Comparative analysis of a client's verbal responses in counseling sessions: quantitative case study.

PubMed

Lee, Han-Jong

2011-04-01

This study investigated how the in-session change in a client's verbal behavior might influence the effectiveness of counseling sessions. 10 sessions of counseling with a male undergraduate suffering from depressive mood were conducted by a humanistically oriented counselor. The two most effective and the two least effective sessions were identified according to the client's evaluation of the effectiveness of counseling sessions. Results indicated that over the three segments of the most effective sessions, the client gradually increased responses that indicated exploration of his own emotions, thoughts, and behaviors. By contrast, the client continued talking mainly about past events in a storytelling manner throughout the least effective sessions.

Informal Discussions in Substance Abuse Treatment Sessions with Spanish-speaking Clients

PubMed Central

Bamatter, Wendy; Carroll, Kathleen M.; Añez, Luis M.; Paris, Manuel; Ball, Samuel A.; Nich, Charla; Frankforter, Tami L.; Suarez-Morales, Lourdes; Szapocznik, Jose; Martino, Steve

2010-01-01

This study investigated the extent to which bilingual counselors initiated informal discussions about topics that were unrelated to the treatment of their monolingual Spanish-speaking Hispanic clients in a National Institute on Drug Abuse Clinical Trial Network protocol examining the effectiveness of motivational enhancement therapy (MET). Session audiotapes were independently rated to assess counselor treatment fidelity and the incidence of informal discussions. Eighty-three percent of the 23 counselors participating in the trial initiated informal discussions at least once in one or more of their sessions. Counselors delivering MET in the trial initiated informal discussion significantly less often than the counselors delivering standard treatment. Counselors delivering standard treatment were likely to talk informally the most when they were ethnically non-Latin. Additionally, informal discussion was found to have significant inverse correlations with client motivation to reduce substance use and client retention in treatment. These results suggest that informal discussion may have adverse consequences on Hispanic clients’ motivation for change and substance abuse treatment outcomes and that maintaining a more formal relationship in early treatment sessions may work best with Hispanic clients. Careful counselor training and supervision in MET may suppress the tendency of counselors to talk informally in sessions. PMID:20817381

The In-Session and Long-Term Role of a Significant Other in Motivational Enhancement Therapy for Alcohol Use Disorders

PubMed Central

Bourke, Emilie; Magill, Molly; Apodaca, Timothy R.

2016-01-01

Objective To examine how significant other (SO) language in support of or against client abstinence from alcohol influences clients’ in-session speech and drinking behavior over the 9 months post-Motivational Enhancement Therapy (MET). Method Sequential analyses were used to examine the language of Project MATCH clients who invited an SO to participate in an MET session. Hierarchical regressions investigated the predictive relationship between SO language and clients’ post-treatment drinking behavior. A cohort analytic design compared the change language of these SO-involved participants against a matched group who chose client-only therapy. Results 'SO Support Change' language increased the odds of client Change Talk in the next utterance (p < .01). SO Support Change did not significantly predict reduced post-treatment drinking whereas 'SO Against Change' significantly predicted an increase in average drinks per drinking day (DDD) across months 7-9 post-MET (p = .04). In the matched comparison, the proportion of change-related client language was comparable across the SO-involved and client-only groups. Conclusions Motivational interviewing theory was supported by the sequential association between SO and client language as well as the predictive link between SO Against Change and client drinking intensity. Given the centrality of pro-sobriety language in the literature, it was surprising that SO Support Change did not predict alcohol use outcomes. Findings are discussed in relation to contemporary treatment process research and clinical practice. PMID:26951920

A novel application in the study of client language: Alcohol and marijuana-related statements in substance-using adolescents during a simulation task.

PubMed

Ladd, Benjamin O; Garcia, Tracey A; Anderson, Kristen G

2016-09-01

The current study explored whether laboratory-based techniques can provide a strategy for studying client language as a mechanism of behavior change. Specifically, this study examined the potential of a simulation task to elicit healthy talk, or self-motivational statements in favor of healthy behavior, related to marijuana and alcohol use. Participants (N = 84) were adolescents reporting at least 10 lifetime substance use episodes recruited from various community settings in an urban Pacific Northwest setting. Participants completed the Adolescent Simulated Intoxication Digital Elicitation (A-SIDE), a validated paradigm for assessing substance use decision making in peer contexts. Participants responded to 4 types of offers in the A-SIDE: (a) marijuana, (b) food (marijuana control), (c) alcohol, and (d) soda (alcohol control). Using a validated coding scheme adapted for the current study, client language during a structured interview assessing participants' response to the simulated offers was evaluated. Associations between percent healthy talk (PHT, calculated by dividing the number of healthy statements by the sum of all substance-related statements) and cross-sectional outcomes of interest (previous substance use, substance use expectancies, and behavioral willingness) were explored. The frequency of substance-related statements differed in response to offer type; rate of PHT did not. PHT was associated with behavioral willingness to accept the offer. However, PHT was not associated with decontextualized measures of substance use. Associations between PHT and global expectancies were limited. Simulation methods may be useful in investigating the impact of context on self-talk and to systematically explore client language as a mechanism of change. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Improving client-provider communication: evaluation of a training program for women, infants and children (WIC) professionals in New York state.

PubMed

Newes-Adeyi, Gabriella; Helitzer, Deborah L; Roter, Debra; Caulfield, Laura E

2004-11-01

Results are presented from evaluation of an intensive 1 day training program to improve the growth monitoring counseling skills of Special Supplemental Nutrition Program for Women, Infants and Children (WIC) providers. The training was framed by the patient-centered approach, and focused on a seven-step technique that emphasized eliciting client perspective on the child's health and negotiating follow-up strategies. Changes in skill were assessed during audiotaped mock counseling sessions with simulated clients. Observed intervention effects were moderate but encouraging for future training programs. After the training, more providers elicited client perspective, and provider level of engagement in negotiating with the client increased. At post-test providers asked more open-ended questions than at pre-test, and provider-to-client talk ratio decreased. Increases in provider total and competence-related satisfaction paralleled improvements in counseling proficiency. Study results suggest that counseling skills of non-physician health providers can change after a 1 day focused training: providers were more client-centered in their discussions. Limitations and implications of the study are discussed.

Contemplative Listening in Moral Issues: Moral Counseling Redefined in Principles and Method

PubMed Central

van Hoek, Maria E.C.

2017-01-01

We present a listening grid for moral counseling, in which we pay particular attention, alongside the what, to how clients talk about themselves: as if they were spectators; aware what this talking does to them; how they perceive what is good from the past; and what they will strive for in the future. By this moral talk, clients discover a picture of the conviction that will enable them to make a decision. PMID:28618880

A Comparison of Natural Language Processing Methods for Automated Coding of Motivational Interviewing.

PubMed

Tanana, Michael; Hallgren, Kevin A; Imel, Zac E; Atkins, David C; Srikumar, Vivek

2016-06-01

Motivational interviewing (MI) is an efficacious treatment for substance use disorders and other problem behaviors. Studies on MI fidelity and mechanisms of change typically use human raters to code therapy sessions, which requires considerable time, training, and financial costs. Natural language processing techniques have recently been utilized for coding MI sessions using machine learning techniques, rather than human coders, and preliminary results have suggested these methods hold promise. The current study extends this previous work by introducing two natural language processing models for automatically coding MI sessions via computer. The two models differ in the way they semantically represent session content, utilizing either 1) simple discrete sentence features (DSF model) and 2) more complex recursive neural networks (RNN model). Utterance- and session-level predictions from these models were compared to ratings provided by human coders using a large sample of MI sessions (N=341 sessions; 78,977 clinician and client talk turns) from 6 MI studies. Results show that the DSF model generally had slightly better performance compared to the RNN model. The DSF model had "good" or higher utterance-level agreement with human coders (Cohen's kappa>0.60) for open and closed questions, affirm, giving information, and follow/neutral (all therapist codes); considerably higher agreement was obtained for session-level indices, and many estimates were competitive with human-to-human agreement. However, there was poor agreement for client change talk, client sustain talk, and therapist MI-inconsistent behaviors. Natural language processing methods provide accurate representations of human derived behavioral codes and could offer substantial improvements to the efficiency and scale in which MI mechanisms of change research and fidelity monitoring are conducted. Copyright © 2016 Elsevier Inc. All rights reserved.

Veterinarians' role for pet owners facing pet loss

PubMed Central

Fernandez-Mehler, P.; Gloor, P.; Sager, E.; Lewis, F. I.; Glaus, T. M

2013-01-01

Owners' satisfaction with, and expectations from, their veterinarians around euthanasia, including questions on disposal of pet remains subject to animal species, clients' gender, age, family conditions, area of living and type of veterinary clinic visited were evaluated by questionnaire. Questionnaires were to be filled out by clients consecutively visiting the individual practices and hospitals for any kind of consultations. Of 2350 questionnaires distributed, 2008 were returned and available for analysis. Owner satisfaction concerning the procedure of euthanasia was high (92 per cent, 1173/1272). After the event of euthanasia, 14 per cent (170/1250) had changed their veterinarian, even though 75 per cent of these 170 had been satisfied with the procedure. Most owners (88 per cent) expected veterinarians to talk about their pet's final destination, and 38 per cent expected this to happen early in the pet's life. For 81 per cent clients, the veterinarian was the primary informant about the possibilities concerning the disposal of pet remains, and 33 per cent indicated their veterinarian as the contact person to talk about pet loss. Area of living, or veterinary specialisation, only marginally influenced the answers. Veterinarians play an important role to inform their clients concerning questions around euthanasia and the care of pet remains, and to support them during the process of mourning. PMID:23492929

Therapy Talk: Analyzing Therapeutic Discourse

ERIC Educational Resources Information Center

Leahy, Margaret M.

2004-01-01

Therapeutic discourse is the talk-in-interaction that represents the social practice between clinician and client. This article invites speech-language pathologists to apply their knowledge of language to analyzing therapy talk and to learn how talking practices shape clinical roles and identities. A range of qualitative research approaches,…

Group motivational interviewing for adolescents: Change talk and alcohol and marijuana outcomes

PubMed Central

D’Amico, Elizabeth J.; Houck, Jon M.; Hunter, Sarah B.; Miles, Jeremy N.V.; Osilla, Karen Chan; Ewing, Brett A.

2014-01-01

Objective Little is known about what may distinguish effective and ineffective group interventions. Group motivational interviewing (MI) is a promising intervention for adolescent alcohol and other drug (AOD) use; however, the mechanisms of change for group MI are unknown. One potential mechanism is change talk, which is client speech arguing for change. The present study describes the group process in adolescent group MI and effects of group-level change talk on individual alcohol and marijuana outcomes. Method We analyzed 129 group session audio recordings from a randomized clinical trial of adolescent group MI. Sequential coding was performed using the Motivational Interviewing Skill Code (MISC) and the CASAA Application for Coding Treatment Interactions (CACTI) software application. Outcomes included past-month intentions, frequency, and consequences of alcohol and marijuana use, motivation to change, and positive expectancies. Results Sequential analysis indicated that facilitator open-ended questions and reflections of change talk (CT) increased group CT. Group CT was then followed by more CT. Multilevel models accounting for rolling group enrollment revealed group CT was associated with decreased alcohol intentions, alcohol use and heavy drinking three months later; group sustain talk was associated with decreased motivation to change, increased intentions to use marijuana, and increased positive alcohol and marijuana expectancies. Conclusions Facilitator speech and peer responses each had effects on change and sustain talk in the group setting, which was then associated with individual changes. Selective reflection of CT in adolescent group MI is suggested as a strategy to manage group dynamics and increase behavioral change. PMID:25365779

The Negotiation of Interactive Frames and Discourse Identities in China's Rural Insurance Sales Interactions

ERIC Educational Resources Information Center

Wang, Weichao; Peng, Huan

2017-01-01

This paper analyzes dialogues between insurance sales agents and their clients in transformational rural China from the perspective of interactive frames, footings and discourse identities. Through the analysis of three types of talk, namely, friendship talk, institutional talk and task-oriented talk, the ambiguous and conflicting identities that…

Dream Work in Grief Therapy

PubMed Central

Noronha, Konrad Joseph

2014-01-01

Working with dreams is useful with grief and loss clients who present with dreams. Adlerian dream analysis is one-way of exploring dreams. It incorporates the life-style of the client. This case report demonstrates how Adlerian dream analysis was used with a client. Progress was noted in improved life-style once the client began to talk about her dream. PMID:25035561

The impact of peer mentor communication with older adults on depressive symptoms and working alliance: A pilot study.

PubMed

Joo, Jin Hui; Hwang, Seungyoung; Gallo, Joseph J; Roter, Debra L

2018-04-01

The objective of this pilot study was to describe peer communication in meetings with depressed elders, associate their relationship with working alliance and depression and assess congruence of communication with training. Three peers with a history of depression, in recovery, received 20h of training in peer mentoring for depression as part of an 8-week pilot program for 23 depressed older adults. Each peer-client meeting was recorded; a sample of 69 recorded meetings were chosen across the program period and coded with the Roter Interaction Analysis System, a validated medical interaction analysis system. Generalized linear mixed models were used to examine peer talk during meetings in relation to working alliance and client depression. Peers used a variety of skills congruent with their training including client-centered talk, positive rapport building and emotional responsiveness that remained consistent or increased over time. Client-centered communication and positive rapport were associated with increased working alliance and decreased depressive symptoms (all p<0.001). Trained peer mentors can use communication behaviors useful to older adults with depression. Specifically, client-centered talk may be important to include in peer training. Peer mentors can be a valuable resource in providing depression counseling to older adults. Copyright © 2017 Elsevier B.V. All rights reserved.

The Challenge of Prejudice: Counsellors' Talk about Challenging Clients' Prejudices

ERIC Educational Resources Information Center

Spong, Sheila J.

2012-01-01

This paper considers the implications for training and practice of counsellors' responses to the notion of challenging clients' prejudices. It explores tensions in counselling discourse between social responsibility, responsibility to the client and responsibility for one's self as counsellor. Three focus groups of counsellors were asked whether a…

Therapeutic change in interaction: conversation analysis of a transforming sequence.

PubMed

Voutilainen, Liisa; Perakyla, Anssi; Ruusuvuori, Johanna

2011-05-01

A process of change within a single case of cognitive-constructivist therapy is analyzed by means of conversation analysis (CA). The focus is on a process of change in the sequences of interaction, which consist of the therapist's conclusion and the patient's response to it. In the conclusions, the therapist investigates and challenges the patient's tendency to transform her feelings of disappointment and anger into self-blame. Over the course of the therapy, the patient's responses to these conclusions are recast: from the patient first rejecting the conclusion, to then being ambivalent, and finally to agreeing with the therapist. On the basis of this case study, we suggest that an analysis that focuses on sequences of talk that are interactionally similar offers a sensitive method to investigate the manifestation of therapeutic change. It is suggested that this line of research can complement assimilation analysis and other methods of analyzing changes in a client's talk.

Counselor Self-Disclosure, East Asian American Client Adherence to Asian Cultural Values, and Counseling Process

ERIC Educational Resources Information Center

Kim, Bryan S. K.; Hill, Clara E.; Gelso, Charles J.; Goates, Melissa K.; Asay, Penelope A.; Harbin, James M.

2003-01-01

After completing a measure of adherence to Asian cultural values, 62 East Asian American clients talked about personal issues in a counseling session with a European American counselor who either disclosed personal information or refrained from disclosing personal information. Disclosure condition and client adherence to Asian values did not…

Making a Case for Client Insistence in Social Work Interaction

ERIC Educational Resources Information Center

Matarese, Maureen T.; van Nijnatten, Carolus

2015-01-01

It has been argued that the goals of the institution can shape the talk therein. What happens when a client consistently invokes topics and role identities that are outside the parameters of the institution, insisting on his or her own goals and gaining and maintaining a control of the floor usually expected of practitioners? Client power is often…

Does the quality of safetalk motivational interviewing counseling predict sexual behavior outcomes among people living with HIV?

PubMed

Grodensky, Catherine; Golin, Carol; Parikh, Megha A; Ochtera, Rebecca; Kincaid, Carlye; Groves, Jennifer; Widman, Laura; Suchindran, Chirayath; McGirt, Camille; Amola, Kemi; Bradley-Bull, Steven

2017-01-01

Although past research has demonstrated a link between the quality of motivational interviewing (MI) counseling and client behavior change, this relationship has not been examined in the context of sexual risk behavior among people living with HIV/AIDS. We studied MI quality and unprotected anal/vaginal intercourse (UAVI) in the context of SafeTalk, an evidence-based secondary HIV prevention intervention. We used a structured instrument (the MISC 2.0 coding system) as well as a client-reported instrument to rate intervention sessions on aspects of MI quality. Then we correlated client-reported UAVI with specific counseling behaviors and the proportion of interactions that achieved MI quality benchmarks. Higher MISC-2.0 global ratings and a higher ratio of reflections to questions both significantly predicted fewer UAVI acts at 8-month follow-up. Analysis of client ratings, which was more exploratory, showed that clients who rated their sessions higher in counselor acceptance, client disclosure, and relevance reported higher numbers of UAVIs, whereas clients who selected higher ratings for perceived benefit were more likely to have fewer UAVI episodes. Further research is needed to determine the best methods of translating information about MI quality into dissemination of effective MI interventions with people living with HIV. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Promoting informed choice: evaluating a decision-making tool for family planning clients and providers in Mexico.

PubMed

Kim, Young Mi; Kols, Adrienne; Martin, Antonieta; Silva, David; Rinehart, Ward; Prammawat, Sarah; Johnson, Sarah; Church, Kathryn

2005-12-01

The World Health Organization (WHO) has developed a decision-making tool to be used by providers and clients during family planning visits to improve the quality of services. It is important to examine the tool's usability and its impact on counseling and decision-making processes during family planning consultations. Thirteen providers in Mexico City were videotaped with family planning clients three months before and one month after attending a training session on the WHO decision-making tool. The videotapes were coded for client-provider communication and eye contact, and decision-making behaviors were rated. In-depth interviews and focus group discussions explored clients' and providers' opinions of the tool. After providers began using the decision-making tool, they gave clients more information on family planning, tailored that information more closely to clients' situations and more often discussed HIV/AIDS prevention, dual protection and condom use. Client involvement in the decision-making process and client active communication increased, contributing to a shift from provider-dominated to shared decision making. Clients reported that the tool helped them understand the provider's explanations and made them feel more comfortable talking and asking questions during consultations. After one month of practice with the decision-making tool, most providers felt comfortable with it and found it useful; however, they recommended some changes to the tool to help engage clients in the decision-making process. The decision-making tool was useful both as a job aid for providers and as a decision aid for clients.

Change talk sequence during brief motivational intervention, towards or away from drinking.

PubMed

Bertholet, Nicolas; Faouzi, Mohamed; Gmel, Gerhard; Gaume, Jacques; Daeppen, Jean-Bernard

2010-12-01

To investigate whether different sequences of 'change talk' utterances within a brief motivational intervention (BMI) are associated with drinking outcomes. Speech content analysis of recorded BMI. BMI delivered in an emergency department for at-risk drinking. Ninety-seven subjects who received a BMI. Ninety-seven BMI were coded in duplicate by two psychologists with the Motivational Interviewing Skill Code (MISC), a Hidden Markov Model was used to identify three different patient states reflecting attitudes regarding changing their drinking behaviour within a BMI: towards change, away from change and non-determined. Adjusted regression models were used to predict drinking at 12 months' follow-up using patient attitudes regarding changing drinking at the beginning, during the intervention and at the end. The dynamic process at place within a BMI was marked mainly by stability: at each point during the intervention, staying in the same attitude was far more likely than transitioning from one attitude to another. When subjects did change from one attitude to another, they were more likely to move from an 'away from change' to a 'towards change' state. At 12 months, subjects with an attitude towards change at the end of the BMI drank significantly less (13.1 drinks per week) than subjects with an attitude away from change, independent of their attitude at the beginning of the intervention. Transition in 'change talk' between 'away from change' and 'towards change' appears to be rare in brief motivational intervention for excessive alcohol consumption. Moreover, change talk 'towards change' at the end of the intervention is associated with improved outcomes at follow-up, independently of the type of change talk at the beginning of the intervention, suggesting that it is important to end a BMI session with a positive attitude towards change by the client. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.

Contemplative Listening: A Rhetorical-Critical Approach To Facilitate Internal Dialog

PubMed Central

2017-01-01

This article presents a discussion technique that is tailored to clients needing to reorient their convictions following a critical life event. The technique has three distinctive characteristics. The client’s statements are not classified into categories from conventional layer models that are designed to track the themes or content of talk. Instead, we adopt a rhetorical approach because of the fundamental metaphysical nature of conviction that this article assumes. The primary focus is on how clients talk about themselves and their convictions. This focus allows the professional to support clients in their personal work. The technique is a tool that professionals can use during the discussion to monitor whether they themselves are in fact doing what they promised the client they would do. Finally, the technique is a third way, alongside a kerygmatic and therapeutic approach, in which chaplains can conduct discussions. The terminology it employs can be used as a common language for much of the work carried out by chaplains from different philosophical backgrounds. PMID:28618879

Therapeutic Doll Making in Art Psychotherapy for Complex Trauma

ERIC Educational Resources Information Center

Stace, Sonia M.

2014-01-01

Therapeutic doll making can hold diverse functions for clients in therapy, particularly for those clients who are working through complex trauma histories. Recent literature pertaining to the treatment of complex trauma suggests that talking treatments have their limits; supplementary therapeutic approaches that focus on sensory, physical,…

Do professional boundaries limit trust?

PubMed

Smythe, Elizabeth; Hennessy, Julia; Abbott, Max; Hughes, Frances

2018-02-01

The present study uses stories of mental health support workers talking about their relationship with clients to wonder about how trust might be limited by the professional boundaries of nursing. The writing arose out of an appreciative inquiry study looking at the role of mental health support workers. Participants talked about how they worked with their clients. As researchers, we were struck by the depth of trust that was built between worker and client. We have brought a phenomenological lens to wonder about the nature of trust, as shown in the data. The original research sought to identify what was working well for mental health support workers. The present study brings a phenomenological interpretive approach to four stories from the discovery phase of the study, with our thinking informed by Heidegger and van Manen. Interviews were conducted with 26 mental health support workers and six stakeholders in 2012-2103. For this paper, we drew from those transcripts stories of three mental health support workers and one stakeholder. Through a process of talking together, writing, and rewriting, we wondered about the meaning within these stories, with a strong focus on how trust was enacted. We saw that mental health support workers in this study, by not carrying the boundaries of being 'professional', seemed free to grow a stronger relationship of trust which was therapeutic. We ask: Is it time to rethink how professional boundaries limit the level of trust achieved with clients to the detriment of impactful care? © 2017 Australian College of Mental Health Nurses Inc.

Construction of group exercise sessions in geriatric inpatient rehabilitation.

PubMed

Wallin, Marjo; Talvitie, Ulla; Cattan, Mima; Karppi, Sirkka-Liisa

2008-01-01

There is little knowledge about the ways geriatric physiotherapy is being carried out in practice and about the situational construction of formal policies for promoting physical activity. This article examines how professional physiotherapists and frail community-dwelling older adults as their clients use talk and action to construct a group exercise session in an inpatient rehabilitation setting in Finland. The analysis of 7 group exercise sessions with a total of 52 clients and 9 professional physiotherapists revealed 3 different practitioner approaches, which served different functions in older adults' empowerment and lifestyle activity change. The highly structured approach favored taciturn physical performances completed independently and successfully by frail older adults. The guided exercise approach with individualized guidance encouraged occasional coconstruction of shared understanding of learning the exercises. The circuit training approach facilitated occasional self-regulation by the clients. The results of this study indicate that a combination of different approaches is required to address the multifaceted needs of heterogeneous frail older adults.

The interpersonal context of client motivational language in cognitive-behavioral therapy.

PubMed

Sijercic, Iris; Button, Melissa L; Westra, Henny A; Hara, Kimberley M

2016-03-01

Previous research has found that client motivational language (especially arguments against change or counterchange talk; CCT) in early therapy sessions is a reliable predictor of therapy process and outcomes across a broad range of treatments including cognitive-behavioral therapy (CBT). Existing studies have considered the general occurrence of CCT, but the present study differentiated 2 types of CCT in early CBT sessions for 37 clients with generalized anxiety disorder: (a) statements that are uttered to express ambivalence regarding change versus (b) statements that are intended to oppose the therapist or therapy. Two process coding systems were used to accomplish this differentiation. Findings indicated that a higher number of CCT statements that occurred in the presence of resistance (opposition to the therapist or therapy) were a substantive and consistent predictor of lower homework compliance and poorer outcomes, up to 1 year posttreatment. Moreover, when both types of CCT were considered together, only opposition CCT was related to outcomes, and ambivalent CCT was not significantly predictive of proximal and distal outcomes. These findings suggest that the interpersonal context in which CCT statements occur may be critically important to their predictive capacity. More broadly, the findings of this study have implications for the future study of client motivational language and underscore the clinical importance of detecting opposition CCT. (c) 2016 APA, all rights reserved).

Independence as a practice issue in occupational therapy: the safety clause.

PubMed

Russell, Cherry; Fitzgerald, Maureen H; Williamson, Peter; Manor, Debra; Whybrow, Samantha

2002-01-01

This article reports findings from interviews that explored the meanings occupational therapists attach to independence as a value and a therapeutic goal in interactions with elderly clients. Through a historical review of the literature, we trace the changing use of this term and identify two analytically distinct concepts associated with it: independence as self-reliance in activity and independence as autonomy, self-determination, or choice. We show how the latter has emerged in contemporary service contexts to represent an ideal of client-centered practice for persons with chronic disabilities, such as frail elderly clients. Using a "critical incident" interview approach with 12 Australian occupational therapists, we identified the therapists' explicit and implicit understandings of independence as a value concept and practice issue. Our findings suggest that a mismatch often exists between idealized and practice-based talk about independence and that therapists narrativize this opposition around what we call "the safety clause." That is, therapists invoke concerns about safety and duty of care as a caveat to implementing their independence ideals and justifying the retention of professional control. We identify key issues that therapists need to address if the rhetoric of independence-related client-centered practice is to be achieved in reality.

Action reflections: a client-centered technique to bridge the WHY-HOW transition in Motivational Interviewing.

PubMed

Resnicow, Ken; McMaster, Fiona; Rollnick, Stephen

2012-07-01

When using Motivational Interviewing (MI), once resistance or ambivalence are resolved and motivation is solidified, many practitioners struggle with how best to transition the discussion toward action planning, while still retaining the spirit and style of client centeredness, i.e., moving from the WHY phase to the HOW phase of counseling in a style that is MI-consistent. For many, there is a perception that the counseling style, skills, and strategies used to build motivation are distinct from those used in the action planning phase. The WHY to HOW transition does not, however, necessitate abandoning a client-centered style for a more overtly educational or directive style. Goal setting, action planning, provision of advice, and relapse prevention can be implemented from an autonomy supportive, MI consistent framework. To this end, this article will present a new class of reflection, which we have termed "action reflections", that can be used to help bridge the WHY-HOW gap. Action reflections (AR) allow the clinician to maintain a tone and orientation that are consistent with MI, i.e. autonomy support; guiding versus directing, during the action phase of counseling. They differ from reflecting change talk as they focus not on the WHY of change, but the HOW, WHEN, or WHERE. Action Reflections (ARs) also differ from the more common type of reflections such as those that focus on client feelings, rolling with resistance, or acknowledging ambivalence as ARs usually contain a potential concrete step that the client has directly or obliquely mentioned. Like any type of reflection, ARs represent the clinician's best guess for what the client has said or, more apropos here, where the conversation might be heading. This article describes the various types of ARs and provides examples of each to help clinicians incorporate them into their behavior change counseling.

Men's constructions of masculinity and male sexuality through talk of buying sex.

PubMed

Huysamen, Monique; Boonzaier, Floretta

2015-01-01

Commercial sex is an everyday occurrence across a range of contexts in South Africa. In this paper we turn our attention to the often-marginalised role of the buyers of sex by drawing on narrative interviews with male clients of female sex workers recruited through online advertisements in order to explore the ways in which heterosexual men construct, negotiate and perform their masculinity and sexuality through talking about their experiences of paying for sex. We highlight parallels between men's narratives of paying for sex and dominant discourses of gender and heterosexuality. We show how men draw on heteronormative sexual scripts in constructing and making sense of paid sexual encounters and how men are simultaneously able to construct and enact a particular idealised version of masculinity and male sexuality through their talk on paying for sex. Finally, we discuss how online resources could be used more extensively in future research with the male clients of sex workers.

Walking the Talk: Fit WIC Wellness Programs Improve Self-Efficacy in Pediatric Obesity Prevention Counseling

PubMed Central

Crawford, Patricia B.; Gosliner, Wendi; Strode, Poppy; Samuels, Sarah E.; Burnett, Claudia; Craypo, Lisa; Yancey, Antronette K.

2004-01-01

Six sites of the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participated in a staff wellness pilot intervention designed to improve staff self-efficacy in counseling WIC clients about childhood overweight. A pre-post test design with intervention and control groups was used; outcome measures included staff perceptions of the intervention’s effects on the workplace environment, their personal habits and health beliefs, and their counseling self-efficacy. Intervention site staff were more likely to report that the workplace environment supported their efforts to make healthy food choices (P < .001), be physically active (P < .01), make positive changes in counseling parents about their children’s weight (P < .01), and feel more comfortable in encouraging WIC clients to do physical activities with their children (P < .05). PMID:15333298

The Embodied Attunement of Therapists and a Couple within Dialogical Psychotherapy: An Introduction to the Relational Mind Research Project.

PubMed

Seikkula, Jaakko; Karvonen, Anu; Kykyri, Virpi-Liisa; Kaartinen, Jukka; Penttonen, Markku

2015-12-01

In dialogical practice, therapists seek to respond to the utterances of clients by including in their own response what the client said. No research so far exists on how, in dialogs, therapists and clients attune themselves to each other with their entire bodies. The research program The Relational Mind is the first to look at dialog in terms of both the outer and the inner dialogs of participants (clients and therapists), observed in parallel with autonomic nervous system (ANS) measurements. In the ANS, the response occurs immediately, even before conscious thought, making it possible to follow how participants in a multiactor dialog synchronize their reactions and attune themselves to each other. The couple therapy case presented in this article demonstrates how attunement is often not a simple "all at the same time" phenomenon, but rather a complex, dyadic or triadic phenomenon which changes over time. In the case presented, there was strong synchrony between one therapist and one client in terms of their arousal level throughout the therapy session. It was also observed that high stress could occur when someone else was talking about something related to the participant, or if that person mirrored the participant's words. Overall, it seems that in evaluating the rhythmic attunement between therapists and clients it is not enough to look at single variables; instead, integrated information from several channels is needed when one is seeking to make sense of the embodiment. © 2015 Family Process Institute.

