Client Well-being Research Articles

Navigating the storm: How proficient organizational culture promotes clinician retention in the shift to evidence-based practice.

ObjectiveClinician turnover is a major concern as mental health systems and organizations invest substantial resources in the implementation of evidence-based practice (EBP). In this study, we identify malleable factors associated with reduced clinician turnover during a system-wide EBP implementation initiative. Specifically, we examine how proficient organizational culture (i.e., norms and behavioral expectations that clinicians prioritize improvement in client well-being and exhibit competence in up-to-date treatment practices), EBP implementation climate (i.e., perceptions that the organization’s policies, procedures, and practices support EBP use), and change in these organizational characteristics relate to clinician turnover during a system-wide EBP transformation.MethodData were collected from 236 clinicians in 19 mental health clinics across 3 years of a system-wide EBP implementation initiative in the City of Philadelphia. Clinicians reported on proficient organizational culture and EBP implementation climate at baseline (T1) and two-year follow-up (T2). Administrators reported on clinician turnover at three-year follow-up (T3). Hypotheses were tested via multilevel mediation analyses incorporating mixed effects logistic regression models.ResultsControlling for organization size, clinician job satisfaction, attitudes towards EBP, job tenure, and age, higher levels of proficient organizational culture and improvement in proficient culture from baseline to two-year follow-up predicted reduced clinician turnover in the year following; these effects were mediated by EBP implementation climate and by improvement in EBP implementation climate, respectively.ConclusionsOrganizations with more proficient cultures have more supportive EBP implementation climates that predict reduced clinician turnover during system-wide EBP implementation initiatives. Strategies that target these antecedents in mental health service organizations may contribute to reduced clinician turnover.

Exposing the impact of intensive advice services on health: A realist evaluation.

Attention has turned to welfare advice as a potential health and social care intervention. However, establishing direct evidence of health impact has proven difficult. This is compounded by the need to understand both the facilitative contexts and mechanisms through which this impact occurs. This study investigated if, how and in which circumstances an intensive advice service had an impact on stress and well-being (as precursors to health impacts), for clients attending a branch of Citizens Advice, located in the North East of England. A mixed methods realist evaluation of three intensive advice services offered by Citizens Advice (CA) was operationalised in five phases: (a) Building programme theories, (b) refining programme theories, (c) Development of a data recording tool, (d) Testing programme theories with empirical data, (e) Impact interviews. This paper focuses on phase 4. The Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and Perceived Stress Scale (PSS) were completed by 191 clients, with a 91% follow-up rate (data collected: February 2016 to March 2017). Twenty-two CA clients participated in interviews (data collected: October 2015 to November 2016). The PSS indicated a significant decrease in stress from initial consultation to approximately 4-6weeks post advice from 31.4 to 10.3 (p<0.001) and the WEMWBS indicated a significant increase in client well-being from a mean of 26.9 to 46.5 (p<0.001). Nine refined programme theories are presented which combine the qualitative and quantitative analysis; they are underpinned by three abstract theories: Capabilities model, The Decision to Trust Model, and Third Space. An explanatory framework is presented covering the micro, meso, and macro levels of CA. Use of a stress and well-being lens has allowed insight into the precursors of health in those receiving intensive advice. Using these measures whilst explaining contextual and mechanistic properties, begins to build a complex and real picture of how advice services impact on health.

Development and implementation of dementia-related integrated knowledge translation strategies in rural home care

Purpose: As the Canadian population ages the provision of high quality dementia care may be increasingly challenging, particularly in under-resourced rural areas. Researchers have also suggested that rural care providers have unmet dementia-related educational needs and would benefit from formal knowledge exchange supports, such as a knowledge broker (KB). The current research aimed to address this issue by employing a KB to facilitate the development and implementation of integrated knowledge translation (iKT) strategies within two rural home care centres.Methods: In this longitudinal multiple case study, iKT processes at each site were assessed at baseline, 6 months, and following the termination of KB assistance. Data from 38 semi-structured interviews at the latter time points with registered and licensed practical nurses, health care aides, managers, and other care providers (n=19) were analyzed thematically to examine their perceptions of strategy processes and impacts, including the KB role.Findings: Perceived facilitators of iKT strategy development and implementation included collaborative development by knowledge users, alignment with organizational values and culture, and regular communication. Home care providers (HCPs) identified the importance of leadership and perceived the KB to be integral for facilitating communication, keeping strategies on track, and brokering information. Barriers to strategy implementation also emerged however, including significant time constraints, limited resources, and the variable nature of dementia. HCP reported that the iKT strategies enabled rural/community-specific solutions, enhanced their knowledge and ability to use best practice dementia information, increased their capacity to exchange dementia knowledge, and ultimately enhanced family and client well-being.Conclusions: HCPs reported professional benefits from their participation in the iKT strategies, and perceived benefits for people living with dementia and their caregivers. Findings suggest the utility of such strategies for addressing ongoing education needs of rural care providers. Keywords: dementia, integrated knowledge translation, home care, rural DOI: http://dx.doi.org/10.14574/ojrnhc.v18i2.509

