Client Group Research Articles

Enacting multisectoral service chains and packages in the health and social care regions in Finland

Abstract Several studies have concluded that about 10% of the users of the health care and social services use most services and produce about 80% of the costs of care. However, this client group and their needs for services, which are often complex and multisectoral, are poorly characterized. The new Act on Organizing Health and Social Care Services in Finland obliges the health and social care regions to identify the client groups who need integrated services and to define the multisectoral service chains and packages for these clients. The assumption is that an individual client's personal service path can be planned and enacted by utilizing the pre-defined service chains and packages. This study aimed at studying the definition, development and enactment of the service chains and packages. The study was based on a survey which was carried out in the 22 health and social care regions in spring 2023 for analyzing 1) to which client groups the service chains and packages are defined, 2) what needs there are in the background of defining service chains and packages, 3) what kind of goals are defined for the service chains and packages, 4) what the current developmental state of the service chains and packages is and how they manage to cross the sectoral and disciplinary boundaries, and 5) what successes and challenges there are in defining, developing and enacting the service chains and packages. The survey was the first part of a study which focuses on the development and enactment of service chains and packages in the health and social care regions. The survey results showed that most of the development activities were in the definition phase. The survey gives perspective and background knowledge to the second part of the study which focuses on one specific client group, the children with neuropsychiatric symptoms, and on the definition and enactment of their service chains and packages within three regions.

Coping Strategies of Social Service Clients over the Course of the COVID-19 Pandemic: Qualitative Research on Social Workers in Poland

This paper aims to establish strategies of coping with COVID-19 pandemic adopted by the clients of social assistance from the perspective of social workers. The qualitative research among Polish social workers and family assistants was conducted from September to November 2021. Based on 30 in-depth interviews with social work professionals, groups of social assistance clients’ behaviours were identified and classified into the theoretical models of reactions to social change by Merton and Giddens. The following types of behaviour have been selected and categorized into four groups of reactions when dealing with social workers in a pandemic situation: coolheaded calculation, defiance, confusion, and adaptation. At the same time, reactions to the situation of social change were categorized into one of the strategies of active or passive behaviour: innovation, contestation, retreat, and acceptance. In addition, we discussed the impact of clients’ coping strategies on social workers and established three attitudes of the surveyed social workers: adapting to the pandemic situation and customer behaviour, assuming the role of an emotional buffer and informant, and expecting support from superiors and coworkers. Knowing the behaviour of social assistance clients in a challenging situation makes it possible to adopt tailor-made measures.

Different clinical presentations of Achilles tendinopathy: a cross-sectional study.

Achilles tendinopathy (AT) is a common debilitating tendon disorder in the lower extremity. Clinical presentation of AT might differ from place to place, depending on different variables including cultural factors. This study was conducted to determine the clinical picture of AT in a group of clients referring to an outpatient orthopedics clinic in Shiraz, southern Iran. In this cross-sectional study, a convenient sample of 61 (46 female and 15 male) patients attending to a referral outpatient clinic affiliated to Shiraz University of Medical Sciences with a definite diagnosis of AT was studied. Patients with partial- or full-thickness tear of Achilles tendon, history of radicular pain or lower extremity injury, previous history of surgery on their lower extremity, and pregnant women were excluded from the study. We used Maffulli et al. (Foot Ankle Surg 26:240-9, 2020) criteria for the diagnosis of AT in our patients. The patients had a mean age of 47.7 (SD 11.1) years and mean BMI of 28.7 (4.2) kg/m2. There was no significant correlation between the age and body mass index of the participants (Pearson's r = -0.028, p = 0.832). The prevalence of insertional AT among 58 patients with only one site affected, was 84% (95% CI 72-92%), significantly (p < 0.001) higher than that of midportional AT (16%). Women were more frequently affected than men (p < 0.001). The clinical presentation of AT in southern Iran is somewhat different from those reported in other parts of the world. Further studies on larger groups of patients should be done to determine the causes of the observed differences.

