Client Group Research Articles

Cultural Conversations in Therapy: How Often Clients Talk About Their Identities.

The purpose of this study was to examine how often clients report discussing cultural identities during counseling sessions; the extent to which discussion of cultural identities during treatment varies across therapists; whether identifying as BIPOC (Black, Indigenous, and people of color) predicts clients' discussion of cultural identities in sessions; and whether differences in the frequency of cultural conversations (i.e., dialogue that focuses on client cultural identities) across client groups depend on the therapist. This study examined variation in reports of engagement in cultural conversations during sessions (N=10,731) with 1,997 clients and 72 therapists from a university counseling center. Data were analyzed by using Bayesian multilevel models. Overall, clients reported having cultural conversations in 48.4% of sessions. Cultural conversations were much more likely to occur in sessions with BIPOC clients than with White clients: 66.2% of sessions with BIPOC clients involved conversations about cultural identities, compared with only 39.8% of sessions with White clients. Of note, the magnitude of this difference varied by therapist. Cultural conversations were more likely to occur in treatment with BIPOC clients than with White clients, and the presence of cultural conversations in treatment varied by therapist.

On-demand insurance: idea, development, impact on market equilibrium

The article presents the definition, idea, development, and current state of a new business model known as on-demand insurance which has been in existence since the early 21st century. Moreover, the article does not only describe the premises behind the development of this new method of creating value for clients of insurance companies and the opportunities that appear in the market but also addresses the challenges that insurance providers can encounter. Based on the analysis and available source materials, the most interesting types of these insurance products and the entities that include such products in the portfolios were presented. In addition, some new regulatory challenges and trends were described. The purpose of this study is to analyse the behaviour of the insurance market after the introduction of on-demand products in light of the classical definition of equilibrium in a competitive insurance market under conditions of information asymmetry. The authors analysed the economic implications of implementing on-demand insurance, demonstrating its potential to enhance the overall welfare of the insured population by increasing utility for certain risk groups of clients.

‘Mind the gap’: tensions, transitions and tactics in Canadian and Norwegian community services for older adults

This article compares community services provided to older adults living in Bergen, Norway, and Toronto, Canada. We investigate the gaps that are left unattended in the respective jurisdictions and consequently maintained by the organizations. Our findings reveal the importance of community organizations in positively influencing the initial transition from independence to needing more supports. Our findings show differences between the jurisdictions in the experiences of care gaps for diverse groups of providers and clients, while the overall importance of community organizations for older adults is shared in both jurisdictions, particularly by filling gaps between the formal and informal care systems.

Improving the Monitoring and Management of Clozapine-Induced Gastrointestinal Hypomotility (CIGH) in Community Mental Health Services: A Quality Improvement Approach.

Clozapine is the only approved antipsychotic for refractory schizophrenia to date. It can cause a range of serious and fatal adverse effects, including Clozapine-Induced Gastrointestinal Hypomotility (CIGH). While guidance is readily available to help manage CIGH effectively in hospital inpatients, practical recommendations applicable to the community (outpatient) setting are lacking. This project set out to improve the prevention, detection and management of CIGH in psychiatric outpatients. An initial baseline audit followed by quality improvement work was undertaken in a busy support worker-run community clozapine clinic focusing on, education and training, risk assessments and clinical documentation. The project was registered and managed using the Life QI web-based platform, where a set of primary and secondary drivers were defined and change ideas were executed. Qualitative and quantitative data were collected over a three-month period, demonstrating a significant improvement in clinical documentation (up from 36% to 99%). 23% of enhanced risk assessments resulted in treatment recommendations, modifiable risk factors were proactively discussed in 53% of clinic appointments and 65% of patients were provided with additional written information on CIGH. It was evident from staff and our patient feedback that further efforts would be required to continue to raise awareness about harms of unmanaged constipation among this client group. Future approaches may include enhanced collaborative efforts with primary care, and improving the skill mix in existing clozapine clinics, which could include the utilisation of mental health pharmacists.

