Client Empowerment Research Articles

Building Mutually Beneficial Collaborations Between Digital Navigators, Mental Health Professionals, and Clients: Naturalistic Observational Case Study.

Despite the efficacy of digital mental health technologies (DMHTs) in clinical trials, low uptake and poor engagement are common in real-world settings. Accordingly, digital technology experts or "digital navigators" are increasingly being used to enhance engagement and shared decision-making between health professionals and clients. However, this area is relatively underexplored and there is a lack of data from naturalistic settings. In this paper, we report observational findings from the implementation of a digital navigator in a multidisciplinary mental health clinic in Sydney, Australia. The digital navigator supported clients and health professionals to use a measurement-based DMHT (the Innowell platform) for improved multidimensional outcome assessment and to guide personalized decision-making. Observational data are reported from implementation logs, platform usage statistics, and response rates to digital navigator emails and phone calls. Ultimately, support from the digital navigator led to improved data collection and clearer communications about goals for using the DMHT to track client outcomes; however, this required strong partnerships between health professionals, the digital navigator, and clients. The digital navigator helped to facilitate the integration of DMHT into care, rather than providing a stand-alone service. Thus, collaborations between health professionals and digital navigators are mutually beneficial and empower clients to be more engaged in their own care.

Nurse Practitioners (NPs) as Game Changers in Tanzania Health Delivery System: Lessons Learnt from Fujita Bantane Hospital in Japan.

Shortage of physicians/doctors in the primary health care system has been evidenced in various countries. Among other things, these countries deployed nurse practitioners (NPs) in the health care delivery system to address this shortage. Countries in America, Europe, and Asia use NPs to address physicians/doctors shortage in the primary health care delivery systems. Various studies have shown that NPs have been deployed in primary health care facilities to curb these shortages.While in Tanzania shortage of physicians/doctors and other health professionals is evidenced in every sector of the health care system, nurses play a crucial role to cover this shortage by providing care and support for individuals and communities. Nurses work in various settings from being a nurse, counselor, laboratory technologist, social worker, educationist, and physician, to name a few. Nurses play a key role in preventing, diagnosing, and attending to common health problems. The question is, "When will the Tanzanian health delivery system recognize the pivotal role of these nurses and upgrade them to NPs?" This study suggests that deployment of NPs in Tanzania's health care systems could be a "game changer." As a fellow on Critical Care Nursing Course at Fujita Health University Bantane Hospital in Japan, witnessed deployment of NPs in health care delivery and the reaped benefits are enormous; increased access to health care services, reduction in health care costs, reduced hospital stays, and customer satisfaction through client empowerment and comfort. This is an observational study of tasks performed by NPs in Fujita Health University Bantane Hospital and their relevance as a positive innovation to curb physician shortages for effective health care delivery. The duration of the study at Bantane Hospital was 2 months from January 15 to March 16, 2024. One-to-one interviews with NPs on duty were conducted. Also, collected and reviewed information from Tanzanian government Web sites, published government documents, and academic literature. Results show that NPs perform a lot of procedures that physicians/doctors were supposed to do. In the wards, theater, laboratories, and clinics, they play a pivotal role to curb shortage of physicians/doctors in health settings. NPs are an effective addition to medical facilities. They perform various procedures in the absence of the doctors. The findings from this study have important implications for improving health care delivery in Tanzania. NPs could be "game changers" in the health care landscape in Tanzania. Investment on nurses' education, proper training, and policy changes in nurse practice regulations are key for this to succeed.

