Majority Of Clients Research Articles

Signpost appointments in an adult psychological therapies team

PurposeIn Scotland, individuals referred for NHS psychological therapies are expected to commence “treatment” within 18 weeks of receipt of referral. With high demand, high non-attendance rates and limited capacity, this can be a challenging goal. The service discussed here was keen to develop a way of seeing individuals referred sooner and improving the efficiency of the assessment process. The purpose of this paper is to look at the impact of introducing assessment (“Signpost”) appointments on waiting times, attendance, and treatment planning.Design/methodology/approachSignpost appointments were offered to all existing, and any new referrals, to an adult psychological therapies team (PTT) in NHS Lanarkshire. Clinicians kept a record of the outcomes of these appointments over a six month period. Waiting times and attendance figures were compared before and after the introduction of the Signpost system.FindingsFollowing the introduction of Signpost appointments, individuals were seen sooner for both assessment and therapy. Attendance at first appointments improved and Signpost appointments helped inform treatment planning. Although alternatives were discussed, the majority of clients were still offered individual therapy. Service user and staff satisfaction was high.Practical implicationsThe results from this study led to assessment (“Signpost”) appointments being rolled out across other adult PTTs in NHS Lanarkshire.Originality/valueThere is little research looking at the impact of assessment/signpost appointments on adult mental health services in the UK. In the current climate of public service cuts, this study provides an innovative way of reducing waiting times and maintaining service user satisfaction, without requiring more resources.

Can community care workers deliver a falls prevention exercise program? A feasibility study

BackgroundAlmost half of older people receiving community care fall each year and this rate has not improved in the last decade. Falls prevention programs targeted at this group are uncommon, and expensively delivered by university trained allied health professionals.PurposeTo investigate the feasibility of community care workers delivering a falls prevention exercise program to older clients, at low or medium risk of falling, as part of an existing service provision.Patients and methodsCommunity care workers from 10 community care organizations participated in the training for, and delivery to their clients of, an 8-week evidence-based falls prevention exercise program. Community care workers included assessment staff (responsible for identifying the need for community care services through completing an assessment) and support workers (responsible for providing support in the home). Clients were surveyed anonymously at the completion of the intervention and workers participated in a semi-structured interview.ResultsTwenty-five community care workers participated in the study. The falls prevention program was delivered to 29 clients, with an average age of 82.7 (SD: 8.72) years and consisting of 65.5% female. The intervention was delivered safely with no adverse events recorded, and the eligibility and assessment tools were completed by the majority of community care workers (93.1%). Assessment staff found it difficult to find time to deliver the intervention. Support workers were able to complete the intervention within their current service delivery period, with the initial assessment taking a small amount of additional time. Support workers reported enjoying the additional responsibility afforded by delivering the falls prevention program and seeing changes in their clients. The majority of clients (82%) reported enjoying the exercises, with 59% reporting that they felt it made a positive change in their health. Clients completed the exercises on average 4.8 (SD: 2.2) days per week.ConclusionCommunity care workers who have completed appropriate training are able to deliver a falls prevention exercise program to their clients as part of their current services. Further research is required to determine whether the program reduces the rate of falls for community care clients and whether integration of a falls prevention program into an existing service is cost-effective.

Facteurs Lies Au Stress Chez Les Couples Infertiles A Partir De Cas Recenses A L’unite Biologique De La Reproduction De L’institut Pasteur d’Abidjan

The stress associated with infertility is a painful experience for couples who are struggling to conceive of the value attached to the child in African society. This article apprehends the question of the management of stress caused by infertility from the cases identified at “Institut pasteur d’Abidjan”. The methodology adopted concerns observation techniques, semi-structured interview as well as the use of stress scale submitted to a sample of 120 subjects, including 60 men and 60 infertile women. The data collected were processed manually with proportion calculations. The results indicate that the majority of clients (73.33%) experience episodes of stress related to their infertility whose main sources are biological, psychological and environmental. In sum, the existence of a holistic support network can effectively communicate infertility and reduce the effect of these factors.

