Client-centred Approach Research Articles

Effectiveness of Cognitive Orientation to Daily Occupational Performance in Parkinson’s Disease: A Case Report

Introduction: Parkinson’s disease is a chronic progressive neurodegenerative disorder causing impaired motor function and various non-motor symptoms. One of the most common problems in Parkinson’s patients is occupational performance problems. The cognitive orientation to daily occupational performance (CO-OP) is one of the client-centered and problem-solving approaches in occupational therapy evaluations and interventions. This study aims to determine the effectiveness of the CO-OP approach on perceived satisfaction and occupational performance in a 62-year-old woman with Parkinson’s disease.
 Case Description: The client was a 62-year-old woman with moderate cognitive impairment, stage 3 on the Hoehn and Yahr scale, and signs of depression. In our case study, the outcome measures were the Canadian occupational performance measure (COPM), functional independence measure (FIM), Montreal cognitive assessment (MOCA), and Beck depression inventory-II (BDI-II). We administered the CO-OP intervention for six weeks. Sessions were performed twice a week for one hour per session.
 Results: The results indicate that the CO-OP intervention improves the client’s satisfaction, occupational performance, and functional independence. Although the results from this single case cannot be generalized, the findings suggest that CO-OP intervention may help improve satisfaction and occupational performance in adults with Parkinson’s disease. Further investigation is necessary.
 Conclusion: These results suggest that CO-OP can be a valuable occupational therapy interventions for individuals with Parkinson’s disease. We recommend that occupational therapists consider using this approach in their practice to improve the occupational performance of their patients with Parkinson’s disease.

Keeping clients connected: exploring Australian alcohol and other drug clinicians’ perspectives on barriers and facilitators to treatment attendance

Substance use contributes to significant individual and social harms. Although psychosocial treatment is effective, early treatment discontinuation is common. Despite this, exploration of clinicians’ perspectives on barriers and facilitators to attendance has been limited in scope (e.g. specialized settings, written responses). The current study used an in-depth approach to explore the views of clinicians on barriers and facilitators to attendance in psychosocial alcohol and other drug (AOD) treatment, with a view to translating these views to clinical practice. Semi-structured interviews were conducted with AOD clinicians from a range of professional backgrounds (n = 15: 7 female; 8 male) working in treatment settings in Australia. Thematic analysis was used to analyze interview content. Themes relating to attendance included client-related factors (motivation, expectations, beliefs; complexity, access, level of support), clinician-related factors (therapeutic relationship), organizational and systemic factors (individual service factors; systemic/sector wide factors), and stigma (experienced across clinician-related, organization and systemic domains). A complex combination of practical, psychosocial, and systemic/organizational factors intersect with, and influence, client attendance. These findings speak to the importance of client-centered and flexible approaches from clinicians and organizations. Such approaches might simultaneously mitigate a key barrier to attendance: stigma. This study highlights the impact of the therapeutic relationship on attendance despite organizational and funding constraints.

Impact of occupational therapy on comprehensive care in pediatric oncology.

e22018 Background: Children with cancer can experience difficulties in performing and engaging in their usual activities and the families can also experience interruptions to their daily routines as well as family dynamics. Yet, current cancer rehabilitation tends to focus more on the aspect of bodily repair and functional restoration. This study intends to illustrate the impact of occupational therapy approaches that were identified to have positive influence on the children with cancer and their family. Methods: Three cases of children with brain tumor of age 1, 4 and 16 were reviewed and their caregivers were interviewed. Family education on disease progression, caregiver burden, unhealthy caregiving style, and activity participation facilitation, and coping strategies for the teenaged survivor were included in the regular occupational therapy sessions. Results: Of the three cases, two families of the younger clients who later deceased, reported being supported with the occupational therapy service from emotional support to facilitating activity participation. The other case was reported to have resumed activity participation both in the hospital and at home following a client-centered occupational therapy approach. Conclusions: Although it is important to facilitate functional restoration or preservation, it does not facilitate activity participation on children with cancer if psychological and/or contextual factors are not taken into consideration. It is equally important to meet children’s developmental needs and educate their caregiver/family to provide the proper care they need. Coping is required for both child survivor and their caregiver/family. Client-centered approach that is used in occupational therapy can provide comprehensive care to both children and their family in meeting the needs of the child and family and facilitating activity participation.