Reasons for non-attendance at a day hospital for people with enduring mental illness: the clients' perspective.

PubMed

McGonagle, I M; Gentle, J

1996-01-01

This paper describes a research project which aimed to discover the reasons clients give for failing to attend a mental health day hospital. There was concern that this service provision, for people with enduring mental illness, had a high level of non-attendance and therefore might not be meeting the needs of the people for whom it is targeted. Over a period of 6 months 36 people failed to attend, despite assessment and apparent agreement to attend. Of the 36, 14 agreed to talk about their reasons for not attending. An open interview format was used which enabled the clients to talk in depth about their experiences, which they felt led to the decision to stop attending. Content analysis of the interview data resulted in the identification of common themes. Main findings suggest a lack of partnership in decisions on choice of therapy, particularly the emphasis on groupwork, which 86% found unhelpful. Other main factors for non-attendance were a lack of an individual approach to care, not being listened to, and a lack of warmth from the staff. Recommendations for future practice are given, with particular attention to the need to develop a partnership with clients aimed at meeting individual needs.

Disentangling the impact of resistance and ambivalence on therapy outcomes in cognitive behavioural therapy for generalized anxiety disorder.

PubMed

Button, Melissa L; Westra, Henny A; Hara, Kimberley M; Aviram, Adi

2015-01-01

Resistance and ambivalence about change are increasingly recognized as important determinants of treatment outcomes. Moreover, resistance and ambivalence are thought to be theoretically related in that clients who are more ambivalent about change are more likely to demonstrate resistance to the process and tasks of treatment. In the context of cognitive behavioural therapy (CBT) for generalized anxiety disorder, the present study simultaneously examined early resistance and ambivalence using two observer-based coding systems in order to determine their inter-relationship and, importantly, to investigate their relative contributions to outcome. Resistance was also coded during mid-treatment in order to investigate possible mediation pathways. Early ambivalence (clients' arguments against change or counter-change talk) was found to be no longer related to outcomes when early resistance was taken into account, suggesting that disharmony in the therapeutic relationship is more important to outcomes than ambivalence per se. Moreover, mid-treatment resistance partially mediated the relationship between early resistance and post-treatment worry severity. That is, higher early opposition to therapist direction is related to poorer outcomes, in part because it is associated with greater resistance during the working phase of CBT. The findings underscore the critical need for therapists to be sensitive to identifying resistance early and throughout treatment.

A Journey with Mid-life Hearing Loss | NIH MedlinePlus the Magazine

MedlinePlus

... lot of social and business gatherings in noisy restaurants and cocktail bars,” he says. “I was tired ... or talking with colleagues and clients in busy restaurants, he found himself agreeing to do tasks for ...

Earthdata Search: Scaling, Assessing and Improving Relevancy

NASA Technical Reports Server (NTRS)

Reese, Mark

2016-01-01

NASA's Earthdata Search (https:search.earthdata.nasa.gov) application allows users to search, discover, visualize, and access NASA and international interagency data about the Earth. As a client to NASA's Common Metadata Repository (CMR), its catalog of data collections grew 700 in late 2015. This massive expansion brought improved search and discovery to the forefront of the client's usability needs. During this talk, we will give a brief overview of the application, the challenges that arose during this period of growth, the metrics-driven way we addressed them, and the latest outcomes.

Knowledge displays: Soliciting clients to fill knowledge gaps and to reconcile knowledge discrepancies in therapeutic interaction.

PubMed

Pino, Marco

2016-06-01

To examine knowledge displays (KDs), a practice by which Therapeutic Community (TC) professionals exhibit previous knowledge about their clients' circumstances and experiences. Conversation analysis is used to examine 12 staff-led meetings recorded in Italy (8 in a drug addiction TC; 4 in a mental health TC). The TC professionals use KDs within broader sequences of talk where they solicit their clients to share personal information and where the clients provide insufficient or inconsistent responses. In these circumstances, the staff members employ KDs to pursue responses that redress emerging knowledge gaps and discrepancies regarding the clients' experiences or circumstances. KDs allow the staff members to achieve a balance between respecting their clients' right to report their own experiences and influencing the ways in which they report them. KDs help to reinforce the culture of openness that is central to many forms of therapeutic interaction, to forward the therapeutic agenda and to expand the staff members' knowledge of the clients' experiences and circumstances. KDs can be used to solicit clients to share personal information. This paper illustrates core features that underlie the function of KDs (where they are used and how they are constructed). Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

'I can actually talk to them now': qualitative results of an educational intervention for emergency nurses caring for clients who self-injure.

PubMed

McAllister, Margaret; Moyle, Wendy; Billett, Stephen; Zimmer-Gembeck, Melanie

2009-10-01

This Australian study evaluated the effectiveness of a solution-focused education intervention in extending and improving emergency nursing responses to patients who present because of self-injury. Emergency nurses commonly report lack of training and feeling unskilled in managing people who present because of self-harm. Most educational interventions have provided content knowledge, yet rarely have they focused on conveying the value of health promotion strategies such as proactive skills and coping strategies. A mixed method pretest-posttest group design was used. Nurses (n = 36) were interviewed to examine differences in professional identity, awareness of self-injury and clinical reasoning. The qualitative results are presented in this paper and these showed improvements in knowledge and understanding of self-harm, self-belief in nurses' capacity to positively influence clients and the value of health promotion skills. The intervention produced a positive attitudinal shift towards clients and an expressed intention to act in ways that were more person-centred and change oriented. The solution-focused education intervention appears to show promise as an intervention for enabling nurses to value their unique contribution to providing a health service that is more proactive and health-promoting. Interactive education bringing psychosocial skills to technical nursing staff builds confidence, competence and more person-focused care.

Make customer service a priority.

PubMed

2017-09-02

BVA has partnered with Moneypenny, one of the UK's leading outsourced communications providers, to provide members with an effective way to respond to client calls. Moneypenny talked to Pauline Sloan, receptionist at Village Vets in East Lothian, about her practice's experience of using their service. British Veterinary Association.

Culture-Sensitive Functional Analytic Psychotherapy

ERIC Educational Resources Information Center

Vandenberghe, L.

2008-01-01

Functional analytic psychotherapy (FAP) is defined as behavior-analytically conceptualized talk therapy. In contrast to the technique-oriented educational format of cognitive behavior therapy and the use of structural mediational models, FAP depends on the functional analysis of the moment-to-moment stream of interactions between client and…

The development of a change model of "exits" during cognitive analytic therapy for the treatment of depression.

PubMed

Sandhu, Sundeep Kaur; Kellett, Stephen; Hardy, Gillian

2017-11-01

"Exits" in cognitive analytic therapy (CAT) are methods that change unhelpful patterns or roles during the final "revision" phase of the therapy. How exits are conceived and achieved is currently poorly understood. This study focussed on the revision stage to explore and define how change is accomplished in CAT. Qualitative content analysis studied transcripts of sessions 6 and 7 of a protocol delivered 8-session CAT treatment for depression. Eight participants met the study inclusion criteria, and therefore, 16 sessions were analysed. The exit model developed contained 3 distinct (but interacting) phases: (a) developing an observing self via therapist input or client self-reflection, (b) breaking out of old patterns by creating new roles and procedures, and (c) utilisation of a range of methods to support and maintain change. Levels of interrater reliability for the exit categories that formed the model were good. The revision stage of CAT emerged as a complex and dynamic process involving 3 interacting stages. Further research is recommended to understand how exits relate to durability of change and whether change processes differ according to presenting problem. Exit work in cognitive analytic therapy is a dynamic process that requires progression through stages of insight, active change, and consolidation. Development of an "observing self" is an important foundation stone for change, and cognitive analytic therapists need to work within the client's zone of proximal development. A number of aspects appear important in facilitating change, such as attending to the process and feelings generated by change talk. Copyright © 2017 John Wiley & Sons, Ltd.

Do U.S. family planning clinics encourage parent-child communication? Findings from an exploratory survey.

PubMed

Jones, Rachel K

2006-09-01

Clinics that receive Title X funding have a mandate to encourage parent-child communication for minors seeking family planning services. Little is known about the programs and practices that clinics have adopted to achieve this goal, or whether clinics not receiving Title X funds encourage family participation. As part of a larger project examining parental engagement among adolescents using family planning clinics, 81 clinics that served 200 or more adolescent contraceptive clients in 2001 completed a questionnaire containing closed- and open-ended items. Topic areas included clinic counseling and policies regarding clients younger than 18, activities to improve parent-child communication and community relations. Frequency distributions were calculated for the prevalence of activities, and cross-tabulations were used to compare prevalence by clinic characteristics. Every clinic engaged in at least one activity to promote parent-child communication, and nine in 10 offered multiple activities. Most of the clinics used counseling sessions to talk to adolescent clients about the importance of discussing sexual health issues with parents (73-94%, depending on the reason for the visit). More than eight in 10 clinics (84%) distributed pamphlets on how to talk about these issues. A substantial minority (43%) offered or referred interested individuals to educational programs designed to improve communication. Some of these exploratory findings reflect the prevalence of activities among all U.S. family planning clinics that serve adolescent clients. Evaluation and expansion of clinic efforts to promote voluntary communication about sexual health issues between parents and children could help encourage family participation.

Providing an information prescription in veterinary medical clinics: a pilot study.

PubMed

Kogan, Lori R; Schoenfeld-Tacher, Regina; Gould, Lauren; Viera, Ann R; Hellyer, Peter W

2014-01-01

The study assesses the impact on client behavior and attitudes toward receiving an information prescription as part of a veterinary office visit. A random sample of veterinary clinics from a Western US metropolitan area was asked to distribute an information prescription in addition to their customary veterinary services. All clients, regardless of the reason for their visit, were presented with an information prescription: a handout that included the uniform resource locator (URL) to a general veterinary medicine website and several tips to help their clients make more informed choices about where to seek pet health information online. Nearly 40% of clients who reported that they remembered receiving the information prescription accessed the website at least once. Of the clients who reported accessing the suggested website, 86.3% reported finding it "very helpful" or "somewhat helpful." Nearly all the clients (87.9%) reported feeling the information on the site helped them make better decisions for their pets. Most clients reported that it helped them talk to their veterinarians (89.9%) and added to the information they received during their veterinary visits (83.5%). Clients appreciate and utilize veterinary prescriptions, suggesting that this is a tool that both veterinarians and librarians can use to improve animal health and client relations. The value placed on reliable Internet information by veterinary clients suggests several opportunities for librarians to become more proactive in partnering with veterinarians to facilitate the education of pet owners.

Providing an information prescription in veterinary medical clinics: a pilot study

PubMed Central

Kogan, Lori R.; Schoenfeld-Tacher, Regina; Gould, Lauren; Viera, Ann R.; Hellyer, Peter W.

2014-01-01

Objective: The study assesses the impact on client behavior and attitudes toward receiving an information prescription as part of a veterinary office visit. Methods: A random sample of veterinary clinics from a Western US metropolitan area was asked to distribute an information prescription in addition to their customary veterinary services. All clients, regardless of the reason for their visit, were presented with an information prescription: a handout that included the uniform resource locator (URL) to a general veterinary medicine website and several tips to help their clients make more informed choices about where to seek pet health information online. Results: Nearly 40% of clients who reported that they remembered receiving the information prescription accessed the website at least once. Of the clients who reported accessing the suggested website, 86.3% reported finding it “very helpful” or “somewhat helpful.” Nearly all the clients (87.9%) reported feeling the information on the site helped them make better decisions for their pets. Most clients reported that it helped them talk to their veterinarians (89.9%) and added to the information they received during their veterinary visits (83.5%). Conclusions: Clients appreciate and utilize veterinary prescriptions, suggesting that this is a tool that both veterinarians and librarians can use to improve animal health and client relations. Implications: The value placed on reliable Internet information by veterinary clients suggests several opportunities for librarians to become more proactive in partnering with veterinarians to facilitate the education of pet owners. PMID:24415918

A Randomized Controlled Trial of a Group Motivational Interviewing Intervention for Adolescents with a First Time Alcohol or Drug Offense

PubMed Central

D’Amico, Elizabeth J.; Hunter, Sarah B.; Miles, Jeremy N.V.; Ewing, Brett A.; Osilla, Karen Chan

2013-01-01

Group Motivational Interviewing (MI) interventions that target youth at-risk for alcohol and other drug (AOD) use may prevent future negative consequences. Youth in a teen court setting (n=193; 67% male, 45% Hispanic; mean age 16.6 (SD = 1.05) were randomized to receive either a group MI intervention, Free Talk, or usual care (UC). We examined client acceptance, intervention feasibility and conducted a preliminary outcome evaluation. Free Talk teens reported higher quality and satisfaction ratings, and MI integrity scores were higher for Free Talk groups. AOD use and delinquency decreased for both groups at three months, and 12-month recidivism rates were lower but not significantly different for the Free Talk group compared to UC. Results contribute to emerging literature on MI in a group setting. A longer term follow-up is warranted. PMID:23891459

Effectiveness of a theoretically-based judgment and decision making intervention for adolescents.

PubMed

Knight, Danica K; Dansereau, Donald F; Becan, Jennifer E; Rowan, Grace A; Flynn, Patrick M

2015-05-01

Although adolescents demonstrate capacity for rational decision making, their tendency to be impulsive, place emphasis on peers, and ignore potential consequences of their actions often translates into higher risk-taking including drug use, illegal activity, and physical harm. Problems with judgment and decision making contribute to risky behavior and are core issues for youth in treatment. Based on theoretical and empirical advances in cognitive science, the Treatment Readiness and Induction Program (TRIP) represents a curriculum-based decision making intervention that can be easily inserted into a variety of content-oriented modalities as well as administered as a separate therapeutic course. The current study examined the effectiveness of TRIP for promoting better judgment among 519 adolescents (37 % female; primarily Hispanic and Caucasian) in residential substance abuse treatment. Change over time in decision making and premeditation (i.e., thinking before acting) was compared among youth receiving standard operating practice (n = 281) versus those receiving standard practice plus TRIP (n = 238). Change in TRIP-specific content knowledge was examined among clients receiving TRIP. Premeditation improved among youth in both groups; TRIP clients showed greater improvement in decision making. TRIP clients also reported significant increases over time in self-awareness, positive-focused thinking (e.g., positive self-talk, goal setting), and recognition of the negative effects of drug use. While both genders showed significant improvement, males showed greater gains in metacognitive strategies (i.e., awareness of one's own cognitive process) and recognition of the negative effects of drug use. These results suggest that efforts to teach core thinking strategies and apply/practice them through independent intervention modules may benefit adolescents when used in conjunction with content-based programs designed to change problematic behaviors.

Effectiveness of a Theoretically-Based Judgment and Decision Making Intervention for Adolescents

PubMed Central

Knight, Danica K.; Dansereau, Donald F.; Becan, Jennifer E.; Rowan, Grace A.; Flynn, Patrick M.

2014-01-01

Although adolescents demonstrate capacity for rational decision making, their tendency to be impulsive, place emphasis on peers, and ignore potential consequences of their actions often translates into higher risk-taking including drug use, illegal activity, and physical harm. Problems with judgment and decision making contribute to risky behavior and are core issues for youth in treatment. Based on theoretical and empirical advances in cognitive science, the Treatment Readiness and Induction Program (TRIP) represents a curriculum-based decision making intervention that can be easily inserted into a variety of content-oriented modalities as well as administered as a separate therapeutic course. The current study examined the effectiveness of TRIP for promoting better judgment among 519 adolescents (37% female; primarily Hispanic and Caucasian) in residential substance abuse treatment. Change over time in decision making and premeditation (i.e., thinking before acting) was compared among youth receiving standard operating practice (n = 281) versus those receiving standard practice plus TRIP (n = 238). Change in TRIP-specific content knowledge was examined among clients receiving TRIP. Premeditation improved among youth in both groups; TRIP clients showed greater improvement in decision making. TRIP clients also reported significant increases over time in self-awareness, positive-focused thinking (e.g., positive self-talk, goal setting), and recognition of the negative effects of drug use. While both genders showed significant improvement, males showed greater gains in metacognitive strategies (i.e., awareness of one’s own cognitive process) and recognition of the negative effects of drug use. These results suggest that efforts to teach core thinking strategies and apply/practice them through independent intervention modules may benefit adolescents when used in conjunction with content-based programs designed to change problematic behaviors. PMID:24760288

The Genetic Counseling Video Project (GCVP): Models of Practice

PubMed Central

Roter, D.; Ellington, L.; Erby, L. Hamby; Larson, S.; W, Dudley

2009-01-01

Genetic counseling is conceptualized as having both “teaching” and “counseling” functions; however, little is known about how these functions are articulated in routine practice. This study addresses the question by documenting, on videotape, the practices of a national sample of prenatal and cancer genetic counselors (GCs) providing routine pretest counseling to simulated clients (SCs). 177 GCs recruited at two annual conferences of the National Society of Genetic Counselors (NSGC) were randomly assigned to counsel one of six female SCs of varying ethnicity, with or without a spouse, in their specialty. 152 videotapes were coded with the Roter Interaction Analysis System (RIAS) and both GCs and SCs completed evaluative questionnaires. Two teaching and two counseling patterns of practice emerged from cluster analysis. The teaching patterns included: (1) Clinical teaching (31%) characterized by low psychosocial, emotional and facilitative talk, high levels of clinical exchange, and high verbal dominance; and (2) Psycho-educational teaching (27%) characterized by high levels of both clinical and psychosocial exchange, low levels of emotional and facilitative talk, and higher verbal dominance. The counseling patterns included: (1) Supportive counseling (33%) characterized by low psychosocial and clinical exchange, high levels of emotional and facilitative talk, and low verbal dominance; and (2) Psychosocial counseling (9%) with high emotional and facilitative talk, low clinical and high psychosocial exchange, and the lowest verbal dominance. SCs ratings of satisfaction with communication, the counselor’s affective demeanor, and the counselor’s use of nonverbal skills were highest for the counseling model sessions. Both the teaching and counseling models seem to be represented in routine practice and predict variation in client satisfaction. PMID:16941666

Talking Typewriter Training Program in a Rehabilitation Setting.

ERIC Educational Resources Information Center

Kupshunas, Sue

1984-01-01

As part of a state residential center's 16-week training program to assist blind adults, aged 16-65, in acquiring employability skills, clients receive hands-on training in mastering the IBM Memory 100 Audio Unit typewriter. Training includes assessing prerequisite secretarial skills, using self-instructional materials, and evaluating performance.…

CrossTalk: The Journal of Defense Software Engineering. Volume 24, Number 1, Jan/Feb 2011

DTIC Science & Technology

2011-02-01

Social Networks: A variety of websites connect users in- terested in specific subjects. Examples are YouTube, Wikipedia, Blogger , Facebook, and...the artist, engineers see beauty in their creations, however our muse is not aesthetic but functional. We prefer client awe and satisfaction to

Client Perceptions of Helpfulness in Therapy: a Novel Video-Rating Methodology for Examining Process Variables at Brief Intervals During a Single Session.

PubMed

Cocklin, Alexandra A; Mansell, Warren; Emsley, Richard; McEvoy, Phil; Preston, Chloe; Comiskey, Jody; Tai, Sara

2017-11-01

The value of clients' reports of their experiences in therapy is widely recognized, yet quantitative methodology has rarely been used to measure clients' self-reported perceptions of what is helpful over a single session. A video-rating method using was developed to gather data at brief intervals using process measures of client perceived experience and standardized measures of working alliance (Session Rating Scale; SRS). Data were collected over the course of a single video-recorded session of cognitive therapy (Method of Levels Therapy; Carey, 2006; Mansell et al., 2012). We examined the acceptability and feasibility of the methodology and tested the concurrent validity of the measure by utilizing theory-led constructs. Eighteen therapy sessions were video-recorded and clients each rated a 20-minute session of therapy at two-minute intervals using repeated measures. A multi-level analysis was used to test for correlations between perceived levels of helpfulness and client process variables. The design proved to be feasible. Concurrent validity was borne out through high correlations between constructs. A multi-level regression examined the independent contributions of client process variables to client perceived helpfulness. Client perceived control (b = 0.39, 95% CI .05 to 0.73), the ability to talk freely (b = 0.30, SE = 0.11, 95% CI .09 to 0.51) and therapist approach (b = 0.31, SE = 0.14, 95% CI .04 to 0.57) predicted client-rated helpfulness. We identify a feasible and acceptable method for studying continuous measures of helpfulness and their psychological correlates during a single therapy session.

The Use of Touch in Therapy: Can We Talk?

ERIC Educational Resources Information Center

Taylor, Melanie A.

The empirical literature regarding the use of nonerotic touch in psychotherapy is reviewed. Theoretical and ethical concerns are discussed, including the taboo against touching clients, situations in which touch may be appropriate, and whether or not nonerotic touch leads to erotic touch. It is difficult to design controlled studies for ongoing…

The Genetic Counseling Video Project (GCVP): models of practice.

PubMed

Roter, D; Ellington, L; Erby, L Hamby; Larson, S; Dudley, W

2006-11-15

Genetic counseling is conceptualized as having both "teaching" and "counseling" functions; however, little is known about how these functions are articulated in routine practice. This study addresses the question by documenting, on videotape, the practices of a national sample of prenatal and cancer genetic counselors (GCs) providing routine pre-test counseling to simulated clients (SCs). One hundred and seventy-seven GCs recruited at two annual conferences of the National Society of Genetic Counselors (NSGC) were randomly assigned to counsel one of six female SCs of varying ethnicity, with or without a spouse, in their specialty. One hundred and fifty-two videotapes were coded with the Roter Interaction Analysis System (RIAS) and both GCs and SCs completed evaluative questionnaires. Two teaching and two counseling patterns of practice emerged from cluster analysis. The teaching patterns included: (1) clinical teaching (31%) characterized by low psychosocial, emotional and facilitative talk, high levels of clinical exchange, and high verbal dominance; and (2) psycho-educational teaching (27%) characterized by high levels of both clinical and psychosocial exchange, low levels of emotional and facilitative talk, and higher verbal dominance. The counseling patterns included: (1) supportive counseling (33%) characterized by low psychosocial and clinical exchange, high levels of emotional and facilitative talk, and low verbal dominance; and (2) psychosocial counseling (9%) with high emotional and facilitative talk, low clinical and high psychosocial exchange, and the lowest verbal dominance. SCs ratings of satisfaction with communication, the counselor's affective demeanor, and the counselor's use of non-verbal skills were highest for the counseling model sessions. Both the teaching and counseling models seem to be represented in routine practice and predict variation in client satisfaction, affective demeanor, and nonverbal effectiveness. (c) 2006 Wiley-Liss, Inc.

Depression screening among older adults attending low-vision rehabilitation and eye-care services: Characteristics of those who screen positive and client acceptability of screening.

PubMed

Holloway, Edith E; Sturrock, Bonnie A; Lamoureux, Ecosse L; Keeffe, Jill E; Rees, Gwyneth

2015-12-01

To investigate characteristics associated with screening positive for depressive symptoms among older adults accessing low-vision rehabilitation and eye-care services and to determine client acceptability of depression screening using the Patient Health Questionnaire-2 (PHQ-2) in these settings. One-hundred and twenty-four older adults (mean = 77.02 years, SD = 9.12) attending low-vision rehabilitation and eye-care services across Australia were screened for depression and invited to complete a telephone-administered questionnaire to determine characteristics associated with depressive symptoms and client acceptability of screening in these settings. Thirty-seven per cent (n = 46/124) of participants screened positive for depressive symptoms, and the majority considered the new depression screening method to be a 'good idea' in vision services (85%). Severe vision loss (<6/60 in the better eye) was associated with an increased odds of screening positive for depressive symptoms (odds ratio 2.37; 95% confidence interval 1.08-6.70) even after adjusting for potential confounders. Participants who screened positive had a preference for 'talking' therapy or a combination of medication and 'talking therapy' delivered within their own home (73%) or via telephone (67%). The PHQ-2 appears to be an acceptable method for depression screening in eye-care settings among older adults. Targeted interventions that incorporate home-based or telephone delivered therapy sessions may improve outcomes for depression in this group. © 2014 ACOTA.

An Evaluation of the Effectiveness of Policy Communication in the Professional Development Centre's Training Programs.

ERIC Educational Resources Information Center

Rudasill, Susann E.

In the face of rising juvenile violent crime rates and media talk of waste, abuse, fraud, and ineffectiveness within the Florida Department of Health and Rehabilitative Services (HRS), the state recommended the adoption of a family-focused approach in client intervention strategy. The Florida Atlantic University Professional Development Centre…

The Use of Assigned Writings as an Adjunct to Therapy with Individuals, Couples, and Families.

ERIC Educational Resources Information Center

Kelley, Patricia; Williams, Bonnie

Although psychotherapy traditionally has been thought of as talking therapy, written communication can be used as an effective supplement, across a range of theoretical approaches and therapeutic stages. Writing can aid clients in deepening awareness and enable them to use their inherent resources for becoming whole persons. For example, one…

Talking high-tech turkey: USDA uses new software to analyze habitat management scenarios

Treesearch

H. Michael Rauscher; John E. Spearman; C. Preston Fout; Robert H. Giles; Mark J. Twery

2001-01-01

Researchers at the USDA Forest Service, Northeastern and Southern Research Stations, with many collaborators, have been developing a computer software product called the NED Decision Support System. This program is designed to help forestry consultants and their private landowner clients develop goals, assess current and potential conditions, provide ways to study and...

Development of a Drug Rehabilitation Center or Mistakes We Have Made.

ERIC Educational Resources Information Center

Fox, Twilah A.; And Others

The authors discuss their first efforts at providing a contact point where young people could come for information crisis intervention and talk. Major mistakes, such as too exclusive reliance on ex-users, are elaborated. Clients' demographic and psychiatric data receive brief mention, as does the initial screening procedure. The bulk of the paper…

Investigating interactional competencies in Parkinson's disease: the potential benefits of a conversation analytic approach.

PubMed

Griffiths, Sarah; Barnes, Rebecca; Britten, Nicky; Wilkinson, Ray

2011-01-01

Around 70% of people who develop Parkinson's disease (PD) experience speech and voice changes. Clinicians often find that when asked about their primary communication concerns, PD clients will talk about the difficulties they have 'getting into' conversations. This is an important area for clients and it has implications for quality of life and clinical management. To review the extant literature on PD and communication impairments in order to reveal key topic areas, the range of methodologies applied, and any gaps in knowledge relating to PD and social interaction and how these might be usefully addressed. A systematic search of a number of key databases and available grey literatures regarding PD and communication impairment was conducted (including motor speech changes, intelligibility, cognitive/language changes) to obtain a sense of key areas and methodologies applied. Research applying conversation analysis in the field of communication disability was also reviewed to illustrate the value of this methodology in uncovering common interactional difficulties, and in revealing the use of strategic collaborative competencies in naturally occurring conversation. In addition, available speech and language therapy assessment and intervention approaches to PD were examined with a view to their effectiveness in promoting individualized intervention planning and advice-giving for everyday interaction. A great deal has been written about the deficits underpinning communication changes in PD and the impact of communication disability on the self and others as measured in a clinical setting. Less is known about what happens for this client group in everyday conversations outside of the clinic. Current speech and language therapy assessments and interventions focus on the individual and are largely impairment based or focused on compensatory speaker-oriented techniques. A conversation analysis approach would complement basic research on what actually happens in everyday conversation for people with PD and their co-participants. The potential benefits of a conversation analysis approach to communication disability in PD include enabling a shift in clinical focus from individual impairment onto strategic collaborative competencies. This would have implications for client-centred intervention planning and the development of new and complementary clinical resources addressing participation. The impact would be new and improved support for those living with the condition as well as their families and carers. © 2011 Royal College of Speech & Language Therapists.

Does indirect speech promote nondirective genetic counseling? Results of a sociolinguistic investigation.

PubMed

Benkendorf, J L; Prince, M B; Rose, M A; De Fina, A; Hamilton, H E

2001-01-01

To date, research examining adherence to genetic counseling principles has focused on specific counseling activities such as the giving or withholding of information and responding to client requests for advice. We audiotaped 43 prenatal genetic counseling sessions and used data-driven, qualitative, sociolinguistic methodologies to investigate how language choices facilitate or hinder the counseling process. Transcripts of each session were prepared for sociolinguistic analysis of the emergent discourse that included studying conversational style, speaker-listener symmetry, directness, and other interactional patterns. Analysis of our data demonstrates that: 1) indirect speech, marked by the use of hints, hedges, and other politeness strategies, facilitates rapport and mitigates the tension between a client-centered relationship and a counselor-driven agenda; 2) direct speech, or speaking literally, is an effective strategy for providing information and education; and 3) confusion exists between the use of indirect speech and the intent to provide nondirective counseling, especially when facilitating client decision-making. Indirect responses to client questions, such as those that include the phrases "some people" or "most people," helped to maintain counselor neutrality; however, this well-intended indirectness, used to preserve client autonomy, may have obstructed direct explorations of client needs. We argue that the genetic counseling process requires increased flexibility in the use of direct and indirect speech and provide new insights into how "talk" affects the work of genetic counselors.

Exploring the relationship between client perspectives, clinical expertise and research evidence.

PubMed

Roulstone, Sue

2015-06-01

This paper examines the relationship between components of evidence-based practice (clinical expertise, patient perspective and research evidence). Findings are examined from two research programs: the Better Communication Research Program and Child Talk, including exploratory studies of the views of parents and children regarding speech-language pathology and studies of current practice by SLPs in England. Systematic reviews of the research literature were also undertaken. The paper analyses relationships between outcomes valued by children and parents and those reported in the literature and in practice, parents' perspectives regarding intervention in comparison with clinicians' reports of practice and the extent to which research evidence underpins current practice is examined. Parents and children value functional outcomes and positive experiences; these are not routinely measured in research or practice. Therapy is perceived positively by most parents; however, some are ambivalent and less clear about the rationale. Commonly used interventions are supported by evidence, but there are gaps regarding some critical therapy components. The paper discusses four challenges to evidence-based practice: the consistency and clarity of descriptions of interventions; consensus based models of practice; understanding of the mechanisms of change; and, finally, the operationalization of client preferences within an evidence-based practice framework.

Schooling and Globalization: What Do We Tell Our Kids & Clients? What Are We Being Told?

ERIC Educational Resources Information Center

Grant, Carl A.; Grant, Alicia

2007-01-01

With the effects of globalization everywhere, what should we say to our children and grandchildren about globalization and education? What are the print media--the books and magazines--telling us about globalization and education? This article examines what a person may take from the print media to talk with their children about effects of…

Reach a New Threshold of Freedom and Control with Dell's Flexible Computing Solution: On-Demand Desktop Streaming

ERIC Educational Resources Information Center

Technology & Learning, 2008

2008-01-01

When it comes to IT, there has always been an important link between data center control and client flexibility. As computing power increases, so do the potentially crippling threats to security, productivity and financial stability. This article talks about Dell's On-Demand Desktop Streaming solution which is designed to centralize complete…

The Change Grid and the Active Client: Challenging the Assumptions of Change Agentry in the Penal Process.