The Audacity Health Method: Enhancing Therapeutic Understanding and Client Empowerment

The Audacity Health method utilizes the Feynman Technique, a learning method developed by Nobel Prize-winning physicist Richard Feynman. It emphasizes deep understanding and simplification of complex concepts through teaching. This paper explores the application of the technique within the context of psychotherapy to enhance both therapist and client comprehensions of psychological processes. Implementing a step-by-step approach, therapists can break down and demystify intricate behavioural and emotional patterns, facilitating a more profound grasp of factors that cause and maintain the mental illness the individual is seeking therapy to treat. Through a case study example, this paper demonstrates how the method can be employed to clarify the client’s issues, empowering them to gain insight into their mental health and generate solutions for symptoms. The outcomes suggest that the Audacity Health method fosters more effective communication, reinforces therapeutic alliance, and promotes active client participation in treatment. Ultimately, this integration aims to optimize therapeutic efficacy by merging educational simplification with evidence-based psychotherapeutic interventions to advance mental health.

Understanding the Factors That Contribute to Creating a Collaborative Psychological Formulation: A Qualitative Systematic Review.

Creating a formulation is one of the key competencies of a clinical psychologist and is understood to be important for guiding therapeutic input and understanding client distress. However, client experience of formulations can vary, with some reporting it is unhelpful and distressing. This novel review explores the experiences of clinicians and clients when creating a formulation, specifically the barriers and facilitators to collaborating on a formulation. This ultimately aims to improve client experience and engagement in formulation. A systematic search of PubMed, Web of Science, PsycINFO and EMBASE was conducted using PRISMA guidelines. The protocol was registered on PROSPERO. This search was conducted using terms related to 'psychological formulation' and 'experience'. Nineteen qualitative papers met inclusion criteria and were appraised using the Critical Appraisal Skills Programme. Findings that pertained to formulation were thematically synthesised. Three analytical themes were identified: toleration of the formulation process-'a necessary evil', which highlights the potential emotional impact of formulation on the client and indicates the importance of responding to client readiness and expectations of formulation; development of the therapeutic relationship-'it's like a two way thing, isn't it?', which suggests that client empowerment, adapting to client needs and clinicians creating a safe and containing environment facilitated the formulation process; systemic factors-'walking a tightrope', which highlights the constraints of resources and team dynamics in therapists' ability to engage in collaborative formulation. Facilitators to a collaborative formulation include the following: simple formulations, thorough assessment and preparation for formulation, 'doing with' activities such as timelines and diagrams and working environments that include supportive colleagues and time for reflection and training.

Practicing up: Teaching social workers how to influence authority figures

ABSTRACT Social workers often practice in challenging organizational contexts that hinder the ability to uphold social work values and ethics and empower clients. This article introduces the concept of ‘practicing up,’ defined as the ability to communicate effectively and persuasively with people in power, and to act with courage on behalf of clients. The article presents an argument that social work education should intentionally include content on practicing up, distinguishes practicing up from other forms of social work advocacy, and describes prerequisites and example skills it can require. The role of social workers’ intersectional identities when practicing up are discussed. The article concludes by considering how learning to practice up could help to shift conceptualizations of how social workers use power.

‘‘If You don’t Feel Empowered, Then How are You Going to Empower Someone else?” Perspectives of Executive Directors and Supervisors on Community Health Worker Workforce Development

ABSTRACT Expansion of the Community Health Worker (CHW) workforce has become a national priority. It is critical to understand CHW strengths and individual challenges, associated professional development needs, and specific strategies that may meet needs from the perspectives of those who employ, manage, and supervise this growing workforce. Through a community-partnership with eight member organizations of the Association of Perinatal Networks of New York, we conducted two focus groups with 7 Executive Directors and 6 CHW Supervisors. Data were analyzed according to the six steps of thematic analysis. Analyses revealed seven salient themes across three superordinate categories of strengths, individual challenges, and mechanisms of support. CHWs are a critical component of the US health workforce. Challenges related to navigating boundaries, use of empowerment-focused approaches and effective documentation require skills-based training and trauma-informed workplace-based supports. Supervision is an effective mechanism through which CHWs receive support needed to optimize job performance.

Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial.