Contradictions in the Development of the Welfare Non-Profit Sector in Russia

The article focuses on the core contradictions within the development of the social non-profit sector in Russia. The empirical basis of the study comprises statistical data, legal documents regulating the social services’ sphere, research data from previous studies conducted in Russia, as well as qualitative data collected for this study. The introduction provides background information on the stages of reforming the social service system in Russia. The first part is devoted to the contradictions between international trends and Russian patterns. In line with a neoliberal approach, non-profit NGOs play a significant role as key actors in social work providing social services for different client groups. At the same time, they are not independent and Russian civil society is not yet strong enough to realize social rights of citizens. In the next section, some of the key issues of interaction between the government and NGOs are discussed. An analysis of the current situation demonstrates that while a social partnership between the state and NGOs is affirmed by authorities on official level, in practice, the state still dominates the social sector. The article then focuses on how Russian NGOs have reoriented their efforts toward financial sustainability through government support.

Near and far: Representation of online psychotherapy in a group of clients

The research born with the aim of exploring the perspective with which the Digital Natives (ND) are confronted with online psychological counseling and video conference psychotherapy (VCP) is presented. To this end, 30 interviews were conducted, distinguishing those who had only experiences in offline settings, those who had experiences in mixed settings (offline/online) and those who had no experience of psychological interventions. The narratives were analyzed through a cluster analysis and a subsequent correspondence analysis. The results underline the importance of the physical co-presence and the organizational aspects of the setting as facilitating factors of the clinical process but do not allow to specifically characterize the NDs. The representations collected regarding online psychological counseling/VCP seem in fact to have been influenced more by the emotional correlates of the pandemic period than by the characteristics of remote psychological work.

Challenges of social work towards women abusing alcohol. Reflections and observations based on selected results of own research

The article describes the problem of alcohol abuse and alcohol addiction among women. The reflections and observations contained therein are based on the results of own research conducted as part of a research project: “Interdisciplinary activities of selected social services with women abusing alcohol”. As part of the research, interviews were conducted with social workers who meet this group of clients in their daily work. Their statements allow us to understand the difficult situation of an addicted woman, raise awareness about her problems and show the circumstances that are the beginning of a difficult addiction battle.Of course, the social worker works only with a specific group of women struggling with the problem of alcohol abuse and addiction. Many of them are unknown to the environment, and they themselves do not ask for any help. This has to do with the way society perceives women abusing alcohol.

Information technologies of application architecture`s IT services

The development of the System Architecture of the IT infrastructure focused on the usage of modern Data Centers is considered. The purpose of the research is to develop a strategy for the development of the System Architecture of the IT infrastructure based on the usage of advanced methodologies and concepts of leading manufacturer’s hardware and software. The following principle of IT infrastructure construction is formulated: IT infrastructure architectures define a set of services. IT services are provided to three groups of clients. IT services and clients are connected by 5 implementation scenarios. The integration of IT services is determined by 5 architectures. As IT services, we understand information technologies aimed at maintaining the following elements in technically good condition: network devices, computing equipment, data storage devices, automatic software deployment services, network services, perimeter protection services, directory services, file and print services, data management services, business application services, IT management services, archiving and recovery services, certificate management services, integration services. Architectures define the fundamental principles of building IT services and their relationship. One of the most important architectures is the architecture of software applications. The architecture of software applications is determined by the business needs of the corporation and the approaches, methods of creating applications by a specific developer. It defines the execution environment for applications, mechanisms of communication between applications and components, tools for controlling the application and managing its state, as well as storage for structured and unstructured data types. Tasks of the architecture: to provide an environment for the execution of application components; support dispatching mechanisms for communications between application components; implement tools for monitoring the level of services and diagnosing problems; provide storage of structured and unstructured information. Standardization of the application architecture allows you to minimize costs associated with the support of several types of architectures, each for a specific type of business application.

The social self in humanistic counseling: A dialogical alternative for the practice of wellness and social justice

AbstractClassical humanistic philosophy and psychology both infer the persistence of a stable, authentic, and volitional self, which neither fully coheres with the values implicit to professional counseling nor offers sufficient relevance to culturally diverse client groups. As an alternative, the authors suggest that humanistic counseling can emerge as a distinct discipline of practice independent of its early influences. Further, the authors offer a dialogical alternative for humanistic counseling practice that might better support contemporary clients and their various social determinants of experience.

