoir si les services fournis par le modèle de traitement communautaire intensif sont basés sur une compréhension du rétablissement en tant que phénomène principalement clinique plutôt qu’une progression fondamentalement liée à l’autodétermination, à l’inclusion sociale, à la citoyenneté et aux droits civiques. Jusqu’à récemment, on a présumé que le niveau limité d’inclusion sociale, dont les utilisateurs de traitement communautaire intensif faisaient l’expérience, résultait du travail individuel ou de la formation insuffisante des praticiens. Ces explications nient le rôle qu’ont les conditions organisationnelles dans l’adoption de pratiques quotidiennes diminuant systématiquement les opportunités d’inclusion. La présente étude identifie des domaines clés où des pratiques compatibles à la vision actuelle du rétablissement et aux théories courantes d’inclusion sociale sont remplacées par des pratiques acceptées et légitimées par une approche reposant sur le modèle médical. L’étude démontre comment et pourquoi cela se produit dans le cadre de la pratique quotidienne des praticiens