Acceptance and commitment therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with mobile health ecological momentary interventions may increase its treatment effects and empower clients to take treatment into their own hands. This study aimed to investigate and predict treatment engagement with and acceptability of acceptance and commitment therapy in daily life (ACT-DL), a novel ecological momentary intervention for people with an ultrahigh risk state and a first episode of psychosis. In the multicenter randomized controlled trial, 148 individuals with ultrahigh risk or first-episode psychosis aged 15-65 years were randomized to treatment as usual only (control) or to ACT-DL combined with treatment as usual (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone app, delivering ACT skills and techniques in daily life. For individuals in the intervention arm, we collected data on treatment engagement with and acceptability of ACT-DL during and after the intervention. Predictors of treatment engagement and acceptability included baseline demographic, clinical, and functional outcomes. Participants who received ACT-DL in addition to treatment as usual (n=71) completed a mean of 6 (SD 3) sessions, with 59% (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant with 6 of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness) and that 91% (n=42) of participants reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Multiple linear regression models were fitted to predict treatment engagement and acceptability. Ethnic minority backgrounds predicted lower notification response compliance (B=-4.37; P=.01), yet higher app usefulness (B=1.25; P=.049). Negative (B=-0.26; P=.01) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness, respectively. Being female (B=-1.03; P=.005) predicted lower usefulness of the ACT metaphor images on the app. Our results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. OMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803.

A Relational Cultural Approach to Perfectionism

ABSTRACT Perfectionism is a growing concern and leads to multiple psychosocial consequences. Of note, perfectionism greatly impacts relationships and the ability to form meaningful connections. Relational Cultural Theory is an approach to helping clients realize the importance of growth-fostering relationships and focuses on client empowerment. A relational cultural approach can be a highly effective approach for working through perfectionism. This article conceptualizes perfectionism through a relational cultural lens and provides treatment recommendations.

Professionals Evaluating Clients' Suitability for Digital Health and Social Care: Scoping Review of Assessment Instruments.

Increased digital health and social care services are generally considered to improve people's access to services. However, not everyone can equally access and use these resources. Health and social care professionals should assess clients' suitability for digital solutions, but to succeed, they need information about what to evaluate and how. This scoping review aimed to identify evaluation tools that professionals can use when assessing clients' suitability for digital health and social care. We summarized the dimensions and the practical usefulness of the instruments. The MEDLINE (Ovid), CINAHL, Web of Science, and ASSIA databases were searched in February 2023 following the Joanna Briggs Institute's Manual for Evidence Synthesis. Studies were included if they focused on health and social care clients and professionals, examined clients' suitability for using digital health or social care, and applied related assessment methods in the direct client work of professionals. Studies focusing primarily on instruments intended for research use without clear applicability to professionals' practical contexts were excluded. Details of the eligible studies were extracted, and qualitative content analysis according to the research objectives was performed. A total of 19 articles introducing 12 different assessment instruments intended for the health care context were included in the review. No instruments were found for evaluating the suitability for digital social care. The instruments contained 60 dimensions of the client's suitability for digital health, which reflected four perspectives: (1) skill-based suitability, (2) suitability based on general ability to maintain health, (3) suitability based on attitude and experience, and (4) suitability based on practical matters. The described practical usefulness of the instruments included professionals' possibility to (1) identify clients most in need of education and support, (2) direct and recommend the right clients for the right digital services, (3) ensure that clients can use digital health, (4) improve effectiveness and maximize the provision of digital health, (5) develop and redesign services, and (6) empower clients. Based on the diverse assessment instruments available and the dimensions they measure, there seems to be no comprehensive evaluation tool for assessing clients' prerequisites to use digital solutions. It is important to further develop comprehensive screening tools applicable to professionals' busy work (both in health and social care) with defined threshold values for suitability.

