Client Goals Research Articles

Art Therapy and the Malnourished Brain: The Development of the Nourishment Framework

Art therapy can be particularly successful in addressing the specific needs of individuals struggling with anorexia nervosa (AN) through the use of the creative process. This article provides an understanding of the effect of malnourishment on the brain for individuals with AN and discusses how their unique needs can be met through the application of the Nourishment Framework. The Nourishment Framework is a structured treatment approach that utilizes the individual components of the Expressive Therapies Continuum (ETC) to address specific clinical needs for those struggling with AN. A case study documents the application of the Nourishment Framework while highlighting the directives and materials used to meet client goals.

Mediational paths from supervisor support to turnover intention and actual turnover among community mental health providers.

Turnover is a critical problem for community mental health providers, and supervisors may play an important role in mitigating turnover. The current study examined the potential impact of supervisory support on turnover intention and actual turnover among community mental health providers. We conducted path analyses with data collected longitudinally from 186 direct clinical care providers at two community mental health centers. Increased supervisory support was associated with lower turnover intention 6 months later, as well as reduced actual turnover 12 months later. Type of supervisory support mattered: supervisors' emotional support was most strongly associated with reduced turnover intention and turnover. However, client goal alignment support (supporting providers to help consumers achieve their goals) was directly associated with increased turnover. The current study suggests an important role for direct supervisors to attend to care providers' emotional support needs, which may reduce turnover intention and actual turnover. Differential supervisory support functions might impact turnover in unique ways; thus, examining more detailed change mechanisms would facilitate our understanding of factors that may prevent future turnover. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Assessing the value for money of an integrated health and wellbeing service in the UK

Lay health workers have been utilized to deliver health promotion programmes in a variety of settings. However, few studies have sought to determine whether these programmes represent value for money, particularly in a UK context. The present study involved an economic evaluation of Wellbeing for Life, an integrated health and wellbeing service in northern England. The service combined one-to-one interventions delivered by lay health workers (known as health trainers), group wellbeing interventions, volunteering opportunities and other community development activities. Value for money was assessed using an established economic model developed with input from a panel of commissioners and providers, and the main data source was the national health trainer data collection and reporting system. Between June 2015 and January 2017, behaviour change outcomes (i.e. whether client goals in relation to diet, physical activity, smoking or other behaviours, had been achieved) were recorded for 2433 of the 3179 individuals who accessed one-to-one interventions. The level of achievement observed gave an estimated total health gain of 287.7 quality-adjusted life years (QALYs). In addition, there were 4669 health-promoting events, five asset mapping projects and 1595 occurrences of signposting to other services. Combining the value of individual behaviour change with the value of these additional activities gave an overall net cost per QALY gained of £3900 and a total estimated societal value of at least £3.45 for every £1 spent on the service. These results suggest that the Wellbeing for Life service offered good value for money. Further research is needed to systematically and comprehensively determine the societal value of similar holistic, asset-based and lay-led approaches.

Modern Retirement Theory: Reaching Client Goals in Every Market

In contract to rational utility theory, prospect theory has shown individuals to be loss averse. Loss aversion and emotion often clouds an individual's financial decision-making. This paper offers an a priori framework approach to guide client's decision processes for individual retirement planning. The primary concepts of modern retirement theory (MRT) that individual financial plan be established on the basis of two individually unknowable facts: longevity and conditions within longevity. These facts are both unknown and unknowable in individual client terms. Advisors and planners can build more robust plans that balance work around these two concerns to provide retirees peace of mind through a liability matching process displayed in the MRT pyramid. The image of a hierarchical pyramid show the prioritization for the individual to offset individual retirement risks in an unknowable context. Four conceptual funds that can be used to offset the individually unknowable are: Base Fund, Contingency Fund, Discretionary Fund, and Legacy Fund.

The co-design of timely and meaningful information needed to enhance social participation in community aged care services: Think tank proceedings.

To determine what information from community aged care social participation and quality of life assessments needs to be captured, and meaningfully utilised as part of an integrated information and communication technology system. Two think tank sessions comprised of community aged care staff and researchers (n=9) were conducted over 5weeks. The sessions were guided by the Continuous Quality Improvement framework. Thematic analysis was used to categorise the think tank data. To monitor progress over time, participants needed more contextual information captured in the assessment forms, such as client goals and outcomes of assessments. The aged care provider agreed to embed outcome measure score and action following assessment into its information and communication technology system. Collaboration between aged care staff and researchers resulted in adjustments to the aged care provider's information and communication technology system to better target the monitoring and planning of its clients' psychosocial needs.