Quality indicators for occupational therapy: a scoping review

BackgroundOccupational therapists are increasingly asked to demonstrate the effectiveness, appropriateness, and efficiency of their interventions to funding bodies. However, the extent to which this is practiced and the health policy context within which such a practice is situated differs internationally. The aim of this scoping review was to establish which quality indicators are used internationally for this purpose.MethodsWe conducted a scoping review, limiting our search to Europe and the English-speaking world. To search for suitable literature, we used specialized databases from medicine, health sciences, and related fields, including CINAHL Complete and MEDLINE, as well as free internet search via Google. Furthermore, we contacted national occupational therapy associations from several countries asking for access to documents found within this search that were only accessible to association members.ResultsThe screening process identified 32 studies and documents from six national contexts. We identified and described process-level indicators, functional outcome indicators, one outcome indicator based on individual goal attainment (the Goal Attainment Scale, or GAS), and PRO-Ergo, a patient-reported experience measure (PREM). There was little information on the use of quality indicators to demonstrate the effectiveness, appropriateness, and efficiency of occupational therapy services to funding bodies in Europe and the English-speaking world that was openly available. The identified process indicators were in most cases not specific to occupational therapy interventions. Functional outcome indicators were highly specific to certain client groups or health conditions and partially appropriate for use in occupational therapy. The GAS was found to be a highly customizable measure which allowed an evaluation on body structure and function levels as well as activity and participation levels. PRO-Ergo was focused on the clients’ subjective view and their experience with occupational therapy interventions.ConclusionsAll identified quality indicators have advantages and disadvantages. Process-level indicators specific to occupational therapy could be a chance to foster the use of best practice methods. GAS and PRO-Ergo seem to be the most versatile assessment, allowing an evaluation on the level of activity and participation. Functional outcome indicators that cover a broad area of client problems may be useful additional quality indicators for some areas of practice.

Consensus on the Components of Therapeutic Alliance in Stuttering Intervention: An e-Delphi study with Speech and Language Therapists

BACKGROUND: Therapeutic alliance is the term used to describe the interactional and relational processes that occur during therapy. The strength of a therapeutic alliance is associated with treatment adherence, treatment outcomes and clients’ satisfaction with treatment. Therapeutic alliance has been identified by key stakeholders as an essential component of stuttering intervention, however, this construct and its components remain relatively underexplored in the literature. OBJECTIVE: This study aims to build consensus amongst speech and language therapists working with adults who stutter on the core components of therapeutic alliance, and the factors that influence its development. It also aims to develop a guiding framework for the establishment and maintenance of therapeutic alliance with this client group. METHODS: Speech and language therapists participated in a three-rounded e-Delphi survey focused on: (1) identifying the core components of the therapeutic alliance; and (2) gaining group consensus on the core components of therapeutic alliance. Statements representing the core components that obtained consensus were categorised using a framework of therapeutic alliance. RESULTS: A total of 24 speech and language therapists agreed to participate. 24/24 (100%) completed Round 1, 24/24 (100%) completed Round 2, and 23/24 (95.83%) participated in Round 3. Following inductive content analysis of Round 1, 62 statements were generated, and consensus was achieved on 60 statements which were agreed by participants to represent the core components of therapeutic alliance. These statements were then categorised, resulting in a guiding framework of therapeutic alliance to support speech and language therapists working with clients who stutter. CONCLUSIONS: Consensus on the core components of the therapeutic alliance for stuttering intervention was reached through engagement with speech and language therapists. The framework presented demonstrates the vital role speech and language therapists play in the formation and maintenance of therapeutic alliance during the delivery of stuttering interventions with adults.

Responding to suicidal behaviour in children and young people with a child maltreatment history: A scoping review