IT 통합예술치료의 CERAT 단계 및 회기 내 구조 OMCA에 나타나는 6가지 심리치료 접근방식의 융합적 활용특성 고찰

The purpose of this study is to examine the convergent utilization characteristics of the six psychotherapy approaches shown in the CERAT stage of IT Integrative Arts Therapy and intra-sessional structure OMCA. As a research method, the characteristics and properties of six psychotherapy theories and each stage of IT Integrative Arts Therapy were phenomenologically analyzed and connected, and the core functions of the therapist required at each stage were derived. The conclusion is that an eclectic and Integrative·Integral Psychotherapy approach is used throughout all stages of IT Integrative Arts Therapy CERAT and OMCA, and that Gestalt, Client-centered, Adlerian Psychotherapy, Behavior Therapy and REBT Psychotherapy approaches are used in each detailed stage. In addition, the core functions and attitudes of the therapist as Moderator, Coordinator, Buffer, Expander, Mediator, Emitter, Contactor, Acceptor, Facilitator, Creator, Director, Connecter, Practice Encourager, Linker, Confirmer, and Supporter are required respectively.

Biopsychosocial predictors of drug dependence among Filipino drug users in community-based drug rehabilitation

This study examines the biopsychosocial predictors of drug use and dependence among Filipino drug users enrolled in community-based drug rehabilitation. Data from 925 clients revealed that the severity of drug use, cigarette and alcohol use, recovery skills, and mental health problems predict drug dependence. Family support, life skills, and psychological well-being are indirect predictors of severity of use. Results also revealed differences in predictors by sex, level of use, and type of clients. These findings highlight the importance of a client-centered approach to treatment and suggest what might be critical elements in a community-based drug rehabilitation program in the Philippines.

Circles of hell or circles of support? (Using the «person-in-environment» concept in social work practice)

Modern trends in the development of client-centered approaches in social work, which rely on the client’s internal resources and his strengths, although they consider a person as an expert in his own life situation and one who is able to cope with life challenges, emphasize the influence of the environment in which the client is. This paper is based on the theoretical analysis of the "person-in-environment" concept and reflection of the experience of using tools based on this concept in the authors’ structured interventions focused on the clients' strengths development. The analysis of the academic literature confirmed that the “person-in-environment", developed in the 1980s, remains a popular concept of eco-system social work. It suggests considering the client's experience and life situation through the lenses of dependence on the external environment. An individual's environment affects how a person evaluates the surrounding reality and the processes occuring in their life, way of thinking, and behavior patterns in response to difficulties. From the viewpoint of this concept, the social work objective is to understand the needs and problems of clients through the study of environmental influences, finding and assessing the resourcefulness of social systems that affect the clients’ well-being, and working to strengthen them. The "person-in-nvironment" concept is used to obtain a holistic view of the impact of the environment on clients, it can be applied as a basis for practical interventions, focused on the use of strengths, which allows you to resist social pressure, to defend own interests and needs, and will strengthen faith in own ability. The experience of piloting of techniques based on the "person-in-environment" concept gives reason to say that they help clients to understand their dependence on environmental systems, to identify a "toxic environment", to realize the possibility of control over their own lives, to strengthen faith in their own strength and ability to make decisions about desired relationships in a person's life.

Occupational therapy in the rehabilitation management of obesity in adults

Obesity is a global human problem due to its high prevalence and negative consequences for health, life duration and quality of life of the population. This situation makes it necessary to pay more attention to effective rehabilitation of overweight and obese persons. The article considers approaches to the application of occupational therapy measures in the rehabilitation management of obesity: the impact of the disease on occupation is described, the methods of occupational therapy assessment and the goals of occupational therapy interventions are defined, the role of occupational therapy measures is substantiated, an overview of the main occupational therapy strategies that have confirmed their effectiveness in the treatment of obesity in the adult population is provided. A client-centered approach to occupational therapy has been found to be particularly valuable in the treatment of chronic relapsing obesity. Using analysis of occupation performance and understanding the client's performance skills helps occupational therapists implement meaningful and effective interventions that promote the client's active participation in changing the daily life habits, roles, and patterns that underlie the development of obesity. Prospects for further research are practical testing and research of the effectiveness of occupational therapy programs for people with obesity in the context of the Ukrainian health care system.