ERIC Educational Resources Information Center

Klofas, John; Duffee, David E.

1981-01-01

Reexamines the assumptions of the change grid regarding the channeling of masses of clients into change strategies programs. Penal organizations specifically select and place clients so that programs remain stable, rather than sequence programs to meet the needs of clients. (Author)

Toward an Information-Processing Theory of Client Change in Counseling.

ERIC Educational Resources Information Center

Martin, Jack

1985-01-01

Information-processing models of client-centered and rational-emotive counseling are constructed that relate counseling skills and strategies employed in these approaches to hypothesized client cognitive changes. An integrated view of client cognitive change in counseling also is presented. (Author/BL)

A social constructionist analysis of talk in episodes of psychiatric student nurses conversations with clients in community clinics.

PubMed

Middleton, Lyn; Uys, Leana

2009-03-01

This paper is a report of a study of the 'discursive doings' of psychiatric nursing students' practice as they are jointly constructed in conversations with clients in community psychiatric clinics. This construction of psychiatric nursing as a therapeutic, holistic, person-centred, interactional process is central to the identity of psychiatric nursing as a discipline. However, recent studies are beginning to suggest a dissonance between the person-centred rhetoric and institutional practice. A discourse analysis was conducted in 2002-03 using the transcripts of seven conversations between nursing students and clients visiting psychiatric community clinics on a monthly basis. These were selected from a sample of 20 conversations based on their clarity and completeness. Texts were analysed using the notational systems of Silverman and Mishler and some of Fairclough's analytic text structure features. In all the transcripts, an agenda for surveillance was explicitly established in the students' opening sequences of each text. Almost all exchanges in the texts were organized around cycles of questions from students and responses from clients, which allowed students to control the conversations. Information delivery was also found to be at work within the texts, although it is not as prominent or as persistent as the question and answer structure. Students took up the responses of clients selectively as though working to a pre-set agenda. These discursive activities manifest a symptom-like approach to nursing care and have the effect of disabling the development of client-authorized expressions of agency.

Application of the transtheoretical model of behaviour change for identifying older clients' readiness for hearing rehabilitation during history-taking in audiology appointments.

PubMed

Ekberg, Katie; Grenness, Caitlin; Hickson, Louise

2016-07-01

The transtheoretical model (TTM) of behaviour change focuses on clients' readiness for adopting new health behaviours. This study explores how clients' readiness for change can be identified through their interactions with audiologists during history-taking in initial appointments; and whether clients' readiness has consequences for the rehabilitation decisions they make within the initial appointment. Conversation analysis (CA) was used to examine video-recorded initial audiology appointments with older adults with hearing impairment. The data corpus involved 62 recorded appointments with 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 appointments. Clients' readiness for change could be observed through their interaction with the audiologist. Analysis demonstrated that the way clients described their hearing in the history-taking phase had systematic consequences for how they responded to rehabilitation recommendations (in particular, hearing aids) in the management phase of the appointment. In particular, clients identified as being in a pre-contemplation stage-of-change were more likely to display resistance to a recommendation of hearing aids (80% declined). The transtheoretical model of behaviour change can be useful for helping audiologists individualize management planning to be congruent with individual clients' needs, attitudes, desires, and psychological readiness for action in order to optimize clients' hearing outcomes.

Institutional policy changes aimed at addressing obesity among mental health clients.

PubMed

Knol, Linda L; Pritchett, Kelly; Dunkin, Jeri

2010-05-01

People with mental illness often experience unique barriers to healthy eating and physical activity. For these clients, interventions should focus on changes in the immediate environment to change behaviors. The purpose of this project was to implement and evaluate policy changes that would limit calorie intake and increase calorie expenditure of clients receiving mental health services. This intervention was implemented in a rural mental health system in the southeastern United States. Clients live in small group homes, where they are served breakfast, dinner, and a snack, and attend outpatient day treatment programs, where they are served lunch and can purchase snacks from vending machines. This intervention included institutional policy changes that altered menus and vending machine options and implemented group walking programs. Primary outcome measures were changes in clients' weight at 3 and 6 months after policy implementation. At the 3-month follow-up, the median weight loss for overweight/obese clients (n = 45) was 1.4 kg. The 33 overweight/obese clients who were still in the group homes at the 6-month follow-up either maintained or continued to lose weight. Institutional policy changes aimed at improving dietary intake and physical activity levels among clients receiving mental health services can promote weight loss in overweight clients.

Using topic coding to understand the nature of change language in a motivational intervention to reduce alcohol and sex risk behaviors in emergency department patients.

PubMed

Kahler, Christopher W; Caswell, Amy J; Laws, M Barton; Walthers, Justin; Magill, Molly; Mastroleo, Nadine R; Howe, Chanelle J; Souza, Timothy; Wilson, Ira; Bryant, Kendall; Monti, Peter M

2016-10-01

To elucidate patient language that supports changing a health behavior (change talk) or sustaining the behavior (sustain talk). We developed a novel coding system to characterize topics of patient speech in a motivational intervention targeting alcohol and HIV/sexual risk in 90 Emergency Department patients. We further coded patient language as change or sustain talk. For both alcohol and sex, discussions focusing on benefits of behavior change or change planning were most likely to involve change talk, and these topics comprised a large portion of all change talk. Greater discussion of barriers and facilitators of change also was associated with more change talk. For alcohol use, benefits of drinking behavior was the most common topic of sustain talk. For sex risk, benefits of sexual behavior were rarely discussed, and sustain talk centered more on patterns and contexts, negations of drawbacks, and drawbacks of sexual risk behavior change. Topic coding provided unique insights into the content of patient change and sustain talk. Patients are most likely to voice change talk when conversation focuses on behavior change rather than ongoing behavior. Interventions addressing multiple health behaviors should address the unique motivations for maintaining specific risky behaviors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The concept of readiness to change.

PubMed

Dalton, Cindy C; Gottlieb, Laurie N

2003-04-01

Readiness is associated with change, yet there is little understanding of this construct. The purpose of this study was to examine readiness; its referents, associated factors and the resulting consequences. In the course of nursing five clients living with multiple sclerosis over a 7-month period using a Reflective Practice Model, data were systematically gathered using open-ended and then more focused questioning. Data collected during 42 client encounters (28 face-to-face encounters; 14 telephone contacts) were analysed using Chinn and Kramer's concept analysis technique. Findings. The concept of readiness was inductively derived. Readiness is both a state and a process. Before clients can create change they need to become ready to change. A number of factors trigger readiness. These include when: (a) clients perceive that a health concern is not going to resolve, (b) a change in a client's physical condition takes on new significance, (c) clients feel better able to manage their stress, (d) clients have sufficient energy, (e) clients perceive that they have adequate support in undertaking change. When one or more of these factors is present clients become ready to consider change. The process of readiness involves recognizing the need to change, weighing the costs and benefits and, when benefits outweigh costs, planning for change. The desire to change and to take action determines clients' degree of readiness. When they experience a high degree of readiness they report less anger, less depression, and view their condition in a more positive light. In contrast, when they experience a low degree of readiness they report feeling depressed, afraid and vulnerable in the face of change. Nursing has an important role to play in creating conditions to support change. To fulfil this role, nurses need to be able to assess readiness for change and the factors that enable it and then to intervene in ways that facilitate readiness.

"What should we talk about?" The association between the information exchanged during the mental health intake and the quality of the working alliance.

PubMed

Nakash, Ora; Nagar, Maayan; Kanat-Maymon, Yaniv

2015-07-01

We investigated the association between the content of the information exchanged between clients and therapists during mental health intake and the quality of the therapeutic alliance. Thirty-eight therapists and 107 clients from four mental health clinics in Israel participated in the study. The content of information discussed was coded directly from the recorded intakes by blinded raters. Clients and therapists completed the Working Alliance Inventory immediately following the intake. Therapists spent the majority of intake time in collecting information about their clients' diagnostic symptoms and personal history and sociocultural background. Due to the high negative correlation between these factors, r(107) = -.68, p < .001, we created a measure of delta score with higher scores reflecting more discussion of personal history and sociocultural background and less discussion of diagnostic symptoms. We computed three-level hierarchical linear model analysis, with intakes nested within therapists and therapists nested within sites, to examine the association between the delta score and the working alliance, while controlling for intake duration. Results showed significant association between the delta score and clients' rating of the working alliance (γ200 = 0.014, p = .02), indicating that discussing more personal history and sociocultural background and less diagnostic symptoms was associated with better clients' rating of the working alliance. Therapists' rating of the working alliance was not significantly associated with the content of the information exchanged. The restricted intake time allocated to therapists dictates use of strategies to deal with time trade-offs to complete a thorough diagnostic assessment while allowing clients to tell their personal story. (c) 2015 APA, all rights reserved).

Hsp90 Orchestrates Transcriptional Regulation by Hsf1 and Cell Wall Remodelling by MAPK Signalling during Thermal Adaptation in a Pathogenic Yeast

PubMed Central

Leach, Michelle D.; Budge, Susan; Walker, Louise; Munro, Carol; Cowen, Leah E.; Brown, Alistair J. P.

2012-01-01

Thermal adaptation is essential in all organisms. In yeasts, the heat shock response is commanded by the heat shock transcription factor Hsf1. Here we have integrated unbiased genetic screens with directed molecular dissection to demonstrate that multiple signalling cascades contribute to thermal adaptation in the pathogenic yeast Candida albicans. We show that the molecular chaperone heat shock protein 90 (Hsp90) interacts with and down-regulates Hsf1 thereby modulating short term thermal adaptation. In the longer term, thermal adaptation depends on key MAP kinase signalling pathways that are associated with cell wall remodelling: the Hog1, Mkc1 and Cek1 pathways. We demonstrate that these pathways are differentially activated and display cross talk during heat shock. As a result ambient temperature significantly affects the resistance of C. albicans cells to cell wall stresses (Calcofluor White and Congo Red), but not osmotic stress (NaCl). We also show that the inactivation of MAP kinase signalling disrupts this cross talk between thermal and cell wall adaptation. Critically, Hsp90 coordinates this cross talk. Genetic and pharmacological inhibition of Hsp90 disrupts the Hsf1-Hsp90 regulatory circuit thereby disturbing HSP gene regulation and reducing the resistance of C. albicans to proteotoxic stresses. Hsp90 depletion also affects cell wall biogenesis by impairing the activation of its client proteins Mkc1 and Hog1, as well as Cek1, which we implicate as a new Hsp90 client in this study. Therefore Hsp90 modulates the short term Hsf1-mediated activation of the classic heat shock response, coordinating this response with long term thermal adaptation via Mkc1- Hog1- and Cek1-mediated cell wall remodelling. PMID:23300438

Reducing resistance and denial by exercising ambivalence during the treatment of addiction.

PubMed

Shaffer, H J; Simoneau, G

2001-01-01

Stage change models and motivational enhancement therapies have significantly influenced the therapeutic tactics clinicians employ in the treatment of addictive behaviors. While motivational enhancement strategies have addressed client ambivalence to increase motivation to change, this article suggests that focusing on ambivalence during treatment has even wider clinical utility than previously thought. Resistance reduction concentrates on exercising ambivalence without an investment in clients changing, thereby strengthening client tolerance for ambivalent thoughts and feelings. Exercising ambivalence reduces resistance to treatment and change by validating a wide array of possible outcomes through detailed exploration of how a behavior pattern works for a client. Since resistance reduction does not require clients to want to change for therapy to progress, exploring the decision-making process becomes paramount. A general discussion of the resistance reduction model, ambivalence, and how clients present for treatment precedes clinical case examples.

Changing the Conversation with Home Care Clients.

PubMed

Wojtak, Anne; Klopp, Joy

2015-01-01

Traditional home care delivery involves executing tasks for clients within a limited timeframe. Five years ago, when surveys of clients of Toronto Central Community Care Access Centre (TC CCAC) showed the lowest client experience levels across the 14 CCACs in Ontario, TC CCAC and its contracted Service Provider Organizations developed and implemented Changing the Conversation, a philosophy and framework that focuses on asking clients "what is most important" to them and then using that information as the basis for how care is delivered. Changing the Conversation has made a measurable difference to clients' experiences and has now expanded to other parts of the province and the country. It has been recognized as a Leading Practice by Accreditation Canada.

Exploring Psychotherapy Clients' Independent Strategies for Change While in Therapy

ERIC Educational Resources Information Center

Mackrill, Thomas

2008-01-01

Psychotherapy research usually describes how client change is caused by therapist interventions. This article describes how clients change by continuing to use and revising the strategies for change that they bring with them when they first enter therapy. This article presents data from a qualitative diary study of psychotherapy. Three cases…

Is training effective? A study of counseling psychology doctoral trainees in a psychodynamic/interpersonal training clinic.

PubMed

Hill, Clara E; Baumann, Ellen; Shafran, Naama; Gupta, Shudarshana; Morrison, Ashley; Rojas, Andrés E Pérez; Spangler, Patricia T; Griffin, Shauna; Pappa, Laura; Gelso, Charles J

2015-04-01

We investigated changes over 12 to 42 months in 23 predoctoral trainees during their externship training in a psychodynamic/interpersonal psychotherapy clinic. Over time, trainees increased in client-rated working alliance and real relationship, therapist-rated working alliance, client-rated interpersonal functioning, ability to use helping skills (e.g., challenges, immediacy), higher-order functioning (e.g., conceptualization ability, countertransference management), feelings about themselves as therapists (e.g., more authentic, more self-aware), and understanding about being a therapist (e.g., theoretical orientation, curiosity about client dynamics). In contrast, trainees did not change in engaging clients (return after intake or for at least 8 sessions), judge-rated psychodynamic techniques in third and ninth sessions across clients (although trainees used more cognitive-behavioral techniques over time in third but not ninth sessions), or changes in client-rated symptomatology. Trainees primarily attributed changes to graduate training, individual and group supervision, research participation, and working with clients. Implications for training and research are discussed. (c) 2015 APA, all rights reserved).

The perspectives of adults with aphasia and their team members regarding the importance of nine life areas for rehabilitation: a pilot investigation.

PubMed

Pettit, Lauren K; Tönsing, Kerstin M; Dada, Shakila

2017-03-01

Client-centred rehabilitation implies that persons with aphasia and their significant others are actively involved in all decisions regarding rehabilitation, including the setting of rehabilitation priorities and goals. This study aimed to describe and compare the perspectives of adults with aphasia, their significant others and their speech-language pathologists (SLPs) regarding the importance of nine life areas for the rehabilitation of adults with aphasia. A total of 15 adults with expressive aphasia rated the importance of nine life areas using the Talking Mats™ framework. A questionnaire was used to obtain the ratings of 15 of their significant others and the 15 SLPs treating them. Most life areas were rated as important to work on in rehabilitation by most participants. The adults with aphasia rated the areas as important more frequently than their significant others and SLPs. All participants rated Communication as important. Statistically significant differences were noted for three of the nine life areas. The life areas which the participants were questioned about seem to provide a good starting point for rehabilitation teams to find common ground for collaborative goal setting. The Talking Mats™ approach allowed adults with aphasia to participate in the process. It can be a useful tool to promote client-centred rehabilitation for adults with expressive communication difficulties.

Improving Dairy Organizational Communication from the Veterinarian's Perspective: Results of a Continuing Veterinary Medical Education Pilot Program.

PubMed

Moore, Dale A; Sischo, William M; Kurtz, Suzanne; Siler, Julie D; Pereira, Richard V; Warnick, Lorin D; Davis, Margaret A

2016-01-01

The increasing size and complexity of US dairy farms could make it more difficult for a veterinary practitioner to effectively communicate protocol recommendations for prevention or treatment on the farm. A continuing education workshop was set up based on the results of research on dairy organizational communication on dairy farms, which resulted in a tool to assess dairy communication structure and flow. The workshop specifically focused on communication structure and whom to talk to when implementing health care changes in calf rearing. In addition, modern methods of veterinary-client communication knowledge and skills were provided. Primary outcomes of the workshops were to obtain feedback from participants about research findings and the communication model, to improve awareness about the complexity of communication structures on dairy farms, and to change participants' knowledge and skills associated with on-farm communication by providing communication theory and skills and an approach to evaluate and improve dairy organizational communication. Of the 37 participants completing the pre-program assessment, most recognized a need for themselves or their practice to improve communication with clients and farm employees. After the program, most participants were confident in their new communication skills and would consider using them. They highlighted specific new ideas they could apply in practice, such as conducting a "communication audit." The results from the assessment of this communication workshop, focused on dairy veterinarians, highlighted the need for communication training in this sector of the profession and practitioners' desire to engage in this type of training.

Improving Dairy Organizational Communication from the Veterinarian's Perspective: Results of a Continuing Veterinary Medical Education Pilot Program

PubMed Central

Moore, Dale A.; Sischo, William M.; Kurtz, Suzanne; Siler, Julie D.; Pereira, Richard V.; Warnick, Lorin D.; Davis, Margaret A.

2016-01-01

The increasing size and complexity of US dairy farms could make it more difficult for a veterinary practitioner to effectively communicate protocol recommendations for prevention or treatment on the farm. A continuing education workshop was set up based on the results of research on dairy organizational communication on dairy farms, which resulted in a tool to assess dairy communication structure and flow. The workshop specifically focused on communication structure and whom to talk to when implementing health care changes in calf rearing. In addition, modern methods of veterinary–client communication knowledge and skills were provided. Primary outcomes of the workshops were to obtain feedback from participants about research findings and the communication model, to improve awareness about the complexity of communication structures on dairy farms, and to change participants' knowledge and skills associated with on-farm communication by providing communication theory and skills and an approach to evaluate and improve dairy organizational communication. Of the 37 participants completing the pre-program assessment, most recognized a need for themselves or their practice to improve communication with clients and farm employees. After the program, most participants were confident in their new communication skills and would consider using them. They highlighted specific new ideas they could apply in practice, such as conducting a “communication audit”. The results from the assessment of this communication workshop, focused on dairy veterinarians, highlighted the need for communication training in this sector of the profession and practitioners' desire to engage in this type of training. PMID:26751909

Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting.

PubMed

Landsberg, Adina; Shannon, Kate; Krüsi, Andrea; DeBeck, Kora; Milloy, M-J; Nosova, Ekaterina; Kerr, Thomas; Hayashi, Kanna

2017-08-01

Previous research indicates that criminalization of sex work is associated with harms among sex workers. In 2013, the Vancouver Police Department changed their sex work policy to no longer target sex workers while continuing to target clients and third parties in an effort to increase the safety of sex workers (similar to "end-demand sex work" approaches being adopted in a number of countries globally). We sought to investigate the trends and correlates of rushing negotiations with clients due to police presence among 359 sex workers who use drugs in Vancouver before and after the guideline change. Data were derived from three prospective cohort studies of people who use drugs in Vancouver between 2008 and 2014. We used sex-stratified multivariable generalized estimating equation models. The crude percentages of sex workers who use drugs reporting rushing client negotiations changed from 8.9% before the guideline change to 14.8% after the guideline change among 259 women, and from 8.6 to 7.1% among 100 men. In multivariable analyses, there was a significant increase in reports of rushing client negotiation after the guideline change among women (p = 0.04). Other variables that were independently associated with increased odds of rushing client negotiation included experiencing client-perpetrated violence (among both men and women) and non-heterosexual orientation (among women) (all p < 0.05). These findings indicate that despite the policing guideline change, rushed client negotiation due to police presence appeared to have increased among our sample of female sex workers who use drugs. It was also associated with client-perpetrated violence and other markers of vulnerability. These findings lend further evidence that criminalizing the purchase of sexual services does not protect the health and safety of sex workers.

The Perceived Effectiveness of Brief Therapy at a University Counseling Center: The Relationship among Working Alliance, Readiness to Change, and Client Symptom Severity

ERIC Educational Resources Information Center

Mahon, Megan M.

2009-01-01

A sample of university counseling center students was investigated to determine whether student clients who attended short term individual counseling at a university counseling center show progress as evidenced by perceived client and counselor outcomes, and to explore how client motivation to change and working alliance affected counseling…

Video gaming and sexual violence: rethinking forensic nursing in a digital age.

PubMed

Mercer, Dave; Parkinson, Denis

2014-01-01

This article reports findings from a qualitative study into how forensic nurses, and male personality disordered sexual offenders, talked about "pornography" in one U.K. high-security hospital. Research rationale was rooted in current professional and political debates, adopting a discourse analytic design to situate the project in a clinical context. Semistructured interviews, as co-constructed accounts, explored talk about sexual media, offending, treatment, and risk. Data were analyzed using a version of discourse analysis popular in healthcare research, identifying discursive repertoires, or collective language use, characteristic of the institutional culture. Findings revealed that masculine discourse marginalized female nurses and contradicted therapeutic goals, where men's talk about pornography, sex, and sexual crime represented discriminatory and gendered language. Nursing definitions of pornography were constructed in the context of the client group and an organizational need to manage risk. In a highly controlled environment, with a long-stay population, priority in respondent talk was given to mainstream commercial sexual media and everyday items/images perceived to have embedded sexual meaning. However, little mention was made of contemporary modes of producing/distributing pornography, where sex and sexual violence are enacted in virtual realities of cyberspace. Failure to engage with information technology, and globally mediated sex, is discussed as a growing concern for forensic health workers.

It Takes Two to Talk--The Hanen Program and families of children with motor disorders: a UK perspective.

PubMed

Pennington, L; Thomson, K

2007-11-01

Speech and language therapy for young children who have motor disorders targets both the children themselves and their parents. Therapy for parents often involves training about communication and how to foster children's development. It Takes Two to Talk--The Hanen Program for Parents has become popular in the UK, but has not been specifically evaluated for this client group. This study, which was part of a larger investigation of the acceptability and potential effects of the programme on the communication patterns of mothers and their young children with motor disorders, investigated therapists' experiences of providing the training in the National Health Service (NHS) and their views on its effectiveness. Four focus groups, which involved 16 speech and language therapists who provide It Takes Two to Talk in NHS Trusts in England, were analysed using qualitative methods. The themes indicated that therapists perceived the training programme to be effective in helping parents to develop a facilitative communication style. Therapists reported secondary outcomes of positive changes in parents' confidence and in relationships between parents and their children and between parents and therapists. Barriers to the provision and success of the programme were thought to relate to resources, parents' apprehensions about the programme's content and delivery and support from key stakeholders. Barriers were seen to be minimized in services where other members of the healthcare teams actively supported the training programme and where the intervention was integrated as part of a care pathway. The information from this study may assist service providers in the marketing, planning and delivery of new intervention methods, to ensure that they are seen as valuable and acceptable by parents.

Partnering with consumers to develop and evaluate a Vietnamese Dementia Talking-Book to support low health literacy: a qualitative study incorporating codesign and participatory action research

PubMed Central

Goeman, Dianne; Michael, J; King, J; Luu, Huy; Emmanuel, Claire; Koch, S

2016-01-01

Objective The aim of the Vietnamese Dementia talking-book was to address low health literacy in older people of Vietnamese background living with dementia through the provision of an online resource to help individuals, their families and carers better understand and manage this condition and provide information about available dementia services. Design This qualitative study used codesign and participatory action research to develop and refine the talking-book in consultation with expert stakeholders, a consumer advocacy group and the Vietnamese community to assess its utility and ensure cultural and linguistic appropriateness and relevance. Participants 59 members of the Vietnamese community, 11 stakeholders from community health services and ethnic agencies, consumer advocacy groups and the research team participated in the codesign and refinement of the talking-book. 22 members of the Vietnamese community appraised the final product. Setting Vietnamese community planned activity groups in the Western, Northern and Southern suburbs of Melbourne, Australia. Results Our codesign study outlines the process required to develop a Vietnamese Dementia Talking-Book resource partnering with consumers and expert stakeholders to identify consumer need, selection of the content and appropriate language level, construction of the book, measuring acceptability of the talking-book, modification based on feedback and production and dissemination. Feedback on the final version of the talking-book revealed widespread consensus that the book enhanced the knowledge of members of the Vietnamese community in regard to understanding dementia and navigation and accessing of available services. Conclusions This free internationally available online Vietnamese Dementia Talking-Book facilitates improved dementia-related health literacy in the Vietnamese community. The book also serves as a tool to facilitate the provision of care to Vietnamese people living with memory loss by assisting health professional staff to develop relationships with Vietnamese clients, their families and carers in a culturally appropriate manner. PMID:27670516

Excusing exclusion: Accounting for rule-breaking and sanctions in a Swedish methadone clinic.

PubMed

Petersson, Frida J M

2013-11-01

Methadone maintenance treatment has been subjected to much debate and controversy in Sweden during the last decades. Thresholds for getting access are high and control policies strict within the programmes. This article analyses how professionals working in a Swedish methadone clinic discuss and decide on appropriate responses to clients' rule-breaking behaviour. The research data consist of field notes from observations of three interprofessional team meetings where different clients' illicit drug use is discussed. A micro-sociological approach and accounts analysis was applied to the data. During their decision-oriented talk at the meetings, the professionals account for: (1) sanctions, (2) nonsanction, (3) mildness. In accounting for (2) and (3), they also account for clients' rule-breaking behaviour. Analysis shows how these ways of accounting are concerned with locating blame and responsibility for the act in question, as well as with constructing excuses and justifications for the clients and for the professionals themselves. In general, these results demonstrate that maintenance treatment in everyday professional decision-making, far from being a neutral evidence-based practice, involves a substantial amount of professional discretion and moral judgements. Sanctions are chosen according to the way in which a deviance from the rules is explained and, in doing so, a certain behaviour is deemed to be serious, dangerous and unacceptable - or excusable. Copyright © 2013 Elsevier B.V. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Casella, R.

RESTful (REpresentational State Transfer) web services are an alternative implementation to SOAP/RPC web services in a client/server model. BNLs IT Division has started deploying RESTful Web Services for enterprise data retrieval and manipulation. Data is currently used by system administrators for tracking configuration information and as it is expanded will be used by Cyber Security for vulnerability management and as an aid to cyber investigations. This talk will describe the implementation and outstanding issues as well as some of the reasons for choosing RESTful over SOAP/RPC and future directions.

Promoting behavior change: making healthy choices in wellness and healing choices in illness - use of self-determination theory in nursing practice.

PubMed

Johnson, Vicki D

2007-06-01

This article explores more efficacious strategies for holistic nurses to promote healthy behavior choices in their clients. It presents an overview of self-determination theory (SDT) and describes research evidence that supports the application of SDT to promoting healthy behavior change in clients. When nurses act in ways that support clients' innate needs for autonomy, competence, and relatedness, clients may be more successful at internalizing self-regulation and more inclined to adopt and maintain lifelong behavioral changes. Some examples of nursing interventions to motivate behavior change are outlined in this article.

Capabilities of NASA's Space Physics Data Facility as Resources to Enable the Heliophysics Virtual discipline Observatories (VxOs)

NASA Technical Reports Server (NTRS)

McGuire, Robert E.; Candey, Robert M.

2007-01-01

SPDF now supports a broad range of data, user services and other activities. These include: CDAWeb current multi-mission data graphics, listings, file subsetting and supersetting by time and parameters; SSCWeb and 3-D Java client orbit graphics, listings and conjunction queries; OMNIWeb 1/5/60 minute interplanetary parameters at Earth; product-level SPASE descriptions of data including holdings of nssdcftp; VSPO SPASE-based heliophysics-wide product site finding and data use;, standard Data format Translation Webservices (DTWS); metrics software and others. These data and services are available through standard user and application webservices interfaces, so middleware services such as the Heliophysics VxOs, and externally-developed clients or services, can readily leverage our data and capabilities. Beyond a short summary of the above, we will then conduct the talk as a conversation to evolving VxO needs and planned approach to leverage such existing and ongoing services.

Let’s talk about sex: helping substance abuse counsellors address HIV prevention with men who have sex with men

PubMed Central

Spector, Anya Y.; Pinto, Rogério M.

2012-01-01

Integrating HIV prevention into substance abuse counselling is recommended to ameliorate the health outcomes of men who have sex with men. However, culture-based countertransferences (CBCs) may hamper this effort. Using a case illustration, this paper will explain the manifestation of CBCs held among substance abuse counsellors and how they hinder counsellors’ work with men who have sex with men. The following CBCs will be explored: distancing, topic avoidance, heteronormativity, assumptions and denying client strengths. These CBCs allow counsellors to avoid discussions about sexual practices and curtail HIV prevention counselling, while undermining the counsellor-client relationship. Based on the empirical literature on HIV and substance abuse prevention with men who have sex with men, we provide recommendations to help counsellors overcome CBCs and integrate HIV prevention consistently with men who are in treatment for substance abuse. PMID:21308577

AIDS and the question of culture: focus on social cognitive theory.

PubMed

Kim, Suk-hee

2010-01-01

Each of us has a variety of personal theories we use to explain physical, biological, and interpersonal phenomena. Also, our personal theories are our guides as we move toward greater meaning and belief in our lives. This writing shows the reason to utilize the new/recent theory approach in social work practice concerning the issue of AIDS in a cultural-based study on a micro level, though it may compete with macro-level values equally. The social work practice setting needs to open up for engaging dialogue with individuals and large groups within a safe environment and a positive attitude. Not only does this gate allow us to understand clients' and social workers' ways of doing, being, and saying but also ways in which our audience/player (client/we) can perform their/our power of talking about AIDS without fear, guilt, shame, and feelings of despair.

The impact of illicit drug market changes on health agency operations in Sydney, Australia.

PubMed

Gibson, Amy; Day, Carolyn; Degenhardt, Louisa

2005-01-01

At the end of 2000, in Sydney, Australia, there was a dramatic reduction in heroin availability. This study examines how health agencies treating clients for drug and alcohol related issues were able to respond to the changes that took place in their clients and their treatment needs. Key informant interviews were conducted with 48 staff from a wide range of health services in Sydney to provide the data for a thematic analysis. Changes experienced by health agencies included changed patterns of drug use in their clients, increased aggressive incidents, changed numbers of clients accessing treatment services, and a need for more assistance from outside agencies. A strong evidence base for a range of drug treatment options, support of staff development in aggression management skills, and development of good interagency links between mental health, drug and alcohol, and law enforcement services would make health services better prepared for future changes in the drug use of their clients.

Vocational Exploration of Drug Dependent Clients.

ERIC Educational Resources Information Center

Melancon, Donald; Pankey, Clyde

1981-01-01

Describes a program to assess the vocational interests of clients at the Kankakee Drug Abuse Rehabilitation Center. The program attempted to intervene and impact those with erratic work histories. Results indicate clients made some job progress but the number changing jobs and seeking new employment did not change. (JAC)

Adding a vocational focus to mental health rehabilitation.

