Client Support Research Articles

Healing the Fallout From Transgenerational Trauma: Supporting Clients in Making Peace With Their History

The author describes research into the impact of transgenerational trauma and how such trauma is passed from generation to generation in the process of bonding between parents and children. She argues that a disturbed and confused family system can be the result of unresolved historical trauma. She considers ways to address clinical issues that arise and where systemic and individual approaches may be needed. Theory and methodology from family constellations work are integrated with transactional analysis and an understanding of trauma. Questions are raised about how we might understand cure after such difficulties.

Video streaming over Ad hoc on-demand distance vector routing protocol

Video streaming is content sent in compressed form over the netwoks and viwed the users progressively. The transmission of video with the end goal that it can be prepared as consistent and nonstop stream. The point is that to give client support to client at anyplace and at whatever time. Mobile Ad hoc Networks (MANETs) are considered an attractive nertwork for information transmission in many applications where the customer programme can begin showing the information before the whole record has been transmitted. Ad hoc On-demand Distance Vector (AODV) protocol is considered as one of the most important routing protocols in MANET. However, routing protocols assume a crucial part in transmission of information over the network. This paper investigates the performance of AODV Routing Protocol under video traffic over PHY IEEE 802.11g. The protocol model was developed in OPNET. Different outcomes from simulation based models are analyzed and appropriate reasons are also discussed. A different scenarios of video streaming were used. The metric in terms of throughput, end to end delay, packet delivery ratio and routing overhead were measured. A comparision with GRP and GRP are also reported.

Demonstrating Nursing Excellence Through Equality: The Relationship Between Magnet® Status and Organizational LGBTQ Client Services and Support

Introduction: Human Rights Campaign annually scores health care treatment of lesbian, gay, bisexual, transgender, and queer (LGBTQ) employees and clients among four measured dimensions in its Healthcare Equality Index (HEI). The purpose of this study was to determine if the score organizations earned on the 2018 HEI dimension measuring LGBTQ client services and support correlated with organizations' American Nurses Credentialing Center Magnet® recognition status, a distinction of nursing excellence. Method: Using a secondary data analysis approach, data obtained from Human Rights Campaign that specifically rated LGBTQ client services and support in 2018 HEI participating organizations (n = 626) were compared with the most recent inventory of American Nurses Credentialing Center Magnet health care organizations (n = 477). Results: LGBTQ client services and support HEI scores positively correlated with Magnet status (p = .0002). Discussion: Provision of LGBTQ client services and Magnet recognition is strongly related to higher quality nursing care, suggesting organizations earning Magnet recognition provide more equitable services to its LGBTQ clients.

Image Offload Computation Algorithm for Energy Efficiency in Mobile Cloud Computing

The cloud proclaims another period of compute where relevance administrations are given throughout the Internet. Cloud Computing may improve the calculating ability of mobile frameworks. Cloud Computing is a new worldview in which computing advantages, for instance, preparing, memory, and capacity aren’t actually exhibit at the client's area. Moderately, a dedicated co-op claims and contracts with these benefits, and customers obtain to them through resources of the web. Amazon Web Services offers customers a possibility to hoard entity in sequence through resources of its easy storage space check and execute computations on place not here in sequence. This kind of calculating give small introductory capital speculation, shorter start-up instant for novel administrations, lesser upkeep and task costs, superior use by virtualization, and simpler catastrophe recuperation. Cloud Computing may give power investment funds as a support of mobile clients; however it likewise represents some extraordinary difficulties. This paper basically center around image information offload as of mobile to remote server, which at that point procedures image and changes over it to suitable, good low goals image on solicitation through new mobile customers. This change lessens mobile gadget energy utilization pretty downloading equal lofty goals imagery.

Australian welfare workers and street-level discretion when working with clients from culturally and linguistically diverse (CALD) backgrounds

This article explores street-level discretion of Australian welfare workers when working with clients from culturally and linguistically diverse (CALD) backgrounds. The research is situated within the context of New Public Management (NPM) and neoliberalism in the welfare sector. Findings suggest that workers’ discretion oscillates between extra support for clients, or further scrutiny and sanction. Such contradictory patterns of discretion highlight workers’ capacity to resist neoliberalism while concurrently upholding it. The article argues that cultural understanding, recognition of the limitations in welfare-to-work policies and neoliberalism, and how those factors, together with ethnicity, may influence street-level discretion are necessary for welfare workers to support CALD clients effectively.