Child maltreatment affects millions of children internationally every year. Development is negatively impacted by maltreatment increasing the likelihood of maladaptive behaviours. Associations between child maltreatment and suicidal behaviour and suicide in young people has been established. However, there is a research gap in understanding effective ways to respond to and intervene with suicidal behaviour in young people who have experienced child maltreatment. A scoping review was conducted in accordance with the Joanna Briggs Institute methodology to investigate interventions that may be effective in preventing and reducing suicidal behaviours in young people who have experienced child maltreatment. Inclusion criteria were studies: (a) of children and young people who engage in suicidal behaviour and have experienced child maltreatment; (b) published in English during the time period 2000–2020; and (c) focused on responses and interventions to prevent or address suicidal behaviour. Across 37 studies, several intervention targets were identified through reflexive thematic analysis including cultivation of self-compassion, gratitude and future orientation, alleviation of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms and psychological distress and addressing cognitive errors and negative views of the self. Screening and clear assessment of suicidal risk by health professionals and child welfare professionals was endorsed across studies. Several evidence-based treatments were proposed to support intervening with this client group, although only Emotional Intelligence Therapy (EIT) was empirically tested with this population. Utilisation of safe systems that the child or young person is in may be beneficial in addressing and reducing suicidal behaviour, such as inclusion of families, peers and the implementation of school-based interventions strategies. Future research is needed to empirically test and assess the effectiveness of interventions.

Re-design methodology for an under-risk multi-business supply network

ABSTRACT Currently, several supply chains of the same business may be managed independently. This is due to different groups of clients or different marketing channels. Parallely, changes in the environment, due to unexpected situations, lead the decision-makers to modify the configuration of supply chains. Therefore, we propose a redesign methodology based on a progression of steps to study holistic synergies. This design analysis is carried out at a static and dynamic level for strategic, tactical and operational decisions. The use of qualitative and quantitative tools allows a set of solutions to be obtained, which take into account inventory levels, processing times, costs and service levels. To compare the preliminary solutions, AHP (Analytic Hierarchical Process) is combined with TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution). It is applied to an example of pharmaceutical distribution in South America. The results indicate an improvement of service levels and a reduction of costs from risks.

Wellbeing in stroke and aphasia (WISA): protocol for a feasibility study setting up an accessible service offering psychological therapy to people with post-stroke aphasia

Background and aimFollowing a stroke, around a quarter of people will have aphasia, a language disability. Aphasia can have a devastating long-term impact on a person’s psychological wellbeing, yet their language difficulties make it challenging to access mental health care. The Wellbeing In Stroke and Aphasia (WISA) study aims to evaluate the feasibility of setting up an accessible psychological service for people with aphasia.MethodsThe service will be open to people with post-stroke aphasia (n = 30) who live in the UK, are able to access the service either in the university clinic or via telehealth and are not currently receiving therapy from a mental health professional. Participants will be offered up to 8 therapy sessions over 6 months, either one-to-one, with family, or in a group. The intervention is Solution Focused Brief Therapy (SFBT), a brief psychological therapy, delivered by speech and language therapists with training in SFBT under the supervision of a stroke-specialist clinical psychologist. As part of this service, a protocol for addressing mental health care has been developed. Feasibility will be assessed by monitoring referral rates, therapy received, discharge processes, resource capability, costs, challenges, and adverse events. Patient-reported outcome measures collected pre and post intervention will assess mental wellbeing, mood, participation, and satisfaction with therapy and the service. A purposive sample will take part in in-depth interviews following therapy.DiscussionGiven the high levels of psychological distress in this client group, there is a need to investigate innovative ways to provide accessible and acceptable psychological support.

Considerations for the use of dialectical behavior therapy for individuals experiencing oppression.

As the popularity of dialectical behavior therapy (DBT) grows, so does its use with increasingly diverse groups of clients. In this article, we demonstrate that DBT in its standard form can incorporate the sequelae of oppression as a target of treatment by providing clients with skills to identify oppression and its impact while responding effectively. To support the use of DBT with individuals experiencing emotion/behavior dysregulation and oppression, we review how each of the primary strategies of DBT can be used within the context of oppression. Specifically, we discuss how dialectical philosophy, the acceptance/change dialectic, communication strategies, and case management strategies can be viewed through an oppression lens. A brief review of DBT research with historically oppressed populations and common pitfalls in treating oppressed individuals is presented. As research in examining and adapting DBT for minoritized groups continues to catch up to clinical need, guidance is presented here for researchers and clinicians interested in using this empirically supported treatment in communities that experience oppression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessing the experiences of teenage mothers in accessing healthcare in Rwanda