PubMed

Blankertz, L; Robinson, S

1996-11-01

The study examined the effect of adding two employment specialists to the staff of a community mental health center; their sole responsibility was to develop the skills and positive work attitudes that clients with severe mental illness need to enter the state vocational rehabilitation system or to seek employment. A total of 122 clients were randomly assigned to a program with an employment specialist or to a control group with no specialized vocational services. Clients in the program were taught work skills and attitudes in group and individual sessions and through a trial work experience. A schedule of rewards reinforced positive changes. Outcomes measured were skill gains, changes in work attitudes, attainment of employment, and entry into the state vocational rehabilitation system. At nine months, 34 of the 61 clients in the program achieved positive changes in vocational status that included competitive employment, participation in training and evaluation programs operated by the state vocational system, and formal referral to the system. Only one client in the control group was linked to the state system. Skill gains and positive changes in work attitudes were found for all program clients. Logistical regression suggested that program participation, rather than client characteristics, was an important predictor of a positive outcome. Over a relatively short time period, targeted vocational programs can help clients with severe mental illness develop the skills and attitudes necessary to attain employment or entry into the vocational rehabilitation system. Vocational rehabilitation can be an integral part of the rehabilitation process for all mental health clients.

Primary care nurses' communication and its influence on patient talk during motivational interviewing.

PubMed

Östlund, Ann-Sofi; Wadensten, Barbro; Häggström, Elisabeth; Lindqvist, Helena; Kristofferzon, Marja-Leena

2016-11-01

The aim of this study was to describe what verbal behaviours/kinds of talk occur during recorded motivational interviewing sessions between nurses in primary care and their patients. The aim was also to examine what kinds of nurse talk predict patient change talk, neutral talk and/or sustain talk. Motivational interviewing is a collaborative conversational style. It has been shown to be effective, in addressing health behaviours such as diet, exercise, weight loss and chronic disease management. In Sweden, it is one of the approaches to disease prevention conversations with patients recommended in the National Guidelines for Disease Prevention. Research on the mechanisms underlying motivational interviewing is growing, but research on motivational interviewing and disease prevention has also been called for. A descriptive and predictive design was used. Data were collected during 2011-2014. Fifty audio-recorded motivational interviewing sessions between 23 primary care nurses and 50 patients were analysed using Motivational Interviewing Sequential Code for Observing Process Exchanges. The frequency of specific kinds of talk and sequential analysis (to predict patient talk from nurse talk) were computed using the software Generalized Sequential Querier 5. The primary care nurses and patients used neutral talk most frequently. Open and negative questions, complex and positive reflections were significantly more likely to be followed by change talk and motivational interviewing-inconsistent talk, positive questions and negative reflections by sustain talk. To increase patients' change talk, primary care nurses need to use more open questions, complex reflections and questions and reflections directed towards change. © 2016 John Wiley & Sons Ltd.

Planning and pre-testing: the key to effective AIDS education materials.

PubMed

Ostfield, M L; Romocki, L S

1991-06-01

The steps in designing and producing effective AIDS prevention educational materials are outlines, using as an example a brochure originated in St. Lucia for clients at STD clinics. The brochure was intended to be read by clients as they waited for their consultation, thus it was targeted to a specific audience delimited by age, sex, language, educational level, religion and associated medical or behavioral characteristics. When researching the audience, it is necessary to learn the medium they best respond to, what they know already, what is their present behavior, how they talk about AIDS, what terms they use, how they perceive the benefits of AIDS prevention behavior, what sources of information they trust. The minimum number of key messages should be selected. Next the most appropriate channel of communication is identified. Mass media are not always best for a target audience, "little media" such as flyers and give-always may be better. The draft is then pre-tested by focus groups and interviews, querying about the text separately, then images, color, format, style. Listen to the way the respondents talk about the draft. Modify the draft and pre-test again. Fine-tune implications of the message for realism in emotional responses, respect, self-esteem, admiration and trust. To achieve wide distribution it is a good idea to involve community leaders to production of the materials, so they will be more likely to take part in the distribution process.

CHANGES IN CONDOM USE OVER TIME AMONG FEMALE SEX WORKERS AND THEIR MALE NONCOMMERCIAL PARTNERS AND CLIENTS

PubMed Central

Tracas, Ashley; Bazzi, Angela Robertson; Artamonova, Irina; Rangel, M. Gudelia; Staines, Hugo; Ulibarri, Monica D.

2017-01-01

Female sex workers (FSWs) often report inconsistent condom use with clients and noncommercial male partners, yet changes in condom use with various partner types during participation in observation studies remains underexplored. This longitudinal study of 214 FSWs and their male, noncommercial partners in the Mexico-U.S. border region, where HIV prevalence among FSWs continues to be high, utilized negative binomial regressions to examine changes in condom use with intimate partners and clients (regular and nonregular) over 24 months. Condom use decreased over time among couples in Ciudad Juarez, but there was no change in condom use among couples in Tijuana. FSWs’ condom use with regular and nonregular clients significantly increased over time, which is consistent with previous research finding behavioral changes when participating in observational studies. Findings suggest the need for continued efforts to promote condom use among FSWs and their noncommercial male partners in addition to clients. PMID:27427926

Response to Patterson's "Winds of Change for Client-Centered Counseling."

ERIC Educational Resources Information Center

Brodley, Barbara Temaner

1993-01-01

Responds to previous article by Patterson in which Patterson defends Rogers' theory of psychotherapy and the traditional form in which it is practiced by many client-centered counselors. Shares Patterson's concern about the changes being advocated for client-centered counseling on the grounds that the approach is inadequate. Attempts to clarify…

Increase the success of weight loss programs by creating an environment for change.

PubMed

Churchill, Julie

2010-12-01

Veterinary professionals frequently recommend weight loss programs for pets, but success is often elusive. By learning techniques to assess clients' readiness for change, the veterinary team can apply communication tools and strategies to help clients overcome obstacles and barriers to sustainable change. With a better assessment of a client's ability to change, a weight loss plan can be implemented at the right time in the right way to achieve better adherence to the agreed-upon plan and improve patient health.

Conversational pursuit of medication compliance in a Therapeutic Community for persons diagnosed with mental disorders*

PubMed Central

Mortari, Luigina

2014-01-01

Purpose In this article, we contribute to the debate on medication compliance by exploring the conversational “technologies” entailed in the process of promoting clients’ adherence to psychopharmacological prescriptions. Using a case study approach, we explore how medication-related problems are dealt with in conversational interaction between the staff members and the clients of a mental health Therapeutic Community (TC) in Italy. Method Four meetings between two staff members (Barbara and Massimo) and the clients of the TC were audio-recorded. The data were transcribed and analyzed using the method of Conversation Analysis. Results Barbara and Massimo recur to practices of topic articulation to promote talk that references the clients’ failure to take the medications. Through these practices they deal with the practical problem of mobilizing the clients’ cooperation in courses of action that fit into the institutional agenda of fostering medication adherence. Conclusions Barbara and Massimo’s conversational practices appear to reflect the assumption that medication-related problems can be reduced to compliance problems. This assumption works to make the clients accountable for their failure to take the medications while shaping a conversational environment that is unreceptive to their complaints about side effects. Implications for the understanding of mental health rehabilitation practice in TCs are discussed. Implications of RehabilitationTherapeutic community staff members should be aware of the challenges and blocks in communicating with their clients.Therapeutic communities can promote staff members’ awareness of communication challenges through reflective workshops in which they can jointly view and comment on interaction with their clients.Reflective workshops can be used to raise awareness of the presuppositions underlying therapeutic community staff members’ communication practices. PMID:24053481

The Role of Reflection on Clients' Change in the Coaching Process

ERIC Educational Resources Information Center

Kristal, Zuno

2010-01-01

This study explored the role of reflection in the personal life-coaching process and the ways it affects clients' change, as perceived by both coach and client. Underlying this study is that coaching is currently recognized as a learning process, yet how reflection is understood or used is currently unspecified. Insights gained from the adult…

Investigation of Clinically Significant Change by Severity Level in College Counseling Center Clients

ERIC Educational Resources Information Center

Wolgast, Brad M.; Rader, Jill; Roche, Deborah; Thompson, C. Patricia; von Zuben, F. Christian; Goldberg, Allan

2005-01-01

The authors investigated the number of sessions necessary for college counseling center clients of different levels of severity of distress at intake to achieve clinically significant change (CS) in therapy. The Outcome Questionnaire-45 (M. J. Lambert, N. B. Hansen, et al., 1996) was used to categorize 914 clients by severity of distress. Analyses…

"That in your hands". A comprehensive process analysis of a significant event in psychotherapy.

PubMed

Elliott, R

1983-05-01

This article illustrates a new approach to the study of change processes in psychotherapy. The approach involves selecting significant change events and analyzing them according to the Comprehensive Process Model. In this model, client and therapist behaviors are analyzed for content, interpersonal action, style and response quality by using information derived from Interpersonal Process Recall, client and therapist objective process ratings and qualitative analyses. The event selected for analysis in this paper was rated by client and therapist as significantly helpful. The focal therapist response was a reflective-interpretive intervention in which the therapist collaboratively and evocatively expanded the client's implicit meanings. The event involved working through an earlier insight and realization of progress by the client. The event suggests an association between subjective "felt shifts" and public "process shifts" in client in-therapy behaviors. A model, consistent with Gendlin's experiential psychotherapy (1970), is offered to describe the change process which occurred in this event.

The development and validation of the client expectations of massage scale.

PubMed

Boulanger, Karen T; Campo, Shelly; Glanville, Jennifer L; Lowe, John B; Yang, Jingzhen

2012-01-01

Although there is evidence that client expectations influence client outcomes, a valid and reliable scale for measuring the range of client expectations for both massage therapy and the behaviors of their massage therapists does not exist. Understanding how client expectations influence client outcomes would provide insight into how massage achieves its reported effects. To develop and validate the Client Expectations of Massage Scale (CEMS), a measure of clients' clinical, educational, interpersonal, and outcome expectations. Offices of licensed massage therapists in Iowa. A practice-based research methodology was used to collect data from two samples of massage therapy clients. For Sample 1, 21 volunteer massage therapists collected data from their clients before the massage. Factor analysis was conducted to test construct validity and coefficient alpha was used to assess reliability. Correlational analyses with the CEMS, previous measures of client expectations, and the Life Orientation Test-Revised were examined to test the convergent and discriminant validity of the CEMS. For Sample 2, 24 massage therapists distributed study materials for clients to complete before and after a massage therapy session. Structural equation modeling was used to assess the construct, discriminant, and predictive validity of the CEMS. Sample 1 involved 320 and Sample 2 involved 321 adult massage clients. Standard care provided by licensed massage therapists. Numeric Rating Scale for pain and Positive and Negative Affect Schedule-Revised (including the Serenity subscale). The CEMS demonstrated good construct, convergent, discriminant and predictive validity, and adequate reliability. Client expectations were generally positive toward massage and their massage therapists. Positive outcome expectations had a positive effect on clients' changes in pain and serenity. High interpersonal expectations had a negative effect on clients' changes in serenity. Client expectations contribute to the nonspecific effects of massage therapy.

13 CFR 113.3-3 - Structural accommodations for handicapped clients.

Code of Federal Regulations, 2013 CFR

2013-01-01

... handicapped clients. 113.3-3 Section 113.3-3 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... ADMINISTRATOR General Provisions § 113.3-3 Structural accommodations for handicapped clients. (a) Existing... by handicapped clients. Where structural changes are necessary to make the recipient's goods or...

13 CFR 113.3-3 - Structural accommodations for handicapped clients.

Code of Federal Regulations, 2012 CFR

2012-01-01

... handicapped clients. 113.3-3 Section 113.3-3 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... ADMINISTRATOR General Provisions § 113.3-3 Structural accommodations for handicapped clients. (a) Existing... by handicapped clients. Where structural changes are necessary to make the recipient's goods or...

13 CFR 113.3-3 - Structural accommodations for handicapped clients.

Code of Federal Regulations, 2014 CFR

2014-01-01

... handicapped clients. 113.3-3 Section 113.3-3 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... ADMINISTRATOR General Provisions § 113.3-3 Structural accommodations for handicapped clients. (a) Existing... by handicapped clients. Where structural changes are necessary to make the recipient's goods or...

13 CFR 113.3-3 - Structural accommodations for handicapped clients.

Code of Federal Regulations, 2010 CFR

2010-01-01

... handicapped clients. 113.3-3 Section 113.3-3 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... ADMINISTRATOR General Provisions § 113.3-3 Structural accommodations for handicapped clients. (a) Existing... by handicapped clients. Where structural changes are necessary to make the recipient's goods or...

Effects of communication with important social referents on beliefs and intentions to use condoms.

PubMed

Strader, M K; Beaman, M L; McSweeney, M

1992-06-01

Data from a 1989 survey using the condom attitude and belief instrument with 310 clients from two sexually transmitted disease clinics identified significant social referents who influence condom-use intentions. They are sexual partner, father and friends. The present study found that communication with these referents had a positive net effect on beliefs about and intentions to use condoms. Implications applicable for intervention programmes to increase condom use are to promote talking about condoms between the sexual partners and important social referents and to develop such communication skills.

Distributed computer taxonomy based on O/S structure

NASA Technical Reports Server (NTRS)

Foudriat, Edwin C.

1985-01-01

The taxonomy considers the resource structure at the operating system level. It compares a communication based taxonomy with the new taxonomy to illustrate how the latter does a better job when related to the client's view of the distributed computer. The results illustrate the fundamental features and what is required to construct fully distributed processing systems. The problem of using network computers on the space station is addressed. A detailed discussion of the taxonomy is not given here. Information is given in the form of charts and diagrams that were used to illustrate a talk.

Successful Vocational Rehabilitation of Clients with Retinitis Pigmentosa.

ERIC Educational Resources Information Center

Taheri-Araghi, M.; Hendren, G.

1994-01-01

Statistical analysis of 10 personal (client) variables and four program variables related to 76 people who became blind from retinitis pigmentosa revealed that 6 variables predicted clients' rehabilitation outcomes: age, gender, race, work status, amount of case-service money spent on the client's behalf, and number of changes in career objectives…

Cultural Implications of a Global Context: The Need for the Reference Librarian To Ask Again "Who Is My Client?".

ERIC Educational Resources Information Center

McSwiney, Carolyn

Globalization provides the contextual framework for cultural changes in the library user group. In order to be more effective, and realistically, more client-focused, the reference librarian is challenged to ask again "Who is my client?" in this changing context. This paper presents a positive and practical response to cultural change…

An investigation of client mood in the initial and final sessions of cognitive-behavioral therapy and psychodynamic-interpersonal therapy.

PubMed

Mcclintock, Andrew S; Stiles, William B; Himawan, Lina; Anderson, Timothy; Barkham, Michael; Hardy, Gillian E

2016-01-01

Our aim was to examine client mood in the initial and final sessions of cognitive-behavioral therapy (CBT) and psychodynamic-interpersonal therapy (PIT) and to determine how client mood is related to therapy outcomes. Hierarchical linear modeling was applied to data from a clinical trial comparing CBT with PIT. In this trial, client mood was assessed before and after sessions with the Session Evaluation Questionnaire-Positivity Subscale (SEQ-P). In the initial sessions, CBT clients had higher pre-session and post-session SEQ-P ratings and greater pre-to-post session mood change than did clients in PIT. In the final sessions, these pre, post, and change scores were generally equivalent across CBT and PIT. CBT outcome was predicted by pre- and post-session SEQ-P ratings from both the initial sessions and the final sessions of CBT. However, PIT outcome was predicted by pre- and post-session SEQ-P ratings from the final sessions only. Pre-to-post session mood change was unrelated to outcome in both treatments. These results suggest different change processes are at work in CBT and PIT.

Alcohol and drug abusers' reasons for seeking treatment.

PubMed

Cunningham, J A; Sobell, L C; Sobell, M B; Gaskin, J

1994-01-01

Clients at two different treatment facilities were asked at assessment how influential each of 10 possible reasons were in their decision to change their alcohol or drug use. Clients at both facilities most often endorsed "weighing the pros and cons of drinking or drug use" and a "warning from spouse." Client's reasons for seeking treatment were also examined in relation to treatment compliance. Three reasons--"weighing the pros and cons," "hitting rock bottom," and experiencing a "major lifestyle change"--were predictive of treatment compliance. Clients who rated any of these reasons as influential were more likely to enter and complete treatment. Although more research is needed, knowledge of clients' reasons for seeking treatment might be useful in treatment matching.

The Use of Acceptance to Promote Positive Change by Decreasing Shame and Guilt: A Practice Exemplar.

PubMed

Meltzer, Mary-Ellen

2015-01-01

The use of acceptance by mental health clinicians in the clinical setting is an effective method for providing a safe environment for clients to make positive changes. Acceptance means that mental health clinicians are non-judgmental and acknowledge the clients' situations as they are. When actively used by clinicians, acceptance decreases clients' anxiety and the intensity of their feelings of guilt and shame. Clients are then able to begin to accept themselves as they are. The purpose of this article is to discuss the ways in which mental health clinicians promote clients' acceptance of themselves using the tools of acceptance and commitment therapy and dialectical behavioral therapy.

When Does Premature Treatment Termination Occur? Examining Session-by-Session Dropout Among Clients with Gambling Disorder.

PubMed

Pfund, Rory A; Peter, Samuel C; Whelan, James P; Meyers, Andrew W

2018-06-01

Premature termination challenges the successful outcomes of psychological treatments for gambling disorder. To date, research has primarily identified clients who are at particular risk for dropping out of treatment. A smaller but growing body of literature has investigated when dropout occurs. Typically, those studies have not considered improvement in psychological distress within their operationalizations of dropout and therefore may have misrepresented when dropout occurs. The current study examined when dropout occurs using an operationalization based on the criteria of attaining reliable change in a naturalistic sample of clients with gambling disorder, and the classification rates yielded from that operationalization were compared to the rates from a more common operationalization. Participants (n = 334) were clients meeting diagnostic criteria for gambling disorder at an outpatient private practice who completed a measure of psychological distress at baseline and prior to each subsequent treatment session. A survival analysis was conducted to determine temporal patterns of treatment dropout (i.e., clients who discontinued treatment before realizing reliable changes in psychological distress) and completion (i.e., clients who discontinued treatment after realizing reliable changes in distress) at each treatment session. Forty-nine percent of clients were classified as dropouts, and the majority of those clients did so in the first few sessions. The more common operationalization of dropout classified clients as dropouts when they had improved in their distress and clients as completers when they had not improved in their distress. Discussion centers on the implications of dropout occurring at various stages of treatment and future directions.

Feasibility and Effectiveness of a Peer Referral Incentive Intervention to Promote Male Circumcision Uptake in Zambia

PubMed Central

Bolton, Carolyn; Lyabola, Lane-Lee; Phiri, Gabriel; Samona, Alick; Kaonga, Albert; Thirumurthy, Harsha

2016-01-01

Background: Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV epidemics, but demand creation interventions are needed to support scale-up. We piloted a peer referral intervention in which circumcision clients were offered incentives for referring their peers for circumcision. Methods: The intervention was implemented between June 2014 and February 2015 in 6 randomly selected health facilities in Southern Province, Zambia. For the first 5 months, circumcision clients ≥18 years of age were given referral vouchers that allowed them to refer up to 5 peers for circumcision within a 3-month period. An incentive of US$2 was offered for each referral. The primary outcome was the number of circumcisions performed per month in each facility. To assess the effect of the intervention, a difference-in-difference analysis was performed using longitudinal data from the intervention facilities and 22 nonintervention facilities. A questionnaire was also implemented to understand men's perceptions of the intervention. Results: During the 8-month intervention period, 1222 men over 18 years of age were circumcised in intervention facilities. In the first 5 months, 699 circumcision clients were enrolled and 385 clients brought a referral voucher given to them by an enrolled client. Difference-in-difference analyses did not show a significant increase in circumcisions performed in intervention facilities. However, circumcision clients reported that the referral incentive motivated them to encourage their friends to seek male circumcision. Peer referrals were also reported to be an important factor in men's decisions because 78% of clients who were referred reported that talking with a circumcised friend was important for their decision to get circumcised. Conclusions: The peer referral incentive intervention for male circumcision was feasible and acceptable. However, the intervention did not have a significant effect on demand for male circumcision. Barriers to circumcision and features of the intervention may have limited the effect of the intervention. Further efforts regarding encouraging male-to-male communication and evaluations with larger sample sizes are needed. PMID:27404006

The future of veterinary communication: Partnership or persuasion? A qualitative investigation of veterinary communication in the pursuit of client behaviour change

PubMed Central

Bard, Alison M.; Main, David C. J.; Haase, Anne M.; Whay, Helen R.; Roe, Emma J.; Reyher, Kristen K.

2017-01-01

Client behaviour change is at the heart of veterinary practice, where promoting animal health and welfare is often synonymous with engaging clients in animal management practices. In the medical realm, extensive research points to the link between practitioner communication and patient behavioural outcomes, suggesting that the veterinary industry could benefit from a deeper understanding of veterinarian communication and its effects on client motivation. Whilst extensive studies have quantified language components typical of the veterinary consultation, the literature is lacking in-depth qualitative analysis in this context. The objective of this study was to address this deficit, and offer new critical insight into veterinary communication strategies in the pursuit of client behaviour change. Role-play interactions (n = 15) between UK cattle veterinarians and an actress experienced in medical and veterinary education were recorded, transcribed and analysed thematically. Analysis revealed that, overall, veterinarians tend to communicate in a directive style (minimal eliciting of client opinion, dominating the consultation agenda, prioritising instrumental support), reflecting a paternalistic role in the consultation interaction. Given this finding, recommendations for progress in the veterinary industry are made; namely, the integration of evidence-based medical communication methodologies into clinical training. Use of these types of methodologies may facilitate the adoption of more mutualistic, relationship-centred communication in veterinary practice, supporting core psychological elements of client motivation and resultant behaviour change. PMID:28257511

Promoting Participation in Organizational Decision Making by Clients with Severe Mental Illness

ERIC Educational Resources Information Center

Linhorst, Donald M.; Eckert, Anne; Hamilton, Gary

2005-01-01

This qualitative study assessed clients' participation in organizational decision making in a public long-term psychiatric hospital. Numerous examples were found in which clients meaningfully participated in the decision-making process and achieved favorable policy changes. Three means of involving clients were found to be especially useful: (1)…

Assessing client self-narrative change in emotion-focused therapy of depression: an intensive single case analysis.

PubMed

Angus, Lynne E; Kagan, Fern

2013-12-01

Personality researchers use the term self-narrative to refer to the development of an overall life story that places life events in a temporal sequence and organizes them in accordance to overarching themes. In turn, it is often the case that clients seek out psychotherapy when they can no longer make sense of their life experiences, as a coherent story. Angus and Greenberg (L. Angus and L. Greenberg, 2011, Working with narrative in emotion-focused therapy: Changing stories, healing lives. Washington, DC: American Psychological Association Press) view the articulation and consolidation of an emotionally integrated self-narrative account as an important part of the therapeutic change process that is essential for sustained change in emotion-focused therapy of depression. The purpose of the present study was to investigate client experiences of change, and self-narrative reconstruction, in the context of one good outcome emotion-focused therapy dyad drawn from the York II Depression Study. Using the Narrative Assessment Interview (NAI) method, client view of self and experiences of change were assessed at three points in time--after session one, at therapy termination, and at 6 months follow-up. Findings emerging from an intensive narrative theme analyses of the NAI transcripts--and 1 key therapy session identified by the client--are reported and evidence for the contributions of narrative and emotion processes to self-narrative change in emotion-focused therapy of depression are discussed. Finally, the implications of assessing clients' experiences of self-narrative change for psychotherapy research and practice are addressed.

Facilitating neurorehabilitation through principles of engagement.

PubMed

Danzl, Megan M; Etter, Nicole M; Andreatta, Richard D; Kitzman, Patrick H

2012-01-01

A primary goal of neurorehabilitation is to guide recovery of functional skills after injury through evidence-based interventions that operate to manipulate the sensorimotor environment of the client. While choice of intervention is an important decision for clinicians, we contend it is only one part of producing optimal activity-dependent neuroplastic changes. A key variable in the rehabilitation equation is engagement. Applying principles of engagement may yield greater neuroplastic changes and functional outcomes for clients. We review the principles of neuroplasticity and engagement and their potential linkage through concepts of attention and motivation and strategies such as mental practice and enriched environments. Clinical applications and challenges for enhancing engagement during rehabilitation are presented. Engagement strategies, such as building trust and rapport, motivational interviewing, enhancing the client education process, and interventions that empower clients, are reviewed. Well-controlled research is needed to test our theoretical framework and suggested outcomes. Clinicians may enhance engagement by investing time and energy in the growth and development of the therapeutic relationship with clients, as this is paramount to maintaining clients' investment in continuing therapy and also may act as a driver of neuroplastic changes.

Clients' collaboration in therapy: Self-perceptions and relationships with client psychological functioning, interpersonal relations, and motivation.

PubMed

Bachelor, Alexandra; Laverdière, Olivier; Gamache, Dominick; Bordeleau, Vincent

2007-06-01

To gain a closer understanding of client collaboration and its determinants, the first goal of this study involved the investigation of clients' perceptions of collaboration using a discovery-oriented methodology. Content analysis of 30 clients' written descriptions revealed three different modes of client collaboration, labeled active, mutual, and therapist-dependent, which emphasized client initiative and active participation, joint participation, and reliance on therapists' contributions to the work and change process, respectively. The majority of clients valued the therapist's active involvement and also emphasized the helpfulness of their collaborative experiences. In general, the therapist actions and attitudes involved in clients' views of good collaboration varied among clients. A second goal was to examine the relationships between client psychological functioning, quality of interpersonal relationships, and motivation, and clients' collaborative contributions, as rated by clients and therapists. Of these, only motivation was significantly associated with client collaboration, particularly in the perceptions of therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Innovative tools help counselors discuss childhood obesity with parents.

PubMed

Herrera, Jennifer; Lockner, Donna; Kibbe, Debra; Marley, Scott C; Trowbridge, Frederick; Bailey, Angie

2013-04-01

Childhood overweight and obesity pose potential health risks for many children under the age of 5 years. Women, Infants, and Children (WIC) nutritionists are in a unique position to help reduce this problem because of their frequent counseling contacts with clients during certification visits. Therefore, four new tools to facilitate nutritional counseling of parents of overweight children during certifications were developed and systematically evaluated. The Nutrition and Activity Self-History (NASH) form, Report Card/Action Plan (ReCAP), Talking Tips, and Healthy Weight Poster were evaluated by WIC nutritionists via an online survey. Anchors on the Likert scale were 0 for Strongly Disagree to 6 for Strongly Agree. Four regional focus groups were also conducted. Data were analyzed descriptively. The response rate on the survey was 83% (n=63). Focus groups were comprised of staff that volunteered to participate (n=34). The NASH form, which replaces a food frequency questionnaire for identifying nutrition risk, had a mean rating of 5.20 as "Helpful when counseling about weight." The ReCAP, Talking Tips, and Healthy Weight Poster achieved mean ratings of 5.70, 4.75, and 5.30, respectively, in this category. Focus group responses were very positive about the usefulness of the ReCAP and Healthy Weight Poster to visually convey the concept of BMI percentile for age using a green, yellow, and red color-coded "traffic light" approach to showing healthy versus unhealthy BMI values. WIC programs and other pediatric health care settings may want to consider adopting these innovative tools to better serve their clients and address pediatric overweight in the populations they serve.

Forging partnerships between optometrists and ergonomists to improve visual comfort and productivity in the workplace.

PubMed

Long, Jennifer

2014-01-01

Ergonomists and optometrists often have mutual clients/patients with complex visual needs in the workplace but communication between the professionals is usually indirect through the client/patient. This paper describes a joint professional development meeting between optometrists and ergonomists in Canberra, Australia, which included a discussion to explore how to improve communication between the two professions. Optometrists and ergonomists reported they would prefer more information before conducting assessments and providing advice. Vision screening forms commonly in use for computer workers were viewed as inadequate to meet these needs. Communication between the two professions was hampered by absence of contact details of the optometrist/ergonomist, perceptions that the other profession is too busy to talk, privacy considerations in sharing information and funding issues for shared care arrangements. There are opportunities for increasing awareness of good vision in workplaces. Communication between optometrists and ergonomists can be improved by developing information-sharing documents relevant to modern workplaces.

Men in family planning: changing the world one life at a time.

PubMed

Feldman, J

1992-01-01

While women created the family planning (FP) movement, men have also been involved since its inception (albeit in a minor way). Today men must redefine masculinity in order to become more effective as FP providers and clients. While women have carved out newly self-sufficient identities, men have had to search for new identities which appropriately respond to changing gender relations. The Planned Parenthood of Central and Northern Arizona has 12 males on a staff of 130. The male FP providers have an opportunity to redefine gender relations, masculinity, and reproductive responsibility through their interactions with clients, whether the clients are themselves male or female. The male FP providers have a rare opportunity to exhibit a balance between the "fierceness of the warrior patient and the warmth of the parent" in their dealings with clients. Female clients of male FP providers can realize a therapeutic, emotionally-corrective experience. Male clients of male providers can receive insights into women's lives; into healthful living; and into ways to achieve greater access to feelings, emotions, and experiences. The changes at hand in the world demand that traditionally female values such as nurturing and compassion be brought into the traditionally male world of ambition, profit, and power. Male FP providers can contribute to this improvement as they affect one client at a time.

A clinical reasoning model focused on clients' behaviour change with reference to physiotherapists: its multiphase development and validation.

PubMed

Elvén, Maria; Hochwälder, Jacek; Dean, Elizabeth; Söderlund, Anne

2015-05-01

A biopsychosocial approach and behaviour change strategies have long been proposed to serve as a basis for addressing current multifaceted health problems. This emphasis has implications for clinical reasoning of health professionals. This study's aim was to develop and validate a conceptual model to guide physiotherapists' clinical reasoning focused on clients' behaviour change. Phase 1 consisted of the exploration of existing research and the research team's experiences and knowledge. Phases 2a and 2b consisted of validation and refinement of the model based on input from physiotherapy students in two focus groups (n = 5 per group) and from experts in behavioural medicine (n = 9). Phase 1 generated theoretical and evidence bases for the first version of a model. Phases 2a and 2b established the validity and value of the model. The final model described clinical reasoning focused on clients' behaviour change as a cognitive, reflective, collaborative and iterative process with multiple interrelated levels that included input from the client and physiotherapist, a functional behavioural analysis of the activity-related target behaviour and the selection of strategies for behaviour change. This unique model, theory- and evidence-informed, has been developed to help physiotherapists to apply clinical reasoning systematically in the process of behaviour change with their clients.

The Role of the Therapist in Therapeutic Change: How Knowledge From Mental Health Can Inform Pediatric Rehabilitation.