Current practice of cognitive rehabilitation following traumatic brain injury: An international survey

ABSTRACT Traumatic brain injury (TBI) is a global public health issue, frequently resulting in impairments in the cognitive domains of attention, information processing speed, memory, executive function, and communication. Despite the importance of rehabilitating cognitive difficulties, and the release of clinical practice guidelines (CPGs) for cognitive rehabilitation, little is known about current clinician practice. This study aimed to explore current international clinician practice of cognitive rehabilitation. One hundred and fifteen English-speaking allied health professionals, including neuropsychologists and occupational therapists, from 29 countries outside Australia, were surveyed online about their current practice and reflections on cognitive rehabilitation. Both cognitive retraining and functional compensation approaches to cognitive rehabilitation were commonly utilized. Clinicians mostly targeted deficits in attention and executive functioning with retraining interventions, whilst memory deficits were mostly targeted with compensatory interventions. Clinicians were aware of and utilized various resources for cognitive rehabilitation, including CPGs. Clinicians considered the client’s social support network, client engagement and motivation in rehabilitation, multidisciplinary team collaboration, and goal setting and implementation as highly impactful factors on the success of cognitive rehabilitation interventions. Whilst practice is broadly consistent with current CPG recommendations, addressing facilitating factors can further optimize client outcomes and quality of life following TBI.

An Exploratory Study of Veterinary Professionals' Self-Reported Support of Bereaved Clients Before, During, and After Companion Animal Euthanasia in Southwestern Ontario, Canada.

Veterinary professionals are recognized as an important source of support for many veterinary clients, particularly during companion animal euthanasia and end-of-life care. While many veterinary professionals recognize the importance of their role, many also report feeling unsure about what methods of support are most effective. Furthermore, few evidence-based guidelines currently exist to inform veterinary professionals on the support of grieving clients. To begin bridging this gap, this study qualitatively explored how veterinary professionals currently report supporting grieving clients before, during, and after companion animal euthanasia. Findings suggest that veterinary participants in this study strive to be meaningful sources of support for grieving clients and employ an array of support practice to do so. However, opportunities exist for veterinary professionals to better explore clients' needs, expectations, and feelings as they relate to companion animal euthanasia, including offering more grief-related resources and access to professional counseling services.

A framework for GPU‐accelerated exploration of massive time‐varying rectilinear scalar volumes

AbstractWe introduce a novel flexible approach to spatiotemporal exploration of rectilinear scalar volumes. Our out‐of‐core representation, based on per‐frame levels of hierarchically tiled non‐redundant 3D grids, efficiently supports spatiotemporal random access and streaming to the GPU in compressed formats. A novel low‐bitrate codec able to store into fixed‐size pages a variable‐rate approximation based on sparse coding with learned dictionaries is exploited to meet stringent bandwidth constraint during time‐critical operations, while a near‐lossless representation is employed to support high‐quality static frame rendering. A flexible high‐speed GPU decoder and raycasting framework mixes and matches GPU kernels performing parallel object‐space and image‐space operations for seamless support, on fat and thin clients, of different exploration use cases, including animation and temporal browsing, dynamic exploration of single frames, and high‐quality snapshots generated from near‐lossless data. The quality and performance of our approach are demonstrated on large data sets with thousands of multi‐billion‐voxel frames.

Hubungan Dukungan Sosial Keluarga dengan Perilaku Perawatan Diri pada Klien Diabetes Melitus Tipe 2 di Wilayah Kerja Puskesmas Kaliwates, Jember

Type 2 diabetes mellitus (T2DM) is a metabolic disease that can cause various chronic complications and they can be minimized by self-care. One of the factors that affect self-care in diabetic clients is family social support. The aim of the research was to analyze the correlation between family social support and self care behavior client with T2DM)in the area of Kaliwates public health center, Jember. This research applied an observational analytic design with cross-sectional approach. A total of 84 respondents were enrolled in this study by using purposive sampling technique. The data collection method used the HDFSS (Hensarling Diabetes Family Support Scale) and SDSCA (Summary of Diabetes Self Care Activity) questionnaires, it conducted on January 7th-22nd 2019. The data analysis used Spearman correlation test with a significance level of 0.05.The result showed that median of the family social support was 86 with a minimum value of 69 and a maximum value of 106, whereas the mean value of self-care behaviour was 2,27 days with a standard deviation of 0.45 days. There was a significant positive correlation between family sosial support and self-care behaviour (p value: 0.001; r; +0.378), meaning that the higher the level of family social support the better the self-care behaviour. This study suggests the importance of assessing family social support to improve self-care in clients with type 2 diabetes mellitus.