Delivery of the antimalaria on advice in pharmacies deprived of the district of Bamako, Mali

Context and Objective: Malaria is a well-known disease of the Malian population; as a result pharmacists are giving more and more advices regarding this disease to the population. In order to better understand the problem of the delivery of antimalarials without prescription, we initiated this study with the objective of studying the practice of dispensing antimalarials without prescription in accordance with the guidelines of Mali's national malaria program.Patient and Methods: This was a cross-sectional descriptive study on the delivery of antimalarials based on counseling. We included in the study all clients aged 15 years and over who were received in Bamako pharmacies for a non-prescription antimalarial medication for themselves or for another person based on mutual consentment.Results: The study was carried out in 199 of the 230 pharmacies in the district of Bamako; we recorded 466 requests for advice. The sex ratio M / F was 1.7 and 28.9% of clients for whom the drug was intended were under 20 years of age, in which case 52.4% of the costumers were not the actual patients. Artemisinin-based combination therapy was the most recommended (52%). Sulfadoxine Pyrimethamine was the most widely purchased antimalarial among non-CTA antimalarials. In 34.5% of cases, antimalarials are associated with other therapeutic classes where analgesics / antipyretics constitute 77.6% of these classes followed by antibiotics (21%).Conclusion: The pharmacy is the first resort in the healthcare system for the majority of clients with clinical suspicion of malaria.Keywords: Advice, malaria, pharmacy, Bamako

Access to and utilisation of healthcare services by sex workers at truck-stop clinics in South Africa: A case study.

Sex worker-specific health services aim to respond to the challenges that this key population faces in accessing healthcare. These services aim to integrate primary healthcare (PHC) interventions, yet most services tend to focus on prevention of HIV and sexually transmitted infections (STIs). North Star Alliance (North Star) is a public-private partnership providing a healthcare service package in roadside wellness clinics (RWCs) to at-risk populations along transport corridors in sub-Saharan Africa. To inform future service development for sex workers and describe North Star's contribution to healthcare provision to this population in South Africa, we describe services provided to and utilised by sex workers, and their views of these services. Using a mixed-methods approach, we present quantitative analyses of anonymised North Star routine data for sex workers for October 2013 - September 2015, covering nine sites in seven provinces. Clinic visits were disaggregated by type of service accessed. We performed thematic analysis of 25 semi-structured interviews conducted at five clinics. A total of 2 794 sex workers accessed RWCs during the 2 years. Sex workers attending clinics were almost exclusively female (98.2%) and aged <40 years (83.8%). The majority were South African (83.8%), except at Musina, where the majority of clients were Zimbabwean. On average, sex workers visited the clinics 1.5 times per person. However, in most cases only one service was accessed per visit. PHC services other than for HIV and STIs were accessed more commonly than HIV-specific services and STI treatment. There was an increase in the number of services accessed over time, the figure almost doubling from 1 489 during the first year to 2 936 during the second year. Although during recruitment participants reported having had sex in exchange for goods or money during the past 3 months, not all participants self-identified as sex workers during interviews; however, all reported feeling at higher risk of poor health than the general population owing to their involvement in sex work. Participants reported satisfaction with site accessibility, location and operating hours. Sex workers accessing sites described services as being suitable and accessible, with friendly staff. RWCs were highly appreciated by the users, as they are suitable and accessible. The sex workers who used the clinics visited them irregularly, mostly for PHC services other than HIV and STIs. Services other than the one for which the sex worker came to the clinic rarely appeared to be offered. We recommend areas for service expansion.

Implementation of Trauma-Informed Care in a Housing First Program for Survivors of Intimate Partner Violence: A Case Study

The intersection of trauma with the need for safe, stable, sustainable, and long-term housing is important when working with survivors of intimate partner violence (IPV). IPV advocacy agencies are advised to use a trauma-informed approach to help practitioners understand the impact of IPV on individuals. Housing First, a model addressing homelessness that provides permanent housing without preconditions, has been found to increase housing stability for survivors of IPV. Thus, we used a case study approach to examine how practitioners and administrators implement trauma-informed care in a Housing First program for IPV survivors. Trauma-informed care principles and the Housing First model were found to be complementary. The majority of clients in this program retained housing up to 3-months after services ended and increased their safety and knowledge of domestic violence. Combining Housing First with trauma-informed care may increase success for survivors of IPV.