Child and parent perspectives of life quality of children with physical impairments compared with non-disabled peers

Background: Life quality has become a widely used concept within rehabilitation and occupational therapy practice.Aim: This study explored child and parent perspectives of life quality of children with physical impairments compared with a group of non-disabled children.Method: Data were collected with the Icelandic self- and proxy-reported versions of the KIDSCREEN-27. For children with physical impairments, reports from 34 children and 40 parents were included in the analyses, and in control group reports from 429 children and 450 parents were included.Results: Children with physical impairments evaluated their life quality within the average range on four out of five life quality dimensions. The lowest scores were within the physical well-being dimension. Self-reported scores of children with physical impairments were higher than those of their parents on all dimensions except autonomy and parent relations. Thus, the parents considered more environmental and personal factors to negatively influence their child’s life quality than children did themselves.Conclusion: Children with physical impairments experience their life quality similarly to non-disabled children.Significance: Focus on life quality can help occupational therapists to identify what circumstances positively or negatively influence client well-being and to focus more on contextual factors that contribute to disablement.

Bed bug education for school, childcare center, and healthcare workers: Traditional versus webinar venues

To protect the health and well-being of children and clients, workers in schools, childcare centers, and the healthcare industry need regular, state-of-the-art education on bed bug avoidance and control. For some, webinars provided by the United States Environmental Protection Agency are a convenient, free source of this education. Bed bug webinars were found to be as effective in conveying actionable information as traditional classroom-style workshops. Webinar audiences also grasped the bed bug prevention and control concepts as well as participants in classroom sessions. The study also documents the preferred education venue for each audience, the differences in attendance, and the environmental and cost savings afforded by webinars.

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

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

Field Training Experiences of Child Welfare Workers: Implications for Supervision and Field Education

Given social workers’ essential connection to child welfare work and the importance of field day training to both worker retention and client wellbeing, this study used a theories of transfer framework and qualitative interviews with newly-hired workers to examine their field day training experiences including the value workers placed on them and the conditions that facilitated successful learning. From a statewide sample of newly-hired child welfare workers (N = 1501), participants (N = 38) were randomly selected to participate in telephone interviews. Almost 50% had positive, meaningful experiences, 40% did not, and the remaining had mixed experiences. Those with positive experiences generally felt that field days exposed them to critical, realistic job content while those with negative experiences felt frustrated that they received incomplete training and wasted time in agency offices without guidance. Congruent with the theories of transfer framework, meaningful field days depended upon the level of: (1) integration of knowledge and skills learned in the classroom with practice; (2) structure; (3) functioning in disrupted environments; and (4) engagement between newly-hired workers and certified workers. Notwithstanding complex work responsibilities and pressured environments, training efforts could benefit from recognizing the need for coordinated integration of classroom and field training content and providing the time necessary for certified workers and newly-hired workers to partner and review training content in a supportive environment.

Presence in the Nurse–Client Relationship: An Integrative Review

Aim:To integrate empirical literature related to the use and outcomes of presence. Design: An integrative review of empirical research was conducted.Method:A comprehensive search from 1966 to August 2017 was conducted using Whittemore and Knafl’s five-step method. Twenty-six studies were eligible for the review.Results:Presence is a deliberate, interpersonal intervention that is implemented through physical, psychological, and spiritual actions to promote client well-being. Nursing actions associated with presence include use of self, availability, and therapeutic communication.Conclusion:This diverse range of primary sources indicates the significance of presence to nursing practice.