Evolution of the Assisted Outpatient Treatment (AOT) Program Through the Application of a Social Work Lens

Assisted Outpatient Treatment (AOT) is a court-mandated program intended to engage adults with serious mental illness who have challenges with voluntary treatment adherence. AOT programs are designed to promote outpatient treatment participation, reduce emergency care, and decrease justice involvement. Research has found AOT programs to be effective in reducing hospitalizations and justice involvement. Yet, concerns have been raised, including limiting individual autonomy and self-determination and overrepresentation of individuals from BIPOC backgrounds. This article describes the evolution the AOT Houston Model. Through applying the social work lens, this innovative model builds on AOT strengths and addresses limitations. The Houston AOT Model has five goals guided by the core tenets of client empowerment and self-determination. This Model prioritizes six elements including housing, employment, access to public benefits, transportation, service continuity, and care coordination/communication. Implications for practice and policy are presented with strategies for successful implementation of comprehensive AOT programs in other jurisdictions.

EMPOWERMENT OF HEALTH CADRES IN SUPPORTING THE WELLBEING OF CLIENTS WITH CHRONIC KIDNEY DISEASE (PGK) IN SURABAYA, INDONESIA

Chronic kidney disease (CKD) is a public health problem with an increasing prevalence and incidence of CKD. This increase in incidence is in line with the increase in the incidence of hypertension and diabetes mellitus. Health cadre support for clients with CKD has never been done because specific knowledge about efforts to support health in clients with CKD has never been done. Objective To increase the potential of health cadres through empowerment in order to provide support and motivation for Chronic Kidney Disease clients towards wellbeing. The method used was training including lectures, questions and answers, discussions, role play, pre tests and post tests and the media used: modules and needs identification sheets for CKD clients. Implementation of activities for 3 meetings which are divided into stages of providing material, assigning cadres to identify the support needs of clients, the second meeting discussing the results of identifying needs divided into groups, and the last meeting cadres role play to provide support to clients. The results showed that there was an increase in knowledge before and after empowerment through training. Based on the results of the pre-test assessment, the highest score was 93 and the lowest score was 60, the average score was 70.2, while the highest post-test score was 100 and the lowest score was 67, the average score was 80.4. The difference between post-test and pre-test results ranged from 0-26 points. It was found that more social support needs are needed by CKD clients Empowerment carried out on health cadres is one way to improve wellbeing conditions in CKD clients through various supports. ,

Receptivity towards Remote Service Delivery among Social Work Clients and Practitioners during COVID Times: A Systematic Review

ABSTRACT Purpose This systematic review aims to identify and synthesize the available evidence on the receptivity toward, perceived advantages and challenges of remote service delivery among social work clients and practitioners during the context of COVID-19. Method Two electronic databases were searched from 2020 to 2022. Identified papers were screened against the established eligibility criteria, yielding 15 papers. Two additional papers were further identified through hand-search. As heterogeneity of studies was high, a narrative synthesis was performed to summarize the overall evidence. Results Our review provides evidence that remote service delivery holds the potential to increase access to services among selected client populations as well as promote a sense of empowerment for clients and opportunities for practice enhancement for practitioners. Discussion & Conclusion The findings from our study highlighted the need for innovative solutions and practical considerations for ongoing remote service, including the careful considerations of social work clients’ and practitioners’ suitability, the need for provision of training and ongoing support to optimize practitioners’ well-being. As the delivery of services transition to face-to-face or remain remote, further research is needed to assess the promise of remote practice in optimizing overall service delivery, while maintaining client-reported satisfaction.

Perceived Impact of Microfinance on Livelihood Improvement in Kaski District of Nepal