PubMed

King, Gillian

2017-05-01

The therapist is a neglected and poorly understood variable in pediatric rehabilitation. Much more attention has been paid to the role of intervention on client change than the role of therapist-related variables. This article synthesizes what is known in the adult and child mental health literature about the role of the therapist, and integrates this with work in pediatric rehabilitation. The article reviews the mental health literature on the therapist as a random variable associated with client outcomes (role of the therapist alone) and the role of three other therapist-related constructs: the therapist-client relationship (therapist and client), treatment implementation (therapist and intervention), and therapy process (therapist, client, and intervention considered holistically). Implications for clinical practice in pediatric rehabilitation include recognition of change as a multi-determined phenomenon involving common therapist-related factors, the therapist's role in creating facilitative conditions for change (through supportive relationships, positive expectancies, and mastery and learning experiences), and the importance of training in collaborative partnership skills. A contextual approach to therapeutic change is advocated, in which psychosocial factors and mechanisms are acknowledged, the therapist is seen as crucial, and the intervention process is seen as the context or vehicle through which changes occur.

Therapist strategies early in therapy associated with good or poor outcomes among clients with low proactive agency.

PubMed

von der Lippe, Anna Louise; Oddli, Hanne Weie; Halvorsen, Margrethe Seeger

2017-09-10

Within a mixed methods program of research the present study aimed at expanding knowledge about interactions in the initial therapeutic collaboration by combining focus on client interpersonal style and therapist contribution. The study involves in-depth analyses of therapist-client interactions in the initial two sessions of good and poor outcome therapies. Based on interpersonal theory and previous research, the Inventory of Interpersonal Problems (IIP-64-C) was used to define poor outcome cases, that is, low proactive agency cases. To compare good and poor outcome cases matched on this interpersonal pattern, cases were drawn from two different samples; nine poor outcome cases from a large multi-site outpatient clinic study and nine good outcome cases from a process-outcome study of highly experienced therapists. Qualitative analysis of therapist behaviors resulted in 2 main categories, fostering client's proactive agentic involvement in change work and discouraging client's proactive agentic involvement in change work, 8 categories and 22 sub-categories. The findings revealed distinct and cohesive differences in therapist behaviors between the two outcome groups, and point to the particular therapist role of fostering client agency through engagement in a shared work on change when clients display strong unassertiveness and low readiness for change. Clinical or Methodological Significance Summary: The present analysis combines focus on client interpersonal style, therapist strategies/process and outcome. The categories generated from the present grounded theory analysis may serve as a foundation for identifying interactions that are associated with agentic involvement in future process research and practice, and hence we have formulated principles/strategies that were identified by the analysis.

Contraceptive use among clients of the Atlanta Feminist Women's Health Center at three to five weeks post-abortion.

PubMed

Moslin, Trisha A; Rochat, Roger W

2011-08-01

Little is known about women's contraceptive use and sexual activity in the immediate post-abortion period although effective contraceptive use is paramount during this time because fertility returns almost immediately. This study sought to learn more about women's contraceptive use and sexual behaviors to inform abortion providers and help them serve their clients better, potentially leading to a decline in the rates of unintended pregnancy and repeat abortion. Abortion clients of an Atlanta, GA clinic were surveyed over the telephone 3-5 weeks post-abortion. Background information was collected from clinic medical charts. Simple and stratified frequencies and logistic regression were used to describe women's sexual activity and contraceptive use in the immediate post-abortion period and to determine if variables known at the time of the abortion could predict contraceptive use 3-5 weeks post-abortion. 54.2% (n = 39) of women had engaged in sexual intercourse in the immediate post-abortion period. Of these, 30.8% (n = 12) were not using a contraceptive method or were not using it effectively. Women who said they did not want or need information about birth control on their medical history form were less likely to be using contraception 3-5 weeks post abortion. Emphasizing the rapid return of fertility and risk of conception in pre-abortion counseling sessions could prevent future unintended pregnancies among abortion clients. Further research could explore the interaction between a willingness to talk about contraceptive methods at the time of abortion and method use post-abortion.

The Effect of Brief Training in Motivational Interviewing on Client Outcomes and Trainee Skill Development

ERIC Educational Resources Information Center

Young, Tabitha L.

2010-01-01

Motivational Interviewing (MI) is an evidence-based practice that focuses on working through client ambivalence and increasing clients' motivation to change. The purposes of this study were to investigate the effect that a unique student-based training in MI had on counselor trainees' ability to perform MI, and on client outcomes. This training…

'Getting back to normal': the added value of an art-based programme in promoting 'recovery' for common but chronic mental health problems.

PubMed

Makin, Sally; Gask, Linda

2012-03-01

OBJECTIVES. The aim of this project was to explore the added value of participation in an Arts on Prescription (AoP) programme to aid the process of recovery in people with common but chronic mental health problems that have already undergone a psychological 'talking'-based therapy. METHODS. The study utilized qualitative in-depth interviews with 15 clients with persistent anxiety and depression who had attended an 'AoP' service and had previously received psychological therapy. RESULTS and discussion. Attending AoP aided the process of recovery, which was perceived by participants as 'returning to normality' through enjoying life again, returning to previous activities, setting goals and stopping dwelling on the past. Most were positive about the benefits they had previously gained from talking therapies. However, these alone were not perceived as having been sufficient to achieve recovery. The AoP offered some specific opportunities in this regard, mediated by the therapeutic and effect of absorption in an activity, the specific creative potential of art, and the social aspects of attending the programme. CONCLUSIONS. For some people who experience persistent or relapsing common mental health problems, participation in an arts-based programme provides 'added value' in aiding recovery in ways not facilitated by talking therapies alone.

Cross talk in the Lambert-Beer calculation for near-infrared wavelengths estimated by Monte Carlo simulations.

PubMed

Uludag, K; Kohl, M; Steinbrink, J; Obrig, H; Villringer, A

2002-01-01

Using the modified Lambert-Beer law to analyze attenuation changes measured noninvasively during functional activation of the brain might result in an insufficient separation of chromophore changes ("cross talk") due to the wavelength dependence of the partial path length of photons in the activated volume of the head. The partial path length was estimated by performing Monte Carlo simulations on layered head models. When assuming cortical activation (e.g., in the depth of 8-12 mm), we determine negligible cross talk when considering changes in oxygenated and deoxygenated hemoglobin. But additionally taking changes in the redox state of cytochrome-c-oxidase into account, this analysis results in significant artifacts. An analysis developed for changes in mean time of flight--instead of changes in attenuation--reduces the cross talk for the layers of cortical activation. These results were validated for different oxygen saturations, wavelength combinations and scattering coefficients. For the analysis of changes in oxygenated and deoxygenated hemoglobin only, low cross talk was also found when the activated volume was assumed to be a 4-mm-diam sphere.

ASK Talks with Gary Klein

NASA Technical Reports Server (NTRS)

Klein, Gary

2004-01-01

Gary Klein, PH.D., is chief scientist of Klein Associates, Inc., a company he founded in 1978 to better understand how to improve decision making in individuals and teams. The company has 30 employees working on projects for both government and commercial clients. Dr. Klein is one of the founders of the field of naturalistic decision making. His work on recognitional decision making has been influential for the design of new systems and interfaces, and for the development of decision training programs. He has extended his work on decision making to describe problem detection, opinion generation, sense making, and planning.

FirebrowseR: an R client to the Broad Institute’s Firehose Pipeline

PubMed Central

Deng, Mario; Brägelmann, Johannes; Kryukov, Ivan; Saraiva-Agostinho, Nuno; Perner, Sven

2017-01-01

With its Firebrowse service (http://firebrowse.org/) the Broad Institute is making large-scale multi-platform omics data analysis results publicly available through a Representational State Transfer (REST) Application Programmable Interface (API). Querying this database through an API client from an arbitrary programming environment is an essential task, allowing other developers and researchers to focus on their analysis and avoid data wrangling. Hence, as a first result, we developed a workflow to automatically generate, test and deploy such clients for rapid response to API changes. Its underlying infrastructure, a combination of free and publicly available web services, facilitates the development of API clients. It decouples changes in server software from the client software by reacting to changes in the RESTful service and removing direct dependencies on a specific implementation of an API. As a second result, FirebrowseR, an R client to the Broad Institute’s RESTful Firehose Pipeline, is provided as a working example, which is built by the means of the presented workflow. The package’s features are demonstrated by an example analysis of cancer gene expression data. Database URL: https://github.com/mariodeng/ PMID:28062517

FirebrowseR: an R client to the Broad Institute's Firehose Pipeline.

PubMed

Deng, Mario; Brägelmann, Johannes; Kryukov, Ivan; Saraiva-Agostinho, Nuno; Perner, Sven

2017-01-01

With its Firebrowse service (http://firebrowse.org/) the Broad Institute is making large-scale multi-platform omics data analysis results publicly available through a Representational State Transfer (REST) Application Programmable Interface (API). Querying this database through an API client from an arbitrary programming environment is an essential task, allowing other developers and researchers to focus on their analysis and avoid data wrangling. Hence, as a first result, we developed a workflow to automatically generate, test and deploy such clients for rapid response to API changes. Its underlying infrastructure, a combination of free and publicly available web services, facilitates the development of API clients. It decouples changes in server software from the client software by reacting to changes in the RESTful service and removing direct dependencies on a specific implementation of an API. As a second result, FirebrowseR, an R client to the Broad Institute's RESTful Firehose Pipeline, is provided as a working example, which is built by the means of the presented workflow. The package's features are demonstrated by an example analysis of cancer gene expression data.Database URL: https://github.com/mariodeng/. © The Author(s) 2017. Published by Oxford University Press.

Nanoscale thermal cross-talk effect on phase-change probe memory.

PubMed

Wang, Lei; Wen, Jing; Xiong, Bangshu

2018-05-14

Phase-change probe memory is considered as one of the most promising means for next-generation mass storage devices. However, the achievable storage density of phase-change probe memory is drastically affected by the resulting thermal cross-talk effect while previously lacking of detailed study. Therefore, a three dimensional model that couples electrical, thermal, and phase-change processes of the Ge2Sb2Te5 media is developed, and subsequently deployed to assess the thermal cross-talk effect based on Si/TiN/ Ge2Sb2Te5/diamond-like carbon structure by appropriately tailoring the electro-thermal and geometrical properties of the storage media stack for a variety of external excitations. The modeling results show that the diamond-like carbon capping with a thin thickness, a high electrical conductivity, and a low thermal conductivity is desired to minimize the thermal cross-talk, while the TiN underlayer has a slight impact on the thermal cross-talk. Combining the modeling findings with the previous film deposition experience, an optimized phase-change probe memory architecture is presented, and its capability of providing ultra-high recording density simultaneously with a sufficiently low thermal cross-talk is demonstrated. . © 2018 IOP Publishing Ltd.

Post-treatment Stage of Change Predicts 12-month Outcome of Treatment for Alcohol Problems

PubMed Central

Heather, Nick; McCambridge, Jim

2013-01-01

Aims: To evaluate relationships between clients' self-reported ‘stage of change’ and outcomes after treatment for alcohol problems. Methods: Using data from the ‘United Kingdom Alcohol Treatment Trial’, clients who had received at least one session of treatment and who had complete data (n = 392) entered the analysis. Two continuous measures of drinking behaviour (% days abstinent (PDA) and drinks per drinking day (DDD)) and categorical outcomes at the 12-month follow-up were compared between clients in Pre-action and Action stages of change at either pre- or post-treatment assessment. Multiple and logistic regression analyses examined the relationships between stage of change and treatment outcomes, evaluating the strength of these relationships by controlling for likely confounders. Results: Pre-treatment stage of change did not predict outcome but post-treatment stage of change predicted PDA and DDD at the 12-month follow-up. In unadjusted and adjusted analyses, clients in Action at post-treatment were two to three times more likely to show a favourable categorical outcome, variously defined, than those in Pre-action. There were no differences between clients who had received Motivational Enhancement Therapy and those who had received Social Behaviour and Network Therapy in proportions maintaining or moving towards Action from before to after treatment. Conclusions: These findings confirm previous reports that motivational variables predict outcome of treatment but add that such a relationship is seen for post-treatment stage of change. For therapists, it would seem important to monitor the client's stage of change—which in good clinical practice often occurs in informal ways—and have strategies to deal with low motivation to change whenever it occurs throughout treatment. The findings are also consistent with a ‘common factors’ perspective on effective treatment for alcohol problems. PMID:23408241

Asynchronous data change notification between database server and accelerator controls system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fu, W.; Morris, J.; Nemesure, S.

2011-10-10

Database data change notification (DCN) is a commonly used feature. Not all database management systems (DBMS) provide an explicit DCN mechanism. Even for those DBMS's which support DCN (such as Oracle and MS SQL server), some server side and/or client side programming may be required to make the DCN system work. This makes the setup of DCN between database server and interested clients tedious and time consuming. In accelerator control systems, there are many well established software client/server architectures (such as CDEV, EPICS, and ADO) that can be used to implement data reflection servers that transfer data asynchronously to anymore » client using the standard SET/GET API. This paper describes a method for using such a data reflection server to set up asynchronous DCN (ADCN) between a DBMS and clients. This method works well for all DBMS systems which provide database trigger functionality. Asynchronous data change notification (ADCN) between database server and clients can be realized by combining the use of a database trigger mechanism, which is supported by major DBMS systems, with server processes that use client/server software architectures that are familiar in the accelerator controls community (such as EPICS, CDEV or ADO). This approach makes the ADCN system easy to set up and integrate into an accelerator controls system. Several ADCN systems have been set up and used in the RHIC-AGS controls system.« less

Examining maintenance responsibilities.

PubMed

Lam, K C

2001-06-01

This paper has examined the important responsibilities of the two organisations involved in the provision of maintenance service for the vital building services in many of our highly serviced buildings. The issues raised could be put to beneficial use in both clients and maintenance providers. All in all, the clients should work closely with their maintenance providers. Engineering services in buildings will not perform satisfactorily and efficiently if both parties do not work together and understand the maintenance tasks based on a business partnering mode. Put forward is the view that the management of the activities involved in the operation and maintenance process is a "shared commitment/involvement" between the client and the maintenance provider. It is obvious that many factors can influence the continued effectiveness of a quality maintenance scheme set up by client and provider. Some of these factors are: Change in key personnel Updates in technology Amendments to engineering practice Implementation of legislative requirements Changes in operation by client or provider Change of use of building Passage of time These factors must be fully reviewed by both parties from time to time, and necessary actions taken. A cooperative team working relationship and improved communication should be fostered by the client and his provider for the best management of services maintenance. This arrangement will contribute to better building services systems with continuous improvement; improved value for clients and higher return for the maintenance provider.

Experience-Seeking Characteristics of Methadone Clients.

ERIC Educational Resources Information Center

Kohn, Paul M.; And Others

1979-01-01

Methadone clients scored higher than controls on measures reflecting boredom, desire for change and attraction to physically thrilling activities. Correlations of these measures with length of most recent dependency before treatment, time on program, and time since initial dependency suggest peculiarities of methadone clients antedated involvement…

Reframing Recovery: Developmental Considerations for Maintaining Change

ERIC Educational Resources Information Center

Lawson, Gerard; Lambert, Simone F.; Gressard, Charles F.

2011-01-01

Lasting recovery for clients can be challenging to establish in addictions counseling. Through the combination of 2 approaches, motivational interviewing and developmental counseling and therapy, client treatment can be refined to promote transformative change and long-lasting recovery. (Contains 2 tables.)

The Development and Validation of the Client Expectations of Massage Scale

PubMed Central

Boulanger, Karen T.; Campo, Shelly; Glanville, Jennifer L.; Lowe, John B; Yang, Jingzhen

2012-01-01

Background: Although there is evidence that client expectations influence client outcomes, a valid and reliable scale for measuring the range of client expectations for both massage therapy and the behaviors of their massage therapists does not exist. Understanding how client expectations influence client outcomes would provide insight into how massage achieves its reported effects. Purpose: To develop and validate the Client Expectations of Massage Scale (CEMS), a measure of clients’ clinical, educational, interpersonal, and outcome expectations. Setting: Offices of licensed massage therapists in Iowa. Research Design: A practice-based research methodology was used to collect data from two samples of massage therapy clients. For Sample 1, 21 volunteer massage therapists collected data from their clients before the massage. Factor analysis was conducted to test construct validity and coefficient alpha was used to assess reliability. Correlational analyses with the CEMS, previous measures of client expectations, and the Life Orientation Test–Revised were examined to test the convergent and discriminant validity of the CEMS. For Sample 2, 24 massage therapists distributed study materials for clients to complete before and after a massage therapy session. Structural equation modeling was used to assess the construct, discriminant, and predictive validity of the CEMS. Participants: Sample 1 involved 320 and Sample 2 involved 321 adult massage clients. Intervention: Standard care provided by licensed massage therapists. Main Outcomes: Numeric Rating Scale for pain and Positive and Negative Affect Schedule–Revised (including the Serenity subscale). Results: The CEMS demonstrated good construct, convergent, discriminant and predictive validity, and adequate reliability. Client expectations were generally positive toward massage and their massage therapists. Positive outcome expectations had a positive effect on clients’ changes in pain and serenity. High interpersonal expectations had a negative effect on clients’ changes in serenity. Conclusions: Client expectations contribute to the nonspecific effects of massage therapy. PMID:23087774

Fixed and dynamic predictors of treatment process in therapeutic communities for substance abusers in Belgium.

PubMed

Goethals, Ilse; Vanderplasschen, Wouter; Vandevelde, Stijn; Broekaert, Eric

2012-10-11

Research on substance abuse treatment services in general reflects substantial attention to the notion of treatment process. Despite the growing popularity of process studies, only a few researchers have used instruments specifically tailored to measure the therapeutic community (TC) treatment process, and even fewer have investigated client attributes in relation to early TC treatment process experiences. The aim of the current study is to address this gap by exploring clients' early in-treatment experiences and to determine the predictors that are related to the treatment process, using a TC-specific multidimensional instrument. Data was gathered among 157 adults in five TCs in Flanders (Belgium). Descriptive statistics were used to explore clients' early in-treatment experiences and multiple linear regressions were conducted to determine the fixed and dynamic predictors of Community Environment and Personal Development and Change (two indicators of TC treatment process). Clients reveal a more positive first-month response to TC social processes than to personal-development processes that require self-reflection and insight. The variance in clients' ratings of Community Environment was primarily due to dynamic client factors, while the variance in clients' ratings of Personal Development and Change was only related to fixed client factors. Suitability for treatment was the strongest predictor of Community Environment ratings, whereas a judicial referral more strongly predicted Personal Development and Change scores. Special attention should be devoted to suitability for treatment as part of motivational assessment as this seems to be a very strong predictor of how clients react to the initiation stage of TC treatment. To help improve clients' (meta-)cognitive skills needed to achieve insight and self-reflection and perhaps speed up the process of recovery, the authors suggest the introduction of (meta-)cognitive training strategies in the pre-program and/or the induction stage of a TC program.

Improving the Quality of Postabortion Care Services in Togo Increased Uptake of Contraception

PubMed Central

Mugore, Stembile; Kassouta, Ntapi Tchiguiri K; Sebikali, Boniface; Lundstrom, Laurel; Saad, Abdulmumin

2016-01-01

ABSTRACT High-quality postabortion care (PAC) services that include family planning counseling and a full range of contraceptives at point of treatment for abortion complications have great potential to break the cycle of repeat unintended pregnancies and demand for abortions. We describe the first application of a systematic approach to quality improvement of PAC services in a West African country. This approach—IntraHealth International’s Optimizing Performance and Quality (OPQ) approach—was applied at 5 health care facilities in Togo starting in November 2014. A baseline assessment identified the following needs: reorganizing services to ensure that contraceptives are provided at point of treatment for abortion complications, before PAC clients are discharged; improving provider competencies in family planning services, including in providing long-acting reversible contraceptive implants and intrauterine devices; ensuring that contraceptive methods are available to all PAC clients free of charge; standardizing PAC registers and enhancing data collection and reporting systems; enhancing internal supervision systems at facilities and teamwork among PAC providers; and engaging PAC providers in community talks. Solutions devised and applied at the facilities during OPQ resulted in significant increases in contraceptive counseling and uptake among PAC clients: During the 5-month baseline period, 31% of PAC clients were counseled, while during the 13-month intervention period, 91% were counseled. Of all PAC clients counseled during the baseline period, 37% accepted a contraceptive, compared with 60% of those counseled during the intervention period. Oral contraceptive pills remained the most popular method during both periods, yet uptake of implants increased significantly during the intervention period—from 4% to 27% of those accepting contraceptives. This result demonstrates that the solutions applied maintained method choice while expanding access to underused long-acting reversible contraceptives. OPQ shows great potential for sustainability and scale in Togo and for application in similar contexts where the health system struggles to offer safe, high-quality, accessible PAC services. PMID:27688719

Job Change: A Practitioner's View.

ERIC Educational Resources Information Center

Lenz, Janet G.; Reardon, Robert C.

1990-01-01

Suggests ways that career counselors can use Loughead and Black's "job change thermostat" in working with clients. Program and policy issues include service delivery settings, crisis-oriented versus long-term client needs, individual versus group approaches, staff competence, and availability of resources. (34 references) (SK)

Virtual Libraries: Service Realities.

ERIC Educational Resources Information Center

Novak, Jan

2002-01-01

Discussion of changes in society that have resulted from information and communication technologies focuses on changes in libraries and a new market for library services with new styles of clients. Highlights client service issues to be considered when transitioning to a virtual library situation. (Author/LRW)

Providing therapy can be therapeutic for a therapist.

PubMed

Rosenblatt, Paul C

2009-01-01

In this paper, the case is made that providing therapy to a client can be therapeutic for the therapist. Therapist change is not intentionally sought nor professionally delivered, but is from those client interactions experienced as healing. The possible mechanisms of change for the therapist include exposure of much about him- or herself being "on the line" in therapy, and the therapeutic relationship as a collaborative, two-way system. In the collaborative system, much might affect a therapist, including how the client understands and reacts to the therapist's disposition, motivation, self-disclosure, and skill and what the client reveals about his or her life that may lead the therapist to a new sense of her or his own life.

Simplifying the Analysis of Data from Multiple Heliophysics Instruments and Missions

NASA Astrophysics Data System (ADS)

Bazell, D.; Vandegriff, J. D.

2014-12-01

Understanding the intertwined plasma, particles and fields connecting the Sun and the Earth requires combining data from many diverse sources, but there are still many technological barriers that complicate the merging of data from different instruments and missions. We present an emerging data serving capability that provides a uniform way to access heterogeneous and distributed data. The goal of our data server is to provide a standardized data access mechanism that is identical for data of any format and layout (CDF, custom binary, FITS, netCDF, CSV and other flavors of ASCII, etc). Data remain in their original format and location (i.e., at instrument team sites or existing data centers), and our data server delivers a dynamically reformatted view of the data. Scientists can then use tools (clients that talk to the server) that offer a single interface for browsing, analyzing or downloading many different contemporary and legacy heliophysics data sets. Our current server accesses many CDF data resources at CDAWeb, as well as multiple other instrument team sites. Our webservice will be deployed on the Amazon Cloud at http://datashop.elasticbeanstalk.com/. Two basic clients will also be demonstrated: one in Java and one in IDL. Python, Perl, and Matlab clients are also planned. Complex missions such as Solar Orbiter and Solar Probe Plus will benefit greatly from tools that enable multi-instrument and multi-mission data comparison.

Emerging Thoughts on an Approach to Engaging Pupils in Effective Group Talk in Science

ERIC Educational Resources Information Center

Hewitt, Elizabeth

2014-01-01

Group talk opportunities in science can be a rich site for conceptual change. The role of the teacher is vital in scaffolding the exploratory talk which can lead children to talk their way to new understandings and clarify their ideas with peers. This study aims to uncover teacher strategies which lead to effective talk for developing scientific…

The Value of Client Perceptions in University Strategic Planning: An Empirical Research Study

ERIC Educational Resources Information Center

del Barrio-Garcia, Salvador; Luque-Martinez, Teodoro

2009-01-01

Given the normative changes in higher education at European, national and regional levels, together with social, economic, demographic and technological developments, universities need to adopt a client-oriented approach and to make this client orientation an integral component of their strategic planning process. The university's…

77 FR 75229 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Designation of a Longer...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-19

...-Located Clients December 12, 2012. On October 10, 2012, The NASDAQ Stock Market LLC (``Exchange'' or... change to establish fees for new optional wireless connectivity for co-located clients. The proposed rule... connectivity for co-located clients. [[Page 75230

Equifinality in Functional Analytic Psychotherapy: Different Strokes for Different Folks

ERIC Educational Resources Information Center

Darrow, Sabrina M.; Dalto, Georgia; Follette, William C.

2012-01-01

Functional Analytic Psychotherapy (FAP) is an interpersonal behavior therapy that relies on a therapist's ability to contingently respond to in-session client behavior. Valued behavior change in clients results from the therapist shaping more effective client interpersonal behaviors by providing effective social reinforcement when these behaviors…

Advancing the recovery orientation of hospital care through staff engagement with former clients of inpatient units.

PubMed

Kidd, Sean A; McKenzie, Kwame; Collins, April; Clark, Carrie; Costa, Lucy; Mihalakakos, George; Paterson, Jane

2014-02-01

This study was undertaken to assess the impact of consumer narratives on the recovery orientation and job satisfaction of service providers on inpatient wards that focus on the treatment of schizophrenia. It was developed to address the paucity of literature and service development tools that address advancing the recovery model of care in inpatient contexts. A mixed-methods design was used. Six inpatient units in a large urban psychiatric facility were paired on the basis of characteristic length of stay, and one unit from each pair was assigned to the intervention. The intervention was a series of talks (N=58) to inpatient staff by 12 former patients; the talks were provided approximately biweekly between May 2011 and May 2012. Self-report measures completed by staff before and after the intervention assessed knowledge and attitudes regarding the recovery model, the delivery of recovery-oriented care at a unit level, and job satisfaction. In addition, focus groups for unit staff and individual interviews with the speakers were conducted after the speaker series had ended. The hypothesis that the speaker series would have an impact on the attitudes and knowledge of staff with respect to the recovery model was supported. This finding was evident from both quantitative and qualitative data. No impact was observed for recovery orientation of care at the unit level or for job satisfaction. Although this engagement strategy demonstrated an impact, more substantial change in inpatient practices likely requires a broader set of strategies that address skill levels and accountability.

Supporting Aboriginal Women to Quit Smoking: Antenatal and Postnatal Care Providers' Confidence, Attitudes, and Practices.

PubMed

Tzelepis, Flora; Daly, Justine; Dowe, Sarah; Bourke, Alex; Gillham, Karen; Freund, Megan

2017-05-01

Tobacco use during pregnancy is substantially higher among Aboriginal women compared to non-Aboriginal women in Australia. However, no studies have investigated the amount or type of smoking cessation care that staff from Aboriginal antenatal and postnatal services provide to clients who smoke or staff confidence to do so. This study examined Aboriginal antenatal and postnatal staff confidence, perceived role and delivery of smoking cessation care to Aboriginal women and characteristics associated with provision of such care. Staff from 11 Aboriginal Maternal and Infant Health Services and eight Aboriginal Child and Family Health services in the Hunter New England Local Health District in Australia completed a cross-sectional self-reported survey (n = 67, response rate = 97.1%). Most staff reported they assessed clients' smoking status most or all of the time (92.2%). However, only a minority reported they offered a quitline referral (42.2%), provided follow-up support (28.6%) or provided nicotine replacement therapy (4.7%) to most or all clients who smoked. Few staff felt confident in motivating clients to quit smoking (19.7%) and advising clients about using nicotine replacement therapy (15.6%). Staff confident with talking to clients about how smoking affected their health had significantly higher odds of offering a quitline referral [OR = 4.9 (1.7-14.5)] and quitting assistance [OR = 3.9 (1.3-11.6)] to clients who smoke. Antenatal and postnatal staff delivery of smoking cessation care to pregnant Aboriginal women or mothers with young Aboriginal children could be improved. Programs that support Aboriginal antenatal and postnatal providers to deliver smoking cessation care to clients are needed. Aboriginal antenatal and postnatal service staff have multiple opportunities to assist Aboriginal women to quit smoking during pregnancy and postpartum. However, staff confidence and practices of offering various forms of smoking cessation support to pregnant Aboriginal women is unexplored. This is the first study to examine the amount and type of smoking cessation support Aboriginal antenatal and postnatal service staff provide to Aboriginal women, staff confidence and their perceived role in delivering smoking cessation care. This information is valuable for developing strategies that assist antenatal and postnatal staff to improve their delivery of smoking cessation care to Aboriginal women. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The necessary and sufficient conditions of therapeutic personality change.

PubMed

Rogers, Carl R

2007-09-01

This reprinted article originally appeared in Journal of Consulting Psychology, 1957(Apr), Vol 21(2), 95-103. (The following abstract of the original article appeared in record 1959-00842-001.) "For constructive personality change to occur, it is necessary that these conditions exist and continue over a period of time: (1) Two persons are in psychological contact. (2) The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious. (3) The second person, whom we shall term the therapist, is congruent or integrated in the relationship. (4) The therapist experiences unconditional positive regard for the client. (5) The therapist experiences an empathic understanding of the client's internal frame of reference and endeavors to communicate this experience to the client. (6) The communication to the client of the therapist's empathic understanding and unconditional positive regard is to a minimal degree achieved." (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Coping - Adjusting to Cancer

Cancer.gov

Information that helps you and your family face life’s changes from cancer. Includes talking with your doctors, talking to children, changes for the family, and information on cancer support groups.

An organisational change intervention for increasing the delivery of smoking cessation support in addiction treatment centres: study protocol for a randomized controlled trial.

PubMed

Bonevski, Billie; Guillaumier, Ashleigh; Shakeshaft, Anthony; Farrell, Michael; Tzelepis, Flora; Walsberger, Scott; D'Este, Catherine; Paul, Chris; Dunlop, Adrian; Searles, Andrew; Kelly, Peter; Fry, Rae; Stirling, Robert; Fowlie, Carrie; Skelton, Eliza

2016-06-14

The provision of smoking cessation support in Australian drug and alcohol treatment services is sub-optimal. This study examines the cost-effectiveness of an organisational change intervention to reduce smoking amongst clients attending drug and alcohol treatment services. A cluster-randomised controlled trial will be conducted with drug and alcohol treatment centres as the unit of randomisation. Biochemically verified (carbon monoxide by breath analysis) client 7-day-point prevalence of smoking cessation at 6 weeks will be the primary outcome measure. The study will be conducted in 33 drug and alcohol treatment services in four mainland states and territories of Australia: New South Wales, Australian Capital Territory, Queensland, and South Australia. Eligible services are those with ongoing client contact and that include pharmacotherapy services, withdrawal management services, residential rehabilitation, counselling services, and case management services. Eligible clients are those aged over 16 years who are attending their first of a number of expected visits, are self-reported current smokers, proficient in the English language, and do not have severe untreated mental illness as identified by the service staff. Control services will continue to provide usual care to the clients. Intervention group services will receive an organisational change intervention, including assistance in developing smoke-free policies, nomination of champions, staff training and educational client and service resources, and free nicotine replacement therapy in order to integrate smoking cessation support as part of usual client care. If effective, the organisational change intervention has clear potential for implementation as part of the standard care in drug and alcohol treatment centres. Australian and New Zealand Clinical Trials Registry, ACTRN12615000204549 . Registered on 3 March 2015.