Teen mothers are more susceptible to the negative consequences of pregnancy, due to system-wide and socio-cultural barriers to accessing needed services, posing higher pregnancy complications and health risks to the babies and mothers. Understanding their lived experience can inform context-specific health programs and interventions that address their needs and improve the health outcomes. Twenty-three women who had delivered her first child before the age of 18 years were interviewed using semi-structured interview guide. The transcripts were coded, categorized and summarized into four major themes: 1) Many pregnant teen girls were disadvantaged by the system from accessing the healthcare services, 2) Although being judged, many found the health care services positive and important, 3) Faced financial difficulty in accessing health services, despite most medical services are covered by community based health insurance, 4) Health care services focuses mostly on the medical health of pregnancy, the social and psychological needs were mostly not available. The study highlighted the gap in providing mental health services, financial support to the teen mothers as part of a comprehensive health services. Some of them consulted health services for the first time with and did not return for follow up if perceived the services was bad. More sensitive and targeted materials and ANC services can be offered to this unique group of clients. More acceptance training to the health care providers and the public is needed. For health facilities, there is a need to also check their psychological wellbeing when seeking ANC services. Online or mobile phone-based mental health interventions may provide some solutions to the issue. Government should re-evaluate the health insurance system to avoid unintentional exclusion of this group of population. Policy to facilitate men to take responsibilities on teen pregnancy issue is needed.

PSYCHOLOGICAL BOARD GAMES: MYTH OR REALITY

The article is devoted to a new tool in the arsenal of a practicing psychologist - psychological board games. There has been a rapid increase in the popularity of games and the emergence of works describing the creation and use of psychological board games for a variety of client groups. A wide range of applied problems solved using games is outlined. The lack of unity in the understanding of the term “psychological board games” is stated. The authors note an expanded use of the term without theoretical justification and with a pronounced marketing component. Various points of view on the content of the concept of psychological board games are considered. It is emphasised that a psychologist should conduct psychological board games.

Cooking Well with Diabetes: A Healthy Cooking School for Diabetes Prevention and Management.

One in ten Americans suffers from type 2 diabetes, which, if not managed well, can result in severe complications, disability, and premature death. Diabetes education classes can play a pivotal role in providing practical education on diabetes and self-care behaviors, with a particular emphasis on dietary management, which is often regarded as the most demanding diabetes self-care behavior. The Texas A&M AgriLife Extension Service developed Cooking Well with Diabetes (CWWD), a four-week interactive diabetes education series, with each week consisting of a lecture on healthy eating coupled with cooking lessons featuring diabetes-friendly recipes. The current study aimed to examine the effectiveness of CWWD in improving the frequency of healthy food preparation and consumption of program participants. Secondary data from 2017 to 2023 was analyzed involving 1574 adults from 59 predominantly rural Texas counties. Data from self-reported pre and post evaluations showed improvements in healthy food preparation and consumption behaviors. The curriculum enabled Extension Educators to introduce healthful dietary behaviors to a diverse group of clients. The curriculum can be adapted by Extension Educators in other states reaching a broader audience. The findings will inform future research aimed at planning and implementing successful diabetes education programs.

The Impact of Strengths-Based Working on Long-Term Housing Outcomes: A Qualitative Comparative Analysis

Abstract Strengths-based working (SBW) is being adopted across multiple sectors, but the evidence base for its effectiveness is limited. In this assessment of a social outcomes contract, authors evaluated the impact of SBW on the delivery of homelessness-related outcomes for a high-risk client group. The novel impact evaluation design first identified characteristics in frontline staff associated with SBW and then decoded conjectural causal links between these characteristics and their clients’ social outcomes using qualitative comparative analysis. Data were collected from 65 frontline workers, measuring reflective practice, self-efficacy, and innovativeness. Authors found that clients of staff who most strongly exhibited characteristics associated with SBW achieved better long-term outcomes. This article makes four important contributions to our understanding of SBW. First, authors show how it is possible to undertake rigorous impact evaluation of SBW in a complex setting and identify moderately complex causal relations with limited sample size. Second, authors propose and test the presence of key characteristics associated with SBW and, in doing so, contribute to the theoretical understanding of SBW. Third, authors present new evidence on the effectiveness of SBW. Finally, the article demonstrates how social outcomes contracts can provide a framework for testing innovative social interventions.

