Complex Clients Research Articles

The Value of Auditor Industry Specialization - Evidence from a Structural Model

This study investigates the value of auditor industry specialization. In the first step, we use a discrete choice model to derive the first-order demand for auditor industry specialization. Our results reveal that clients have a general preference for auditor industry specialization, relating to both audit firm and audit office specialization. Further, we observe that specializations at the audit firm and audit office are substitutes. We also find that larger and more complex clients have a stronger demand for specialization at the audit office but not the audit firm level. In the second step, we use the results from the discrete choice model to quantify the value of auditor industry specialist for clients. We find that the aggregate value of industry specialization for all clients is around 5 million US dollars and that it shapes the audit market as losing it results in the loss of approximately 5% of clients.

Archival Evidence on the Audit Process: The Effect of Early Planning and Interim Effort on Audit Hours, Disclosure Timeliness, and Audit Quality

Using proprietary data from a global accounting firm, we investigate the determinants of auditors’ interim effort as well as the impact of interim effort on audit quality, client disclosure timeliness, audit hours, and audit fees. Public statements from accounting firms and regulators suggest various benefits from accelerating auditor effort, but these claims remain largely untested. We find that interim effort is higher for large, complex clients that require integrated audits of both financial statements and internal control over financial reporting. With respect to consequences, we find that allocating relatively more work to the interim period is associated with a reduced likelihood of late 10-K filings, decreased total audit hours, and higher fees. Although increasing interim period effort is not, on average, associated with a reduced likelihood of misstatement, we do find that current period material weaknesses are less likely with greater interim work. Thus, greater interim effort appears to facilitate the remediation of internal control deficiencies before year-end. We also show that the benefits of increased interim period effort allocation are much stronger – including improved audit quality – when manager and partner interim involvement is high. Overall, our study provides important new insights on audit production and highlights benefits of reduced hours for auditors, earlier identification of control deficiencies for clients, and more timely financial reports for investors.

Audit market concentration, audit fees, and audit quality: A cross-country analysis of complex audit clients

Regulators around the world are concerned about the potentially harmful effects of high audit market concentration on audit pricing and quality. However, results in the overall literature have failed to reach consensus on this issue. We contribute to this debate by arguing that the audit market is segmented and that concentration in the Big 4 segment of the market leads to higher audit pricing. Accordingly, our analyses use international data and focus on concentration within the Big 4 group of firms across countries. We find that audit fees are increasing in our concentration measure for clients where the barriers to entry by competing auditors are higher, as proxied by client size, international operations, and IFRS use. Finally, we find evidence that audit quality is decreasing in Big 4 market concentration for these types of engagements. This indicates a wealth transfer from shareholders to audit firms when auditor concentration is high because these complex clients are charged more, but receive audits that are of lower quality.

Male nursing students' experiences of simulation used to replace maternal-child clinical learning in Qatar

BackgroundIn today's health care context, nurse educators teach with limited clinical placement availability, competition for available spaces and increasingly complex clients. SettingAs part of the baccalaureate of nursing program at the University of Calgary in Qatar, students are required to complete 208 h of maternal-child clinical. Unfortunately, due to social and cultural norms in this predominantly Muslim country, male nursing students are prohibited from practicing with mothers and babies in Qatar. In order to address this need, we developed a fully simulated clinical practice module for these male students. ObjectivesThe aim of the current study was to better understand the learning experiences of the students undertaking this experience. DesignThe authors developed and implemented a fully simulated, campus-based, maternity clinical experience that used a variety of levels of fidelity, incorporated the tenets of Kolb's (1984) experiential learning theory, and Jeffries' (2005) simulation design framework. Post-simulation debriefing sessions were recorded and transcribed. Typed weekly reflections were provided. All data was blinded. ParticipantsA convenience sample of ten adult, male participants was obtained. MethodsUsing an inductive qualitative approach, researchers analyzed transcripts of debriefing sessions and reflective journals. ResultsThe main themes were knowledge application, clinical judgement, communication, and crossing cultural barriers. ConclusionsThemes from this study can be used to support and/or change existing practices in a way that supports learner-centered, experiential teaching practices.