LAYANAN KONSELING INDIVIDUAL PENDEKATAN CLIENT CENTERED BERBASIS DALAM JARINGAN (DARING) UNTUK MENGEMBANGKAN CITRA DIRI (SELF IMAGE) SISWA

Self image is a person's self concept which includes the physical and intelligence that is displayed to the people around him. One of the characteristics of high school students' puberty is that they want to show their existence, one of which is by displaying a self-image, but in reality the self-image that is displayed is negative, such as low self-esteem, shyness and closing off. The role of BK teachers is to develop students' self-image by using individual counseling services with a client centered approach. This study aims to describe group guidance services with a client centered approach that can develop students' self-image. The research method used is descriptive qualitative. Data collection was done by interview and documentation. Data analysis used the Miles and Huberman analysis technique which consisted of three activities, namely data reduction, data presentation and data verification. The research results obtained include (1) the counseling service process begins by analyzing student problems, preparing RPL and setting a counseling schedule (2) Individual counseling services are carried out through zoom meetings and attended by one student, BK teacher and researcher (3) student responses are very good and feel helped by doing client centered approach counseling. Keywords: Self Image, Individual Service, Client Centered

Contraceptive counseling in 2 urban cities in Ghana and the extent of shared decision-making

Increased use of contraception is associated with reduced maternal mortality worldwide; however, an unmet need remains high in many places, including Ghana. The quality of care provided by family planning practitioners influences contraceptive use; one way to improve the quality of care is to adopt a client-centered approach to counseling, including engaging in shared decision-making. In Ghana, little is currently known about the extent of shared decision-making between clients and providers in contraceptive counseling encounters. The purpose of this study was to explore the extent of shared decision-making during contraceptive counseling in 2 cities in Ghana. This was a cross-sectional study across 6 urban family planning clinics in Accra and Kumasi, Ghana. We recorded, transcribed, and analyzed 20 family planning patient-provider interactions using the "Observing PatienT InvOlvemeNt" (OPTION) scale. This scale has 12 domains, which are scored on a 5-point scale, from 0 ("the behavior is not observed") to 4 ("the behavior is observed and executed at a high standard"); the scores of each domain are summed up for a total score ranging from 0 to 48. In these encounters, the mean total scores for each interaction ranged from a low of 9.25/48 to a high of 21.5/48. Although providers were thorough in sharing medical information with clients, they did not actively involve clients in the decision-making process and did not generally elicit client preferences. Across the 12 domains, the mean total score was 34.7%, which is below the 50% that would correspond with a "baseline skill level," suggesting there are very low levels of shared decision-making currently occurring. In these 20 patient-provider encounters, counseling was mainly a sharing of medical information from the provider with the client, without the provider eliciting information from the client about her preferences for method characteristics, side effects, or method preference. Family planning counseling in these settings would benefit from increased shared decision-making to engage patients in their contraceptive choice.

Integrating Immigrant Health Professionals into the U.S. Healthcare Workforce: Barriers and Solutions

Internationally educated immigrant healthcare workers face skill underutilization working in lower-skilled healthcare jobs or outside healthcare. This study explored barriers to and solutions for integrating immigrant health professionals. Content analysis identifying key themes from semi-structured qualitative interviews with representatives from Welcome Back Centers (WBCs) and partner organizations. 18 participants completed interviews. Barriers facing immigrant health professionals included lack of access to resources, financial constraints, language difficulties, credentialing challenges, prejudice, and investment in current occupations. Barriers facing programs that assist immigrant health professionals included eligibility restrictions, funding challenges, program workforce instability, recruitment difficulties, difficulty maintaining connection, and pandemic challenges. Long-term program success depended on partner networks, advocacy, addressing prejudice, a client-centered approach, diverse resources and services, and conducting research. Initiatives to integrate immigrant health professionals require multi-level responses to diverse needs and collaborations among organizations that support immigrant health professionals, healthcare systems, labor, and other stakeholders.

Evaluating Counseling for Choice in Malawi: A Client-Centered Approach to Contraceptive Counseling.