The Black Perspective in Clinical Social Work

Given the persistence of oppression in contemporary society, social workers may expect to encounter social bias in the clinical setting. On the one hand, clients who identify as a member of a disadvantaged social group may report experiences of oppression accompanied by emotional, behavioral, and physical responses (Carter in Couns Psychol 35(1):13–105, 2007; Sue in Microaggressions and marginality: manifestation, dynamics, and impact, Wiley, Hoboken, 2010). On the other hand, those who are members of a historically privileged social group may present with negative affective and behavioral responses associated with prejudicial ideations towards disadvantaged social groups (Sullaway and Dunbar in Clin Psychol 3(4):296–309, 1996). This paper provides evidence from my field experiences that directly confronting social bias encountered in the clinical setting promotes client wellbeing and social justice with diverse clients. In doing so, I respond to the call for front line practitioners to share their perspectives regarding the integration of social justice and social work (Maschi et al. in J Soc Work Pract 25(2):233–253, 2011). I also elaborate on Howard University School of Social Work’s Black Perspective as a theoretical orientation for clinical social work with diverse populations (Gourdine and Brown in Howard University School of Social Work in the 1970s: social action, advocacy, and agents of change, Black Classic Press, Baltimore, 2016). Because Black perspectives are often marginalized in scholarship and practice, I hope to shed light on their critical role in addressing contemporary clinical issues (Bent-Goodley et al. in J Hum Behav Soc Environ 27(1–2):27–35, 2017; Graham in Soc Work Educ 28(3):268–280, 2009).

Evidence for Psychiatric and Mental Health Nursing Interventions: An Update (2011 through 2015)

This state-of-the-evidence review summarizes characteristics of intervention studies published from January 2011 through December 2015, in five psychiatric nursing journals. Of the 115 intervention studies, 23 tested interventions for mental health staff, while 92 focused on interventions to promote the well-being of clients. Analysis of published intervention studies revealed 92 intervention studies from 2011 through 2015, compared with 71 from 2006 through 2010, and 77 from 2000 through 2005. This systematic review identified a somewhat lower number of studies from outside the United States; a slightly greater focus on studies of mental health professionals compared with clients; and a continued trend for testing interventions capturing more than one dimension. Though substantial progress has been made through these years, room to grow remains. In this article, the authors discuss the background and significance of tracking the progress of intervention research disseminated within the specialty journals, present the study methods used, share their findings, describe the intervention domains and nature of the studies, discuss their findings, consider the implications of these studies, and conclude that continued track of psychiatric and mental health nursing intervention research is essential.

Applying the capability approach in social work education

The capability approach is useful in assessing the well-being of clients. In this study, social work students utilised this approach during a class exercise. Each student selected one client from their practice education and presented the data in the form of a vignette. A qualitative study of an exploratory and descriptive nature was undertaken. The goal of the study was to provide a theoretical overview on the capability approach and to explore how third-year social work students could apply this approach in social work education when assessing the well-being of their clients. The participants were able to indicate aspects in their clients’ lives that were not conducive to their general well-being, but could also provide suggestions where functioning and well-being could improve. Five vignettes were chosen from the data, representing the main challenges clients faced. It was concluded that the capability approach could be used by the students to good effect in social work education when assessing the well-being of their clients. Future research into the utilisation of the capability approach in social work education could be done, to better equip students for their practice education.

The impact of microfinance programmes on access to health care, knowledge to health indicators and health status among women in Moshi, Tanzania

Background: Microfinance Institutions (MFI) award small loans and women are the primary target. Whilst much literature has explored and acknowledged its impact on poverty alleviation and gender equality few studies have examined whether the added income also improves health outcomes to program clients. This study examined the association between participation in MFI programmes and wellbeing of clients and their family members via social determinants of health in Moshi, Tanzania.Methods: Cross-sectional data among non-elderly women were collected between October and December 2011. Multistage random sampling technique was employed to obtain study participants. The primary predictor variable was participation in MFI programs while the outcome measures were: odds of facing exclusion to health care, knowledge to health indicators related to health promotion, and self-assessed health status. A questionnaire was used to collect extensive data on demographic and socioeconomic information of the study participants.Results: A total of 900 women participated in the study. Program participation was found to be associated with increasing age (p&lt;0.001), increasing number of living children (p&lt;0.002) and level of income (p&lt;0.001). We found no association between program participation and access to health care, knowledge to health indicators related to health promotion and self-assessed health status. Only one out of seven indicators (14.2%) was significantly associated with MFI participation and access to health care. Two out of six (33.3%) health indicators showed association to MFI programme participation, while only 3 out of 15 (20%) dimensions measured in self-assessed health status showed significant association to MFI programme participation.Conclusion: These findings indicate that MFI programme participation is not associated with improved health outcomes of clients and their family members in Moshi. Strategies are needed to enhance the health-promoting capacity of MFI programmes in Moshi as shown elsewhere.