Client Attachment Status and Changes in Therapeutic Alliance Early in Treatment.

PubMed

Siefert, Caleb J; Hilsenroth, Mark J

2015-01-01

Several studies have examined associations between client attachment status and therapeutic alliance. Most, however, measure alliance at a single time point only. This study is among the first to examine how client attachment relates to changes in the therapeutic alliance early in treatment. Forty-six outpatients from a university-based community clinic participated. Attachment status was assessed with the Relationship Questionnaire (Bartholomew & Horowitz, 1991) prior to beginning treatment. Participants rated therapeutic alliance after an evaluation feedback session and again early in psychotherapy. Fearful insecurity was associated with declines in therapeutic alliance, while attachment security was associated with increasing client-therapist bonds. Although unrelated to global alliance, preoccupied insecurity was associated with greater confident collaboration at both time points and declines in idealized relationship from the evaluation to the early therapy time point. Results are discussed in light of prior theoretical formulations and previous research. Limitations of the study are reviewed, implications for clinical practice are noted, and suggestions for future research are made. Assessing client attachment status can provide clinicians with information that helps them identify clients at risk for difficulties establishing a therapeutic alliance. Clients high in attachment security are more likely to develop strong bonds with therapists during the early portion of treatment. Clients high in fearful insecurity are at risk for developing weaker alliances early in treatment. Such clients appear more likely to experience declines in client-therapist bond, goal-task agreement and overall alliance early in the treatment process. Clients high in preoccupied insecurity may enter therapy with great confidence in the therapist and willing to engage in therapy but report more conflicts with therapists in the early phase of treatment. Copyright © 2014 John Wiley & Sons, Ltd.

How would case managers' practice change in a consumer-directed care environment in Australia?

PubMed

You, Emily Chuanmei; Dunt, David; Doyle, Colleen

2017-01-01

The aim of this study was to explore case managers' perceived changes in their practice in the future when consumer-directed care (CDC) is widely implemented in Australia's community aged care system. Purposeful sampling was used and semi-structured individual and group interviews were conducted between September 2012 and March 2013. Participants were drawn from a list of all case managers who administered publicly funded community aged care packages in Victoria, Australia. Empowerment theory was used to guide the analysis and interpretation of the data. The thematic analysis revealed that case managers had mixed views about CDC. They also perceived changes in case managers' practice in the future when CDC is widely implemented. These might specifically include: first, case managers would not directly manage clients' budgets. While some case managers were concerned about losing power for this change, others believed that they would still have important financial roles to perform, such as setting rules, providing financial support and monitoring clients' use of budgets. Second, case managers would focus on performing roles in providing information, and empowering, facilitating and educating clients. These would help to strengthen clients' capacities and assist them to self-manage their care. Third, case managers would work in partnership with clients through frequent or skilful communication, mutual goal setting and goal facilitation. Fourth, case managers would manage more clients. In addition, they would provide less support to each individual client and perform less care co-ordination role. The findings suggest case managers paying attention to power balance regarding budget management in a CDC environment. Furthermore, they might frequently or skilfully communicate with, empower, facilitate and educate clients; work together with them to set up goals; and facilitate them to achieve goals. New research using empowerment theory to examine the actual practice of case managers in a well-established CDC system is warranted. © 2015 John Wiley & Sons Ltd.

Common Factor Mechanisms in Clinical Practice and Their Relationship with Outcome.

PubMed

Gaitan-Sierra, Carolina; Hyland, Michael E

2015-01-01

This study investigates three common factor mechanisms that could affect outcome in clinical practice: response expectancy, the affective expectation model and motivational concordance. Clients attending a gestalt therapy clinic (30 clients), a sophrology (therapeutic technique) clinic (33 clients) and a homeopathy clinic (31 clients) completed measures of expectancy and the Positive Affect and Negative Affect Schedule (PANAS) before their first session. After 1 month, they completed PANAS and measures of intrinsic motivation, perceived effort and empowerment. Expectancy was not associated with better outcome and was no different between treatments. Although some of the 54 clients who endorsed highest expectations showed substantial improvement, others did not: 19 had no change or deteriorated in positive affect, and 18 had the same result for negative affect. Intrinsic motivation independently predicted changes in negative affect (β = -0.23). Intrinsic motivation (β = 0.24), effort (β = 0.23) and empowerment (β = 0.20) independently predicted positive affect change. Expectancy (β = -0.17) negatively affected changes in positive affect. Clients found gestalt and sophrology to be more intrinsically motivating, empowering and effortful compared with homeopathy. Greater improvement in mood was found for sophrology and gestalt than for homeopathy clients. These findings are inconsistent with response expectancy as a common factor mechanism in clinical practice. The results support motivational concordance (outcome influenced by the intrinsic enjoyment of the therapy) and the affective expectation model (high expectations can lead for some clients to worse outcome). When expectancy correlates with outcome in some other studies, this may be due to confound between expectancy and intrinsic enjoyment. Common factors play an important role in outcome. Intrinsic enjoyment of a therapeutic treatment is associated with better outcome. Active engagement with a therapeutic treatment improves outcome. Unrealistic expectations about a therapeutic treatment can have a negative impact on outcome. Copyright © 2014 John Wiley & Sons, Ltd.

Narcissistic deficits in drug abusers: a self-psychological approach.

PubMed

Nighorn, S

1988-09-01

Using empathic abilities and basing understanding of clients on information as the client sees the situation, one can become much more able to detect what individual clients need to begin to feel better about themselves. This would truly add substance to the intervention by increasing self-esteem. By beginning to apply the client's perspective to one's understanding, the practitioner will discover greater depth and meaning, thus helping to change addictions treatment for the better.

Clients' experiences of treatment and recovery in borderline personality disorder: A meta-synthesis of qualitative studies.

PubMed

Katsakou, Christina; Pistrang, Nancy

2017-01-31

This review synthesized findings from qualitative studies exploring clients' experiences of their treatment for borderline personality disorder (BPD) and their perceptions of recovery. Fourteen studies were identified through searches in three electronic databases. The Critical Appraisal Skills Programme was used to appraise the methodological quality of the studies. Thematic analysis was used to synthesize the findings. The meta-synthesis identified 10 themes, grouped into 3 domains. The first domain, "Areas of change," suggests that clients make changes in four main areas: developing self-acceptance and self-confidence; controlling difficult thoughts and emotions; practising new ways of relating to others; and implementing practical changes and developing hope. The second domain, "Helpful and unhelpful treatment characteristics," highlights treatment elements that either supported or hindered recovery: safety and containment; being cared for and respected; not being an equal partner in treatment; and focusing on change. The third domain, "The nature of change," refers to clients' experience of change as an open-ended journey and a series of achievements and setbacks. The meta-synthesis highlights areas of change experienced by individuals receiving treatment for BPD, and treatment characteristics that they value. However, further research is needed to better understand how these changes are achieved. Clinical or methodological significance summary: The present qualitative meta-synthesis brings together findings from 14 qualitative studies. The emerging themes point to areas of improvement in psychological functioning that people struggling with BPD issues have identified as both important and achievable. They also highlight treatment characteristics that might facilitate change in these areas. Treatments emphasizing these characteristics, namely striking a balance between creating a safe, caring space, and actively promoting change, may increase clients' motivation and engagement with services and facilitate recovery.

Talk with Your Mother or Your Sibling? Developmental Changes in Early Family Conversations about Feelings.

ERIC Educational Resources Information Center

Brown, Jane R.; Dunn, Judy

1992-01-01

Developmental changes in the pattern of 50 families' conversations about feelings were examined when the families' second-born children were 33 and 47 months old. The total amount of talk and the frequency of talk about feelings between sibling pairs increased, whereas the amount of mother-child conversation and references to feelings decreased.…

“Directive Approach” for Chinese Clients Receiving Psychotherapy: Is That Really a Priority?

PubMed Central

Ng, Chi Ting Connie; James, Susan

2013-01-01

The academic literature often suggests that Chinese people prefer directive approaches in therapy. However, studies on this topic are often based on therapists’ self-reports: clients’ perceptions are rarely considered. What does “directive approach” mean? Is it what clients prefer? Using cultural psychology and medical anthropology as a theoretical framework, the ethnography explored the experience of psychotherapy from Chinese clients’ perspectives. Specifically, using ethnographic interview, eight informants, two male and six female, ranging in age from 40 to 55, were interviewed twice in-depth about their experiences of seeing Chinese therapists. All informants are Chinese immigrants who reside in a major Canadian city and saw at least one Chinese therapist in a community counseling agency within 1 year prior to the interview. In the first interview, informants created group of cards describing a list of hypothesized cultural knowledge regarding psychotherapy. After initial data analysis, the cards were presented to the informants in the second interviews, in which they confirmed and/or rejected the hypotheses by grouping, reorganizing, and ranking the cards. In the end each informant created a number of mind-maps with the cards, which served as a representation of informants’ psychological reality of psychotherapy based on their ordinary language. The maps were then further analyzed for themes among informants. Results suggest that clients appreciate therapists who “give homework,” “analyze their problems,” “talk about strategies that other clients have found useful,” “chat,” and “provide resources.” Results also highlight informants’ understanding of their own responsibility for the therapeutic relationship which has never been documented before and has important clinical implications. PMID:23408043

Toy talk: simple strategies to create richer grammatical input.

PubMed

Hadley, Pamela A; Walsh, Kathleen M

2014-07-01

The purpose of this initial feasibility study was to determine whether brief instruction in toy talk would change grammatical properties of adult language, specifically 3rd person lexical noun phrase (NP) subjects. Eighteen college students participated in the study. The use of 3rd person subjects was examined before and after instruction on toy talk strategies (i.e., talk about the toys, give the item its name). Change in the input informativeness for tense (i.e., the proportion of verb forms marked for tense out of all verb forms) was also examined, although adults were not instructed on use of tense/agreement morphemes. Following instruction, statistically significant increases with large effect sizes were observed for use of 3rd person subjects, lexical NP subjects, and input informativeness for tense (Cohen's d = 1.20, 2.08, and 0.89, respectively). These findings demonstrate that young adults can learn these simple strategies with relatively brief instruction, and the use of toy talk also changes the richness of tense/agreement marking in adult language input. Considerations for incorporating toy talk into existing language modeling practices and future plans for evaluating the efficacy of toy talk are discussed.

The emerging role of the client in the delivery of primary care to older Americans.

PubMed Central

Counte, M A

1998-01-01

OBJECTIVE: To address the likely influences, on options faced by older clients, of specific changes in the delivery system and several possible responses to these changes and the changed options, by older persons in the aggregate. STUDY DESIGN: Four specific topics are discussed at length: (1) the probable altered role for the older healthcare client brought on by organizational changes; (2) findings from research on elderly health maintenance behavior and reasons for the increased importance of this issue; (3) the effectiveness of the conventional approach to explaining health services utilization in population studies; and (4) recommendations for future research into the direct or indirect influence of organizational changes in the primary healthcare system on the health-related decisions and behaviors of older persons. PMID:9618677

Toward the Style of the Community Change Educator.

ERIC Educational Resources Information Center

Franklin, Richard

Variations and implications of change agents' patterns or styles of interaction with client systems (individuals, groups, or multigroups) are discussed. Five styles are defined: (1) the instructor, who imparts information to clients and interacts only with his agency; (2) the paterfamilias, who exercises personal, paternalistic influence and…

An exploratory study of engagement in a technology-supported substance abuse intervention

PubMed Central

2010-01-01

Background The continuing gap between the number of people requiring treatment for substance use disorders and those receiving treatment suggests the need to develop new approaches to service delivery. Meanwhile, the use of technology to provide counseling and support in the substance abuse field is exploding. Despite the increase in the use of technology in treatment, little is known about the impact of technology-supported interventions on access to services for substance use disorders. The E-TREAT intervention brings together the evidence-based practice of Motivational Interviewing and theories of Persuasive Technology to sustain clients' motivation to change substance use behaviors, provide support for change, and facilitate continuity across treatment settings. Methods This study used descriptive statistics, tests of statistical significance, and logistic regression to explore the characteristics and perceptions of the first 157 people who agreed to participate in E-TREAT and the predictors of their active engagement in E-TREAT services. In addition, responses to open-ended questions about the participants' experiences with the intervention were analyzed. Results The data reveal that clients who engaged in E-TREAT were more likely than those who did not engage to be female, have children and report a positive relationship with their recovery coach, and were less likely to have completed treatment for a substance use disorder in the past. A majority of people engaging in E-TREAT reported that it was helpful to talk with others with similar problems and that the program assisted them in developing a sense of community. Conclusions The authors conclude that technology-assisted interventions hold promise in expanding access to treatment for substance use disorders especially for women and parents. Further, the characteristics of the relationship with a coach or helper may be critical to engagement in technology-supported interventions. Additional investigation into ways technology may be useful to enhance treatment access for certain subgroups is needed. PMID:20529338

An Evaluation of Army Wellness Center Clients' Health-Related Outcomes.

PubMed

Rivera, L Omar; Ford, Jessica Danielle; Hartzell, Meredith Marie; Hoover, Todd Allan

2018-01-01

To examine whether Army community members participating in a best-practice based workplace health promotion program (WHPP) experience goal-moderated improvements in health-related outcomes. Pretest/posttest outcome evaluation examining an autonomously participating client cohort over 1 year. Army Wellness Center facilities on 19 Army installations. Army community members sample (N = 5703), mostly Active Duty Soldiers (64%). Assessment of health risks with feedback, health assessments, health education classes, and health coaching sessions conducted by health educators at a recommended frequency of once a month for 3 to 12 months. Initial and follow-up outcome assessments of body mass index (BMI), body fat, cardiorespiratory fitness, blood pressure, and perceived stress. Mixed model linear regression testing for goal-moderated improvements in outcomes. Clients experienced significant improvements in body fat (-2% change), perceived stress (-6% to -12% change), cardiorespiratory fitness (+6% change), and blood pressure (-1% change) regardless of health-related goal. Only clients with a weight loss goal experienced BMI improvement (-1% change). Follow-up outcome assessment rates ranged from 44% (N = 2509) for BMI to 6% (N = 342) for perceived stress. Army Wellness Center clients with at least 1 follow-up outcome assessment experienced improvements in military readiness correlates and chronic disease risk factors. Evaluation design and follow-up-related limitations notwithstanding results suggest that best practices in WHPPs can effectively serve a globally distributed military force.

The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes.

PubMed

Winters, S; Kool, R B; Klazinga, N S; Huijsman, R

2014-08-01

To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate structure, QI activities and performance improvements on indicators. In total, 169 residential care homes for the elderly in the Netherlands. Change between 2007 and 2009 in client-reported and professional indicators. A middle-size corporate structure was associated with QI. The QI activity 'multidisciplinary team meetings' was positively correlated with the indicator 'safety environment' for somatic and psycho-geriatric care. The QI activities 'educational material' and 'direct work instructions' were associated negatively with the indicator 'availability of personnel' for somatic clients, but positively for psycho-geriatric clients. QI activities such as 'health plan activities', 'clinical lessons' and 'financial activities' had no relationship to improved performance. For psycho-geriatric clients mainly organizational QI activities were positively associated with QI. The mediating role of the corporate structure for performing QI activities appeared stronger for the change in client-reported than for professional indicators. This study reveals associations between QI activities and corporate structure and changes in indicator performance. A corporate structure was associated with improvement in client-reported indicators, but less on professional indicators, which assumes a central policy at corporate level with impact on client-reported indicators, in contrast to a more local level approach towards activities that result in QI on professional indicators. Tailoring QI activities at the right managerial level may be important to achieve improvement. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

A transactional framework for pediatric rehabilitation: shifting the focus to situated contexts, transactional processes, and adaptive developmental outcomes.

PubMed

King, Gillian; Imms, Christine; Stewart, Debra; Freeman, Matt; Nguyen, Tram

2018-07-01

A paradigm shift is taking place in pediatric rehabilitation research, practice, and policy - a shift towards the real-life contexts of clients rather than requiring clients to navigate the world of pediatric rehabilitation. This article proposes a conceptual framework to bring about a broader awareness of clients' lives and transactional processes of change over the life course. The framework draws attention to transactional processes by which individuals, situated in life contexts, change and adapt over the life course and, in turn, influence their contextual settings and broader environments. This framework is based on (a) basic tenets derived from foundational theories taking a life course perspective to change, and (b) transactional processes identified from relevant pediatric rehabilitation models that bring these foundational theories into the pediatric rehabilitation sphere. The framework identifies three types of transactional processes relevant to pediatric rehabilitation: facilitative, resiliency, and socialization processes. These processes describe how contexts and people mutually influence each other via opportunities and situated experiences, thus facilitating capacity, adaptation to adversity, and socialization to new roles and life transitions. The utility of the framework is considered for research, practice, service organizations, and policy. Implications for Rehabilitation The framework supports practitioners going beyond person and environment as separate entities, to provide services to the "situated person" in real-life contexts The framework shifts the focus from "body structures/functions" and "person in activity" to "person in changing and challenging life contexts" Working from a transactional perspective, practitioner-client conversations will change; practitioners will view client situations through a lens of opportunities and experiences, assess client experiences in real-life contexts, and strive to create context-based therapy opportunities The framework suggests the benefit of greater focus on resiliency processes to support client self-efficacy, self-determination, and autonomy, and socialization processes to enhance ability to enact new life roles at times of transition.

Client attachment in a randomized clinical trial of psychoanalytic and cognitive-behavioral psychotherapy for bulimia nervosa: Outcome moderation and change.

PubMed

Daniel, Sarah Ingrid Franksdatter; Poulsen, Stig; Lunn, Susanne

2016-06-01

In the context of a randomized clinical trial of psychoanalytic psychotherapy (PPT) versus cognitive behavior therapy (CBT) for bulimia nervosa (BN), this study performed secondary analyses of (a) the relation between attachment and pretreatment symptom levels, (b) whether client pretreatment attachment moderated treatment outcome, (c) whether change in client attachment was associated with symptomatic change, and (d) whether client attachment changed differently in the 2 treatments. Sixty-nine women and 1 man of a mean age of 25.8 years diagnosed with BN were randomly assigned to either 2 years of weekly PPT or 5 months of CBT. Assessments at intake, after 5 months, and after 2 years included the Eating Disorder Examination to assess eating disorder symptoms, the Adult Attachment Interview to assess client attachment, and the Symptom Checklist 90-R to assess general psychiatric distress. Repeated measures were analyzed using multilevel analysis. Higher scores on attachment insecurity and attachment preoccupation were associated with more frequent binging pretreatment. Pretreatment attachment did not predict treatment outcome. In PPT, but not in CBT, reduction of binging was associated with an increase in attachment security. The 2 treatment types were not associated with significantly different patterns of attachment-related change. Degree and type of attachment insecurity is related to the frequency of binging in BN. Increase in attachment security may be a treatment-specific mechanism of change in PPT for BN. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

"What's So Special About HIV and AIDS?": Stresses and Strains for Clients and Counsellors.

ERIC Educational Resources Information Center

Kiemle, Gundi

1994-01-01

Discusses supervision and counseling of people with AIDS. Addresses the impact upon the client and the counselor against the background of stigmatization. Conflicts and losses arising at different stages are explored. Discusses implications for the need for supervision to facilitate changes necessary to cope with clients' and counselors' feelings…

Neurons on the couch.

PubMed

Marić, Nadja P; Jašović-Gašić, Miroslava

2010-12-01

A hundred years after psychoanalysis was introduced, neuroscience has taken a giant step forward. It seems nowadays that effects of psychotherapy could be monitored and measured by state-of-the art brain imaging techniques. Today, the psychotherapy is considered as a strategic and purposeful environmental influence intended to enhance learning. Since gene expression is regulated by environmental influences throughout life and these processes create brain architecture and influence the strength of synaptic connections, psychotherapy (as a kind of learning) should be explored in the context of aforementioned paradigm. In other words, when placing a client on the couch, therapist actually placed client's neuronal network; while listening and talking, expressing and analyzing, experiencing transference and counter transference, therapist tends to stabilize synaptic connections and influence dendritic growth by regulating gene-transcriptional activity. Therefore, we strongly believe that, in the near future, an increasing knowledge on cellular and molecular interactions and mechanisms of action of different psycho- and pharmaco-therapeutic procedures will enable us to tailor a sophisticated therapeutic approach toward a person, by combining major therapeutic strategies in psychiatry on the basis of rational goals and evidence-based therapeutic expectations.

Improving client and nurse satisfaction through the utilization of bedside report.

PubMed

Vines, Mary M; Dupler, Alice E; Van Son, Catherine R; Guido, Ginny W

2014-01-01

Bedside reporting improves client safety and trust and facilitates nursing teamwork and accountability; however, many nurses do not consider it best practice when caring for their clients. A literature review was conducted to determine whether bedside report is an essential shift handover process that promotes both client and nursing satisfaction. Implications for nurses in professional development are discussed, and strategies for developing and implementing bedside report using Lewin's theory of planned change are provided.

The Organization as Client: Broadening the Concept of Employee Assistance Programs.

ERIC Educational Resources Information Center

Googins, Bradley; Davidson, Bruce N.

1993-01-01

Notes that many employee assistance programs (EAPs) are broadening their function to address rapidly changing human and social issues of environments in which they operate, refocusing practice to include organization as the client. Discusses traditional EAP practice, evolution of EAPs, changes confronting corporations, and alternative model in…

Creating an Articulate Classroom: Examining Pre-Service Teachers' Experiences of Talk

ERIC Educational Resources Information Center

Fisher, Annie Therese

2011-01-01

This paper examines the continuing "issue" of developing classrooms where talk is used as means of building concepts and understanding. As curriculum guidance increasingly refers to "exploratory talk" and "dialogic talk", it questions why practice seems resistant to change, despite the promotion of social constructivist approaches to learning in…

Talking About Antismoking Campaigns: What Do Smokers Talk About, and How Does Talk Influence Campaign Effectiveness?

PubMed

Brennan, Emily; Durkin, Sarah J; Wakefield, Melanie A; Kashima, Yoshihisa

2016-01-01

Campaign-stimulated conversations have been shown to increase the effectiveness of antismoking campaigns. In order to explore why such effects occur, in the current study we coded the content of naturally occurring conversations. We also examined whether the short-term effects of talking, and of different types of talk, on quitting intentions were mediated through intrapersonal message responses. Using the Natural Exposure(SM) methodology, we exposed 411 smokers to 1 of 6 antismoking advertisements while they were watching television at home. Responses to the advertisement-conversation participation and content, emotional responses, personalized perceived effectiveness, and changes in intentions to quit-were measured within 3 days of exposure. Conversations were coded for appraisal of the advertisement (favorable, neutral, or unfavorable) and the presence of quitting talk and emotion talk. Mediation analyses indicated that the positive effects of talking on intention change were mediated through personalized perceived effectiveness and that the positive effects were driven by conversations that contained a favorable appraisal and/or quitting talk. Conversely, conversations that contained an unfavorable appraisal of the advertisement were negatively associated with campaign effectiveness. These findings highlight the importance of measuring interpersonal communication when evaluating campaigns and the need for further research to identify the message characteristics that predict when smokers talk and when they talk only in desirable ways.

Analysis of Sea Level Rise in Action

NASA Astrophysics Data System (ADS)

Gill, K. M.; Huang, T.; Quach, N. T.; Boening, C.

2016-12-01

NASA's Sea Level Change Portal provides scientists and the general public with "one-stop" source for current sea level change information and data. Sea Level Rise research is a multidisciplinary research and in order to understand its causes, scientists must be able to access different measurements and to be able to compare them. The portal includes an interactive tool, called the Data Analysis Tool (DAT), for accessing, visualizing, and analyzing observations and models relevant to the study of Sea Level Rise. Using NEXUS, an open source, big data analytic technology developed at the Jet Propulsion Laboratory, the DAT is able provide user on-the-fly data analysis on all relevant parameters. DAT is composed of three major components: A dedicated instance of OnEarth (a WMTS service), NEXUS deep data analytic platform, and the JPL Common Mapping Client (CMC) for web browser based user interface (UI). Utilizing the global imagery, a user is capable of browsing the data in a visual manner and isolate areas of interest for further study. The interfaces "Analysis" tool provides tools for area or point selection, single and/or comparative dataset selection, and a range of options, algorithms, and plotting. This analysis component utilizes the Nexus cloud computing platform to provide on-demand processing of the data within the user-selected parameters and immediate display of the results. A RESTful web API is exposed for users comfortable with other interfaces and who may want to take advantage of the cloud computing capabilities. This talk discuss how DAT enables on-the-fly sea level research. The talk will introduce the DAT with an end-to-end tour of the tool with exploration and animating of available imagery, a demonstration of comparative analysis and plotting, and how to share and export data along with images for use in publications/presentations. The session will cover what kind of data is available, what kind of analysis is possible, and what are the outputs.

Future prospect 2012-2025 - How will our business change for the next 10 years -

NASA Astrophysics Data System (ADS)

Tanaka, Sakae

2013-04-01

The purpose of this lecture is to discuss about the "Future". How our business will change in the next 10 years? I believe the key is 3 mega-trends "Sustainability", "Cloud Computing" and "Life Innovation". With the development of social environment, the required business will change, too. The future would be invisible if you shut yourself up in your single industry. It is important to see various business fields horizontally, and recognize various key changes stereoscopically such as demographics, economy, technology, sense of value and lifestyle, when you develop mid-and-long term strategy. "Cloud" is silent, but the revolution of personal computing. It will bring the drastic changes in every industry. It will make "voice" and "moving image" possible to use as the interface to access your computer. Cloud computing will also make the client device more diversified and spread the application range widely. 15 years ago, the term "IT" was equivalent to "personal computer". Recently, it rather means to use smartphone and tablet device. In the next several years, TV and car-navigation system will be connected to broadband and it will become a part of personal computing. The meaning of personal computing is changing essentially year by year. In near future, the universe of computing will expand to the energy, medical and health-care, and agriculture etc. It passed only 20 years since we use "Computer" in a full scale operation. Recently, computer has start understanding our few words and talking in babble like a baby. The history of computing has just started.

Changing our minds: a commentary on `Conceptual change: a discussion of theoretical, methodological and practical challenges for science education'

NASA Astrophysics Data System (ADS)

Mercer, Neil

2008-07-01

This paper begins with a consideration of some important themes dealt with in the paper by Treagust and Duit. These include the relationship between research on conceptual change and educational practice, the significance of emotion and identity in the process of conceptual change, and role of cognitive conflict in motivating change. I then argue that the authors implicitly assert the importance of spoken dialogue as a motor for conceptual change, but do not give it the proper, explicit recognition that it deserves. I first use their own data of transcribed talk to make this point, and then go on to elaborate my case by drawing on other research. Talk amongst students and teacher-student talk are both considered. My conclusion is that while more empirical research is needed to understand how dialogue is involved in conceptual change, available evidence shows very clearly that the role of talk and social interaction is so significant that it cannot be ignored. It is therefore necessary for theoretical accounts to deal with both social (i.e. communicative) and cognitive aspects of conceptual change.

Psychological Counseling Processes of Prospective Psychological Counsellors: An Investigation of Client-Counsellor Interactions

ERIC Educational Resources Information Center

Sanberk, Ismail; Akbas, Turan

2015-01-01

The general purpose of this study is to investigate the client-counsellor interaction in the psychological counseling process at the verbal behavior level. The study also aims to analyze the relationship between the behaviors observed in the process with both clients and counsellors' evaluations of sessions and whether changes were observed in…

Correlations of Male College Students' Verbal Response Mode Use in Psychotherapy with Measures of Psychological Disturbance and Psychotherapy Outcome.

ERIC Educational Resources Information Center

McDaniel, Susan H.; And Others

1981-01-01

Compared verbal response mode use by male students with measures of clients' psychological distress, disturbance, and change. Results indicated more distressed clients used a higher percentage of disclosures and lower percentage of edifications, clients who improved more participated more, no relationship between improvement in psychotherapy and…

Second-Class Citizen? Contract Workers' Perceived Status, Dual Commitment and Intent to Quit

ERIC Educational Resources Information Center

Boswell, Wendy R.; Watkins, Maria Baskerville; Triana, Maria del Carmen; Zardkoohi, Asghar; Ren, Run; Umphress, Elizabeth E.

2012-01-01

Outsourcing of jobs to contract workers who work alongside a client's employees has changed the human resource landscape of many organizations. In this study we examine how a contract worker's perceived employment status similarity to the client's own standard employees influences his/her affective commitment to both the client and the employer…

Relationships between public health nurse-delivered physical activity interventions and client physical activity behavior.

PubMed

Olsen, Jeanette M; Horning, Melissa L; Thorson, Diane; Monsen, Karen A

2018-04-01

The purpose of this study was to identify physical activity interventions delivered by public health nurses (PHNs) and examine their association with physical activity behavior change among adult clients. Physical activity is a public health priority, yet little is known about nurse-delivered physical activity interventions in day-to-day practice or their outcomes. This quantitative retrospective evaluation examined de-identified electronic-health-record data. Adult clients with at least two Omaha System Physical activity Knowledge, Behavior, and Status (KBS) ratings documented by PHNs between October 2010-June 2016 (N=419) were included. Omaha System baseline and follow-up Physical activity KBS ratings, interventions, and demographics were examined. Younger clients typically receiving maternal-child/family services were more likely to receive interventions than older clients (p<0.001). A total of 2869 Physical activity interventions were documented among 197 clients. Most were from categories of Teaching, Guidance, Counseling (n=1639) or Surveillance (n=1183). Few were Case Management (n=46). Hierarchical regression modeling explained 15.4% of the variance for change in Physical activity Behavior rating with significant influence from intervention dose (p=0.03) and change in Physical activity Knowledge (p<0.001). This study identified and described physical activity interventions delivered by PHNs. Implementation of department-wide policy requiring documentation of Physical activity assessment for all clients enabled the evaluation. A higher dose of physical activity interventions and increased Physical activity knowledge were associated with increased Physical activity Behavior. More research is needed to identify factors influencing who receives interventions and how interventions are selected. Copyright © 2017 Elsevier Inc. All rights reserved.

Talking theory, talking therapy: Emmy Gut and John Bowlby.

PubMed

Ross, Lynda R

2006-06-01

Emmy Gut was a psychotherapist who developed, in her later years, a unique theory distinguishing between "productive" and "unproductive" depression. Dr. John Bowlby was a leading psychoanalyst famous for his work on attachment theory. After the death of her second husband, Emmy contacted John because his work on mourning and grief spoke to her own depressed state. Although her views of the world and of her relationship with John were clearly coloured by bouts of depression, she was profoundly influenced by her personal, therapeutic, and intellectual involvement with him. Evidence of his influence is seen in the volumes of correspondence flowing between them beginning in 1971 and continuing until John's death in 1990. During that time, Emmy wrote more than 100-some very lengthy-letters to John. Much of her correspondence was devoted to discussions about their often ambiguous and conflicted therapeutic relationship. Through an analysis of attachment theory and the nature of the client-therapist alliance, this paper offers insights into the effects that imbalances in power, expectations, and shifting needs can play in the recovery process.