Norwegian Health Professionals’ Attitudes Toward Addressing Sexual Health with People with Intellectual Disabilities

Abstract Introduction Staff working with individuals with intellectual disabilities face challenges addressing sexual health. Professionals in this context have diverse backgrounds and education, and little is known about their attitudes and skills in providing support for a healthy sexual life and preventing abuse. Moreover, this topic has not been explored in the Norwegian context. The current study examined health professionals’ attitudes toward addressing sexual health with individuals with intellectual disabilities in Norwegian municipal health and care services. Methods A cross-sectional study was conducted using the Norwegian version of the professionals’ attitudes toward addressing sexual health among 72 health professionals working in municipal services for people with intellectual disabilities in Mid-Norway. The data was collected from November 2022 to January 2023. Results The professionals reported feeling partially comfortable and prepared to address sexual health issues with clients. They consistently expressed a need for more basic knowledge about sexual health and training in communicating about sexuality. Attitudes toward addressing sexual health varied based on the professionals’ education, gender, age, and work experience. Conclusions More targeted training on sexual health is needed within the educational programmes in health and social sciences. Sexual health should also be continuously addressed in the workplace and among colleagues. The differences in attitudes between professionals indicate that the composition of the staff benefits from diversity. Policy Implications Healthcare managers are responsible for ensuring greater openness and reflection on attitudes toward sexuality among individuals with intellectual disabilities in workplaces. Educational institutions must provide the necessary skill development and training in communication about sexual health for this client group.

BPS DSEP position statement: Psychological skills training in youth sport

Young athletes have become an increasingly important client group for sport psychology practitioners and a population whose physical, cognitive, emotional, and social development should be carefully considered by a practitioner when delivering their services (Visek et al., 2009). The aim of this British Psychological Society (BPS) Division of Sport and Exercise Psychology (DSEP) position statement is to summarise existing knowledge about psychological skills training (PST) interventions and discuss optimal service provision of PST in youth sport. In the first section of this position statement, we provide a brief overview of the literature exploring PST during childhood (5–11 years), early adolescence (12–15 years), and mid-to-late adolescence (16–18 years). Within each sub-section, key developmental considerations (i.e. physical, cognitive, emotional, and social) are provided followed by short summaries of research on basic single strategy (i.e. goal setting, imagery, relaxation, and self-talk) and alternative strategy interventions (e.g. mindfulness, music, perceptual training, and self-modelling) with young athletes. In the second section, optimal service provision of PST is discussed by drawing upon practitioners’ experiences of working with young athletes, concluding with 10 recommendations for youth sport organisations, training and accrediting bodies, researchers, and practitioners.

Certified Community Behavioral Health Clinic Services for Clients With Co-occurring Disorders: A Latent Class Approach.

Certified community behavioral health clinics (CCBHCs) are designed to provide comprehensive care for individuals with co-occurring mental and substance use disorders. The authors classified outpatient mental health treatment facilities on the basis of provision of services for clients with co-occurring disorders and assessed whether CCBHCs differed from other outpatient mental health facilities in services provided. The authors used latent class analysis to identify distinct services for clients with co-occurring disorders in 5,692 outpatient mental health facilities in the 2021 National Substance Use and Mental Health Services Survey. Nine indicators were included: treatment for clients with substance or alcohol use disorder co-occurring with serious mental illness or serious emotional disturbance, specialized programs or groups for such clients, medication-assisted treatment (MAT) for alcohol use disorder, MAT for opioid use disorder, detoxification, individual counseling, group counseling, case management, and 12-step groups. A multinomial logistic regression was used to estimate whether CCBHCs were associated with any identified classes after analyses controlled for facility characteristics. A four-class solution provided a model with the best fit, comprising comprehensive services (23.4%), case management services (17.7%), counseling and self-help services (58.6%), and professional services (4.3%). Regressing class membership on facility type and covariates, the authors found that compared with community mental health clinics (CMHCs), CCBHCs were more likely to belong to the comprehensive services class than to the case management services, counseling and self-help services, and professional services classes. CCBHCs were more likely than other outpatient programs to offer comprehensive care, and CCBHC status of a CMHC facilitated enhanced service provisions.