Supporting People Data Linking Programme: Linked data research into the impact of housing-related support on use of healthcare services

ObjectivesWith an annual budget of over £120 million, the Welsh Government Supporting People Programme provided housing-related support to help vulnerable people to avoid homelessness and live as independently as possible. The SPDLP aims to determine the impact of the programme on other public services I.e. healthcare.&#x0D; MethodsEstablish data sharing agreements and acquire data for 21 out of 22 Local Authorities. Link the acquired Wales-wide sample of Supporting People data with other routine health and administrative datasets in the SAIL Databank. Examine the impact on subsequent interactions with other services (i.e. health, social care, housing options and pre-16 education). Create control groups and identify subgroups of clients to better quantify the effects of the Supporting People intervention. Compare service utilisation groups of clients and non-clients to inform future provision of public services.&#x0D; ResultsWork to validate the SPDLP approach by applying the method from the earlier Supporting People Data Linking Feasibility Study (SPDLFS) to the most recent data has been completed. Results from this will be presented along with emerging findings related to repeat homelessness. The development of health economics approaches to evaluating the impact of the programme will also be presented.&#x0D; ConclusionFor most local authorities in Wales, we have developed a longitudinal linked dataset comprising details of people at risk of homelessness. This has successfully enabled statistical research and analysis to explore the wider impact of government programmes to address inequalities and answer research questions around homelessness.

Service user experiences of a physical health group for people experiencing psychosis, designed following service user consultation

Psychosis is associated with physical health comorbidities. Exercise and a healthy diet can improve cardiometabolic risk and mental wellbeing. This study explores the feasibility, acceptability, and experiences of a physical health group for clients experiencing psychosis. The group was developed and refined following consultation with service-users and culturally appropriate peer support workers. It included eight weekly sessions. The aims of the group were to provide psychoeducation on healthy living and to build motivation to engage in healthy living. Attendance, completion, and satisfaction were recorded to determine feasibility and acceptability of local service delivery. Clients took part in follow-up qualitative interviews to understand experiences of attending the group. Interviews were analysed using thematic analysis. Twenty-five clients were referred to the group. Overall, 10 clients enrolled in the group. Clients who enrolled in the group attended a median of 4.5 sessions. The mean satisfaction score for all sessions combined was 9.15/10 [SD 1.18]. Seven individual interviews were conducted. Two themes emerged. 1) Positive views towards the group, with clients feeling more aware of the benefits of healthy living, and clients finding the group setting motivating. 2) Considerations when planning healthy living support, which reflected subthemes in difficulties maintaining healthy living and concerns that the group should not be about weight loss. Investigations were limited to one mental health provider. It was feasible and acceptable to implement a healthy living group for clients with psychosis in a community mental health team, and this intervention was met with positivity.

Sexualised drug use and chemsex in Italy: A questionnaire study based on a cohort of clients attending a STI outpatient service in Milan.

Chemsex is a heterogeneous phenomenon with differences in distribution, setting, motivations and type of substances consumed between countries. The lack of data at national level of the Italian situation creates a perception of reduced need for intervention. Anonymous paper questionnaires were distributed to patients who had registered themselves at the STI Department IRCCS Ca' Granda Policlinico in Milan. A significant association was demonstrated between use of sexualised drugs, chemsex and the following variables: (1). Number of partners: in the group of clients with more than five partners, sexualised drug users were more than twice compared with those in the group with less than five partners (35.2% vs 16.2%) p<0.0001. (2). Use of dating apps: more than one out of two persons who used drugs during sex affirmed looking for partners on internet, p = 0.0059. (3). Low condom uses with occasional partners: percentage of individuals who declared not to use condoms or devices during their sexual encounters with occasional partners is more than twice as high in the sexualised drug users group with respect to controls (44.6% vs 21.4%); p = 0.0006). (4). Use of post exposure prophylaxis (PEP): among the PEP users, more than half participants belonged to the sexualised drug users' group; p = 0.0021. Sexualised drug use and chemsex are frequently practiced in Milan. This survey identified a specific population with higher-risk sexual behaviours and increased incidence of acute bacterial STIs.