Recovery for all in the community; position paper on principles and key elements of community-based mental health care

BackgroundService providers throughout Europe have identified the need to define how high-quality community-based mental health care looks to organize their own services and to inform governments, commissioners and funders. In 2016, representatives of mental health care service providers, networks, umbrella organizations and knowledge institutes in Europe came together to establish the European Community Mental Health Services Provider (EUCOMS) Network. This network developed a shared vision on the principles and key elements of community mental health care in different contexts. The result is a comprehensive consensus paper, of which this position paper is an outline.With this paper the network wants to contribute to the discussion on how to improve structures in mental healthcare, and to narrow the gap between evidence, policy and practice in Europe.Main textThe development of the consensus paper started with an expert workshop in April 2016. An assigned writing group representing the workshop participants built upon the outcomes of this meeting and developed the consensus paper with the input from 100 European counterparts through two additional work groups, and two structured feedback rounds via email.High quality community-based mental health care: 1) protects human rights; 2) has a public health focus; 3) supports service users in their recovery journey; 4) makes use of effective interventions based on evidence and client goals; 5) promotes a wide network of support in the community and; 6) makes use of peer expertise in service design and delivery. Each principle is illustrated with good practices from European service providers that are members of the EUCOMS Network.ConclusionsDiscussion among EUCOMS network members resulted in a blueprint for a regional model of integrated mental health care based upon six principles.

Does training in a top-down approach influence recorded goals and treatment plans?

Five stroke rehabilitation teams were supported in the implementation of Cognitive Orientation to daily Occupational Performance (CO-OP) as part of a knowledge translation (KT) project called CO-OP KT. Medical record auditors noted there was occasionally a disconnect between client goals and treatment plans, revealing a need to better understand the characteristics of each and their relationship to each other. This study aimed to examine the characteristics of goals and treatment plans in occupational therapy before and after CO-OP KT. A descriptive secondary analysis of medical record data was employed. Post intervention, there was a change in goal specificity (p = .04) and therapist-client goal alignment (p = .05). Occupation-based goals were often paired with a bottom-up, impairment-based treatment. Top-down treatments, when present, lacked the same detail given to bottom-up plans. CO-OP KT seemed to lead to more specific goals, but matching top-down treatment plans were not found.

Goal attainment scaling and coaching client core self-evaluations

Objective: With a strengthening of the evidence base for coaching as an effective developmental intervention, greater understanding is needed regarding the factors that may contribute to this effectiveness. This study sought to determine the effect client ‘core self-evaluations’ (CSEs) may have on the attainment of contracted coaching goals. It alsoadopted a revised approach to Spence’s (2007) goal attainment scaling (GAS) procedure.Design: A quasi-experimental design was employed. 135 participants were recruited from undergraduate awards within a UK university. Seeking to improve on previous client trait research, a homogeneous, objectively measurable criterion variable (overall year end grade), was adopted.Method: Each of the four facets in the CSE construct were measured using established psychometric scales. Participants received training in core coaching skills and then took part in six peer coaching sessions, conducted at monthly intervals over a period of half a year.Results: A multiple regression analysis found a non-significant relationship between the four CSE facets and coaching goal attainment (R2 = 0.03%, F 4,130 = 1.04., p < .39).Implications: The amount of outcome variance attributable to participant CSE score was 66 per cent lower than that from a comparable study using self-report measures (Tee et al., 2017), suggesting that the use of objective measures of client goal progress has a marked effect. The rigorous GAS procedure used in this study allowed more consistency in comparing goalattainment across clients. Finally, these findings may imply that ‘core-self evaluations’ may not be the key set of client traits that predict coachability.Keywords:Coaching psychology; client factors; coachability; active ingredients; core self-evaluations; goal attainment scaling.