E-PIMH: A collaborative and integrative model to build cross-sectoral rural and remote workforce capacity in perinatal and infant mental health

Following a series of consultations throughout 2014 and 2015, the Queensland Centre for Perinatal and Infant Mental Health (QCPIMH) identified a significant gap in provision of perinatal and infant mental health (PIMH) services to families living in rural and remote areas of Queensland. Challenges to health service provision in rural and remote areas are well known and include geographically-dispersed populations, the transient nature of some populations (including fly-in/fly-out workers and defence personnel), culturally diverse communities, extreme environments and natural disasters, economic disadvantage, the difficulty of recruiting to service positions, and a generally sparse service environment.1 Using a cross-sectoral approach over a seven month period, the e-PIMH pilot aimed to strengthen relationships with public, private and non-government providers of health and education services. This includes engaging with Indigenous organisations, to support the work done with parents/carers in building strong, positive, and enjoyable relationships with their infant and/or young child. e-PIMH sought to develop awareness, knowledge, and skills among healthcare professionals and other workers in rural and remote communities, to identify perinatal and infant mental health issues early, intervene effectively, and refer appropriately.2,3 Evaluation of the pilot (N = 41) reflected improved awareness of PIMH issues due to engagement with e-PIMH. The average weighted score for improved awareness was 8.49 (out of 10) for both perinatal mental health and infant mental health respectively. Respondents believed this improved outcomes for clients. Respondents also reported that the pilot improved their skills in detecting problems with mental health and wellbeing of clients, and provided useful resources as well as increased knowledge on where to find relevant resources. Three respondents commented on the value of e-PIMH in reducing the gap in service delivery by upskilling health professionals outside the mental health field. When asked, 94% of the respondents (n = 32) felt that the e-PIMH pilot was easy to access and supported by their organisation. While 72% agreed that it fit well within their organisation and complemented existing programs (n = 33). However the evaluation identified a need for clinical support in this area of work. As a consequence, QCPIMH has been developing a state-wide model of telehealth for perinatal and infant mental health incorporating clinical support, such as consultation and liaison, clinical supervision and mentorship, in addition to the non-clinical support and advice. This paper will present information on the evaluation of the effectiveness of the pilot, lessons learned and progress of the collaborative e-PIMH telehealth model.

Transgender Individuals' Perceptions of Maternal Support in Central Appalachia

ABSTRACTThe psychosocial experiences of transgender individuals are shaped by specific cultural beliefs and values that influence family and community interactions. Using a constant-comparative approach to thematic analysis, we analyzed in-depth interviews with 25 transgender-identified adults in Central Appalachia and discovered that their mothers play a crucial role in their social support experiences. Participants described supportive and unsupportive interactions with their mothers and how their mothers' attitudes and behaviors evolved in positive directions over time. They also perceived that their mothers played a key role in influencing how other family and community members behaved toward them. Participants gave meaning to their mothers' behaviors by placing them in the context of strong cultural values about distinct gender roles, family loyalty, religious conservatism, and pride of place. These findings serve as a reminder to family mental health practitioners and health service providers to directly assess family and community strengths and draw on these resources to facilitate the well-being of clients from stigmatized and under-resourced populations.

Nurses’ and Care Workers’ Perception of Care Quality in Japanese Long-Term Care Wards: A Qualitative Descriptive Study

Despite the growing importance of long-term care for older adults, there has been limited attention to its quality assurance issues in Japan. To start planning the initiation of continuous quality improvement in long-term care hospitals, we explored how nurses and care workers themselves perceived current approaches to quality assurance and improvement on their ward. We interviewed 16 licensed nurses and nine care workers, transcribed and analyzed data using qualitative content analysis techniques, and derived six categories: keeping clients alive is barely possible, the absence of a long-term care practice model, the lack of quality indicators, long-term care hospitals as places for castaways, client quality of life as a source of satisfaction, and conflict between staff and client well-being. To develop continuous quality improvement in Japanese long-term care hospitals, it may be first necessary to introduce a practice model of long-term care and mechanisms to evaluate quality.