Volitional questionnaire: Psychometric evaluation of the finnish translation

Background: Supporting clients’ motivation to engage in occupations is essential to occupational therapy practice. The Volitional Questionnaire Finnish version (VQ-FI) can be used to evaluate volitional behaviors of clients with limited ability to communicate.Objective: The many-facet Rasch model was used to evaluate the reliability and validity of the VQ-FI using the FACETS and WINSTEPS software.Methods and materials: Forty-two therapists received an in-person training on the VQ-FI and completed 226 independent ratings of clients. The VQ-FI was evaluated in its rating scale functioning, unidimensionality, person validity, rater severity, item targeting, and item/person separation.Results: The four-point rating scale demonstrated adequate functioning; the ‘passive’ rating category was rarely adopted. The VQ-FI showed unidimensionality, with all 14 items fitting the Rasch model. No evidence for ceiling or floor effects, and the assessment demonstrated appropriate item and person separation. The VQ-FI reliably separated participants to three levels of ability.Conclusions: The study provides preliminary evidence for the reliability and validity of the VQ-FI.Significance: The VQ-FI is an observational measure that can be used to evaluate clients’ volitional behaviors. The VQ-FI offers practitioners and researchers a valid approach to evaluate volition that is theoretically grounded in the Model of Human Occupation.

Relationships between Different Types of Servitization and Operational Performance: Considering the Effect of Cross-Function Integration

There is fierce conflict between theoretical research of servitization which has high potential for manufacturing companies to build sustainable competitive advantages and the practice of manufacturing companies which invest a lot in servitization without getting the expected benefit. This study aimed at filling the aforementioned research gap to examine the relationship between servitization and operational performance. In line with the focus of information and knowledge within this study, we also examine the moderating effect of cross-function integration. Based on the IMSS-IV database, we test these relationships. The results showed the following: (1) The result suggests that service support products has a positive impact on operational performance while the relationship between service support clients’ actions and operational performance is U-shaped; (2) the relationship between two types of service and operational performance is not moderated by cross-function integration. This study contributes to the current literature and practice on servitization and cross-function integration.

Validity and reliability of the (adjusted) Impact on Participation and Autonomy questionnaire for social-support populations

BackgroundDecentralisation of social support and budget cuts spurred interest in outcome-oriented payment systems in the Netherlands. Hence, measurement of relevant outcomes, such as self-reliance and participation, is needed. The Impact on Participation and Autonomy (IPA) questionnaire for rehabilitation clients was adapted for social support, called IPA-MO, and its validity and reliability were tested among social support clients in eight municipalities in 2014 and 2016.MethodsThe total research sample comprised of 4120 persons. Homogeneous subgroups were distinguished based on 1) disability and 2) age. Exploratory factor analysis (PCF) was used to identify domains for IPA-MO. Model fit was assessed with Confirmatory Factor Analysis (CFA) using structural equation modelling.ResultsPCF revealed that the IPA-MO model consists of all five original IPA domains: Autonomy indoors, Family role, Autonomy outdoors, Social life and relations, and Work and education. As a result of new items added, a new, sixth domain was developed: Financial autonomy. Due to high non-response on Work & education, construct validity was first tested for a five-domain IPA-MO model. The composition of the IPA-MO domains showed slight differences: the item on ‘mobility indoor’ shifted from Autonomy indoors (IPA) to Family Role in IPA-MO. The item on reciprocity shifted from Social Life and relations (IPA) to Autonomy outdoors (IPA-MO). Internal reliability was confirmed for all domains (Cronbach’s alpha >.80). CFA showed acceptable construct validity of the five-domain IPA-MO model for the social support population (CFI .936, TLI .925, SRMR .051), all age groups and most disability-based groups. Construct validity including Work & education was tested for 234 participants. Then, PCF revealed six domains and the model fit was acceptable (CFI .915, TLI .903, SRMR .067).ConclusionsIPA-MO is a valid and reliable instrument to assess outcomes of social support. Further research on the domain Financial autonomy is needed. Social-support clients are numerous and dispersed and, in spite of the best intentions, hard to involve widely in policy processes. A valid outcome measure offers municipalities possibilities to gain insight in social costs and benefits of new policies. Outcome measurement also allows to contract bundled-services of providers, thereby changing the incentives for providers from increasing production to much needed innovation. Taking the perceptions of autonomy and participation of social-support clients as the acid test for the effectiveness of social support policies, may prove a serious game-changer in politics.