HIV prevalence, attitudes and behaviour in clients of a confidential HIV testing and counselling centre in Uganda.

PubMed

Müller, O; Barugahare, L; Schwartländer, B; Byaruhanga, E; Kataaha, P; Kyeyune, D; Heckmann, W; Ankrah, M

1992-08-01

To describe clients, operation and impact of an African public HIV testing and counselling centre. Analysis of samples from clients attending the AIDS Information Centre (AIC) in Kampala, Uganda in early 1991. HIV-1-positive and HIV-negative consecutive clients (250 of each), 86 consecutive couples, and 200 consecutive clients who were HIV-negative in 1990 and were attending for their repeat test. HIV seroprevalence rates, attitudes, behaviour and behaviour change. HIV-1 prevalence was 28% overall, 24% in men and 35% in women. Reasons for taking the HIV test were a planned marriage or a new relationship (27%; 84% in couples), to plan for the future (35%), distrust of sexual partner (14%) and illness or disease/death (not HIV-specific) of partner (20%). The majority of the reported intentions in response to a positive or a negative HIV test result were positive, demonstrating the ability to cope with this information. Of repeat clients, two (1%) had become HIV-1-positive. The majority of repeat clients reported one sexual partner only (67%) or sexual abstinence (25%). Compared with pre-test information from AIC clients attending for the first time, repeat clients reported casual sexual contacts less often (6 versus 25%) and, of those, the majority used condoms. Our study demonstrates the demand for and the feasibility of confidential HIV testing and counseling services in Uganda, and illustrates the value of these services in achieving behaviour changes. Such services should be considered an additional approach for the reduction of HIV transmission in Africa, especially in areas with high HIV seroprevalence rates.

Impact of an Adlerian Based Pretrial Diversion Program: Self Concept and Dissociation

ERIC Educational Resources Information Center

Norvell, Jeanell J.

2010-01-01

Clients' self concepts and dissociative experiences were examined to determine the impact of an Adlerian based pretrial diversion program. Clients completing the program displayed a significant change in self concepts and dissociative experiences. A repeated measures multivariate analysis of variance indicated a 35% change, made up of the…

'Getting things done': an everyday-life perspective towards bridging the gap between intentions and practices in health-related behavior.

PubMed

van Woerkum, Cees; Bouwman, Laura

2014-06-01

In this paper, we aim to add a new perspective to supporting health-related behavior. We use the everyday-life view to point at the need to focus on the social and practical organization of the concerned behavior. Where most current approaches act disjointedly on clients and the social and physical context, we take the clients' own behavior within the dynamics of everyday context as the point of departure. From this point, healthy behavior is not a distinguishable action, but a chain of activities, often embedded in other social practices. Therefore, changing behavior means changing the social system in which one lives, changing a shared lifestyle or changing the dominant values or existing norms. Often, clients experience that this is not that easy. From the everyday-life perspective, the basic strategy is to support the client, who already has a positive intention, to 'get things done'. This strategy might be applied to those cases, where a gap is found between good intentions and bad behavior.

Growth curves of clients' emotional experience and their association with emotion regulation and symptoms.

PubMed

Fisher, Hadar; Atzil-Slonim, Dana; Bar-Kalifa, Eran; Rafaeli, Eshkol; Peri, Tuvia

2017-12-06

Emotional experience during psychotherapy is considered a core mechanism of change. Yet the sheer experience itself may not necessarily be beneficial; instead, the trajectories of emotional experience need to be explored as possible predictors of treatment outcomes. This study investigated whether clients' pre-treatment levels of emotion regulation and symptoms predicted patterns of session-to-session change in emotional experience. We also explored which patterns better predict clients' improvement in emotion regulation and symptoms from pre- to post treatment. One-hundred and seven clients undergoing psychodynamic psychotherapy completed questionnaires on their symptoms and emotion regulation at pre- and post- treatment. They also reported their level of emotional experience at the end of each session. Pre-treatment symptoms and difficulties in emotion regulation predicted greater instability in emotional experience. Higher mean levels of emotional experience during treatment were associated with an improvement in emotion regulation, and greater stability during treatment was associated with improvement in emotion regulation and symptoms. These findings lend weight to the idea that experiencing emotion in the therapeutic environment has significant implications for clients' ability to manage their emotions outside the session. However, emotions experienced in an unstable manner within therapy are associated with poorer outcomes. Clinical and methodological significance of this article: Therapists can benefit from observing the patterns and not only the level of their clients' emotional experiences. The identification of clients' difficulties early in treatment may help therapists guide clients through the delicate process of carefully attending to their emotions.

Dilemmas of talking about lifestyle changes among couples coping with a cardiac event.

PubMed

Goldsmith, Daena J; Lindholm, Kristin A; Bute, Jennifer J

2006-10-01

Persons who have experienced a myocardial infarction (MI) and/or coronary artery bypass graft (CABG) surgery may benefit from a low-fat diet, regular exercise, smoking cessation, and stress management. Yet many patients do not make these changes. A spouse or partner's attempts at support may facilitate or interfere with patient behavior change. The present study explores dilemmas that may arise when couples talk about lifestyle changes following one person's MI or CABG. In interviews carried out in Urbana-Champaign, Illinois, and surrounding communities with 25 patients and 16 partners we found communicating support for lifestyle change may be interpreted as undesired control or criticism. The caring conveyed by talking may be viewed positively but can also threaten patient autonomy and entrap partners in unwanted expectations and obligations. Finally, lifestyle change conversations may reflect empowered patients collaborating with partners to take control of health but can also serve as potent reminders of loss. These multiple, potentially conflicting meanings give an account for why talking with a partner does not always facilitate patient lifestyle change. Understanding these dilemmas also suggests practical implications for helping patients and partners.

What big size you have! Using effect sizes to determine the impact of public health nursing interventions.

PubMed

Johnson, K E; McMorris, B J; Raynor, L A; Monsen, K A

2013-01-01

The Omaha System is a standardized interface terminology that is used extensively by public health nurses in community settings to document interventions and client outcomes. Researchers using Omaha System data to analyze the effectiveness of interventions have typically calculated p-values to determine whether significant client changes occurred between admission and discharge. However, p-values are highly dependent on sample size, making it difficult to distinguish statistically significant changes from clinically meaningful changes. Effect sizes can help identify practical differences but have not yet been applied to Omaha System data. We compared p-values and effect sizes (Cohen's d) for mean differences between admission and discharge for 13 client problems documented in the electronic health records of 1,016 young low-income parents. Client problems were documented anywhere from 6 (Health Care Supervision) to 906 (Caretaking/parenting) times. On a scale from 1 to 5, the mean change needed to yield a large effect size (Cohen's d ≥ 0.80) was approximately 0.60 (range = 0.50 - 1.03) regardless of p-value or sample size (i.e., the number of times a client problem was documented in the electronic health record). Researchers using the Omaha System should report effect sizes to help readers determine which differences are practical and meaningful. Such disclosures will allow for increased recognition of effective interventions.

The rehabilitation plan can support clients' active engagement and facilitate the process of change - experiences from people with late effects of polio participating in a rehabilitation programme.

PubMed

Lexell, Eva Månsson; Lexell, Jan; Larsson-Lund, Maria

2016-01-01

To explore how the rehabilitation plan influences the rehabilitation process and its outcome in people with late effects of polio participating in an individualised goal-oriented interdisciplinary rehabilitation programme. Four women and two men with late effects of polio were interviewed before rehabilitation, at discharge, and at follow-up. Data were analysed according to the constant comparative method of grounded theory. The participants' experiences formed one core category: "The same starting point but different rehabilitation processes". Before rehabilitation, all participants experienced a similar starting point: Naïve understanding of rehabilitation. During rehabilitation, two separate processes followed. Four participants experienced their rehabilitation as being a mutually shared process that led to a process of change. They were actively engaged, using the rehabilitation plan, and working towards goals targeting a broad perspective of daily activities. The remaining two participants experienced their rehabilitation as a staff-directed process, with limited use of the rehabilitation plan, focusing on goals mainly related to body functions and self-care, not leading to any substantial changes. When clients experience that they develop a mutually shared rehabilitation process, based on a rehabilitation plan, they became more engaged in their rehabilitation and gained a better understanding of their participation during the process. Knowledge of the differences in how clients use the rehabilitation plan during the rehabilitation process can support their active engagement during rehabilitation. This, in turn, can promote a more holistic view among clients and professionals during the rehabilitation for people with late effects of polio. Implications for Rehabilitation Clients who experience a rehabilitation that is mutually shared with professionals, have a better understanding of their engagement during the rehabilitation process. When clients and professionals use the rehabilitation plan as a mutual tool, clients become more actively engaged in their rehabilitation process. A structured rehabilitation plan can serve as a map, and support clients' process of change during the rehabilitation process, also after the rehabilitation period is completed.

Psychometrics of the Personal Questionnaire: A client-generated outcome measure.

PubMed

Elliott, Robert; Wagner, John; Sales, Célia M D; Rodgers, Brian; Alves, Paula; Café, Maria J

2016-03-01

We present a range of evidence for the reliability and validity of data generated by the Personal Questionnaire (PQ), a client-generated individualized outcome measure, using 5 data sets from 3 countries. Overall pretherapy mean internal consistency (alpha) across clients was .80, and within-client alphas averaged .77; clients typically had 1 or 2 items that did not vary with the other items. Analyses of temporal structure indicated high levels of between-clients variance (58%), moderate pretherapy test-retest correlation (r = .57), and high session-to-session Lag-1 autocorrelation (.82). Scores on the PQ provided clear evidence of convergence with a range of outcome measures (within-client r = .41). Mean pre-post effects were large (d = 1.25). The results support a revised caseness cutoff of 3.25 and a reliable change index interval of 1.67. We conclude that PQ data meet criteria for evidence-based, norm-referenced measurement of client psychological distress for supporting psychotherapy practice and research. (c) 2016 APA, all rights reserved).

When therapists do not want their clients to be homosexual: a response to Rosik's article.

PubMed

Green, Robert-Jay

2003-01-01

This commentary is a response to Rosik's "Motivational, Ethical, and Epistemological Foundations in the Treatment of Unwanted Homoerotic Attraction" (this issue). Such treatment raises complex questions that cannot be resolved by focusing on the therapist's conservative versus liberal values. Most such clients are deeply ambivalent about their homosexual attractions. The degree to which their homosexuality is "unwanted" is highly variable among them and sometimes within them over time. Clients who are exclusively homosexual are very unlikely to be able to change their sexual attractions, whereas some clients who are bisexual may be more able to "manage" their homoerotic attractions (acting only on their heterosexual feelings). Marriage and family therapists should be able to support a client along whatever sexual orientation path the client ultimately takes, and the client's sense of integrity and interpersonal relatedness are the most important goals of all.

From Discharge Planner to “Concierge”: Recommendations for Hospital Social Work by Clients with Intracerebral Hemorrhage

PubMed Central

Linton, Kristen F.; Ing, Marissa M.; Vento, Megan A.; Nakagawa, Kazuma

2016-01-01

Purpose The Affordable Care Act and budget cuts have changed the role of hospital social workers by placing pressure on them to conduct speedy discharges and decrease readmission rates. This qualitative study aimed to assess if hospital social work is meeting the needs of clients in the hospital and post-discharge. Methods Semi-structured interviews with 10 clients with intracerebral hemorrhage (ICH) and 11 caregivers were conducted. Results Participants reported that social work services were not meeting their needs. Clients with ICH and their caregivers expressed needs from social workers that surpassed their roles as discharge planners, including counseling, help with finances and insurance, and advocacy. Participants wanted social work services to begin early in acute treatment with continuity post-discharge. Conclusion Social workers should conduct ethical social work by meeting clients where they are, addressing needs as prioritized by the client, and advocating individually and organizationally for clients. PMID:26252181

Improving client-centered brain injury rehabilitation through research-based theater.

PubMed

Kontos, Pia C; Miller, Karen-Lee; Gilbert, Julie E; Mitchell, Gail J; Colantonio, Angela; Keightley, Michelle L; Cott, Cheryl

2012-12-01

Traumatic brain injury often results in physical, behavioral, and cognitive impairments perceived by health care practitioners to limit or exclude clients' full participation in treatment decision making. We used qualitative methods to evaluate the short- and long-term impact of "After the Crash: A Play About Brain Injury," a research-based drama designed to teach client-centered care principles to brain injury rehabilitation staff. We conducted interviews and observations with staff of two inpatient neurorehabilitation units in Ontario, Canada. Findings demonstrate the effectiveness of the play in influencing practice through the avoidance of medical jargon to improve clients' understanding and participation in treatment; newfound appreciation for clients' needs for emotional expression and sexual intimacy; increased involvement of family caregivers; and avoidance of staff discussions as if clients were unaware. These findings suggest that research-based drama can effect reflexivity, empathy, and practice change to facilitate a client-centered culture of practice in brain injury rehabilitation.

The importance of campaign saliency as a predictor of attitude and behavior change: A pilot evaluation of social marketing campaign Fat Talk Free Week.

PubMed

Garnett, Bernice Raveche; Buelow, Robert; Franko, Debra L; Becker, Carolyn; Rodgers, Rachel F; Austin, S Bryn

2014-01-01

Fat Talk Free Week (FTFW), a social marketing campaign designed to decrease self-disparaging talk about body and weight, has not yet been evaluated. We conducted a theory-informed pilot evaluation of FTFW with two college samples using a pre- and posttest design. Aligned with the central tenets of the Elaboration Likelihood Model (ELM), we investigated the importance of FTFW saliency as a predictor of fat talk behavior change. Our analytic sample consisted of 118 female participants (83% of original sample). Approximately 76% of the sample was non-Hispanic White, 14% Asian, and 8% Hispanic. At baseline, more than 50% of respondents reported engaging in frequent self fat talk; at posttest, this number dropped to 34% of respondents. Multivariable regression models supported campaign saliency as the single strongest predictor of a decrease in self fat talk. Our results support the social diffusion of campaign messages among shared communities, as we found significant decreases in fat talk among campaign attenders and nonattenders. FTFW may be a promising short-term health communication campaign to reduce fat talk, as campaign messages are salient among university women and may encourage interpersonal communication.

Clients of female sex workers in Nyanza province, Kenya: a core group in STD/HIV transmission.

PubMed

Voeten, Helene A C M; Egesah, Omar B; Ondiege, Mark Y; Varkevisser, Corlien M; Habbema, J Dik F

2002-08-01

Commercial sex plays an important role in the spread of HIV and AIDS in Africa, especially in beginning epidemics. The goal was to study the sociodemographic characteristics and sexual risk behavior of clients of female sex workers (FSWs) in Nyanza province, Kenya. In the town of Kisumu and the rural districts Siaya and Bondo, male clients of FSWs were identified in bars, nightclubs, and lodges. An informal conversation was held with 64 clients. The majority of clients were between 25 and 36 years old, were married, and had extramarital partners in addition to FSWs. Most clients had visited several (3-5) different FSWs in the previous year, of whom at least 2 were in long-term, steady client-FSW relationships. Clients visited FSWs an average of once or twice a week. Most clients were not consistently using condoms with FSWs; the main reason given was that they "trusted" their steady FSWs. Commercial sex in Nyanza frequently involves multiple steady relationships instead of rapidly changing one-time contacts. Information, education, and communication (IEC) campaigns aimed at risk reduction in commercial sex should promote condom use in steady FSW-client relationships.

Therapeutic Change in Colombian Families Dealing with Violence: Therapists, Clients, and Referring Systems in Conversation

ERIC Educational Resources Information Center

Ripoll-Nunez, Karen; Villar-Guhl, Carlos Felipe; Villar-Concha, Eduardo

2012-01-01

There is a gap in the Marriage and Family Therapy literature regarding clients', therapists', and family judges' theories of change in relational therapy for family violence. We conducted in-depth interviews with eleven court-referred families, their therapists, and two family judges in Bogota, Colombia. Interviews focused on their expectations of…

Integrating Narrative and Action Processes in Group Counseling Practice: A Multimodal Approach for Helping Clients

ERIC Educational Resources Information Center

Westwood, Marvin J.; Ewasiw, Joan F.

2011-01-01

The aim of this article is to introduce an integrated approach for helping clients. The approach combines and builds on two group-based interventions: guided autobiography and therapeutic enactment. Descriptions of the two interventions individually and a transtheoretical model for change are provided. How change occurs through the proposed…

A Bending Willow Tree: A Japanese (Morita Therapy) Model of Human Nature and Client Change.

ERIC Educational Resources Information Center

Ishiyama, F. Ishu

2003-01-01

Japanese Morita therapy is discussed to highlight its culturally and theoretically unique perspectives on human nature and client change. Key features of this theory are: theory of the nervous trait; multiple-dimensional model of causes and treatment of nervous neurosis; theory of mental attachment; reframing anxiety into constructive desires; and…

Perceived Barriers and Facilitators to Positive Therapeutic Change for People with Intellectual Disabilities: Client, Carer and Clinical Psychologist Perspectives

ERIC Educational Resources Information Center

Ramsden, Sarah; Tickle, Anna; Dawson, David L.; Harris, Samantha

2016-01-01

Studies have highlighted successful outcomes of psychological therapies for people with intellectual disabilities. However, processes underlying these outcomes are uncertain. Thematic analysis was used to explore the perceptions of three clinical psychologists, six clients and six carers of barriers and facilitators to therapeutic change for…

Predicting Change in Emotional and Behavioural Problems during Inpatient Treatment in Clients with Mild Intellectual Disability

ERIC Educational Resources Information Center

Tenneij, Nienke; Didden, Robert; Koot, Hans M.

2011-01-01

Background: Little is known about client characteristics that are related to outcome during inpatient treatment of adults with mild intellectual disability (ID) and severe behavioural problems. Method: We explored variables that were related to a change in behavioural problems in 87 individuals with mild ID during inpatient treatment in facilities…

Brief Therapy at a University Counseling Center: Working Alliance, Readiness to Change, and Symptom Severity

ERIC Educational Resources Information Center

Mahon, Megan; Laux, John M.; Ritchie, Martin H.; Piazza, Nick J.; Tiamiyu, Mojisola F.

2015-01-01

The authors investigated whether students receiving short-term individual counseling at a university counseling center showed progress as evidenced by perceived client and counselor outcomes and the roles that client readiness to change and working alliance played in this setting. The results indicated that the counselor reports, not the client…

Next Generation Multimedia Distributed Data Base Systems

NASA Technical Reports Server (NTRS)

Pendleton, Stuart E.

1997-01-01

The paradigm of client/server computing is changing. The model of a server running a monolithic application and supporting clients at the desktop is giving way to a different model that blurs the line between client and server. We are on the verge of plunging into the next generation of computing technology--distributed object-oriented computing. This is not only a change in requirements but a change in opportunities, and requires a new way of thinking for Information System (IS) developers. The information system demands caused by global competition are requiring even more access to decision making tools. Simply, object-oriented technology has been developed to supersede the current design process of information systems which is not capable of handling next generation multimedia.

Changes in symptom intensity and emotion valence during the process of assimilation of a problematic experience: A quantitative study of a good outcome case of cognitive-behavioral therapy.

PubMed

Basto, Isabel; Pinheiro, Patrícia; Stiles, William B; Rijo, Daniel; Salgado, João

2017-07-01

The assimilation model describes the change process in psychotherapy. In this study we analyzed the relation of assimilation with changes in symptom intensity, measured session by session, and changes in emotional valence, measured for each emotional episode, in the case of a 33-year-old woman treated for depression with cognitive-behavioral therapy. Results showed the theoretically expected negative relation between assimilation of the client's main concerns and symptom intensity, and the relation between assimilation levels and emotional valence corresponded closely to the assimilation model's theoretical feelings curve. The results show how emotions work as markers of the client's current assimilation level, which could help the therapist adjust the intervention, moment by moment, to the client's needs.

Impact of economic policies on reducing tobacco use among Medicaid clients in New York.

PubMed

Murphy, Jill M; Shelley, Donna; Repetto, Patricia M; Cummings, K Michael; Mahoney, Martin C

2003-07-01

New York State (NYS) recently implemented Medicaid coverage for prescription pharmacologic adjuncts for cessation and a 55-cent excise tax on a pack of cigarettes. This study examined awareness and use of stop smoking medications and changes in smoking/purchasing behavior among Medicaid clients. Participants (n = 173) were English-speaking Medicaid clients ages 18-64 years who currently smoked cigarettes and volunteered to be interviewed while waiting to reregister with the NYC Medicaid Office during early 2001. Data were collected using a brief (10-min) interviewer-administered questionnaire. Over 80% of Medicaid clients reported some desire to stop smoking and 40% intended to stop smoking in the next 6 months. Awareness of Medicaid coverage for tobacco cessation pharmacotherapy was 7% for nicotine replacement therapy and 13% for bupropion. Use of these stop smoking medications varied across products but in general was low (<10%). Half of the Medicaid clients reported changing their smoking behavior as a result of the cigarette tax increase. The majority of Medicaid clients report a desire to stop smoking, but these economic influences alone are insufficient to substantially reduce smoking in this population. These findings emphasize the importance of allocating a portion of tobacco tax revenue to promote both expanded awareness of this prescription benefit among Medicaid clients and to support programs to further assist low-income smokers in their attempts to stop smoking.

Symptoms, functioning and quality of life after treatment in a residential sub-acute mental health service in Australia.

PubMed

Thomas, Kerry A; Rickwood, Debra J; Brown, Patricia M

2017-01-01

The aim of this study was to assess clients' and service providers' perspectives on changes in mental health after an admission to a residential recovery-focused, sub-acute service, in Australia. Clients were either step-up clients, entering the service directly from the community, or step-down clients who were transitioning from an inpatient unit to home. During the 30-month period of data collection (August 2011 to January 2014) all clients (N = 102) were invited to participate in the longitudinal study and 41 clients consented to be involved (38% response rate). At admission and exit, participants completed the Behaviour and Symptom Identification Scale (Basis-32) and service providers completed the Life Skills Profile-16 and Health of the Nations Outcome Scales. Follow-up data 3 months after exit were available for 12 clients, including the Basis-32 and a self-report measure of quality of life (Assessment of Quality of Life 8-dimension). Both client groups reported positive improvements between admission and exit in the areas of relation to self and others, psychosis, daily living and presence of depression or anxiety symptoms. Service providers reported gains for clients in the areas of self-care, level of symptoms and presence of social problems. At 3 months, clients generally reported positive quality of life, although there was no significant change in symptoms and functioning. This study demonstrates that after an admission to a sub-acute service, step-up clients experience an improvement in their symptoms and functioning, have avoided a hospital admission and are well enough to return home. Step-down clients also experience further improvements in their symptoms and functioning, indicating that the service has assisted them in their transition to independent living after a hospital admission. Sub-acute residential units provide a continuation of care for inpatients preparing to return home, and people with a mental health problem living in the community who experience an escalation in symptoms and prefer an alternative to hospital. © 2015 John Wiley & Sons Ltd.

Evaluation of the AIDS prevention street nurse program: one step at a time.

PubMed

Hilton, B Ann; Thompson, Ray; Moore-Dempsey, Laura

2009-03-01

The AIDS Prevention Street Nurse Program uses specially prepared community health nurses to focus on HIV and STD prevention with marginalized, hard-to-reach and high-risk clients within a broader context of harm reduction and health promotion. Street nurses (n=17), service providers (n=30), representatives of other HIV/STD programs in the province of British Columbia, Canada (n=5), and clients (n=32) were interviewed during an evaluation for the purpose of describing the nurses' work, the challenges the nurses' face, the fit of the program with other services, and the impact of the nurses' work.This article describes the impact of the nurses' work on clients. Impact/outcome changes reflected a progression from knowledge to behavioural levels and to major indicators of health/illness. Impact on clients included: knowing more about HIV/AIDS, their own situation, and options; receiving essential supplies to reduce harm and promote health; changing behaviour to reduce disease transmission, improve resistance, and promote health; connecting with help; feeling better about themselves and others; feeling supported; influencing others; receiving earlier attention for problems; being healthier with or without HIV; making major changes in drug use; and likely decreasing morbidity and mortality. The program was found to be clearly effective in making a positive impact on clients.

From recovery programs to recovery-oriented practice? A qualitative study of mental health professionals' experiences when facilitating a recovery-oriented rehabilitation program.

PubMed

Dalum, Helle Stentoft; Pedersen, Inge Kryger; Cunningham, Harry; Eplov, Lene Falgaard

2015-12-01

The recovery model has influenced mental health services and fostered new standards for best practice. However, knowledge about how mental health care professionals (HCPs) experience recovery-oriented programs is sparse. This paper explores HCPs' experiences when facilitating a recovery-oriented rehabilitation program. The research question is how do HCPs experience a change in their attitude and practice when applying recovery-oriented programs? This paper draws on semi-structured in-depth qualitative interviews conducted with 16 HCPs experienced in facilitating a recovery-oriented rehabilitation program in either the USA or Denmark. Three themes emerged from the HCPs' reflections on changes in attitudes and practices: "Hopeful Attitude" captures a change in the HCPs' attitude toward a more positive view on the future for clients' living with mental illness; "A New Focus in the Dialogue With Clients" thematizes how the HCPs focus more on the individual's own goal for recovery rather than disease-induced goals in the dialog with clients; "A Person-Centered Role" comprises a shift in the professional role whereby the HCPs value the client's own ideas in addition to the professional's standards. This study supports the theory of the recovery model by its empirical findings and indications that when facilitating a recovery-oriented program, HCPs experience recovery-oriented changes in their attitude toward life with mental illness, and it alters their professional practice toward a stronger focus on client's own goals during treatment. More studies are needed to further clarify how changes in HCPs' attitudes translate into changes in mental health practices. Copyright © 2015 Elsevier Inc. All rights reserved.

The potential of complementary and alternative medicine in promoting well-being and critical health literacy: a prospective, observational study of shiatsu.

PubMed

Long, Andrew F

2009-06-18

The potential contribution of complementary and alternative medicine (CAM) modalities to promote and support critical health literacy has not received substantial attention within either the health promotion or the CAM literature. This paper explores the potential of one CAM modality, shiatsu, in promoting well-being and critical health literacy. Data are drawn from a longitudinal, 6 months observational, pragmatic study of the effects and experience of shiatsu within three European countries (Austria, Spain and the UK). Client postal questionnaires included: advice received, changes made 6 months later, clients 'hopes' from having shiatsu and features of the client-practitioner relationship. At baseline, three-quarters of clients (n = 633) received advice, on exercise, diet, posture, points to work on at home or other ways of self-care. At 6 months follow-up, about four-fifths reported making changes to their lifestyle 'as a result of having shiatsu treatment', including taking more rest and relaxation or exercise, changing their diet, reducing time at work and other changes such as increased body/mind awareness and levels of confidence and resolve. Building on the findings, an explanatory model of possible ways that a CAM therapy could contribute to health promotion is presented to guide future research, both within and beyond CAM. Supporting individuals to take control of their self-care requires advice-giving within a supportive treatment context and practitioner relationship, with clients who are open to change and committed to maintaining their health. CAM modalities may have an important role to play in this endeavour.

SAMP, the Simple Application Messaging Protocol: Letting applications talk to each other

NASA Astrophysics Data System (ADS)

Taylor, M. B.; Boch, T.; Taylor, J.

2015-06-01

SAMP, the Simple Application Messaging Protocol, is a hub-based communication standard for the exchange of data and control between participating client applications. It has been developed within the context of the Virtual Observatory with the aim of enabling specialised data analysis tools to cooperate as a loosely integrated suite, and is now in use by many and varied desktop and web-based applications dealing with astronomical data. This paper reviews the requirements and design principles that led to SAMP's specification, provides a high-level description of the protocol, and discusses some of its common and possible future usage patterns, with particular attention to those factors that have aided its success in practice.

Bringing air pollution into the climate change equation.

PubMed

Pettersen, Marit Viktoria; Fleck, Fiona

2014-08-01

As countries gear up for a major round of international climate talks next year in Paris, the growing problem of air pollution is fast becoming a vital part of the climate change and health debate. Fiona Fleck talks to Marit Viktoria Pettersen.

Constructivist Simultaneous Treatment of Borderline Personality Disorder, Trauma, and Addiction Comorbidity: A Qualitative Case Study.

PubMed

Johansen, Ayna B; Tavakoli, Shedeh; Bjelland, Ingerid; Lumley, Mark

2017-01-01

This qualitative case study explored one client's recovery from borderline personality disorder, trauma, and problem gambling. The client attended 18 months of integrative treatment and was followed for 5 years. The study included 106 data points of both client and therapist data. We identified three phases to treatment. First, alliance formation and normalization appeared as mechanisms, and the client experienced dependence. Second, working alliance and countertransference appeared as mechanisms, and the client experienced reduced gambling and suicidal ideation. Third, external controls and increased opportunity appeared as mechanisms, and "moving into the world" was the client experience. The findings give preliminary support to a phase-based constructivist treatment including trauma assessment to normalize self-feelings, countertransference work to support motivation for restraint, and case management principles to support continuity of change efforts. © The Author(s) 2015.

Calculating Clinically Significant Change: Applications of the Clinical Global Impressions (CGI) Scale to Evaluate Client Outcomes in Private Practice

ERIC Educational Resources Information Center

Kelly, Peter James

2010-01-01

The Clinical Global Impressions (CGI) scale is a therapist-rated measure of client outcome that has been widely used within the research literature. The current study aimed to develop reliable and clinically significant change indices for the CGI, and to demonstrate its application in private psychological practice. Following the guidelines…

Development and initial evaluation of an instrument to assess physiotherapists' clinical reasoning focused on clients' behavior change.

PubMed

Elvén, Maria; Hochwälder, Jacek; Dean, Elizabeth; Söderlund, Anne

2018-05-01

A systematically developed and evaluated instrument is needed to support investigations of physiotherapists' clinical reasoning integrated with the process of clients' behavior change. This study's aim was to develop an instrument to assess physiotherapy students' and physiotherapists' clinical reasoning focused on clients' activity-related behavior and behavior change, and initiate its evaluation, including feasibility and content validity. The study was conducted in three phases: 1) determination of instrument structure and item generation, based on a model, guidelines for assessing clinical reasoning, and existing measures; 2) cognitive interviews with five physiotherapy students to evaluate item understanding and feasibility; and 3) a Delphi process with 18 experts to evaluate content relevance. Phase 1 resulted in an instrument with four domains: Physiotherapist; Input from client; Functional behavioral analysis; and Strategies for behavior change. The instrument consists of case scenarios followed by items in which key features are identified, prioritized, or interpreted. Phase 2 resulted in revisions of problems and approval of feasibility. Phase 3 demonstrated high level of consensus regarding the instrument's content relevance. This feasible and content-validated instrument shows potential for use in investigations of physiotherapy students' and physiotherapists' clinical reasoning, however continued development and testing are needed.