This paper examines the perceived impact of microfinance on livelihood improvement in Kaski district of Nepal. The study is based on a primary survey limited to five MFIs working in rural parts of Kaski district. The impact of microfinance services on people's livelihoods was examined using a descriptive and explanatory research including paired sample t-test, and Wilcoxon signed-rank test The livelihood status of the clients has been measured in terms of economic (microbusiness creation, income level, saving habits, productive investment, consumption, and capital expenditures) and social condition (educational status, health status, women empowerment, and social networking) of the clients after microfinance intervention. The researcher randomly selected 150 clients involved in microfinance institutions for the last three or more years. Microfinance significantly affects the livelihood and raises standards of living. The study finds a significant impact of microfinance on the livelihood improvement of poor and marginalized people. Microfinance interventions have significantly improved clients' economic condition, including microbusiness creation, income level, saving habits, productive investment, consumption, and capital expenditures. The social conditions, particularly educational status, health status, women empowerment, and social networking of clients, have significantly improved. Microfinance can be useful for fostering economic growth and enhancing the lives of low-income people and communities, even though its efficacy is disputed. The regulatory authority should develop sound financial and social outreach efficiencies of microfinance institutions to ensure both the welfare of clients and the sustainability of micro institutions.

Saving time for activation or relationships? The legitimation and performance of automated decision-making for time efficiency in two street-level bureaucracies serving poor and unemployed clients

ABSTRACT In the last decade, digitalized automated decision-making (ADM) has been implemented in many Swedish municipal social services to achieve values such as legal security, client empowerment and time efficiency. The paper aims to understand how ADM policy is legitimized and performed through time efficiency, by a comparison of ADM policy in two Swedish municipalities’ social assistance agencies. It builds on 17 interviews with managers and professionals in two Swedish municipalities’ social assistance units. Findings show ADM is legitimized through arguments of activation and relationships, and performed by handling more applications or increasing time spent with clients, rather than being perceived as increasing the quality of social assistance services. This highlights the significance of organizational goals regarding how street-level bureaucrats perform tasks within their discretionary powers.

Clinicians’ Views on Eye Movement Desensitization and Reprocessing Therapy: A Mixed Method Systematic Review

This mixed methods systematic review aimed to provide insight into the clinicians’ views and experiences of eye movement desensitization and reprocessing (EMDR). Seven electronic databases (PsychINFO, Public MEDLINE [PubMed], Cumulated Index to Nursing and Allied Health Literature [CINAHL], Scopus, Web of Science and Excerpta Medica Database [EMBASE], and Applied Social Sciences Index) and grey literature (ProQuest and Google Scholar) were searched systematically from inception to October 2021. Quality was assessed using the Mixed Methods Appraisal Tool and a convergent integrated approach was used to synthesize and integrate the data. In total, 14 studies were included: 7 qualitative, 5 mixed methods, and 2 quantitative, encompassing 1,065 participants. Thematic synthesis generated two overarching themes and seven subthemes. The first theme related to the facilitators and barriers clinicians experience in adopting and implementing EMDR, including the role of organizational support, clinician confidence, primary theoretical orientation, and client suitability and preparedness. The second theme related to the perceived advantages of EMDR, including rapid results and positive outcomes, client empowerment, and getting to the root of the issue. This review provides a helpful insight into the factors that influence the dissemination and implementation of psychological therapeutic approaches.

The Value of Health Literacy in Communication Sciences and Disorders Programs

Purpose: Achieving self-directed health care with good health outcomes begins with clients having adequate health literacy (HL) skills. Higher education programs, like communication sciences and disorders (CSD), have a role in cultivating HL. This study examines the speech-language pathology leaders' (administrators and faculty) sense-making of HL for their preparation programs and how/why CSD leaders implement/embed health literacy education (HLE). Method: This qualitative, phenomenological study used a screening survey of U.S. CSD leaders to assess their use of HL strategies, based on the Health Literacy Universal Precautions Toolkit–Second Edition. Ten participants who reported at least medium-frequency HL use were identified and interviewed based on the screening survey responses showing at least medium-frequency HL use. Results: CSD leaders' description and value of HL and explanations of how they implement HLE are described under three themes: HL as communicating so clients understand, HL as personal agency toward well-being, and CSD leaders waiting on others to lead HL conversations. The results indicate that most CSD leaders inaccurately perceive HL as providing health resources with clear and simple communication. Participants value HL as a step toward client empowerment. Despite CSD leaders' acknowledgment that HL holds the promise of self-directed health care, without formal conversations making sense of this significance, HLE occurs intuitively and without much depth. Conclusions: CSD leaders must understand that HL is essential for client empowerment and well-being. This unique study demonstrates that CSD leaders need to increase their knowledge of HL to ultimately help their clients achieve empowerment for optimal health outcomes.