Hong Kong women’s future perceptions: integrating the role of gender and culture

ABSTRACTGuided by Social Cognitive Career Theory, this study investigated the future perceptions of Hong Kong female university students. Fifty-eight students completed a semi-structured questionnaire to better understand their beliefs, hopes, and visions about their future. The thematic analysis performed yielded 10 major future life themes in the participants’ responses: (a) work, (b) family, (c) roles and responsibilities, (d) romantic relationships, (e) values, (f) living situation, (g) quality of life, (h) status of education, (i) personal interests and hobbies, (j) finance, and (k) friendship. Findings from this study provide novel information on Hong Kong women’s future perceptions that may help career counsellors when constructing client goals and tasks aimed at exploring and fulfilling their future perceptions.

Interpreting for asylum seekers and their attorneys: the challenge of agency

ABSTRACTThis study is a theoretical reflection based on the description of unique dynamics of interpreters working with asylum seekers and attorneys in the U.S. context, an area of practice that has largely been overlooked in the literature. It is argued that these interpreters face challenges with respect to agency and neutrality as they provide interpreting services alongside written translation and other linguistic services that often fall outside the scope of their work in other legal contexts. The collective goals of attorneys and clients and their various communication needs both during and outside of meetings may require interpreters to adjust their roles and interpreting approaches in order to be effective communication partners. Moreover, their direct contact with the attorneys and asylum seekers themselves gives way to the development of relationships and a certain level of rapport, especially since asylum cases may last for more than a year. While dissociating oneself from the interpreted event is often the ethical canon in different areas of interpreting and a means to earn professional trust from the other parties, doing so in attorney-client asylum cases may have the counter effect and run contrary to the goal of the attorney and client for a successful filing.

Exploratory analyses of intake sessions in psychodynamic psychotherapy: do processes differ for engager versus non-engager clients?

ABSTRACT We investigated differences in negative indicators and topics discussed during intakes for one engager and one non-engager (i.e. dropout) client for each of 18 therapists in psychodynamic psychotherapy. Results indicated that engager clients had fewer negative indicators (patient-therapist interaction, errors in techniques) and more coverage of client goals for treatment than did non-engager clients. Engager and non-engager clients did not differ in terms of client pathology, therapist countertransference, or order in which they were seen in the clinic. Preliminary findings suggest that therapists should be educated about negative processes and encouraged to discuss client goals to lessen the likelihood of dropout.

The implications of the Canadian Stroke Best Practice Recommendations for design and allocation of rehabilitation after hospital discharge: a problematization

Introduction: Implementation of the Canadian Stroke Best Practice Recommendations has improved inpatient rehabilitation. As attention is turned to the design and allocation of rehabilitation after hospitalization, examination of their implications for post-discharge rehabilitation could help optimize service planningMethods: Critical discourse analysis modeled on Alvesson and Sandberg’s method of problematization was conducted to determine how the Canadian Stroke Best Practice Recommendations envision and shape post-discharge rehabilitation, and identify any tensions and potential ways to resolve them.Results: Within the Canadian Stroke Best Practice Recommendations post-discharge rehabilitation is implicitly viewed as a continuation of inpatient rehabilitation. Rehabilitation is largely envisioned as a set of biomedical procedures aimed at normalization through correction of impairment. There is potential tension between this implicit goal and the explicit goal of providing patient and family-centered care and promoting reengagement in valued activities and roles.Conclusion: An alternate vision of post-discharge rehabilitation could help resolve this tension. Post-discharge rehabilitation could be envisioned as a self-management intervention. Rather than primarily an expert-driven process of measuring impairment and applying procedures aimed at normalization, rehabilitation would be considered facilitation of self-management with the goal of reengaging in forms of participation that comprise a satisfying life.Implications for RehabilitationImplicit assumptions within best practice guidelines powerfully influence recommendations. These ideas are difficult to examine because they seem self-evident.Implicit assumptions in the Canadian Stroke Best Practice Guidelines envision post-discharge stroke rehabilitation as an expert-driven, impairment-focused biomedical procedure.This biomedical image makes it difficult to provide care that meets the guideline’s explicit goals of client- and family-centeredness.Reimagining post-discharge stroke rehabilitation as a chronic self-care management intervention aimed at developing a satisfying life after stroke could improve patient care.

Strength-based approach in dealing with severe mental illness

Strength-based approach in dealing with persons with psychiatric illness gained more attention in the clinical setting mainly due to its unique way of addressing clients and their issues. It is a way of conceptualising and understanding people and their circumstances from the strength point of view and clinicians try to build-up from the core strengths, towards achieving client's goals. The current article focuses on the utility of strength-based approach in a case with paranoid schizophrenia and tries to bring evidence-based case discussion in this regard.