Caring for those who care for our pets: veterinary social workers’ perceived role in veterinary medicine

ABSTRACT Seventy percent of homes have at least one pet with 83% of people referring to themselves as a pet-parent. Veterinary Social Workers provide clinical support to both owner and veterinary medical teams. This study focused on the exploration of social workers embedded in veterinary medicine settings. The researcher-created survey explored: (1) general characteristics of Veterinary Social Workers and practice settings; (2) Characteristics of client groups; (3) Description of the role and tasks; (4) overall mental health needs of clients; and (5) Veterinary Social Workers response to mental health needs. Suggestions for future research, and best practices for educating social work students/practitioners about animal-human informed practices are offered.

Lesbian, gay, bisexual, and transgender clinical competence of physiotherapy students in Israel

BackgroundClinical competence encompasses attitudes, skills, and knowledge regarding diverse client groups. Appropriate clinical competence requires an understanding of the cultural context in which healthcare is delivered. In conservative countries such as Israel, there is a noticeable scarcity of information regarding the clinical competency of physiotherapy students (PTSs) in effectively treating lesbian, gay, bisexual and transgender (LGBT) individuals. The objective of this study was to assess the level of LGBT clinical competence among PTSs in Israel.MethodsConducted through an anonymous online self-report survey, this study gathered personal and academic background information and self-reported data on previous LGBT education during undergraduate studies of PTSs. It utilized the Hebrew version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) questionnaire. Descriptive statistics were computed for all outcome measures. The internal reliability of the LGBT-DOCSS was assessed. Total scores of the LGBT-DOCSS, along with scores in each of the three subscales (clinical preparedness, knowledge, and attitudes), were compared across different levels of religiosity and gender.ResultsThe sample comprised of 251 PTSs, with an average age of 25.57 ± 3.07 years (34.7% men, 65.3% women). All students reported a lack of LGBT community-related courses during their undergraduate studies. The translated Hebrew version demonstrated good internal consistency, with Cronbach’s alpha ranging from 0.65 to 0.83. The LGBT-DOCSS total score was 4.55 ± 0.61 out of 7, indicating a low level of clinical competency. The highest mean score was in the attitudes subscale (6.55 ± 0.87), which was significantly higher than the scores for the knowledge subscale (3.14 ± 1.46) and clinical preparedness subscale (3.36 ± 0.86). Religiousness was significantly associated with clinical preparedness and attitudes. Men exhibited higher self-reported levels of knowledge and clinical preparedness, albeit with more negative attitudes compare to women. Sexual orientation was significantly associated with clinical competency, with PTSs who identified as heterosexual demonstrating a lower level of clinical competency compared to participants who identified as non-heterosexual.ConclusionsIn Israel, PTSs demonstrated a low level of clinical competency in terms of self-reported knowledge and self-reported clinical preparedness but contrasting positive attitudes toward the LGBT community. Religiousness, gender and sexual orientation had a significant influence on competency levels.These preliminary findings highlight the urgent necessity to enhance the knowledge of PTSs regarding the LGBT community to improve their clinical competence.Trial registration NRNot applicable.

Speaking English as an additional language: using a Delphi technique to identify the competencies needed by EPs working with EAL students and families

ABSTRACT The proportion of pupils with English as an additional language (EAL) has steadily risen in recent years in England, reaching just under one in five of all pupils aged 5–16 in 2021, with a total of over 365 languages spoken between them. Despite educational psychologists’ (EPs) practice being concerned with reduction of barriers that prevent children from fully accessing education, a review of the educational psychology literature provides little information to suggest that EPs are responding to the increasing linguistic diversity of their client group. Further, there is a lack of shared understanding among EPs of the specific competencies needed to address the specific language needs of this population. Through a three-round Delphi, 90 statements were identified as key features required for EP practice with EAL students and families; these statements were then structured into a guiding framework for EP practice. The implications of this framework, and its limitations, are discussed.