The development of an HIV-specific complexity rating scale.

As treatment for HIV improves, an ageing population is experiencing comorbidity which often leads to complex clinical presentations requiring an interdisciplinary care approach. This study sought to quantify clinician assessment of the level of clinical complexity, through the development of a rating scale for people living with HIV (PLHIV), to improve client care through an interdisciplinary care model. An existing alcohol and other drug complexity rating scale was selected and modified for use with PLHIV. HIV-specific items were included through consultation with an interdisciplinary team. A risk-prediction model was developed and validated using clinician ratings of clients attending The Albion Centre, a tertiary HIV clinic in Sydney, Australia, resulting in the development of the Clinical Complexity Rating Scale for HIV (CCRS-HIV). Multivariable logistic regression models identified eight characteristics based on clinician assessment of complexity in PLHIV: financial instability, social isolation, problematic crystal methamphetamine use, mental illness and/or other problematic substance use, cognitive/neurological impairment, polypharmacy, current hepatitis C infection and/or cancer, and other physical health comorbidity. A weighted risk-prediction model was developed and validated. The final model accurately predicted 85% of complex clients, with a sensitivity of 80% and specificity of 91%. This study developed an HIV-specific clinician-rated complexity scale. Further investigations are required to validate the CCRS-HIV with broader HIV populations. This simple complexity screening tool is a promising adjunct to clinical assessment to identify clients with complex physical and psychosocial needs who may benefit from interdisciplinary care interventions and allocation of resources.

Audit Market Concentration, Audit Fees, and Audit Quality: A Cross-Country Analysis of Complex Audit Clients

Regulators around the world are concerned about the potentially harmful effects of high audit market concentration on audit pricing and quality. However, results in the overall literature have failed to reach consensus on this issue. We contribute to this debate by arguing that the audit market is segmented and that concentration in the Big 4 segment of the market leads to higher audit pricing. Accordingly, our analyses use international data and focus on concentration within the Big 4 group of firms in across countries. We find that audit fees are increasing in our concentration measure for clients where the barriers to entry by competing auditors are higher, as proxied by client size, international operations, and IFRS use. Finally, we find evidence that audit quality is decreasing in Big 4 market concentration for these types of engagements. This indicates a wealth transfer from shareholders to audit firms when auditor concentration is high because these complex clients are charged more, but receive audits that are of lower quality.

Managing advertising agency client partnerships for value co-creation: Characteristics, categories, and challenges

This article examines the role and characteristics of professional client partners in the value co-creation process. Previous literature has studied the role of clients in the co-creation process; however, the effects of different characteristics of clients on co-creation of value are less clear. This study examines these through a research design comprising depth multiple case studies of client relationships with professional service firms (PSFs). Empirical primary data were collected from in situ in-depth interviews with senior account managers in leading advertising agencies in Spain. Our initial results suggested that the type of clients and their characteristics was important for determining the potential and approach to managing their relationships for positive value creation. Further analysis identified key client characteristics and a classification of four types of clients: low involved novice clients, highly involved novice clients, control-concerned expert clients, and integration-concerned expert clients. We also found that not all client relationships resulted in positive value creation because some eventually produce detrimental or negative value consequence. We conceptualize this as the value depletion circle (VDC) and discuss the practical and theoretical implications of this phenomenon. Finally, alternative service relationships scenarios are described which can help institutions understand success and failure in their value creation relations and practices with clients and partners of different types. The contribution of this article is threefold. First, it analyses theoretically the role of client in the service co-creation process. Second, our multi-case study develops a classification of PSF clients into four categories. Third, we explain how dealing with called complex clients may generate a vicious circle, the VDC, which in the long run can seriously damage the sector image.