Differences in the occupational therapy goals of clients and therapists affect the outcomes of patients in subacute rehabilitation wards: a case-control study.

[Purpose] This study aimed to examine the effects of differences in the goals recognized by the client and the occupational therapist on patient outcome. [Participants and Methods] A retrospective case-control study was conducted to compare rehabilitation outcomes of cases wherein the occupational therapy goals were matched/unmatched (control) with those of the patients in seven subacute rehabilitation wards in Japan. The outcomes were Functional Independence Measure, number of days of hospitalization, occupational therapy, and total medical cost. [Results] The motor Functional Independence Measure scores in the matched-goal group were significantly higher than those of the unmatched-goal group, and the home discharge rate showed a tendency to increase. It was speculated whether the client had received an explanation about the goal. [Conclusion] Rehabilitation outcome may vary depending on whether occupational therapy goals are matched.

Feasibility study of goal setting discussions between older adults and volunteers facilitated by an eHealth application: development of the Health TAPESTRY approach

BackgroundIn keeping with the changing needs of the Canadian population, primary care systems need to become more person-focused in providing quality care to older adults. As part of Health TAPESTRY, a complex intervention to strengthen primary care for older adults, a goal setting exercise was developed and tested in an initial feasibility study, intended to foster collaboration between patients and providers.MethodsParticipants—clinic clients—were recruited from the McMaster Family Health Team in Hamilton, Ontario. Five participants took part in the goal setting feasibility study phase I, which tested the functionality of a technology-enabled goal setting exercise between older adults and volunteers. Based on observations and feedback from volunteers, interprofessional team members, and older adults, the exercise was refined to include a guided survey and goals report. The goal setting survey is a list of probing questions designed based on SMART (specific, measurable, attainable, relevant, timely) goal setting strategies and goal attainment scaling (GAS). This was used in phase II, carried out with 16 participants, where the feasibility of goal setting and goal attainment with support from volunteers and interprofessional teams was tested. Volunteers carried out the goal setting survey via a tablet computer, a report of client goals was generated and sent to interprofessional teams, and client goals were discussed during clinic huddles. At 6 months of follow-up, clients self-evaluated their progress using GAS.Results and discussionThe goal setting exercise in phase I took an average of 24:45 (SD 11:42) minutes and yielded a diverse set of life and health goals. Goals identified by older adults were primarily focused on the maintenance of a certain level of activity or health state. Phase I work resulted in important changes to the goal setting process (e.g., asking about goal setting later in conversation, changing wording of questions) and development of a summary report of goals sent to the interprofessional team. In phase II, 44 goals were set by 16 participants during an average 7:23 (SD 4:26) minute discussion. Of these goals, 43.9% were characterized as health goals while 63.4% were characterized as life goals. Under the umbrella of Life goals, productivity featured most prominently at 22.9% of all goals. Goal attainment was not measured in phase I. In phase II, clients had an average weighted goal attainment score of 51.5. Considering client preferences for one goal over another, 68.8% of clients, on average, at least partially achieved the goals they had set.ConclusionGoal setting as part of the Health TAPESTRY approach was feasible and provided interprofessional teams with client narratives that helped improve care management for older adults. The overall intervention—including the refined goal setting component—is being scaled and evaluated in a pragmatic randomized controlled trial.

Language Sample Practices With Children Who Are Deaf and Hard of Hearing.

In this study, we aimed to identify common language sample practices of professionals who work with children who are Deaf/hard of hearing (DHH) who use listening and spoken language as a means to better understand why and how language sampling can be utilized by speech-language pathologists serving this population. An electronic questionnaire was disseminated to professionals who serve children who are DHH and use listening and spoken language in the United States. Participant responses were coded in an Excel file and checked for completeness. Descriptive statistics were used to analyze trends. A total of 168 participants participated in the survey. A majority of participants reported that they use language sampling as a part of their intervention when working with children who are DHH. However, approximately half of participants reported using norm-referenced testing most often when evaluating language of children who are DHH, regardless of the fact that they felt that language samples were more sensitive in identifying the errors of children who are DHH. Participants reported using language samples to monitor progress and set goals for clients. Participants rarely used language samples for eligibility and interprofessional collaboration. Language samples offer a unique way to examine a child's language development that norm-referenced assessments are not sensitive enough to detect, particularly for children who are DHH. This offers insights into current practice and implications for the development of a more clearly defined language sample protocol to guide practices in the use of language samples with children who are DHH and use listening and spoken language.

