Successful Client Outcomes Research Articles

Diagnosing and Treating Dissociative Identity Disorder: A Guide for Social Workers and All Frontline Staff. Gregory L. Nooney

Gregory Nooney’s book Diagnosing and Treating Dissociative Identity Disorder: A Guide for Social Workers and All Frontline Staff is a huge welcome to literature on the topic of dissociative identity disorder (DID). Nooney provides an in-depth understanding of the vast complexities of DID and strongly encourages the absolute necessity to remain educated on DID, for successful outcomes with clients. Though retired, Nooney utilizes his 35 years of experience and research in the mental health field to continue providing education to the social work and other professional fields. I have always been interested in what society historically referred to as “multiple personality disorder,” now known as DID. I have read various books and watched movies both fictional and nonfictional based on persons with DID, and I remain intrigued to the workings of the brain and how it attempts to cope with extreme trauma. As I continue to learn about DID, I have naturally asked myself whether I, along with the clinical teams I have worked with in various mental health settings, could have misdiagnosed or provided the wrong type of treatment to clients. I will be forever grateful for Nooney’s discussion of psychotropic medications being prescribed to DID clients and how a prescriptiod can be harmful to various alters within the system. Throughout the book, Nooney continues to emphasize why it is vital to stay up to date with professional development for successful client outcomes.

Explanatory Styles of Counsellors in Training

Explanatory style is based on how one explains good and bad events according to three dimensions: personalization, permanence, and pervasiveness. With an optimistic explanatory style, good events are explained as personal, permanent, and pervasive, whereas bad events are explained as external, temporary, and specific. For counsellors, an optimistic explanatory style creates positive expectancy judgments about the possibilities and opportunities for successful client outcomes. In this research study, we explored the explanatory styles expressed in 400 events (200 good events and 200 bad events) extracted from 38,013 writing samples of first year and final year graduate level counsellors in training. Across the three optimism dimensions and within good and bad events, there was one occurrence of a positive relationship between counsellor training time and the amount of expressed optimism. The implications of this study include the need to cultivate optimistic explanatory styles of counsellors in training and practicing counsellors.

Emotion‐focused therapy for symptoms of generalised anxiety in a student population: An exploratory study

AbstractAnxiety issues continue to retain the highest prevalence rates within student counselling services (SCS) with generalised anxiety a prominent concern. These issues are associated with poor academic achievement, attrition and self‐injurious behaviours. Cognitive behavioural therapy (CBT) is moderately effective in treating generalised anxiety in students. Initial studies of emotion‐focused therapy (EFT) for GAD are indicating successful outcomes for clients though research investigating a brief format within SCS populations is needed.AimThe present exploratory study represents an early effort to examine the effectiveness of brief EFT for generalised anxiety symptoms within a university SCS and the clients’ experiences of this type of therapy.MethodParticipants (n = 15) presenting to a SCS with worry and generalised anxiety symptoms received an individual EFT for GAD intervention. Outcomes were assessed using two outcome measures pre‐ and post‐therapy and a semi‐structured post‐therapy interview examined the clients’ experiences of therapy and its outcomes.ResultsQuantitative pre–postdata indicated large effect sizes. Qualitative data described experiences of decreased anxiety, increased self‐understanding, resilience, self‐compassion and assertiveness. Experiential work and the therapeutic relationship were experienced as helpful aspects of therapy though experiential work was difficult. Personal difficulty engaging in therapy and some remaining symptoms were unhelpful aspects.ConclusionFindings suggest that brief EFT for generalised anxiety symptoms in students may be an effective SCS intervention and warrants further investigation.

Stories of strangers: Writing donor acquisition letters in the human services

AbstractThis study explores the choices fundraisers make in crafting letters to acquire new donors for a human services organization, and whether the type of client served affects those choices. We use an experiment to control for organizational differences, and code the resulting letters written for elements identified in theory and practice, then perform an exploratory factor analysis to find patterns of co‐occurring variables. Writers tended to focus either on the quality of the organization or the unmet need in the community, but not both. Two of the factors, Universalism and Security, describe distinct personal value constructs that may reflect the preferences of the writer or the presumed preferences of the reader. Compared to participants writing for an older adult client base, participants writing for clients with mental illness were less likely to use a negative frame, more likely to use statistical evidence, and used lower expectations in describing successful client outcomes. Within letters, clients were described using three patterns: by describing a stranger who is worth helping because of intrinsic attributes; by describing a stranger who is worth helping because of their relationships within the social order; by describing the client group using facts and statistics, rather than an emotionally compelling story narrative.