Information Provided by Nurses to Clients during Family Planning Counselling Sessions and Knowledge of Clients on Chosen Method

BACKGROUND: The fundamental problem which prompted this research study lies in the observation that family planning clients do not receive the required information for decision making on the methods that meet their reproductive needs.OBJECTIVES: To determine family planning information provided to the clients by nurses during family planning counselling sessions in the Khomas region to describe the knowledge of the clients on the specific chosen methodMETHODS: A quantitative research design recruited 184 family planning clients and 65 nurses. Closed ended questionnaire was used for data collection.RESULTS: Majority (89%) of nurses indicated that they always explained the advantages of the method selected to the clients, contrary to the majority (77%) of the clients reported advantages never been explained to them. Ninety five percent of the nurses indicated that they always explained to clients how to use the method they had selected, while the majority (72%) of the clients were in disagreement. The majority of the nurses (78%) indicated that they always explained the possible side effects of the method to their clients while, 63% of the clients indicated that the side effects were not explained to them. Only 22% of the injectable contraceptive users indicated changes in menstrual bleeding as a common side effect, while the majority (66 %) indicated that they did not know.CONCLUSION: According to clients’, information provided to them was inadequate. Equally, the majority of clients had not demonstrated sound knowledge about their method of choice.

Loan repayment performance of clients of informal lending institutions

PurposeThe purpose of this article is to examine the effects that dynamic incentives and the borrowing histories of clients of informal lending institutions have on loan repayment performance, in particular, the extent to which multiple borrowing and progressive lending affect the repayment of loans.Design/methodology/approachThe paper uses a data set of 835 borrowers drawn from an informal lending institution in Tanzania. Descriptive analysis and econometric models are used to test the developed hypotheses.FindingsWhereas clients with multiple loans are associated with poor loan repayment, progressive lending contributes to positive repayment outcomes. Multiple borrowers face increased debt levels and thereby an increased inability to meet their repayment obligations; in contrast, progressive lending by building up a lender–client relationship helps clients to obtain higher loans with a minimum amount of screening.Research limitations/implicationsThis was a cross-sectional study based on a sample of individual clients drawn from a single institution. However, since the majority of clients had also taken out loans with other financial institutions, the sample is considered to be representative.Practical implicationsA client’s past repayment performance and multiple loan history must be assessed so that multiple borrowing can be prevented and credit absorption capacity can be gauged more accurately. The repeated nature of the interactions and the threat to cut off any future lending (if loans are not repaid) can be exploited to overcome any information deficit.Originality/valueThis study was conducted in a context in which the degree of information sharing was low and institutional access to clients’ credit histories was limited. It contributes knowledge on how lenders minimise the risk flowing from the ex ante information gap and moral hazards arising from the ex post information gap.

Profile of HIV positive clients: an ICTC record based retrospective study

Background: Deaths in productive age group due to HIV/AIDS have damaging impact on families and communities, skills are lost, workforce shrinks & children's are orphaned. Our study reports the socio-demographic characteristics of HIV/ AIDS clients from one of the Integrated Counselling & Testing Centre (ICTC) situated at Amtala, West Bengal. This will give us an insight on the distribution of various epidemiological characteristics of the HIV positive clients in this region thus help in formulating strategies for effective implementation of its prevention. The objective was to study socio-demographic profile and risk behavior pattern of HIV positive clients attending ICTC.Methods: It was an observational study cross sectional in design. Records of last eight years of HIV positive clients were accessed from ICTC centre at Amtala hospital, rural training centre, Department of community medicine, ESI PGIMSR medical college, Joka, Kolkata. Data was entered in SPSS for Windows version 20 software. Data was presented in percentages, mean with standard deviation etc.Results: Retrospective record of 62 HIV positive clients was studied, of them 37 were males (5 pediatric cases) and 25 females (7 ANC).Excluding pediatric clients, mean age of clients was 32 years. It was observed that majority of clients were illiterate and were on daily wages. Except one male client who was homosexual rest were heterosexual. Majority of clients 71.9% males and 92% females were married, of them 45.3% males and 34.7% females were sero concordant with their spouse. Seventeen subjects were co infected with TB.Conclusions: HIV sero prevalence rate has inverse relation with literacy level. Majority of male clients were daily wagers who act as link between high risk populations to general population i.e. their spouse, which in turn can pass on the infection to her baby. Lack of knowledge on mode of spread and preventive measures against HIV infection devastate the families making many children orphaned. There is need to carry out intense IEC activities for behavior change at grass root level.