Integrating isoniazid preventive therapy into the fast-track HIV treatment model in urban Zambia: A proof-of -concept pilot project.

Most people living with HIV (PLHIV) established on treatment in Zambia receive multi-month prescribing and dispensing (MMSD) antiretroviral therapy (ART) and are enrolled in less-intensive differentiated service delivery (DSD) models such as Fast Track (FT), where clients collect ART every 3-6 months and make clinical visits every 6 months. In 2019, Zambia introduced Isoniazid Preventive Therapy (IPT) with scheduled visits at 2 weeks and 1, 3, and 6 months. Asynchronous IPT and HIV appointment schedules were inconvenient and not client centered. In response, we piloted integrated MMSD/IPT in FT HIV treatment model. We implemented and evaluated a proof-of-concept project at one purposively selected high-volume facility in Lusaka, Zambia between July 2019 and May 2020. We sensitized stakeholders, adapted training materials, standard operating procedures, and screened adults in FT for TB as per national guidelines. Participants received structured TB/IPT education, 6-month supply of isoniazid and ART, aligned 6th month IPT/MMSD clinic appointment, and phone appointments at 2 weeks and months 1-5 following IPT initiation. We used descriptive statistics to characterize IPT completion rates, phone appointment keeping, side effect frequency and Fisher's exact test to determine variation by participant characteristics. Key lessons learned were synthesized from monthly meeting notes. 1,167 clients were screened with 818 (70.1%) enrolled, two thirds (66%) were female and median age 42 years. 738 (90.2%) completed 6-month IPT course and 66 (8.1%) reported IPT-related side effects. 539 clients (65.9%) attended all 7 telephone appointments. There were insignificant differences of outcomes by age or sex. Lessons learnt included promoting project ownership, client empowerment, securing supply chain, adapting existing processes, and cultivating collaborative structured learning. Integrating multi-month dispensing and telephone follow up of IPT into the FT HIV treatment model is a promising approach to scaling-up TB preventive treatment among PLHIV, although limited by barriers to consistent phone access.

A Consensus Statement on Clinical Reasoning in Clinical Sexology

This Delphi study was conducted to develop a consensus statement on clinical reasoning in clinical sexology. 10 participants completed the qualitative interviews. The analysis identified 11 principles that provide a framework for sex therapists to better understand clinical reasoning. These principles were grouped into three domains: 1) client empowerment, 2) self-reflection, and 3) evidence-based inquiry. These three domains reflect the factors that shape sexology-informed clinical reasoning: the patient, the therapist's experience, and evidence-based information.

The Role of Community Care Groups in Supporting Community Client Empowerment in the Community

Pancasila is the thought that the function of punishment is no longer just a deterrent, but also an effort to rehabilitate and reintegrate the social inmates of prisons. Prisons have an important role in the justice system. There are 4 main functions of the Penitentiary, namely; 1) Guidance; 2) Assistance 3) Supervision, and 4) Community Research. The existence of the Correctional Care Community Group (Pokmas Lipas) is very important in supporting the empowerment of correctional clients in the community, Pokmas have their respective roles to support the reintegration of correctional clients so that they can return to the community. The implementation of the correctional system which is the implementation of Pancasila values, namely coaching the personality of prisoners, is carried out by a coaching program with forms of coaching in the form of religious education, general education, skills courses, recreation, sports, arts and job training.

The Role of Community Care Groups in Supporting Community Client Empowerment in the Community

The Role of Community Care Groups in Supporting Community Client Empowerment in the Community