Collaboration Yields Presentations About … Collaboration

Collaboration Yields Presentations About … Collaboration

Research-Supported Treatment and Organizational Culture and Climate’s Impact on Child Welfare Outcomes

Objective: Research-supported treatments (RSTs) are considered the gold standard of client care. Investigating how to best implement and sustain RSTs in real-world practice is important. The present study addressed a gap in the literature concerning the relative contribution of RSTs and culture and climate to client outcomes in community-based child welfare services. Method: Using data collected from 55 programs within a single, large child and family human services agency, this study examined whether programs with less productive cultures and climates were able to implement RSTs and realize successful client outcomes. Results: In contrast to findings of the existing literature, programs with less productive culture and climate scores implemented RSTs and yielded successful client outcomes. Conclusions: Given the choice between maltreated children being treated in a program with good culture and climate or one that provides RSTs, the best selection for improved outcomes would be the one offering RSTs.

Evaluation in everyday occupational therapy practice: Should we be thinking about treatment fidelity?

Evaluation is a core component of the occupational therapy process. To draw meaningful conclusions about the effectiveness of occupational therapy practice, it is essential that therapists consider not only what outcomes are achieved, but also reflect on how interventions are delivered. We suggest that incorporating the concept of ‘treatment fidelity’ into clinical practice offers therapists a means of differentiating between interventions and demonstrating clearer links between occupational therapy practice and successful client outcomes. In so doing, practitioners can highlight more explicitly the unique contribution of occupational therapy interventions.

Optimizing continuity-of-care opportunities to reduce health risks: shared qualitative perspectives from CJDATS 2 research

Current Texas Christian University (TCU) research focuses on reducing risk for relapse and other health-related behaviors associated with HIV, HBV, and HCV. The WaySafe curriculum was developed for prisoners in the last phase of their substance abuse treatment before transitioning back to the community, and was designed to improve decisionmaking and recognizing and planning for risky situations. A critical next step is to shift the setting from incarceration to a community setting with probationers during the high-risk transition period after release from prison or completion of residential or intensive outpatient substance abuse treatment. Literature supports the importance of prevention programs [1] as part of the continuity-of-care for offenders and probationers in addressing some service gaps (in the continuum), which are widely recognized to reduce the likelihood of successful client outcomes [2,3]. The purpose of this presentation is to provide evidence from the recently completed second phase of the Criminal Justice Drug Abuse Treatment Studies (CJDATS 2), with insight from key stakeholders that informs the relevance of continuity-of-care and the significant role that community corrections and community-based health-care agencies fulfill in transitioning probationers from incarceration to home. These qualitative results come from two protocols conducted as part of CJDATS 2: HIV Services and Treatment Implementation in Corrections (HIV-STIC) and Medication-Assisted Treatment in Community Corrections Environments (MATICCE). The organizational-level findings reflect the opinions and views of criminal justice personnel and health-care providers—agencies in partnership with TCU in HIV-STIC and MATICCE. In CJDATS 2, stakeholders participated in an implementation research initiative, utilizing a change team strategy to identify and implement improvements to service delivery. In both HIV-STIC and MATICCE, the services delivery continuum incorporated elements of prison-based services and transition to community-based services in their respective areas. Qualitative results highlight the important contributions of community correction agencies, their direct contact to probationers, and their ability to facilitate linkages to service providers. Findings are discussed, emphasizing the importance of staff commitment and interorganizational relationships in continuity-of-care from prison to community as essential components to optimizing services to probationers.

Pre- and post-delinquency behavior: cross-neighborhood variation in New York City

This study examines whether and how mortgage default risk and the resolution process of defaults interact with neighborhoods where homeowners reside. It uses a unique data that matches household information from the Center for New York City Neighborhoods (CNYCN) with a variety of census tract data. Findings suggest that loan-related triggers of mortgage distress (e.g., payment adjustment) are more significant in neighborhoods with higher price depreciation and higher vacancy rates. With respect to post-delinquency behavior, distressed homeowners residing in neighborhoods with higher house prices tend to underutilize CNYCN services, controlling for their distance to service providers. Along with strong housing market performance, the concentration of Black/African-Americans in a neighborhood is likely to contribute to less successful client outcomes.