Goal focused positive psychotherapy: an integration of positive psychology and psychotherapy

ABSTRACTThis article introduces the empirical support for and theoretical tenets of Goal Focused Positive Psychotherapy (GFPP), a comprehensive, evidence-based, psychotherapy model. GFPP’s approach emerges from positive and social psychology research, and is informed by psychotherapy research from the common and contextual models. Its interventions focus on idiosyncratic and multiculturally-attuned client factors, particularly client strengths and goals, in an effort to increase subjective well-being and facilitate the client’s experience of a meaningful, satisfying life. Enhanced client well-being provides more robust and abundant resources for proactively addressing presenting concerns without requiring intensive focus on client deficits, symptoms, or trauma. The mechanism of change is positive emotion, as informed by the broaden-and-build [Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56(3), 218–226. doi:10.1037/0003-066X.56.3.218] biopsychosocial model. The therapeutic alliance creates a healing context cultivated through a focus on hope, strengths, and client-centred experiences of self-determination.

A Counselor Education Case Study: The Counselor Values‐Based Conflict Model in Action

This article is based on the 2nd‐place winning entry to the 2016–2017 American Counseling Association Graduate Student Ethics Competition and includes a fictional case study of a counselor trainee whose personal beliefs conflict with her client's goals, and of her doctoral supervisor who is reticent to seek consultation. The counselor values‐based conflict model (Kocet & Herlihy, ) is used to generate an ethical resolution for the dilemma. Implications for counselors, supervisors, and counselor educators are discussed.

Evaluation of a Program Model for Minimizing Restraint and Seclusion

This study conducted a longitudinal evaluation of an organizational change effort to minimize restraint and seclusion within a behavioral healthcare facility that serves at-risk and high-risk clients with intellectual, developmental, and psychiatric disabilities, using a context, input, process, and product model. The change effort was developed and implemented at an agency in the mid-Atlantic region of the USA that provided a continuum of care to children and adults in residential, educational, and home settings. There was a 99% decrease in restraint frequency, a 97% decrease in staff injury from a restraint, a 64% decrease in client-induced staff injury, and an increase in client goal mastery 133% from 2003 to 2016. Trauma-informed, less restrictive treatment methods provided safer treatment for individuals with a variety of disabilities, while increasing mastery of individualized goals. It also saved the organization over $16 million in lost time expenses, turnover costs, and workers’ compensation policy costs.

Commentary on "Effects of Suit-Orthosis on Postural Adjustments During Seated Reaching Task in Children With Cerebral Palsy".

“How should I apply this information?” Garments, such as the suit in this study, are used in therapy sessions and at home, with the goal of increasing postural support and alignment. They are often combined with intensive training programs that are costly to families both in time and money. Studies such as this one that dissect interventions that include suit wear compared with a control condition are important to evaluate their benefits. Although postural control during reaching is a functional activity, the data collected in this study does not simulate real-world reaching, which is typically more dynamic and involves reaching in a variety of planes during functional tasks. Overall, results from this study suggest that wearing the suit may be helpful for children classified as Manual Ability Classification System (MACS) II or III rather than MACS I. This intervention should be used with caution and the clinician should assess client goals and level of function when applying this intervention. “What should I be mindful about when applying this information?” The authors do not provide a rationale for using knee pads and shoes during seated activities. The suit in this study takes time to don, and it would be important to compare it to other garments that are less cumbersome and easier to don. This study would be strengthened if investigators examined the effect of the Gross Motor Function Classification System combined with the MACS level on the outcome. Furthermore, including a functional outcome measure such as the Trunk Control Measurement Scale1,2 would offer a more detailed picture of the children's trunk performance and may have provided information about those children for whom the suit was helpful. The design of this study does not allow us to know whether the gains in postural control when wearing the orthosis translate to improved function when the suit is removed. More studies like this are needed that investigate a multidimensional intervention and evaluate the effects on a functional task. Amy F. Bailes PT, PhD, PCS Cincinnati Children's Hospital, Department of Rehabilitation Sciences, University of Cincinnati Cincinnati, Ohio Jenny Dorich, MBA, OTR/L, CHT Cincinnati Children's Hospital Cincinnati, Ohio