Is it possible to provide low-intensity cognitive behavioral treatment (CBT Lite) in Canada without additional costs to the health system? First-year evaluation of a pilot CBT Lite program

ABSTRACTThere is a scarcity of publicly funded Cognitive Behavioral Therapy (CBT) programs in Canada. The evidence-based psychological services can not only reduce the burden of disease, but such services can also potentially pay for themselves. We ran a pilot project of a Cognitive Behavioral Therapy: Low InTEnsity (CBT Lite) which was delivered by the front line workers in a community mental health organization. Low intensity CBT was provided for non-psychotic disorders after a short period of training, under regular supervision and within 6 to 10 sessions to clients attending a community mental health organization in Kingston, Ontario, Canada. Analyses were conducted using statistical package for the social sciences (SPSS) v21. We had a high rate of referrals. The dropout rates were low. We provided low intensity CBT to 47 persons. Statistically, significant differences were noted in post-treatment measures of psychopathology (P = 0.000), anxiety (P = 0.000), depression (P = 0.000) and disability (P = 0.000). A majority of clients were exited from the service (27/47) after completion of the program. None of the attendees returned with a relapse during the study period. The average number of work days by the group increased from 1.5 to 3.53 (P = 0.000). We estimate that an input of CAD $1 would return more than CAD $3 per annum into the national economy. The results of this pilot, CBT Lite program, suggests that it is possible to provide low-intensity CBT by adding resources to the existing health system. Such program will not only cover its costs; it will further add to the national economy.

Health behaviour information provided to clients during midwife-led prenatal booking visits: Findings from video analyses

Objectiveto quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided. Designquantitative video analyses. Setting and participants173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands taking place between August 2010 and April 2011. Measurementsthirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either ‘never mentioned’, ‘briefly mentioned’, ‘basically explained’ or ‘extensively explained’. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and dichotomous outcomes of the extent of information provided were assessed using Generalized Linear Mixed Modelling. Findingsour findings showed that women who did not take folic acid supplementation, who smoked, or had a partner who smoked, were usually provided basic and occasionally extensive explanations about these topics. The majority of clients were provided with no information on recommended weight gain (91.9%), fish promotion (90.8%), caffeine limitation (89.6%), vitamin D supplementation (87.3%), physical activity promotion (81.5%) and antenatal class attendance (75.7%) and only brief mention of alcohol (91.3%), smoking (81.5%), folic acid (58.4) and weight at the start of pregnancy (52.0%). The importance of a nutritious diet was generally either never mentioned (38.2%) or briefly mentioned (45.1%). Nulliparous women were typically given more information on most topics than multiparous women. Key conclusions and implications for practice:although additional information was generally provided about folic acid and smoking, when relevant for their clients, the majority of women were provided with little or no information about the other health behaviours examined in this study. Midwives may be able to improve prenatal health promotion by providing more extensive health behaviour information to their clients during booking visits.

Coming to terms: Client subjective experience of ending psychotherapy

How do clients consider their own contribution and that of their therapist in the last phase of therapy when they are moving toward the end? Thirty-seven clients who had received therapy from highly experienced clinicians were interviewed. Since the time for ending had not been decided at the onset, clients in both short- and long-term therapies were included. Thematic case-by-case analyses were carried out. Clients actively engaged in looking back and looking ahead, as means of reflecting on their capability to handle issues on their own. The majority of clients were satisfied with what they perceived as a reciprocal engagement that enabled them to come to terms with emotionally charged issues in life and in therapy. For some clients unresolved issues remained: wondering whether a therapist with another approach could have helped more; feeling pushed away by the therapist; having to take the lead in ending therapy; the fear of being an “unworthy” client; or wanting to end without the therapist’s approval. Coming to terms with the ending of therapy was highly personally meaningful and loaded with affective tensions, in ways that were not always shared with their therapist.

Tattoo removal by Q-switched yttrium aluminium garnet laser: client satisfaction.

Tattoo removal by Q-switched yttrium aluminium garnet (YAG) lasers is golden standard; however, clients' satisfaction with treatment is little known. To determine clients' satisfaction with tattoo removal. One hundred and fifty-four tattoo removal clients who had attended the private clinic 'Centre for Laser Surgery', Hellerup, Denmark, from 2001 to 2013 completed a questionnaire concerning outcome expectations, level of pain experiences and satisfaction with tattoo removal. The laser surgeon and his team were blinded from data handling. The study design included a minimum 2-year postlaser treatment observation period from 2013 to 2015. Overall, clients were satisfied with their laser treatment; 85% assessed their treatment and results to be acceptable to superb, while 15% assessed their treatment and results to be inferior to unacceptable. Effectiveness relative to colour of tattoo on a scale from 0 (no effect) to 10 (complete removal) scored a mean of blue 9.5, black 9.4, yellow 8.9, red 8.8 and green 6.5. Clients were dissatisfied with green pigment remnants, which could mimic bruising. One hundred and twenty-nine clients (84%) experienced moderate to extreme pain during treatment. Twenty-eight (20%) developed minor scarring. There were many reasons for tattoo removal; e.g. stigmatisation (33%), conspicuousness (29%) and poor artistic quality (22%). One hundred and two clients had expected complete removal of tattoos without a blemish, expectations that were only partly fulfilled. During the treatment period, clients adjusted expectations and adapted more realistic views of outcomes. The majority of clients were satisfied with Q-switched YAG laser removal of tattoos despite high pretreatment expectations which were only partly met. The study supports YAG lasers for tattoo removal as acceptable therapy of today, with room for new approaches.