Navigation delivery models and roles of navigators in primary care: a scoping literature review

BackgroundSystems navigation provided by individuals or teams is emerging as a strategy to reduce barriers to care. Complex clients with health and social support needs in primary care experience fragmentation and gaps in service delivery. There is great diversity in the design of navigation and a lack of consensus on navigation roles and models in primary care.MethodsWe conducted a scoping literature review following established methods to explore the existing evidence on system navigation in primary care. To be included, studies had to be published in English between 1990 and 2013, and include a navigator or navigation process in a primary care setting that involves the community- based social services beyond the health care system.ResultsWe included 34 papers in our review, most of which were descriptive papers, and the majority originated in the US. Most of the studies involved studies of individual navigators (lay person or nurse) and were developed to meet the needs of specific patient populations. We make an important contribution to the literature by highlighting navigation models that address both health and social service navigation. The emergence and development of system navigation signals an important shift in the recognition that health care and social care are inextricably linked especially to address the social determinants of health.ConclusionsThere is a high degree of variance in the literature, but descriptive studies can inform further innovation and development of navigation interventions in primary care.

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In the present time I know every time that the human being is formed has gone from being an analytic challenge based on statistical remains, a process of greater scientific rigor, where identifying the behavior of people can be achieved knowing more about the function of the brain. In order to meet the expectations of complex clients, companies must align before the changing dynamics of customer behavior, for how to achieve the results they have developed over the years in the field of identifying characteristics of the consumer. It is evident that the evolution and modification of human behaviors influenced directly by the emergence of the Internet, has put in a worrisome situation to the companies and directors of marketing. Giving results in sales as done in the past, has become the great headache for organizations, coupled with the large supply of goods and services on the Internet, companies are not allowed to react to the speed of tastes and user preferences. Companies in the present hope to find a suitable group of consumers in order to be able to potentiate a brand of a certain product group, but their ability to react to speed with change will change the rules of the game in business marketing, and the growth in the supply of goods and services on the Internet, is putting challenges to which they can not react, the document breaks down the different techniques of segmentation that help to determine more accurately the proper processes of segmentation, creating interactions between the different tools of analysis, in order to finish creating a general interaction called Geospatial Sociological Segmentation in which are grouped characteristics of statistical studies, analysis and analysis of the subcultural behavior of the elements of a specific population.

Expanding Mental Health Occupational Therapy to Emerging Settings: Provider Perspectives

Abstract Date Presented 3/31/2017 Occupational therapy consultation for homeless adults with mental health conditions was explored. Results reveal the value of assessment in authentic contexts and use of standardized instruments to inform care decisions of complex clients, particularly those with traumatic brain injury. Primary Author and Speaker: MaryBeth Merryman Additional Authors and Speakers: Caitlin Synovec

Development and Evaluation of Acceptance and Commitment Therapy Delivered by Psychologists and Non-Psychologists in an NHS Community Adult Mental Health Service: a Preliminary Analysis.

Previous studies have demonstrated that acceptance and commitment therapy (ACT) is effective for depression and may be useful for complex transdiagnostic clients. To conduct a preliminary evaluation of whether ACT is feasible and effective when delivered by psychologists and non-psychologists for complex clients in a National Health Service (NHS) community mental health service for adults. Staff were trained in ACT and conducted one-to-one therapy with clients. Measures on general mental health, depression, fusion and values were given pre-therapy, post-therapy and at 3-month follow-up. Standardized measures showed significant improvements post-therapy for global mental health, depression, cognitive fusion and values post-treatment. These were partially maintained at follow-up and remained after an intent-to-treat analysis. There were no differences in outcomes between psychologists and non-psychologists. ACT may be delivered effectively with limited training for complex cases in secondary care, though further research is needed.

What Are the Effects of Consultative Occupational Therapy Services on Homeless Adults With Serious Mental Illness?