High-quality contraceptive counseling is critical for supporting full, free, and informed contraceptive decision-making. However, the quality of family planning counseling remains poor globally and is too often not tailored to the individual client. The Counseling for Choice (C4C) approach comprises provider tools and training to structure counseling to center clients' self-identified priorities and to provide relevant information and anticipatory side effects counseling. Providers at 25 public and 20 private facilities in Malawi were trained in the C4C approach. Between October and December 2018, we enrolled women seeking contraceptive services in intervention facilities and in matched comparison clinics in a quasi-experimental study. We collected data immediately before and after contraceptive services were received. We used multilevel logistic regression to compare dimensions of women's counseling experience. Of 1,179 participants, women counseled by C4C-trained providers rated their providers higher on several quality dimensions, including enabling informed decision-making (11.1% of the comparison group rated their provider as excellent versus 34.4% in intervention), respectful care (35.0% comparison versus 51.3% intervention), and information given about side effects (38.1% comparison versus 72.5% intervention). In Malawi, C4C improved the quality of care that clients received and their client experience relative to standard counseling. Counseling approaches that center clients' priorities and provide enhanced anticipatory side effects counseling show promise in improving contraceptive counseling experiences and the quality of care that clients receive.

Photovoice to explore the patient experience of a relative motion orthosis following a hand injury

BackgroundLittle is known about the patient experience of relative motion (RM) orthoses, or how they impact hand use and participation in occupational roles. PurposeTo explore the use of Photovoice methodology in hand-injured patients and the patient experience of wearing a RM orthosis. Study DesignPhotovoice methodology, Qualitative Participatory research, feasibility study MethodsPurposive sampling was used to identify adult patients prescribed a RM orthosis as part of their therapy intervention for an acute hand injury. Over a 2-week period and using their personal camera device participants captured their experience of wearing a RM orthosis and its impact on their daily life. Participants shared 15-20 photos with the researchers. At a face-to-face semi-structured interview, 5 key photographs were selected by the participants with context and meaning explored. Interview data was transcribed, captions and context of images confirmed by member checking, and thematic analysis completed. ResultsProtocol fidelity was observed using our planned Photovoice methodology. Three participants (aged 22-46 years) shared 42 photos and completed individual interviews. All participants reported their involvement as a positive experience. Six themes were identified: adherence, orthosis factors, expectations and comparisons, impact on daily activities, emotions, and relationships. RM orthoses allowed freedom of movement enabling participation in a range of occupations. Challenges included water-based activities, computer use and kitchen tasks. Participants expectation of orthotic wear and recovery appeared to contribute to their overall experience, with RM orthoses viewed favourably when compared to other orthoses and immobilization methods. ConclusionsPhotovoice methodology was a positive process for participant reflection and a larger study is recommended. Wearing a RM orthosis enabled functional hand use as well as providing challenges completing everyday activities. Participants had different demands, experiences, expectations, and emotions associated with wearing a RM orthosis, reinforcing the need for clinicians to take a client-centred approach.

Theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury

Objectives This project used a systematic and integrated knowledge translation (IKT) approach to co-create theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury (SCI). Methods Guided by the IKT Guiding Principles, we meaningfully engaged research users throughout this project. A systematic approach was used. An international, multidisciplinary expert panel (n = 15), including SCI researchers, counselors, and people with SCI, was established. Panel members participated in two online meetings to discuss the best practices by drawing upon new knowledge regarding counselor-client interactions, current evidence, and members’ own experiences. We used concepts from key literature on SCI-specific physical activity counseling and health behavior change theories. An external group of experts completed an online survey to test the clarity, usability and appropriateness of the best practices. Results The best practices document includes an introduction, the best practices, things to keep in mind, and a glossary. Best practices focused on how to deliver a conversation and what to discuss during a conversation. Examples include: build rapport, use a client-centred approach following the spirit of motivational interviewing, understand your client’s physical activity barriers, and share the SCI physical activity guidelines. External experts (n = 25) rated the best practices on average as clear, useful, and appropriate. Conclusion We present the first systematically co-developed theory- and evidence-based best practices for SCI physical activity counseling. The implementation of the best practices will be supported by developing training modules. These new best practices can contribute to optimizing SCI physical activity counseling services across settings.