Do Organizational Culture and Climate Matter for Successful Client Outcomes?

Objectives: The existing literature on the impact of workplace conditions on client care suggests that good cultures and climates provide the best outcomes for clients. The primary purpose of this study was to investigate the relationship between organizational culture and climate and the proportion of children and youth successfully discharged from a large organization in New York state. Method: Thirty-three child and youth programs with existing culture and climate data evaluated outcome information from 1,336 clients exiting its services. Results: Programs reported as having bad culture and climate yielded superior client outcomes, measured as discharge to a lower level of care and successfully completing. Conclusion: This study and its conclusion point to a gap in knowledge concerning the relation between workplace culture and climate and the impact on client care and workers’ perceptions; this warrants further investigation in similar studies of agencies and their outcomes.

Relationship Between Supervisory Working Alliance and Client Outcomes in State Vocational Rehabilitation Counseling

This study investigated the relationship between supervisory working alliance (SWA) and successful client outcomes in the state/federal vocational rehabilitation counseling system and supervision practices associated with SWA. Rehabilitation counselors ( N = 166) from five randomly selected rehabilitation counseling programs participated in an electronic survey. Existence of a supervision contract, regularly scheduled contact with supervisor, and the counselors’ rating of importance of supervision were found to be positively associated with SWA among new counselors. Implications of findings for rehabilitation counselors will be discussed.

Prevalence of Adverse Childhood Experiences (ACEs) among Child Service Providers

Despite increasing evidence in the public health field about the prevalence of adverse childhood experiences (ACEs) in the general population, little is known about the prevalence of ACEs among social service providers. Trauma backgrounds may influence both worker susceptibility to vicarious traumatization as well as clinical decision making. Similarly, individuals with trauma backgrounds are vulnerable to re-enactment of their history. With pressure on social service agencies to demonstrate successful client outcomes, it is critical that agencies explore factors that influence high-quality care. This exploratory study is the first investigation of ACE prevalence among workers in an agency that provides residential treatment, day treatment, and schooling for children with histories of trauma. Study results suggest a high prevalence of ACEs among these workers.

Facilitating medical withdrawal from opiates in rural Ontario

The abuse of oxycodone in Northwestern Ontario, Canada, has escalated at alarming rates raising concerns that opiate use has reached epidemic proportions, particularly among the First Nations communities. The authors were involved in establishing Ontario's first rural inpatient medical withdrawal unit to serve patients seeking abstinence. The development of the medical withdrawal support services (MWSS) required creative and adaptive strategies to respond to the geographical, cultural and institutional circumstances. Key factors to support program efficacy and successful outcomes for clients during the inaugural eight months of operation are interprofessional and collaborative approaches with a cultural awareness.Key words: addiction, Canada, First Nation, medical withdrawal.

Sobriety as an admission criterion for transitional housing: A multi-site comparison of programs with a sobriety requirement to programs with no sobriety requirement

BackgroundThis study examined whether homeless clients enrolled in transitional housing programs that required sobriety (SR) as an admission criterion have outcomes comparable to clients enrolled in programs that did not require sobriety (NSR) as an admission criterion. MethodsA total of 1062 military veterans in 40 transitional housing programs funded by the United States Department of Veterans Affairs were grouped based on whether they were in SR or NSR programs and followed over a one-year period after program discharge. Participants in SR and NSR programs were compared on their ratings of the social climate of the program, and housing and psychosocial outcomes. ResultsParticipants in SR programs reported more days housed and better psychosocial outcomes than participants in NSR programs, although the differences were small and there were no differences in ratings of their social climate. Both participants in SR and NSR programs showed improvements on most outcomes after discharge from transitional housing. There were no significant differences in outcomes between participants actively abusing substances at program entry compared to those who were not. ConclusionsRequiring sobriety as an admission criterion in transitional housing made only a small difference in housing outcomes post-discharge. Further study is needed to determine whether requiring sobriety at admission in transitional housing is necessary for successful client outcomes.