Психологическая помощь родственникам суицидента

&lt;p style="text-align: justify;"&gt;&lt;strong&gt;Relevance. &lt;/strong&gt;After suiced family go through a psychological crisis, relatives are at risk of developing symptoms of emotional distress. At the same time, stigmatization can interfere seeking informal help, which makes it important to provide psychological help to this group of clients. &lt;strong&gt;Purpose of the study&lt;/strong&gt;. Examine various approaches to providing psychological help to relatives of suicides and highlight the targets of such interventions. &lt;strong&gt;Materials and methods.&lt;/strong&gt; The article presents a literature review of foreign studies of the effectiveness of various formats of psychological help for the family of a suicide. &lt;strong&gt;Results&lt;/strong&gt;. There are different forms of psychological help for relatives of suicides: individual, group and family psychotherapy. After a suicide attempt, more research are focus on family therapy, and after a completed suicide on group psychotherapy for relatives of a suicide. For family therapy of suicidal behavior, two approaches are the most developt &amp;ndash; cognitive&amp;ndash;behavioral and attachment&amp;ndash;based psychotherapy. The goals of working with the family are to reduce conflict and criticism, increase cohesion, develop communication skills and stabilization of the emotional state of family members. Inclusion of the family in the therapy of patient after suicide attempt increases the effectiveness of treatment. Support groups have become the most popular format for helping relatives after a completed suicide. Among the goals of working with the grieving are opportunity to share difficult feelings, return control over life, reconstruction of the meaning of what happened, and stoping ruminations. Research shows the effectiveness of these interventions for coping with grief, reducing emotional lability and improving social adaptation. &lt;strong&gt;Conclusions. &lt;/strong&gt;Relatives of suicidal people need opportune psychological help. The most common approach for psychological help is cognitive&amp;ndash;behavioral psychotherapy, which has programs with proven effectiveness for both relatives after a suicide attempt and after a completed suicide.&lt;/p&gt;

Assessing the Feasibility of Conducting Smoking Cessation Outreach in Food Pantries: A Pilot Intervention Study.

Smoking prevalence is high among US adults with food insecurity. This study examined how food assistance settings, namely food pantries, can serve as a community-based venue to reach food insecure adults who smoke for smoking cessation. Partnering with a local hunger relief organization, we conducted surveys and focus groups of food pantry clients in Greater Cleveland, Ohio, followed by food pantry-based outreach events to connect people who smoke to the Ohio Tobacco Quit Line. The survey included 132 participants who visited a food pantry (M age = 47; 74% women; 39% Black/African American), of whom 35% were using tobacco and 31% were smoking cigarettes. Among those currently smoking (M cigarettes/day = 9), 76% intended to quit in the next 6 months, and 82% had not used nor heard of the quitline. Informed by focus group themes, we conducted a total of 22 outreach events at four pantries. Among those interested in smoking cessation resources from the outreach events (n = 54), 78% were able to be subsequently contacted. Of them, 74% provided consent for quitline referral. The remainder either declined or were unable to participate. While it was feasible to leverage food pantries for smoking cessation outreach, the overall reach was low. Despite high interest in quitting, there was limited effectiveness of outreach efforts without adaptations to each pantry setting and in recognition of the immediate food needs and with challenges related to the COVID-19 pandemic. There remains a critical need to address high rates of smoking among populations experiencing food insecurity. Tobacco cessation services are increasingly recognizing the need to address food insecurity and other social needs that commonly occur in populations who use tobacco at higher rates. This research underscores both the value and the challenges related to leveraging food pantries as a community-based venue for smoking cessation outreach. In addition to improvements in outreach models, long-term investments in structural interventions are also needed to address underlying poverty and socioeconomic disadvantage that ultimately drive disparities in smoking and in food insecurity.