Abstract Date Presented 4/8/2016 A mixed-methods study was conducted to assess effectiveness of occupational therapy (OT) consultation services at a medical center for homeless adults. Data support a valued role for OT in assessing function in complex clients with comorbidities, particularly serious mental illness, substance abuse, or head injury. Primary Author and Speaker: Caitlin Synovec Additional Author and Speaker: MaryBeth Merryman

Evaluating Individualized Falls Prevention for Clients with Medically Complex Conditions

ABSTRACTAims: To evaluate mobility outcomes and concerns about falling for community dwelling medically complex clients (MCCs) participating in an individualized falls prevention clinic. Methods: A quantitative retrospective chart review with one group pretest, posttest design compared four outcome measures of Gait Speed, 30 Second Sit-to-Stand Test, Timed Up and Go, and The Falls Efficacy Scale International. Consecutive participants discharged from the Falls Prevention Clinic between January 2014 and December 2014 were screened. Paired t-test was used to determine outcome measure significance. Descriptive statistics and analysis of participant satisfaction surveys were completed. Results: Sixty-nine participants were included. Over 75% of participants had at least one fall in the past year and average number of falls totaled five. Statistical significance was achieved on all four outcome measures. Conclusions: An individualized, multifactorial approach appears to benefit MCCs despite average outcome measure scores still indicating a falls risk. Further examination of defining falls risk for MCCs is warranted.

IOM REPORT ON PSYCHOSOCIAL INTERVENTIONS: COMMENTARY FROM A DBT PERSPECTIVE.

IOM REPORT ON PSYCHOSOCIAL INTERVENTIONS: COMMENTARY FROM A DBT PERSPECTIVE.

Two Seating Systems' Effects on an Adolescent With Cerebral Palsy and Severe Scoliosis.

To compare physiological functioning, communication switch activation, and response accuracy in a 19-year-old young man with quadriplegic cerebral palsy and neurological scoliosis using 2 seating systems within the school setting. Prospective single-subject alternating treatment design with 2 conditions: baseline phase with standard planar inserts (A1), custom-molded back with original seat (B), and return to baseline (A2). Measures included oxygen saturation (SaO2), heart rate (HR), respiration rate (RR), body temperature (BT), processing time to activate switches, and response accuracy. SaO2 levels increased from "distressed" to "normal"; variability decreased. HR, RR, and BT fluctuations decreased with the custom-molded back. Processing time decreased with increased variability, affected by subject's motivation; accuracy improved slightly. Reported social approachability and student-initiated communication increased. SaO2 increased and HR, RR, and BT fluctuations decreased with a custom-molded back. Graphing data may help determine seating effect with complex clients.

Description of arts therapies practice with adults suffering from depression in the UK: Qualitative findings from the nationwide survey

There is growing evidence that arts therapies present a relevant treatment option for depression, but the experiences, methods, tools and methods of practice of arts therapists with this client group remain unclear. Thus, this research study aimed to describe the specifics of the practice of arts therapies with depression. In 2011, all arts therapists registered in the UK were invited to complete an online questionnaire concerning their practice in general and in relation to depression. The Arts Therapies Survey received 395 responses. Arts therapists who work primarily with depression were identified and compared to those who do not work with depression on a range of factors. These quantitative results were presented elsewhere (Zubala, MacIntyre, Gleeson, & Karkou, 2013). An analysis of the qualitative material was guided by the strategy of grounded theory, and findings were obtained through thematic analysis. The current paper introduces these findings, adding depth to the knowledge previously gained through the quantitative analysis. Arts therapists worked across various settings with highly complex clients; however, therapists struggled with the tension of providing care according to guidelines, which they found inflexible and at times misguided. The therapists tended to vary the theoretical model of their therapeutic approach depending on individual client factors and often collaborated with other professionals using a variety of standardized tools to measure outcomes. The findings further offer a detailed understanding of the therapeutic process and describe the meaning of clinical practice within arts therapies.

Teaching psychotherapy skills with a semester-long role play.