Listening to your heart or head? – An interpretative phenomenological analysis of how people experienced making good career decisions

ObjectiveThis study aims at building some knowledge concerning the connection between the decision-making process and the career-related outcomes. This knowledge is to help coaches to engage an efficient coaching process to provide the best support for clients with career decision-making problems. It examines the experience on the thinking processes undergone by eight people, in relation to their career choices which are subjectively perceived as ‘good decisions’.DesignBased on the social constructivism paradigm, it is a qualitative research design.MethodsSemi-structured interviews were used for data collection and interpretative phenomenological analysis for data examination.ResultsFour main themes emerged: ‘Emotional connection’ and positive feelings; Serendipity; Inside battle; Congruence between heart and head.ConclusionsThe decision-making process is perceived as a positive, easy and ‘smooth’ experience when the emotional and rational thinking align. Participants’ own conclusions converge on the importance of one being aware of both inner voices – head’s and heart’s. Being a new research topic, it requires further exploration, through qualitative and quantitative studies, as well. Specific implications and directions for future research are discussed.

Counseling in assisted reproductive technology

The background history of counseling in assisted reproductive technology (ART) relates to when technology was introduced into the infertility treatment of clients. The public reaction then was intense on concern over the vulnerability of potential users and the welfare of children either created or affected by it. As a response, the development of Human Fertilization and Embryology Act (HFEA) in 1990 established infertility counseling with recommendations to address the public perception of moral and social acceptability of ART by the society. The recommendations outlined requirements for clinics offering infertility treatment to individuals and couples to provide counseling for the associated symptoms and treatment consequences that clients may experience with ART. The purpose, definition, indications, types, and scope for counseling in ART were also addressed. Infertility counseling in ART incorporates a clinical team approach consisting of the fertility doctor, fertility nurses, professional counselors and embryologist who through information empower and support clients to cope well with the infertility experiences.

Relational Dynamics Supporting Client Orientation: Perspectives from the Front Lines of Service Delivery

This study explored how identification processes among front-line workers influence client orientation. We interviewed 15 front-line workers from two sport/leisure organizations. Thematic analyses of interview results suggest how identification and relational processes can foster client orientation. Front-line workers may identify with co-workers, the organization (mission was particularly important), the client, and even the activity for which they are responsible. Identification with these targets offers insight into how to treat clients. For example, several of those interviewed noted the importance of mission statements in setting the tone for a client orientation. Two conditions seemed important. First, the mission statement must offer clarity into the role of client orientation in the service delivery model. It should focus directly on serving the client. Second, it must be crafted in a way that encourages identification by staff members. They must see their own value system within the mission statement. These identification processes became critical when other identification targets (in this case, other staff) offered direction that was incompatible with client orientation. We found, for example, that at times co-workers’ values and behaviours could be inconsistent with client orientation. On such occasions, though, those with already high client orientation tendencies failed to identify with, or at least model, the behaviours of their co-workers. Instead they looked to vision for service laid out by the organization. These findings also highlight the importance of staff-participant and staff-activity identification. Observers believed that staff members sharing a sense of similarity and familiarity with program participants, often possessed a client orientation. Particularly striking in our interviews was the notion of a shared passion for the activity (e.g., special event or sport) in developing client orientation. Most leisure service staff described here had a background in the activity they facilitated. As a result, they had a strong passion for that activity. When they interacted with participants who also demonstrated a passion for the activity, identification processes were enhanced. This identification seemed to aid in client orientation. Finally, participants described how job descriptions often failed to capture the nuances of client orientation and instead focused on core tasks. It is perhaps unsurprising then, that client orientation was described as being a lower priority among staff who focused on tasks (as laid out in their job descriptions or in policy). Subscribe to JPRA

How to Support Clients and Vendors in IT Outsourcing Engagements: The Different Roles of Third-party Advisory Services

The outsourcing of information technology to external providers has been a phenomenon for organizations around the world since decades. The main reasons for this trend are, for example, cost reductions through scaling, the temporary inclusion of specific skills in the own organization as well as the joint development of innovative solutions with an external partner. The client organization “RetBa,” a major private insurance company, was facing serious quality and performance issues in the delivery of the workplace services. Hence, in 2005 they decided for an outsourcing solution aiming at moving the responsibility for managing IT workplace services for over 50,000 seats worldwide to the external service provider “EuTu.” Over the years, the outsourcing project faced several problems due to the lack of performance and delayed delivery of services by the service provider EuTu. To solve these quality issues and avoid further failures, in 2011 RetBa appointed Scaleit Consulting, a third-party advisor. Scaleit Consulting had the responsibility to identify the causes for these issues, revise the workplace strategy, and support RetBa in the communication with the service provider.