Health promotion experiences of Filipino physical therapists

Introduction: Health promotion is a potential solution to control and prevent non-communicable diseases, and physical therapists (PT) may be knowledgeable and skilled to be health promoters. However, there is a lack of health promotion policy in the country that can be used as a guideline for promoting health. This study aimed to describe the Filipino PTs health promotion experiences and strategies. Methods: A descriptive phenomenological design was utilized with a self-developed interview guide used for the focus group discussion. Qualitative data was analyzed using a thematic analysis approach. Results: Physical therapists perceive the role of health promoters as significant and should be integrated into physical therapy practice. Participants described different health-promoting strategies that they incorporate in their practice that are: client education; client-centered approach; holistic service; and interprofessional collaboration. Several facilitators and barriers to health promotion also emerged: guidelines and frameworks or lack thereof; institutional support; interprofessional collaboration; networking; PTs interpersonal skills; client behavior; and health determinants. Participants described the determinants of health as the core factors that affect and influence the delivery of health promotion and behavior change of patients. The role of PTs as advocates of health promotion was also emphasized. Discussion: Filipino PTs practice health promotion in client care with several health-promoting strategies, however no specific and unifying health promotion guideline was identified among them. This suggests that our study may serve as a precursor to developing standard health promotion physical therapy practice guidelines aligned with physical therapy professional practice framework and national health promotion policies.

Weaving and Layering Funding: A Territorial Health Agency's Guide to Effective Health Financing.

State and territorial health agencies can optimize programmatic funding through braiding and layering strategies. The Commonwealth Healthcare Corporation, a territorial health agency located on the Pacific Island of Saipan, Commonwealth of the Northern Mariana Islands (CNMI), restructured its Non-Communicable Disease Bureau into 4 new units. Existing funding streams were braided and layered to support the restructuring. A shared vision of strengthening crosscutting connections to improve population health outcomes helped guide the restructuring process. Vision planning with leaders and funding partners, establishing buy-in within agency and external partners, and assessing immediate impacts were a few of the steps taken by the agency to ensure a successful restructuring. The immediate impact of the restructure has been positive. In both the CNMI and select states that have undertaken similar efforts, braiding and layering funding has facilitated more streamlined processes, coordinated approaches across programs and funding partners, and provided deeper levels of trust in partnerships. Although it is still too early to draw long-term assessments in the CNMI, the agency projects that coordinated funds will strengthen its foundational capabilities and promote a more community-centered, collaborative, and effective approach to public health. Restructuring the Non-Communicable Disease Bureau through braiding and layering funds gives the agency the flexibility it needs to more effectively address the social determinants of health and local population health priorities through a client-centered approach, ultimately improving health outcomes for the commonwealth. The agency experienced several challenges throughout the restructuring process that offer lessons learned for addressing effective health financing. For example, ample time is needed at the beginning of the braiding and layering process to establish policies and procedures for efficient accounting, documenting, and reporting. In addition, ongoing support and training opportunities for programmatic teams can smooth out the transition from siloed to braided and layered funding structures. These lessons, in addition to key elements mapped out by experienced state health agencies, can guide and prepare other agencies interested in implementing innovative funding mechanisms.

Multi-level Meals on Wheels insights: a qualitative study

PurposeMeals on Wheels (MOW) support older people to live in their own homes and communities. The purpose of this paper is to explore MOW experiences from a multi-stakeholder level to inform and better equip this valuable service.Design/methodology/approachA qualitative approach was undertaken utilising semi-structured interviews and focus groups with current, former and potential MOW service users and MOW stakeholders.FindingsQualitative analysis explored MOW perspectives and experiences, highlighting a lack of MOW information and awareness, the importance of a client-centred approach the multiple roles of MOW and service transition.Originality/valueThis research explores MOW from the perspective of different groups directly involved in this community service, offering unique multi-stakeholder insights to understand and guide the future of this service.

A Landscape Analysis of Prevention of Vertical Transmission Program Data and Interventions From Fiscal Years 2019-2021.

In 2020, an estimated 150,000 infants acquired HIV infection through vertical transmission. With pregnant and breastfeeding women facing numerous social and health system barriers, continuity of care for mother-infant pairs (MIPs) requires prioritized engagement for timely infant HIV testing and linkage to treatment. PEPFAR Monitoring, Evaluation, and Reporting indicators were analyzed from across 14 USAID-supported countries across 3 fiscal years (FYs) (October 2018-September 2021): number of HIV-exposed infants (HEIs) with a sample collected for an HIV test by age 2 months, percentage of HEI who received an HIV test by age 2 months (EID 2 mo coverage), and final outcome status of HEIs. Qualitative information on implementation of PVT interventions was gathered using a structured survey disseminated to USAID/PEPFAR country teams. From October 2018 to September 2021, 716,383 samples were collected for infant HIV tests. EID 2 mo coverage increased across the FYs from 77.3% in FY19% to 83.5% in FY21. Eswatini, Lesotho, and South Africa demonstrated the highest EID 2 mo coverage across all 3 FYs. Burundi (93.6%), DRC (92%), and Nigeria (90%) had the highest percentage of infants with a known final HIV outcome. Qualitative survey data showed that the most implemented interventions used by the countries were mentor mothers, appointment reminders, cohort registers, and joint provision of MIP services. Achieving eVT requires a client-centered and multipronged approach, typically combining several PVT interventions. Country and program implementers should use person-centered solutions to best target MIPs to be retained in the continuum of care.