Reliability and short version of the Dunphy Outcomes Framework (DOF): Integrating the art and science of dance movement therapy

There is an increasing requirement of evidence-based outcome frameworks in the health sciences. This article presents the Dunphy Outcomes Framework (DOF) for dance movement therapy (DMT), the first generic outcomes framework for DMT. The framework is posited to measure outcomes intrinsic to DMT, and comprehensive for all client groups and contexts. It is therefore suggested as suitable for assessment of DMT interventions and clients’ progress. The DOF comprises six domains (physical, cultural, cognitive, emotional, social and integration), further divided into sub-domains and objectives. Informed by theory and evidence, both from published research and professional practice, the DOF has been developed through an extensive Delphi-like consultation process. The article presents the DOF and data on its reliability and validity. Reliability testing confirmed the factor structure of the original DOF with very good scale homogeneity and excellent interrater-reliability. Heuristically based on the results of an exploratory factor analysis that yielded six dimensions – five corresponding to the original DOF domains, with a slightly different weight of factors – a short version of the DOF (DOF-BREVE) is proposed. Benefits and limitations of the DOF as an assessment tool for the profession of DMT and creative arts therapies are discussed.

Developing a recovery-oriented intervention for people with severe mental illness and an intellectual disability: design-oriented action research.

Mild intellectual disability or borderline intellectual functioning (MID/BIF) are common in people with severe mental health problems (SMHP). Despite this, there is a lack of treatments adapted for this group of clients. This qualitative study describes the development of a new intervention, guided by the principles of action research, for people with SMHP and MID/BIF and mental health professionals to help them talk about all aspects of the process of recovery. The intervention was developed in four cycles and in close cooperation with mental health professionals, experts by experience, other experts in the field of SMHP or MID/BIF, and clients. During all cycles there was a strong focus on the content of the intervention, exercises, understandable language, and drawings for visual support. This resulted in the intervention "Routes to Recovery," which covers both complaints and strengths, coping strategies, helpful (social) activities, and how to determine future steps in a recovery plan. Routes to Recovery is a first step in helping professionals and their clients with SMHP and MID/BIF to have a conversation about personal strengths and what the client needs to recover. Future research should investigate the effects of this intervention.

Accessing Care During the COVID-19 Pandemic Using Telemedicine: Perspectives From People With HIV.

The COVID-19 pandemic has resulted in a steep increase in telemedicine implementation and use. Data are lacking on telemedicine use in marginalized and underserved groups including people with HIV (PWH). The Ryan White HIV/AIDS Program (RWHAP) is the largest single provider of HIV care in the United States (U.S.) and the southern part of the country remains the epicenter of the HIV epidemic. This study recruited PWH from RWHAP clinics across South Texas. To ascertain their perspectives on utilizing telemedicine for HIV care during the COVID-19 pandemic, a survey instrument derived from validated instruments was used. Descriptive statistics were used for client characteristics, quality of telemedicine care, and COVID-19 impact. Wilcoxon Rank Sum and Kruskal-Wallis tests were assessed associations of telemedicine care quality and COVID-19 impact between client groups. Among 246 eligible PWH, 122 clients completed the survey with a response rate of 50%. Clients were predominantly Hispanic males. Significant differences in perception of telemedicine care and the impact of COVID-19 by gender, age, language, and race/ethnicity were observed. Older PWHIV used telemedicine more than younger clients (p = .01). English speakers indicated more impact of the COVID-19 pandemic on daily life than Spanish speakers (p = .02). Worry about the pandemic was most evident among non-Hispanic Black and Hispanic PWH (p = .03). Overall, telemedicine was found to be a favorable and acceptable mechanism of HIV care delivery by PWH in a Southern state during the COVID-19 pandemic.

Development of an Evidence-based Violence Rehabilitation Program for Offenders With Intellectual Disability.