Raising Awareness of Pre-Exposure Prophylaxis (PrEP) among Women in New York City: Community and Provider Perspectives

This study explored the knowledge, attitudes, and perceived facilitators and barriers to adoption of HIV pre-exposure prophylaxis (PrEP) among black women and Latinas in the Bronx, NY. Data were collected in focus group discussions (FGDs) held separately with staff (n = 21) and black and Latina female clients aged 18 to 50 (n = 23) of four organizations providing health and social services. Participants were also asked to give feedback about four action messages regarding PrEP for a social marketing campaign. Transcripts were analyzed by two researchers using grounded theory. We found that the majority of clients (74%) and staff (57%) had not heard about PrEP before participating in the FGDs. Following brief educational messaging about PrEP, participants identified potential facilitators and barriers to PrEP uptake among women, and expressed enthusiasm for more widespread efforts to raise awareness about PrEP as an HIV prevention option. Participants preferred an action message that was brief, referred to PrEP as a pill, and did not mention condoms or STD testing. These findings demonstrate the need to raise awareness about PrEP among women and build the capacity of women-serving organizations to educate, screen, and refer or provide PrEP services.

Abstract A36: [Advocate Abstract:] What patients need, but cannot afford: Uptake and value of supplies and services provided by Cancer Services, Inc, a community-based, non-profit cancer support agency in NC

Abstract Background: Cancer Services, Inc. is a non-profit, 501c3 providing a comprehensive range of services addressing financial, physical and emotional needs of cancer patients primarily in the Triad region of NC. One of the major challenges facing cancer patients is the costs associated with cancer care. This study evaluates the uptake, cost, and value of supplies and services provided to individuals seeking support from a community-based, non-profit cancer support agency over the past five years. Methods: Retrospective de-identified data were obtained from a database maintained by Cancer Services, Inc. between 2011 and 2015. We estimate the most common support provided, whether these supplies and services were provided directly by the agency (either donated or paid), and whether the agency facilitated the receipt of supplies and services from another source. Each supply/service was assigned a monetary value based on the cost the agency paid or estimated value of the procured support. Data are reported in the aggregate and time trends were also assessed. Results: There were 10,448 unduplicated clients served during the five years, including 70% female, 21% African American and 4% Hispanic, with 22% below the 200% federal poverty level. The majority of clients were diagnosed with breast cancer (40), followed by gastrointestinal (11%), hematologic (10%) and thoracic (10%) malignancies. There were 187,485 services/supplies provided during this period. Agency personnel secured more than $44M in medications from external sources by providing technical support, such as determining eligibility for the medication and completing necessary paperwork on behalf of their clients. The agency provided an additional $1.38M in donated supplies/services to their clients, including equipment and home health supplies (59%), wigs (16%), mastectomy supplies (13%), ostomy supplies (3%), and nutritional supplements (3%). The organization incurred $911K in expenses to provide direct support to their clients, with most of these funds going towards medication (60%) and emergency financial assistance (31%). This does not include the cost of staff time required to secure the assistance. The value of the medications accessed through outside agencies has markedly increased from $4.2M in 2011 to $14.5M in 2015, while the amount paid for medications directly from the agency has declined from $132K in 2011 to $81K in 2015. A similar pattern emerged for emergency financial assistance, with a more than doubling in value of medications accessed from outside sources in the past 5 years ($23K to $51K) to a decrease in funds provided directly by the agency to their clients ($75K to $31K). Conclusions: Patients and their families face considerable expenses associated with cancer care that are often not covered by insurance. While programs exist to help support low-resource patients (e.g., Prescription Assistance Programs), they often do not know how or have limited capacity to access these resources. Moreover, some services/supplies (e.g., wigs, nutritional supplements, hospital equipment) must be purchased or rented by the patient, incurring additional expenses often not covered by traditional health insurance. Cancer Services Inc. plays an important role in facilitating the procurement of much-needed cancer care supplies and services that are not paid for by insurance-predominately medication. Such support alleviates the financial toxicity of cancer care, which according to a recent study reported in Cancer, affects 29% of cancer survivors the majority of whom (86%) have health insurance. The financial burden of cancer is a health equity issue, affecting all patients, but especially those with the least resources. Citation Format: Carla Strom, Julie Lanford, Kristie Foley. [Advocate Abstract:] What patients need, but cannot afford: Uptake and value of supplies and services provided by Cancer Services, Inc, a community-based, non-profit cancer support agency in NC. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A36.