Diving deep: three experiential approaches to working with dreams and nightmares

ABSTRACT Dreams have the potential provide intimate access to psychotherapy clients’ inner lives. When therapists are able to help clients experience their dreams in a curious, open, focusing-oriented way, the client gains direct access the dream’s tendency to carry their life situation forward. This paper offers evidence of a paradigm shift away from analytic to experiential, client-centered approaches to dreams. It then describes three experiential dreamwork practices: finding the help in a dream (from focusing), re-entering a dream element (from Gestalt) and dreaming the dream onward (from Jung). Included are several clinical and personal examples which show how entering a dream experientially allows the dreamer to discover something new and how this often leads to a change-moment or, in focusing terms, a felt shift. Several clinical and personal examples illustrate that while dreams may be helpful in their own right, engaging deeply with them in an experiential way allows their fuller potential for personal growth and forward movement to be realized. Over time, this way of engaging with dreams can become a natural ongoing undercurrent, both in dreaming and waking, that is always available and evolving.

Diagnosis, Treatment, and Prevention of Tuberculosis Among People Experiencing Homelessness in the United States: Current Recommendations.

Tuberculosis (TB) is a public health problem, especially among people experiencing homelessness (PEH). The Advisory Council for the Elimination of Tuberculosis issued recommendations in 1992 for TB prevention and control among PEH. Our goal was to provide current guidelines and information in one place to inform medical and public health providers and TB programs on TB incidence, diagnosis, and treatment among PEH. We reviewed and synthesized diagnostic and treatment recommendations for TB disease and latent TB infection (LTBI) as of 2022 and information after 1992 on the magnitude of homelessness in the United States, the incidence of TB among PEH, the role of public health departments in TB case management among PEH, and recently published evidence. In 2018, there were 1.45 million estimated PEH in the United States. During the past 2 decades, the incidence of TB was >10 times higher and the prevalence of LTBI was 7 to 20 times higher among PEH than among people not experiencing homelessness. TB outbreaks were common in overnight shelters. Permanent housing for PEH and the use of rapid TB diagnostic tests, along with isolation and treatment, reduced TB exposure among PEH. The use of direct observation enhanced treatment adherence among PEH, as did involvement of social workers to help secure shelter, food, safety, and treatment for comorbidities, especially HIV and substance use disorders. Testing and treatment for LTBI prevented progression to TB disease, and shorter LTBI regimens helped improve adherence. Federal agencies and the National Health Care for the Homeless Council have helpful resources. Improvements in TB diagnosis, treatment, and prevention among PEH are possible by following existing recommendations and using client-centered approaches.

Therapist Voices on a Youth Mental Health Pilot: Responsiveness to Diversity and Therapy Modality.

This article explores therapists' views on a large youth mental health pilot project (for 18-25-year-olds), which included an individual cognitive behavior therapy (CBT)-informed individual therapy component. Therapists' views on cultural responsiveness, therapy (delivery, modality and duration) and working with LGBTQIA+ youth were explored using two surveys, individual interviews and focus groups at various stages of the life of the pilot. Some therapists saw the CBT approach as imposed on them, preferring familiar therapy modalities. Many therapists were positive toward CBT for its client-centered approach and reported using CBT-informed approaches with many of their clients to good effect. Some therapists felt pressured by their workplace to see clients for fewer sessions than they needed. Therapists wanted to see a more culturally diverse workforce, to increase their cultural competence through training and to have more easily available cultural supervision. There was some acknowledgement of the importance of training therapists to work competently with LGBTQIA+ young people. Involving therapists in co-design of services from the outset will likely benefit future service development.