Restoring trustworthiness in the financial system: Norms, behaviour and governance

We examine how trustworthy behaviour can be achieved in the financial sector. The task is to ensure that firms are motivated to pursue the long-term interests of customers rather than pursuing short-term profits. Firms’ self-interested pursuit of reputation, combined with regulation, is often not sufficient to ensure that this happens. We argue that trustworthy behaviour requires that at least some actors show a concern for the well-being of clients, or a respect for imposed standards, and that the behaviour of these actors is copied in such a way that it becomes a behavioural norm. We briefly suggest what such behavioural norms might need to be if trustworthy behaviour is to be achieved, and consider how they might be supported; we describe the research that is necessary in order to understand these norms in more detail. We argue that the norms of traders are different from the norms of those engaged in other activities, since they are inevitably self-interested, and we consider the risk that traders’ norms might undermine those of other actors. We analyse the task for governance in dealing with this problem, and the role which leadership by a corporate board and management might play in doing this. We describe the need for further research to describe how this might be done.

Adolescent Risk-Taking Behaviors: When Do Student Counselors Break Confidentiality?

Confidentiality is integral to counseling relationships, particularly for adolescent clients. The presence of “serious and foreseeable harm” (American Counseling Association [ACA], 2014, p. 5) may require a counselor to breach confidentiality to protect client well-being. However, counselors disagree about the ethicality of a number of professional behaviors, including definitions of risk. Such ethical divergences are even more pronounced for student counselors and when ethical concerns are value laden. A sample of 208 student counselors responded to a brief demographic questionnaire and 16-item ethics survey about an adolescent client engaging in various risking-taking behaviors. Results indicated student counselors were more likely to endorse notifying a parent/guardian as the frequency, intensity, and duration of behaviors increased or if the behavior involved self-harm. Student counselor age was the only participant/training program variable significantly correlated with ethical ratings. Implications for enhanced student counselor training for ethical work with adolescent clients engaged in risk-taking behaviors are discussed.

Person-centred communication in dementia care: a qualitative study of the use of the SPECAL® method by care workers in the UK

Communication has featured prominently in person-centred dementia care research, but no consensus has been reached on which communication techniques are most helpful in supporting person-centred care. This qualitative study explored communication techniques used by domiciliary and community care workers of people with dementia in the UK. Care workers trained in the SPECAL® method (Specialised Early Care for Alzheimer’s) were invited to semi-structured interviews. The data were analysed using a constructivist grounded theory approach. Themes from the data were discussed as a potential basis for developing a substantive theory. The care workers contributed to client well-being through modifying their communication techniques, expressing a protective, empathetic and reassuring approach, underpinned by reflection. Clients exhibited greater well-being and less anxious behaviour. The care workers’ use of SPECAL® communication methods, supported by supervision, may provide a unique combination of techniques, contributing to the development of caring relationships, to care worker and client well-being, and to the maintenance of client personhood.

Financial performance, employee well-being, and client well-being in for-profit and not-for-profit nursing homes: A systematic review.

Expanding the opportunities for for-profit nursing home care is a central theme in the debate on the sustainable organization of the growing nursing home sector in Western countries. We conducted a systematic review of the literature over the last 10 years in order to determine the broad impact of nursing home ownership in the United States. Our review has two main goals: (a) to find out which topics have been studied with regard to financial performance, employee well-being, and client well-being in relation to nursing home ownership and (b) to assess the conclusions related to these topics. The review results in two propositions on the interactions between financial performance, employee well-being, and client well-being as they relate to nursing home ownership. Five search strategies plus inclusion and quality assessment criteria were applied to identify and select eligible studies. As a result, 50 studies were included in the review. Relevant findings were categorized as related to financial performance (profit margins, efficiency), employee well-being (staffing levels, turnover rates, job satisfaction, job benefits), or client well-being (care quality, hospitalization rates, lawsuits/complaints) and then analyzed based on common characteristics. For-profit nursing homes tend to have better financial performance, but worse results with regard to employee well-being and client well-being, compared to not-for-profit sector homes. We argue that the better financial performance of for-profit nursing homes seems to be associated with worse employee and client well-being. For policy makers considering the expansion of the for-profit sector in the nursing home industry, our findings suggest the need for a broad perspective, simultaneously weighing the potential benefits and drawbacks for the organization, its employees, and its clients.

The Effects of Solution-Focused Group Therapy in Treatment Outcomes and Psychological Well-Being of Substance Abuse Clients

The Effects of Solution-Focused Group Therapy in Treatment Outcomes and Psychological Well-Being of Substance Abuse Clients