Mental health among clients of the Sydney Medically Supervised Injecting Centre (MSIC).

The Sydney Medically Supervised Injecting Centre (MSIC) is a supervised injecting facility (SIF) where people who inject drugs (PWID) can do so legally, under health professional supervision. The majority of clients have low levels of education and employment, high rates of incarceration and unstable housing and poor social networks, and 70 % do not access local health services. These factors increase the risk of poor mental health, and it has been documented that PWID have elevated rates of mood, anxiety, personality and psychotic disorders; post-traumatic stress disorder (PTSD); and higher rates of trauma exposure, suicidality and self-harm. The current study is the first to investigate the mental health among clients of a SIF. Validated instruments to examine clients’ mental health, social networks and trauma histories were administered to 50 frequently attending clients by a mental health nurse. The majority of respondents were unemployed, homeless and had a history of incarceration, and 82 % report they had been diagnosed with a mental health problem, but only 24 % report they were receiving treatment. Respondents had poor social networks, had poorer mental health symptoms compared to US inpatients and had experienced multiple traumatic events, and a high number of respondents had scores indicative of PTSD. These results highlight the need for mental health clinicians to be employed in SIFs and other drug consumption rooms (DCRs) to assist clients to address their mental health and psychosocial needs, particularly in light of the fact that these services are often the only places these PWID engage with in an ongoing way.

Survey of HIV/AIDS Clients in Botswana: Reactions to Supportive Counselling

A survey of HIV/AIDS clients in Botswana, Africa, all of whom were receiving supportive counselling, was conducted. A total of 328 volunteer clients from randomly selected sites completed the survey related to client perceptions of counselling helpfulness, outlook on life, satisfaction with goal setting in counselling, experience of social stigma, and acceptance by family and others. Overall, clients were very positive concerning the benefits received from counselling, their relationship with their counsellor, the goal setting process, their family/friends support system and their present quality of life. The majority of clients did, however, indicate some level of feeling stigmatized by being HIV-positive. Additional major findings indicated that clients with family incomes of less than 10 K pula per year (around US$1 k) were less positive about their counselling and related experiences than were those with higher levels of family income, with the exception of social stigma where lower family income was associated with less perceived social stigma. Clients reporting counselling sessions lasting more than 15 min were generally more positive in their reactions to counselling and related experiences than were clients reporting sessions typically lasting 15 min or less. A discussion of the findings, along with recommendations for areas needing further study and attention, is provided.

Psychosocial Situation and Patient Satisfaction among Clients of Cancer Counselling Centers in Saxony

Outpatient psychosocial counselling (OPC) centers for those affected by cancer fulfill 2 main purposes: (a) to offer low-threshold psychological, social and legal counselling, and (b) to refer clients to other services. Here we report findings from a user-based assessment of OPC in the state of Saxony, Germany. This study was funded in part by the Saxon State Ministry of Social Affairs and Consumer Protection. We used a paper-based questionnaire to survey 213 clients of OPC in Saxony at 2 points (t1: up to one week after first contact, t2: 4 months after t1). All participants were cancer patients. The survey assessed utilization of services, depressive symptoms (PHQ-9), anxiety (GAD-7), quality of life (SF-8) as well as clients' satisfaction with the counselling service (ZUF-8). The majority of clients (81%) were referred to the OPC from a hospital or rehabilitation center. 46% of patients only had one contact. 78% of counselling sessions treated matters of social law. Patients suffered from 13 problems on average, the most common being fatigue and exhaustion, worries, anxiety, uncertainty about the future, and pain. Half the patients (49%) reported moderate to severe anxiety and 68% showed elevated levels of depressive symptoms. Psychosocial distress did not change significantly over time (GAD-7: p=0.580, PHQ-9: p=0.101). Patients' quality of life was low overall (cut-off<50). At t2, quality of life had particularly increased in physical aspects, but overall quality of life remained lower than in the general population (all subscales: p<0.05). We identified younger age and lower income as risk factors for higher psychosocial distress and lower quality of life. Patients were very satisfied with the counselling they received, 9% reported to be dissatisfied. Our results show that psychosocial distress remains high over a longer period of time at least for some patients. This illustrates the persisting need for long-term support regarding physical, mental and social impairments as a consequence of cancer and its treatments. It also shows the challenging demands which OPC centers are faced with. As a consequence, psychosocial support in the outpatient setting needs to be extended and developed further.