One of the most popular types of experiential learning for psychotherapists in training is role play. As a teaching tool, role play has been used in prepracticum (Larson et al., 1999; Woodard, 1999), couples counseling (Shurts et al., 2006), group counseling (Fall & Levitov, 2002), and theories courses (Dollarhide, Smith, & Lemberger, 2007). Further, it is a way for students to learn particular types of skills, such as treatment planning (Osborn, Dean, & Petruzzi, 2004); emotional responsiveness with complex clients (Grant, 2006); assessing crisis scenarios, child maltreatment, and domestic violence (Hodgson, Lamson, & Feldhousen, 2007); broaching sensitive subjects such as culture (Crowe & Villalba, 2012); sexual history and alcohol screening (Haist et al., 2004); and dealing with client resistance (Grossman et al., 2007). Although authors have suggested ways to use role play (Smith, 2009), specific classroom guides have not been offered to those wishing to incorporate this in the classroom. The following brief article offers one model of incorporating a semesterlong role-play assignment for the training of psychotherapy students.

Art therapy, trauma and substance misuse: Using imagery to explore a difficult past with a complex client

Literature regarding the efficacy of treatment programmes for post-trauma pathologies is prolific; however, often little attention is given to the treatment of resistant and complex trauma. Many psychotherapists recognise that a trauma history may need to be considered and explored, particularly when working with complex clients. Avoidance of distressing thoughts, feelings and images can manifest in a range of symptoms and behaviours other than post-traumatic stress disorder (PTSD), including substance abuse and interpersonal problems. Creative therapies, such as art therapy, utilise the potentially unfamiliar language of imagery. Imagery, as an adjunct to a sense of safety and holding, in some cases has been shown to overcome therapeutic avoidance. This paper outlines the unveiling and recognition of intra-familial childhood trauma through Art Therapy with a highly articulate Australian woman battling binge drinking behaviours.

Ethical dilemmas experienced by speech-language pathologists working in private practice

Speech-language pathologists experience ethical dilemmas as they fulfil their professional roles and responsibilities. Previous research findings indicated that speech-language pathologists working in publicly funded settings identified ethical dilemmas when they managed complex clients, negotiated professional relationships, and addressed service delivery issues. However, little is known about ethical dilemmas experienced by speech-language pathologists working in private practice settings. The aim of this qualitative study was to describe the nature of ethical dilemmas experienced by speech-language pathologists working in private practice. Data were collected through semi-structured interviews with 10 speech-language pathologists employed in diverse private practice settings. Participants explained the nature of ethical dilemmas they experienced at work and identified their most challenging and frequently occurring ethical conflicts. Qualitative content analysis was used to analyse transcribed data and generate themes. Four themes reflected the nature of speech-language pathologists’ ethical dilemmas; balancing benefit and harm, fidelity of business practices, distributing funds, and personal and professional integrity. Findings support the need for professional development activities that are specifically targeted towards facilitating ethical practice for speech-language pathologists in the private sector.

Pilot study of Creating Change, a new past‐focused model for PTSD and substance abuse

Creating Change (CC) is a new past-focused behavioral therapy model developed for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD). It was designed to address current gaps in the field, including the need for a past-focused PTSD/SUD model that has flexibility, can work with complex clients, responds to the staffing and resource limitations of SUD and other community-based treatment programs, can be conducted in group or individual format, and engages clients and clinicians. It was designed to follow the style, tone, and format of Seeking Safety, a successful present-focused PTSD/SUD model. CC can be used in conjunction with SS and/or other models if desired. We conducted a pilot outcome trial of the model with seven men and women outpatients diagnosed with current PTSD and SUD, who were predominantly minority and low-income, with chronic PTSD and SUD. Assessments were conducted pre- and post-treatment. Significant improvements were found in multiple domains including some PTSD and trauma-related symptoms (eg, dissociation, anxiety, depression, and sexual problems); broader psychopathology (eg, paranoia, psychotic symptoms, obsessive symptoms, and interpersonal sensitivity); daily life functioning; cognitions related to PTSD; coping strategies; and suicidal ideation (altogether 19 variables, far exceeding the rate expected by chance). Effect sizes were consistently large, including for both alcohol and drug problems. No adverse events were reported. Despite study methodology limitations, CC is promising. Clients can benefit from past-focused therapy that addresses PTSD and SUD in integrated fashion.