A review of the current literature on evidence-based violence prevention programs developed for individuals with an intellectual disability (ID) reveals a paucity of direct evidence for this population. In addition, the existing offence-specific programs are primarily grounded in adapted cognitive behaviour therapy (CBT) programs designed for the mainstream offender population, which may not be suitable for offenders with co-morbid mental health and personality disorders. The current paper discusses the development of a violence rehabilitation program for offenders with an ID. The focus of the article is on the exploration of the empirically supported risk factors associated with violent offending and the incorporation of these dynamic risk factors into the program modules. A case study example was utilized to examine the process of VRP-ID and how the modules targeted the offenders' treatment needs. Responsivity issues are addressed by identifying cognitive difficulties experienced by this cohort and the implications for treatment. The Risk/Need/Responsivity (RNR) model and the good lives Model (GLM) are widely used offender rehabilitation models that can be considered the guiding principles in developing this program. Furthermore, it utilizes contemporary therapeutic frameworks such as motivational interviewing (MI), cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), and GLM reconceptualization and skills. The program is grounded in trauma-informed principles, which acknowledge this client group's high prevalence of victimization.

Viewing Person-Centred Counselling from an Islamic Perspective

Studies have shown that person-centred approach to counselling is effective in helping various groups of clients. It has been almost thirty years after the departure of Carl Rogers, yet, the approach remains influential in counselling profession. In Malaysia, it becomes one of the most practised counselling approaches among counselling practitioners. As the theory was developed in the United States and represents the Western secular worldview, there is a need to look into its philosophy and concepts from the Islamic perspectives. This is due the reason that many counselling practitioners and clients in Malaysia are Muslims. Hence, the article aims to discuss the main features of the person-centred theory such as its philosophy, view of human nature, origin of individual’s problem and counsellor’s personal qualities and review them from an Islamic perspective.

Clients of a HIV-service NPO: structure, typology, behavioral features

Every year the number of registered HIV-infected people is increasing, which by the end of 2021 made 851.8 thousand people. In this connection the organization of work on prevention and treatment of HIV infection is relevant. The survey of 6313 representatives of the key group, i.e. clients of HIV servicing NPOs — Russians (4793 people) and citizens of other countries (1520 people) identified the main risk groups, for which it is necessary to work out the principal activity strategies connected with treatment and prevention. Every tenth client of the Charitable Foundation is HIV-infected and hepatitis C positive, every fourth has had or is having sexually transmitted infection (STI), and 4.6% of men and 1.4% of women have syphilis. The group is characterized by risky behavior in terms of HIV infection, STIs (and other dangerous diseases), including: drug use (17.8% of men — injecting and/or 46.1% of women — non-injecting), prostitution (13.6% of men and 15.4% of women), consume sex services (16.6% of men and 5.0% of women). Based on analytical and mathematical methods, eight basic conditional groups of patients of the Foundation were identified that will allow us to develop work strategies depending on a number of basic socio-demographic characteristics (age, sexual orientation), attainability of clients, morbidity, risk behavior and attitudes regarding morbidity, treatment and prevention. In particular, the most difficult groups of clients to work with at the Foundation have been identified: legal and illegal migrants and men involved in prostitution. What all of these groups have in common is that they depend on their employer and their priority is to keep their jobs, for the sake of which they are willing to sacrifice their health and lead deviant lifestyles.

Efficient Distribution Similarity Identification in Clustered Federated Learning via Principal Angles between Client Data Subspaces

Clustered federated learning (FL) has been shown to produce promising results by grouping clients into clusters. This is especially effective in scenarios where separate groups of clients have significant differences in the distributions of their local data. Existing clustered FL algorithms are essentially trying to group together clients with similar distributions so that clients in the same cluster can leverage each other's data to better perform federated learning. However, prior clustered FL algorithms attempt to learn these distribution similarities indirectly during training, which can be quite time consuming as many rounds of federated learning may be required until the formation of clusters is stabilized. In this paper, we propose a new approach to federated learning that directly aims to efficiently identify distribution similarities among clients by analyzing the principal angles between the client data subspaces. Each client applies a truncated singular value decomposition (SVD) step on its local data in a single-shot manner to derive a small set of principal vectors, which provides a signature that succinctly captures the main characteristics of the underlying distribution. This small set of principal vectors is provided to the server so that the server can directly identify distribution similarities among the clients to form clusters. This is achieved by comparing the similarities of the principal angles between the client data subspaces spanned by those principal vectors. The approach provides a simple, yet effective clustered FL framework that addresses a broad range of data heterogeneity issues beyond simpler forms of Non-IIDness like label skews. Our clustered FL approach also enables convergence guarantees for non-convex objectives.