Integrated day- and night care by the integration of technology

Intramural care is provided by different teams of day- and night care workers. It can be a challenge to provide the necessary care and support, in particular whenever decisions need to be based on care plans and reports made by someone else. Clear communication and coordination between day- and night care professionals seems to be a prerequisite for guaranteeing 24-hour personalized care and support. Increasingly, this coordination between professionals takes place through information systems such as the Electronic Health Record EHR and digital surveillance technologies, of which the latter are mostly used during the night. These systems can provide professionals a better awareness of the client's care and support needs. However, automatic information exchange between the EHR and the surveillance technology is lacking. Thereby, these systems are used separately, forcing care professionals to manually transfer client data from one system to another. Meanwhile, both systems contain a great amount of possibly relevant data that can reinforce each other. Yet, it is unclear which minimum dataset is relevant to exchange and how the exchange of data can contribute to 24/7 care. Furthermore, care providers struggle with the balance between privacy legislations and the safety of their clients. Therefore, an explorative study was performed with the central question: How can it be ensured that care professionals have a good picture of the client's healthcare needs 24 hours a day, regardless of the different systems that are supporting them? Semi-structured interviews and focus groups were performed with day- and night care professionals of six care organizations and developers of six EHR suppliers and six surveillance technology suppliers. The interviews and focus groups were held to gather an insight in their perceptions in respect to the research question. From the study it appeared that standardization is lacking to enable the exchange of information between systems and that a vendor lock-in is quite common among care organizations. Care professionals and organizations have the need to be provided with relevant information at the right time through one central system, or as few solutions as possible. The communication and coordination between day- and night care professionals can – according to care professionals - be accomplished by: having and sharing a clear vision on the use of night care technology among all relevant stakeholders; active support for this vision by the board of directors; assigning key-users to support and promote exchange; and night care integration in EHR. The integrated use of data from various sources is an important condition for exploiting the predictive value of data and more proactively responding to potential risks and needs of clients. Information exchange and the optimal use of this information not only involves the integration of technology, but also the integration of services and work procedures. This requires a cultural change within healthcare organizations with support of all stakeholders. Thus, integrated care must be addressed both at the human and system level.

Exploring Intersecting Program Elements in Longer-Term Concurrent Disorder Services for Adults: A Qualitative Evaluation

Previous research highlights multiple factors that impact the attainment of client-identified recovery goals in substance misuse treatment programs. However, fewer studies examine how programs meet the broad range of needs expressed by clients through their intersecting elements of service delivery. This study seeks to develop an understanding of intersecting program and recovery elements in relation to an overall framework for programming, focusing on how overlapping elements of treatment ventured to support clients in multiple areas of their recovery. Qualitative interviews were conducted with clients (n=41) in three longer term substance use treatment programs, and data from interviews were analysed using analytic induction and constant comparison strategies to surface emergent themes. Data analysis yielded six main findings. These included: Education; Goal Setting; Routine and Stability; Spiritual Development; Exercise; and Transitional Planning. Respondents indicated that programs must focus on bolstering the development of each element across multiple treatment domains (such as group therapy and counselling) to best support clients in achieving recovery outcomes.

Eigen regie en waardigheid in de zorg: een kwestie van persoonsgerichte praktijkvoering

Eigen regie en waardigheid in de zorg: een kwestie van persoonsgerichte praktijkvoering

Power of Linked Administrative Data

IntroductionLinking administrative data provides valuable information about individuals using government services and can be very useful for policy-makers in improving and developing services and policies. The Child and Youth Data Laboratory (CYDL) links and analyses administrative data from Alberta Government ministries to provide evidence for policy and program development.
 Objectives and ApproachData from 20 programs of six Government of Alberta ministries (Advanced Education, Education, Health, Children’s Services, Community and Social Services, and Justice and Solicitor General) were linked anonymously. The data spans six years from 2005/06 to 2010/11 and consists of almost 50 million records corresponding to over 2 million unique Albertans aged 0 to 25 years. A data visualization tool called the Program Overlap Matrix summarises the overlap rates among the programs. It is comprised of a matrix of squares, where each cell represents the overlap between two programs.
 ResultsThe Program Overlap Matrix is publically available at https://visualization.policywise.com/P2matrix/. It consists of overlap rates between programs in any study year (2005/06 to 2010/11), individual years, the first year vs. future years, and the last year vs. previous years which can be used to answer many policy-related questions such as: other service use (e.g., what other services do ESL students use?), over-represented programs (e.g., in what programs are Child Care Subsidy clients over-represented?), resilience (e.g., what is the proportion of Child Intervention clients in post-secondary institutions?), transitions (e.g., what types of services do students with special needs receive as they transition to adulthood?), and time trend (e.g., what types of services did Income Support clients receive in the past?)
 Conclusion/ImplicationsThe program overlap matrix is a powerful tool to discover relationships between programs. It is a useful instrument to inform public and policy-makers about the overlap rates between government programs. It can be used to answer a variety of policy-related questions.