Cultural humility and racial microaggressions in counseling.

Racial microaggressions may contribute to poor counseling outcomes in racial/ethnic minority clients. The present study examined the occurrence of racial microaggressions in counseling using a large and diverse sample and explored the association between perceived cultural humility of the counselor and racial microaggressions. Racial/ethnic minority participants (N = 2,212) answered questions about the frequency and impact of racial microaggressions in counseling and the characteristics of their counselor. The majority of clients (81%) reported experiencing at least 1 racial microaggression in counseling. Participants most commonly reported racial microaggressions involving denial or lack of awareness of stereotypes and bias and avoidance of discussing cultural issues. There were few differences in racial microaggression frequency or impact based on client race/ethnicity and counselor race/ethnicity. Racially matched clients viewed racial microaggressions as more impactful than did clients who were not racially matched. Client-perceived cultural humility of the counselor was associated with fewer microaggressions experienced in counseling. We conclude by discussing limitations, areas for future research, and implications for counseling.

Housing outcomes and predictors of success: the role of hospitalization in street outreach.

What is known on the subject? Outreach services are often successful in engaging and housing street homeless individuals. People experiencing homelessness have greatly increased rates of mental illness and substance abuse. What this paper adds to existing knowledge? Given the relative lack of research involving street homeless individuals, this retrospective chart review examined factors associated with successful housing by a multidisciplinary street outreach team, including the use of hospitalization as an intervention within a housing first framework. The majority of clients were successfully housed by the end of outreach team involvement. An admission to hospital was strongly associated with successful housing for those with a psychotic disorder. What are the implications for practice? Multidisciplinary outreach teams, specifically those with psychiatric and nursing support, successfully work with and house people experiencing street homelessness and psychosis. Mental health nurses embedded in the community are an essential link between inpatient and outpatient care for highly vulnerable street homeless individuals. Introduction Housing-first strategies have helped establish housing as a human right. However, endemic homelessness persists. Multidisciplinary outreach teams that include nursing, social and psychiatric services allow for integrative strategies to engage and support clients on their housing trajectory. The following retrospective review focused on the identification of demographic, clinical, and service characteristics that predicted the obtainment of housing, and explored the role of psychiatric hospitalization as an intervention, not an outcome measure, in contrast to previous studies. These have rarely focused on street homelessness. A retrospective chart review of 85 homeless, primarily rough-sleeping, clients was conducted to determine housing outcomes and the factors associated with obtaining housing through care provided by a psychiatric street outreach team in Toronto, Canada. Demographics, homelessness duration, diagnosis, hospitalization and housing status were tracked during team involvement. Overall, 46% (36/79) were housed during the study term. Securing housing at the end of treatment/data collection was significantly enhanced by hospitalization (OR = 9.04, 95% CI [2.43, 33.59]). It was significantly diminished by psychosis (OR = 0.22, 95% CI [0.05, 0.95]) and prior homelessness >36 months (OR = 0.10, 95% CI [0.02, 0.50]). Twenty-three of 31 (74%) hospitalized clients with psychosis were subsequently housed, compared to 4 of 30 (13%) not hospitalized (Fisher's exact, P < .001). Multidisciplinary street outreach teams successfully house long-standing homeless clients (>12 months without a permanent address) with serious mental illness and/or substance abuse. Hospitalization can be utilized as a complimentary intervention, particularly for those with psychosis, in the continuum of housing first initiatives, and can contribute to securing housing for those with persistent psychotic disorders. Implications for nursing practice Community mental health nurses are uniquely positioned to translate care between hospital and community settings, ensuring timely assessment, intervention and treatment of clients who are historically difficult to engage.