Lawyers and Social Workers Working Together

In Australia, experimentation with, and literature on, interdisciplinary teams comprising lawyers and social workers has remained limited. This is despite the fact that many legal organisations employ social workers to support their practice. In many community legal settings, social workers work alongside lawyers in the delivery of socio-legal services. This article explores the nature and effectiveness of working relationships between lawyers and social workers in community legal centres in Brisbane, Australia. It draws on data obtained from interviews and focus groups with thirteen lawyers and eleven social workers working in community law settings. The group discussions focused on the strengths and weaknesses of collaborative models, and the features of successful lawyer–social worker partnerships. It is concluded that a commitment to feminist legal practice may be associated with positive working relationships, which hopefully will translate into successful outcomes for clients.

A description of how three occupational therapists train children in using the scanning access technique

Scanning is a technique that enables children with severe physical disabilities to access an augmentative and alternative communication device or other assistive technology. The purpose of this study was to identify and describe the methods and rationale used by occupational therapists experienced in training scanning when teaching a child to scan. The research was conducted in two phases: (i) a survey phase in which a questionnaire was distributed; and (ii) a consultation phase involving semistructured interviews. Results of the survey revealed that although the population of scanning users is relatively small, scanning remains an important access technique. Thematic analysis of the interviews yielded four themes: (i) ‘The process of training scanning is progressive and parallel’; (ii) ‘Clients must be considered on an individual basis’; (iii) ‘Training scanning is inextricably linked to functional goals’; and (iv) ‘The importance of training the child and primary carers using a collaborative approach’. A unique insight into the major phases of training scanning has been provided. However, it appears that therapists are not advancing clients beyond linear and row–column techniques or increasing the number of switches for increased speed of output. Recommendations for the provision of basic training are given. Occupational therapists would benefit from further investigation of the issues surrounding scanning for ensuring successful client outcomes.

Case management in action: An examination of two cases in the area of alcohol related brain damage

‘Practice Forum’ provides a forum for social work practitioners to share their practice with others; to describe what they are doing and assess its effectiveness. The practice of case management is applied in a wide range of service delivery models to meet complex client needs. Unfortunately, cost containment and lack of clarity of the role of the case manager has blurred the definition and practice of case management for both the consumer and professional providers. This article examines two cases of a small non-government agency in Melbourne called Alcohol Related Brain Injury Assessment, Accommodation & Support Inc. (ARBIAS) where case management services are delivered to people with alcohol acquired brain damage. The analysis presented here supports the view that continuity of care and intensive relationship building with clients is vital for successful client outcomes and has application to a variety of programs which service chronically disabled clients.

Use of AAC by individuals with acquired neurologic communication disabilities: Results of an Australian survey

A demographic survey of speech pathologists was conducted in Australia to investigate the use of augmentative and alternative communication (AAC) with adults with acquired neurologic communication disabilities. Questionnaires were distributed to all speech pathologists who were members of the Australian Association of Speech and Hearing and listed themselves as working with an adult or mixed caseload. Questions related to the clinician's background, experience and interest in AAC, knowledge of and expertise with high and low technology systems, and factors related to successful outcomes for clients. Subjective data from the questionnaire were collated and the results and their implications are discussed.

Youth and Family Characteristics, Treatment Histories, and Service Outcomes

Based upon BOMIS data, this paper explores youth and family characteristics and treatment processes associated with successful client outcomes at Boysville. Although the study is descriptive rather than predictive, it offers several implications for practice. It also demonstrates the basic research potential of BOMIS data.

Review: locus of control as a predictor of outcome of psychotherapy.

The last 10 years have shown a notable increase in the consideration of locus of control as a variable pertinent to the explanation of outcome in psychotherapy. In particular, a body of research has provided evidence that an internal locus of control orientation facilitates both positive assessments of therapy and favourable outcomes, and that successful outcomes for clients with particular control orientations are facilitated by the degree of structure and directiveness in therapy. There appear to be a number of difficulties with the methods of measurement employed in these studies; in particular, the selection of subject groups and indexes of outcome as well as manipulation of treatment structures may have limited the generalizability of research findings. The possible therapeutic and clinical applications of locus of control in psychotherapy are considered.