A natural language screening measure for motivation to change.

PubMed

Miller, William R; Johnson, Wendy R

2008-09-01

Client motivation for change, a topic of high interest to addiction clinicians, is multidimensional and complex, and many different approaches to measurement have been tried. The current effort drew on psycholinguistic research on natural language that is used by clients to describe their own motivation. Seven addiction treatment sites participated in the development of a simple scale to measure client motivation. Twelve items were drafted to represent six potential dimensions of motivation for change that occur in natural discourse. The maximum self-rating of motivation (10 on a 0-10 scale) was the median score on all items, and 43% of respondents rated 10 on all 12 items - a substantial ceiling effect. From 1035 responses, three factors emerged representing importance, ability, and commitment - constructs that are also reflected in several theoretical models of motivation. A 3-item version of the scale, with one marker item for each of these constructs, accounted for 81% of variance in the full scale. The three items are: 1. It is important for me to . . . 2. I could . . . and 3. I am trying to . . . This offers a quick (1-minute) assessment of clients' self-reported motivation for change.

A Qualitative Study of a Maintenance Support Program for Women at Risk of Homelessness: Part 2: Situational Factors.

PubMed

McMaster, Rose; Lopez, Violeta; Kornhaber, Rachel; Cleary, Michelle

2017-06-01

People who are homeless tend to have a number of complex needs. A housing maintenance support program (MSP) for women from the perspectives of clients, case managers and health professionals within the program was explored in this qualitative descriptive study. Interviews were conducted, and data were analysed using thematic analysis. The overarching theme that emerged from the data was "A life-changing event: I have the power to change." This theme was supported by three sub-themes: personal, situational and societal dimensions. In this article, the sub-theme - situational factors, is presented and refers to poverty, resources and services, as well as social support systems. These aspects all impinged on the client's ability to face life changes with optimism towards a better future. Their experiences of disconnection with the community changed for the clients after being part of the MSP. The MSP enabled the clients to feel part of society again, and empowered them to participate in the world around them. Key aspects of inclusion in the world are relationships based on acceptance, connecting with others, being involved and creating a sense of home/community.

Consultant-Client Relationship and Knowledge Transfer in Small- and Medium-Sized Enterprises Change Processes.

PubMed

Martinez, Luis F; Ferreira, Aristides I; Can, Amina B

2016-04-01

Based on Szulanski's knowledge transfer model, this study examined how the communicational, motivational, and sharing of understanding variables influenced knowledge transfer and change processes in small- and medium-sized enterprises, particularly under projects developed by funded programs. The sample comprised 144 entrepreneurs, mostly male (65.3%) and mostly ages 35 to 45 years (40.3%), who filled an online questionnaire measuring the variables of "sharing of understanding," "motivation," "communication encoding competencies," "source credibility," "knowledge transfer," and "organizational change." Data were collected between 2011 and 2012 and measured the relationship between clients and consultants working in a Portuguese small- and medium-sized enterprise-oriented action learning program. To test the hypotheses, structural equation modeling was conducted to identify the antecedents of sharing of understanding, motivational, and communicational variables, which were positively correlated with the knowledge transfer between consultants and clients. This transfer was also positively correlated with organizational change. Overall, the study provides important considerations for practitioners and academicians and establishes new avenues for future studies concerning the issues of consultant-client relationship and the efficacy of Government-funded programs designed to improve performance of small- and medium-sized enterprises. © The Author(s) 2016.

Neuro Linguistic Programming for Counselors.

ERIC Educational Resources Information Center

Harman, Robert L.; O'Neill, Charles

1981-01-01

Describes contributions of Neuro Linguistic Programming (NLP) to counseling practice. The Meta-Model, representational systems, anchoring, and reframing are described. Counselors interested in learning NLP can integrate many valuable new ways of communicating with clients and changing client behaviors. (Author)

Working with art in a case of schizophrenia.

PubMed

Noronha, Konrad J

2013-01-01

Schizophrenia often requires a lifetime of treatment. This study used art as a therapeutic tool in therapy with a client diagnosed with schizophrenia, along with medical management. The purpose of using art was to enable the non-communicative client to communicate. The clients' drawings were used as a process medium. Progress was seen in changes in social behaviours and communication evidenced by him speaking more, expressing feelings and gaining better insight.

The value of normalization: Group therapy for individuals with brain injury.

PubMed

von Mensenkampff, Barbara; Ward, Marcia; Kelly, Grace; Cadogan, Sam; Fawsit, Feargus; Lowe, Niamh

2015-01-01

This paper reports on a client-driven therapy group designed to help clients actively process changes and equip them with the psychological skills necessary to facilitate rehabilitation. This is an exploratory mixed methods research design based in clinical practice. This study documents results from five therapy groups, each group consisting of 2-hour sessions over an average of 6 weeks with a review session 6 weeks later. Forty-five clients (13 female, 32 male, average age = 40.54, SD = 11.87) with brain injury attended the group with Headway psychological services, Cork. Clients' pre- and post-measures of functioning were gathered to assess the potential therapeutic benefits. Thematic analysis was used to evaluate the qualitative data. Results illustrate a number of benefits to the participants, including normalizing effects, helping with acceptance, finding a new identity and positive mental health changes. Findings are encouraging and help to validate the effectiveness of group therapy as an intervention tool.

Therapeutic Assessment in Personality Disorders: Toward the Restoration of Epistemic Trust.

PubMed

Kamphuis, Jan H; Finn, Stephen E

2018-06-06

Research evidence suggests Therapeutic Assessment positively affects clients with problems in living, including clients with personality disorders, who are typically quite resistant to change. Importantly, this change takes place quickly, in relatively few sessions. This article draws on a relatively new evolutionary-based theory of epistemic trust (ET) and epistemic hypervigilance (EH) as a lens to plausibly explain the efficacy of TA, and especially its influence on PD clients' alliance and motivation for subsequent psychotherapy (Fonagy, Luyten, & Alison, 2015 ). ET is the willingness to take in relevant interpersonally transmited information and it is essential to the immediate success of psychotherapy and its long-term impact. The collaborative, intersubjective framework of TA and many of its specific techniques might be understood as highly relevant to restoring ET in clients, especially those with PD. We close by discussing implications for psychological assessment, psychotherapy, and research.

Meeting People "Where They Are": Case Managers Empower and Motivate Clients to Pursue Their Health Goals.

PubMed

Harkey, Jane; Sortedahl, Charlotte; Crook, Michelle M; Sminkey, Patrice V

The propose of this discussion is to explore the role of the case manager to empower and motivate clients, especially those who appear "stuck" or resistant to change. Drawing upon the experiences of case managers across many different practice settings, the article addresses how case managers can tap into the individual's underlying and sometimes deep-seated desires in order to foster buy-in for making even small steps toward achieving their health goals. The article also addresses how motivational interviewing can be an effective tool used by case managers to uncover blocks and barriers that prevent clients from making changes in their health or lifestyle habits. This discussion applies to case management practices and work settings across the full continuum of health care. The implication for case managers is deeper understanding of the importance of motivation to help clients make positive steps toward achieving their health goals. This understanding is especially important in advocating for clients who appear to be unmotivated or ambivalent, but who are actually "stuck" in engrained behaviors and habits because of a variety of factors, including past failures. Without judgment and by establishing rapport, case managers can tap into clients' desires, to help them make incremental progress toward their health goals.

Home health clients: characteristics, outcomes of care, and nursing interventions.

PubMed Central

Martin, K S; Scheet, N J; Stegman, M R

1993-01-01

OBJECTIVES. The purpose of the study was to provide descriptive data about the characteristics of home health clients, the services that nurses provide, and the outcomes of those services. Such data have been sparse. METHODS. This study examined 2403 home health clients served by four agencies in Nebraska, New Jersey, and Wisconsin. Demographic, health history, and clinical data were analyzed. The Omaha System was used as the model for describing and measuring data specific to clients' health-related problems, nursing interventions, and outcomes of care. RESULTS. The median age of home health clients was 68.6 years. Nurses conducted 70% of all home visits, identified 9107 client problems, and provided over 96,000 interventions. Between admission and dismissal, clients improved by at least 0.52 point on three 5-point problem-specific outcome subscales (Knowledge, Behavior, and Status). CONCLUSIONS. These data show important characteristics of home health clients in a large national sample. They also support the usefulness of the Omaha System in describing and quantifying nursing practice in the community health setting. The magnitude of positive client change between admission and dismissal suggests that community health services do make a difference. PMID:8259804

Goal setting dynamics that facilitate or impede a client-centered approach.

PubMed

Kessler, Dorothy; Walker, Ian; Sauvé-Schenk, Katrine; Egan, Mary

2018-04-19

Client-centred goal setting is central to the process of enabling occupation. Yet, there are multiple barriers to incorporating client-centred goal setting in practice. We sought to determine what might facilitate or impede the formation of client-centred goals in a context highly supportive of client-centred goal setting Methods: We used conversational analysis to examine goal-setting conversations that took place during a pilot trial of Occupational Performance Coaching for stroke survivors. Twelve goal-setting sessions were purposively selected, transcribed, and analyzed according to conventions for conversation analysis. Two main types of interactions were observed: introductory actions and goal selection actions. Introductory actions set the context for goal setting and involved sharing information and seeking clarification related to goal requirements and clients' occupational performance competencies. Goal selection actions were a series of interactions whereby the goals were explored, endorsed or dropped. Client-centred occupational performance goals may be facilitated through placing goal-setting in the context of life changes and lifelong development of goals, and through listening to clients' stories. Therapists may improve consistency in adoption of client-suggested goals through clarifying meaning attached to goals and being attuned to power dynamics and underlying values and beliefs around risk and goal attainability.

Mr. Ngao's proposal: introducing client fees. Case scenarios for training and group discussion.

PubMed

1992-01-01

In this supplement to the issue of "The Family Planning Manager" devoted to fees, a hypothetical case scenario is presented to illustrate the introduction of client fees to a family planning program. Managers are instructed to prepare a plan that includes the necessary information for deciding what to charge for, who to charge, and how much to charge; identifies the administrative changes involved in charging fees; and outlines steps that clinic managers should take before introducing client fees. Decisions should be based on factors such as the objectives of fee charging, client willingness and ability to pay, client perception of the quality of current services, services for which clients would be most willing to pay, estimated cost of providing services, and the cost of new administrative procedures inherent in a fee-for-service approach. Administrative procedures for collecting, handling, and accounting for cash; reporting income and expenses; and implementing a fair and flexible system of waivers and exemptions must be defined. Clients should be informed well in advance of fee introduction, and staff trained to manage potential client complaints.

Client reflections on confirmation and disconfirmation of expectations in cognitive behavioral therapy for generalized anxiety disorder with and without motivational interviewing.

PubMed

Button, Melissa L; Norouzian, Nikoo; Westra, Henny A; Constantino, Michael J; Antony, Martin M

2018-01-22

Addressing methodological shortcomings of prior work on process expectations, this study examined client process expectations both prospectively and retrospectively following treatment. Differences between clients receiving cognitive behavioral therapy (CBT) versus motivational interviewing integrated with CBT (MI-CBT) were also examined. Grounded theory analysis was used to study narratives of 10 participants (N = 5 CBT, 5 MI-CBT) who completed treatment for severe generalized anxiety disorder as part of a larger randomized controlled trial. Clients in both groups reported and elaborated expectancy disconfirmations more than expectancy confirmations. Compared to CBT clients, MI-CBT clients reported experiencing greater agency in the treatment process than expected (e.g., that they did most of the work) and that therapy provided a corrective experience. Despite nearly all clients achieving recovery status, CBT clients described therapy as not working in some ways (i.e., tasks did not fit, lack of improvement) and that they overcame initial skepticism regarding treatment. Largely converging with MI theory, findings highlight the role of key therapist behaviors (e.g., encouraging client autonomy, validating) in facilitating client experiences of the self as an agentic individual who is actively engaged in the therapy process and capable of effecting change.

Hacker tracking Security system for HMI

NASA Astrophysics Data System (ADS)

Chauhan, Rajeev Kumar

2011-12-01

Conventional Supervisory control and data Acquisition (SCADA) systems use PC, notebook, thin client, and PDA as a Client. Nowadays the Process Industries are following multi shift system that's why multi- client of different category have to work at a single human Machine Interface (HMI). They may hack the HMI Display and change setting of the other client. This paper introduces a Hacker tracking security (HTS) System for HMI. This is developed by using the conventional and Biometric authentication. HTS system is developed by using Numeric passwords, Smart card, biometric, blood flow and Finger temperature. This work is also able to identify the hackers.

Behavior treatment: general considerations.

PubMed

Gardner, William I

2005-01-01

The principal goal of behavior treatment for retarded clients is that of modifying behavior as it occurs in a given environment in such a manner that it becomes more appropriate to that environment. The therapeutic or change agents can involve a variety of persons other than the counselor, teacher, and client--this may include parents, peers, work supervisors and others who can provide supportive influences. Education and rehabilitation programs should be tailored to the occupational and social environment of the retarded client and designed to teach those behavior patterns that are relevant to that environment. Additionally, the work tasks for which retarded clients are trained should be highly structured and routine. Excessive demand for adaptability or decision making is a major cause of training failure for retarded clients.

My Therapist is a Student? The Impact of Therapist Experience and Client Severity on Cognitive Behavioural Therapy Outcomes for People with Anxiety Disorders.

PubMed

Mason, Liam; Grey, Nick; Veale, David

2016-03-01

Allocation of trainee therapist cases is often performed based on intuition and clinical circumstances, with lack of empirical evidence on the role of severity of presenting problem. This has the potential to be anxiety-provoking for supervisors, trainees and service users themselves. To determine how therapist experience interacts with symptom severity in predicting client outcomes. An intention-to-treat analysis of annual outcome data for primary and secondary care clients seen by a specialist anxiety disorders service. 196 clients were stratified into mild, moderate and baseline severe symptoms of anxiety (GAD-7) and depression (PHQ-9). We measured percentage change on these measures, as well as number of sessions and therapy dropout. We also examined rates of reliable and clinically significant change on disorder-specific measures. We hypothesized that qualified therapists would achieve better outcomes than trainees, particularly for severe presentations. Overall, outcomes were comparable between trainee and qualified therapists on all measures, and trainees additionally utilized fewer therapy sessions. There was however an interaction between anxiety severity (GAD-7) and therapist group, such that severely anxious clients achieved greater symptom improvement with qualified as compared to trainee therapists. Further, for trainee but not qualified therapists, baseline anxiety was negatively associated with rate of reliable and clinically significant change on disorder-specific measures. These findings indicate generally favourable outcomes for trainee therapists delivering manualized treatments for anxiety disorders. They additionally suggest that trainee therapists may benefit from additional support when working with clients that present with severe anxiety.

A Study of Some Effects of Early Change Agent Behavior on a Group Client System.

ERIC Educational Resources Information Center

Darden, Douglas Wylie

A study was conducted to explore some of the relationships existing between the early behavior of a change agent with a group client system and its subsequent effects on the helping relationship established between them. A review of related literature was made. The model of helping relationship which formed the basis for the design of the study…

Workplace violence among female sex workers who use drugs in Vancouver, Canada: does client-targeted policing increase safety?

PubMed

Prangnell, Amy; Shannon, Kate; Nosova, Ekaterina; DeBeck, Kora; Milloy, M-J; Kerr, Thomas; Hayashi, Kanna

2018-02-01

Workplace violence, by clients or predators, poses serious negative health consequences for sex workers. In 2013, the Vancouver (British Columbia), Canada Police Department changed their guidelines with the goal of increasing safety for sex workers by focusing law enforcement on clients and third parties, but not sex workers. We sought to examine the trends and correlates of workplace violence among female sex workers (FSW) before and after the guideline change, using data collected from prospective cohorts of persons who use illicit drugs in Vancouver, Canada. Among 259 FSW, 21.0% reported workplace violence at least once during the study period between 2008 and 2014. There was no statistically significant change in rates of workplace violence after the guideline change. In our multivariable analysis, daily heroin use was independently associated with workplace violence. The 2013 policing guideline change did not appear to have resulted in decreased reports of workplace violence. Increased access to opioid agonist therapies may reduce workplace violence among drug-using FSW.

Exposed and embedded corrections in aphasia therapy: issues of voice and identity.

PubMed

Simmons-Mackie, Nina; Damico, Jack S

2008-01-01

Because communication after the onset of aphasia can be fraught with errors, therapist corrections are pervasive in therapy for aphasia. Although corrections are designed to improve the accuracy of communication, some corrections can have social and emotional consequences during interactions. That is, exposure of errors can potentially silence the 'voice' of a speaker by orienting to an utterance as unacceptable. Although corrections can marginalize speakers with aphasia, the practice has not been widely investigated. A qualitative study of corrections during aphasia therapy was undertaken to describe corrections in therapy, identify patterns of occurrence, and develop hypotheses regarding the potential effects of corrections. Videotapes of six individual and five group aphasia therapy sessions were analysed. Sequences consistent with a definition of a therapist 'correction' were identified. Corrections were defined as instances when the therapist offered a 'fix' for a perceived error in the client's talk even though the intent was apparent. Two categories of correction were identified and were consistent with Jefferson's (1987) descriptions of exposed and embedded corrections. Exposed corrections involved explicit correcting by the therapist, while embedded corrections occurred implicitly within the ongoing talk. Patterns of occurrence appeared consistent with philosophical orientations of therapy sessions. Exposed corrections were more prevalent in sessions focusing on repairing deficits, while embedded corrections were prevalent in sessions focusing on natural communication events (e.g. conversation). In addition, exposed corrections were sometimes used when client offerings were plausible or appropriate, but were inconsistent with therapist expectations. The observation that some instances of exposed corrections effectively silenced the voice or self-expression of the person with aphasia has significant implications for outcomes from aphasia therapy. By focusing on accurate productions versus communicative intents, therapy runs the risk of reducing self-esteem and communicative confidence, as well as reinforcing a sense of 'helplessness' and disempowerment among people with aphasia. The results suggest that clinicians should carefully calibrate the use of exposed and embedded corrections to balance linguistic and psychosocial goals.

Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU).

PubMed

Frost, Barry G; Turrell, Megan; Sly, Ketrina A; Lewin, Terry J; Conrad, Agatha M; Johnston, Suzanne; Tirupati, Srinivasan; Petrovic, Kerry; Rajkumar, Sadanand

2017-01-03

An ongoing service evaluation project was initiated following the establishment of a new, purpose-built, 20-bed sub-acute Intermediate Stay Mental Health Unit (ISMHU). This paper: provides an overview of the targeted 6-week program, operating within an Integrated Recovery-oriented Model (IRM); characterises the clients admitted during the first 16 months; and documents their recovery needs and any changes. A brief description of the unit's establishment and programs is initially provided. Client needs and priorities were identified collaboratively using the Mental Health Recovery Star (MHRS) and addressed through a range of in-situ, individual and group interventions. Extracted client and service data were analysed using descriptive statistics, paired t-tests examining change from admission to discharge, and selected correlations. The initial 154 clients (165 admissions, average stay = 47.86 days) were predominately male (72.1%), transferred from acute care (75.3%), with schizophrenia or related disorders (74.0%). Readmission rates within 6-months were 16.2% for acute and 3.2% for sub-acute care. Three MHRS subscales were derived, together with stage-of-change categories. Marked improvements in MHRS Symptom management and functioning were identified (z-change = -1.15), followed by Social-connection (z-change = -0.82) and Self-belief (z-change = -0.76). This was accompanied by a mean reduction of 2.59 in the number of pre-action MHRS items from admission to discharge (z-change = 0.98). Clinician-rated Health of the Nation Outcome Scales (HoNOS) improvements were smaller (z-change = 0.41), indicative of illness chronicity. Staff valued the elements of client choice, the holistic and team approach, program quality, review processes and opportunities for client change. Addressing high-levels of need in the 6-week timeframe was raised as a concern. This paper demonstrates that a recovery-oriented model can be successfully implemented at the intermediate level of care. It is hoped that ongoing evaluations support the enthusiasm, commitment and feedback evident from staff, clients and carers.

Study protocol: translating and implementing psychosocial interventions in aged home care the lifestyle engagement activity program (LEAP) for life

PubMed Central

2013-01-01

Background Tailored psychosocial activity-based interventions have been shown to improve mood, behaviour and quality of life for nursing home residents. Occupational therapist delivered activity programs have shown benefits when delivered in home care settings for people with dementia. The primary aim of this study is to evaluate the effect of LEAP (Lifestyle Engagement Activity Program) for Life, a training and practice change program on the engagement of home care clients by care workers. Secondary aims are to evaluate the impact of the program on changes in client mood and behaviour. Methods/design The 12 month LEAP program has three components: 1) engaging site management and care staff in the program; 2) employing a LEAP champion one day a week to support program activities; 3) delivering an evidence-based training program to care staff. Specifically, case managers will be trained and supported to set meaningful social or recreational goals with clients and incorporate these into care plans. Care workers will be trained in and encouraged to practise good communication, promote client independence and choice, and tailor meaningful activities using Montessori principles, reminiscence, music, physical activity and play. LEAP Champions will be given information about theories of organisational change and trained in interpersonal skills required for their role. LEAP will be evaluated in five home care sites including two that service ethnic minority groups. A quasi experimental design will be used with evaluation data collected four times: 6-months prior to program commencement; at the start of the program; and then after 6 and 12 months. Mixed effect models will enable comparison of change in outcomes for the periods before and during the program. The primary outcome measure is client engagement. Secondary outcomes for clients are satisfaction with care, dysphoria/depression, loneliness, apathy and agitation; and work satisfaction for care workers. A process evaluation will also be undertaken. Discussion LEAP for Life may prove a cost-effective way to improve client engagement and other outcomes in the community setting. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612001064897. PMID:24238067

Self-determination theory in health care and its relations to motivational interviewing: a few comments

PubMed Central

2012-01-01

The papers of this special issue have the dual focus of reviewing research, especially clinical trials, testing self-determination theory (SDT) and of discussing the relations between SDT and motivational interviewing (MI). Notably, trials are reviewed that examined interventions either for behaviors such as physical activity and smoking cessation, or for outcomes such as weight loss. Although interventions were based on and intended to test the SDT health-behavior-change model, authors also pointed out that they drew techniques from MI in developing the interventions. The current paper refers to these studies and also clarifies the meaning of autonomy, which is central to SDT and has been shown to be important for effective change. We clarify that the dimension of autonomy versus control is conceptually orthogonal to the dimension of independence versus dependence, and we emphasize that autonomy or volition, not independence, is the important antecedent of effective change. Finally, we point out that SDT and MI have had much in common for each has emphasized autonomy. However, a recent MI article seems to have changed MI's emphasis from autonomy to change talk as the key ingredient for change. We suggest that change talk is likely to be an element of effective change only to the degree that the change talk is autonomously enacted and that practitioners facilitate change talk in an autonomy supportive way. PMID:22385839

Self-determination theory in health care and its relations to motivational interviewing: a few comments.

PubMed

Deci, Edward L; Ryan, Richard M

2012-03-02

The papers of this special issue have the dual focus of reviewing research, especially clinical trials, testing self-determination theory (SDT) and of discussing the relations between SDT and motivational interviewing (MI). Notably, trials are reviewed that examined interventions either for behaviors such as physical activity and smoking cessation, or for outcomes such as weight loss. Although interventions were based on and intended to test the SDT health-behavior-change model, authors also pointed out that they drew techniques from MI in developing the interventions. The current paper refers to these studies and also clarifies the meaning of autonomy, which is central to SDT and has been shown to be important for effective change. We clarify that the dimension of autonomy versus control is conceptually orthogonal to the dimension of independence versus dependence, and we emphasize that autonomy or volition, not independence, is the important antecedent of effective change. Finally, we point out that SDT and MI have had much in common for each has emphasized autonomy. However, a recent MI article seems to have changed MI's emphasis from autonomy to change talk as the key ingredient for change. We suggest that change talk is likely to be an element of effective change only to the degree that the change talk is autonomously enacted and that practitioners facilitate change talk in an autonomy supportive way.

Creating Responsive Schools

ERIC Educational Resources Information Center

Zeigler, Harmon

1973-01-01

Suggests means of resolving the crisis in American education produced by the insulation of educational decision-makers from community and client needs and demands, and the consequent inability or unwillingness of schools to adapt themselves to the changing needs of communities and clients. (Author/JM)

Negotiating behavioural change: therapists' proposal turns in Cognitive Behavioural Therapy.

PubMed

Ekberg, Katie; Lecouteur, Amanda

2012-01-01

Cognitive behavioural therapy (CBT) is an internationally recognised method for treating depression. However, many of the techniques involved in CBT are accomplished within the therapy interaction in diverse ways, and with varying consequences for the trajectory of therapy session. This paper uses conversation analysis to examine some standard ways in which therapists propose suggestions for behavioural change to clients attending CBT sessions for depression in Australia. Therapists' proposal turns displayed their subordinate epistemic authority over the matter at hand, and emphasised a high degree of optionality on behalf of the client in accepting their suggestions. This practice was routinely accomplished via three standard proposal turns: (1) hedged recommendations; (2) interrogatives; and (3) information-giving. These proposal turns will be examined in relation to the negotiation of behavioural change, and the implications for CBT interactions between therapist and client will be discussed.

Communicative practices in talking about death and dying in the context of Thai cancer care.

PubMed

Wilainuch, Pairote

2013-01-01

This article explores communicative practices surrounding how nurses, patients and family members engage when talking about death and dying, based on study conducted in a province in northern Thailand. Data were collected from three environments: a district hospital (nine cases), district public health centres (four cases), and in patients' homes (27 cases). Fourteen nurses, 40 patients and 24 family members gave written consent for participation. Direct observation and in-depth interviews were used for supplementary data collection, and 40 counselling sessions were recorded on video. The raw data were analysed using Conversation Analysis. The study found that Thai counselling is asymmetrical. Nurses initiated the topic of death by referring to the death of a third person--a dead patient--with the use of clues and via list-construction. As most Thai people are oriented to Buddhism, religious support is selected for discussing this sensitive topic, and nurses also use Buddhism and list-construction to help their clients confront uncertain futures. However, Buddhism is not brought into discussion on its own, but combined with other techniques such as the use of euphemisms or concern and care for others.

Tattooist-customer relationships in a diversified environment of professional tattooists and 'scratchers'.

PubMed

Kristensen, Mads Wedel

2015-01-01

The world of tattooing and body art has never been like it is today. This chapter seeks to investigate this situation through the lens of tattooing. One of the areas in which tattooing has changed is the relationship between the tattoo artist and his or her clients. Whereas being a tattoo artist used to be impersonal and very much just a job like any other, it has transformed tremendously today. The cause of this and, even more so, what exactly has changed are what this chapter will seek to shed light on. First of all, the format of the shops and how the art is done have changed, which allows for much greater flexibility from the perspective of the artist. Second, from the perspective of the client/customer, a transformation has also occurred, in some part thanks to developments such as the internet and other social/communication media, which give the client much more room and opportunity to discover and research tattoos. However, most importantly, this chapter seeks to map out a change in discourse when it comes to the relationship between the client and the tattoo artist and to explain how it has changed into a relationship based on mutual and reciprocated communication as well as focussed on making a product/piece of art that both can be satisfied with. © 2015 S. Karger AG, Basel.

Comparing the predictive capacity of observed in-session resistance to self-reported motivation in cognitive behavioral therapy.

PubMed

Westra, Henny A

2011-02-01

Self-report measures of motivation for changing anxiety have been weakly and inconsistently related to outcome in cognitive behavioral therapy (CBT). While clients may not be able to accurately report their motivation, ambivalence about change may nonetheless be expressed in actual therapy sessions as opposition to the direction set by the therapist (i.e., resistance). In the context of CBT for generalized anxiety disorder, the present study compared the ability of observed in-session resistance in CBT session 1 and two self-report measures of motivation for changing anxiety (the Change Questionnaire & the Client Motivational for Therapy Scale) to (1) predict client and therapist rated homework compliance (2) predict post-CBT and one-year post-treatment worry reduction, and (3) differentiate those who received motivational interviewing prior to CBT from those who received no pre-treatment. Observed in-session resistance performed very well on each index, compared to the performance of self-reported motivation which was inconsistent and weaker relative to observed resistance. These findings strongly support both clinician sensitivity to moments of client resistance in actual therapy sessions as early as session 1, and the inclusion of observational process measures in CBT research. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Systemic Case Formulation, Individualized Process Monitoring, and State Dynamics in a Case of Dissociative Identity Disorder.

PubMed

Schiepek, Günter K; Stöger-Schmidinger, Barbara; Aichhorn, Wolfgang; Schöller, Helmut; Aas, Benjamin

2016-01-01

Objective: The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management) including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD) and dissociative identity disorder. Methods: A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client's dynamics of cognitions, emotions, and behavior. The components (variables) of this idiographic system model (ISM) were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS), to capture the client's individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions. Results: For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy. Conclusion: By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and behavioral network and its dynamics (e.g., order transitions). Effects on self-related information processing, on identity development, and toward a more pronounced autonomy in life (instead of feeling helpless against the chaoticity of state dynamics) were evident in the presented case and documented by the monitoring system.

The influence of client brief and change order in construction project

NASA Astrophysics Data System (ADS)

Mahat, N. A. A.; Adnan, H.

2018-02-01

Construction briefing is a statement of needs about intentions and projects objectives. Briefing process is the preliminary stage in the design process and successful briefing can achieve project delivery right on target time, cost and quality of project confidently. Although there are many efforts to approach client’s requirement and needs for a project, it is still not collected adequately to make proper solutions in design. Thus, these may lead the client to include change orders during the construction phase. This paper is concerned toward the influence of client’s briefing of a construction project that impact on the change order on the construction works. The research objective is to identify the influence of client’s brief on change orders, therefore, the aims of the research is to reduce change orders in project delivery. This research adopted both qualitative and quantitative data collection methods which are content analysis and semi structure interview. The findings highlight factors contributing to change orders and the essential attributes of clients during the briefing stage that may help minimise them.

Talking about GI Disorders

MedlinePlus

... Lifestyle Changes Strategies for Improving Bowel Habits Improving Sleep Quality Kids & Dietary Fiber Fruit Juice Surgery Laxatives Living with GI Disorders Talking About GI Disorders Personal Stories Social Security Benefits ...

Maternal and Child Health Block Grant: Program Changes Emerging under State Administration.

DTIC Science & Technology

1984-05-07

client information relating to age, sex , health condi- tion, treatment and outcome, and cost per unit of service. 2Other than for crippled children or high...types of data collected in- clude quantity of services delivered, geographic location or residence of clients served, age and sex of client population...ABOUT THE 901 Of IFORiATION THAT WERE OF GREAT IMOTAWEI NCH BLOCK GRAT DECISIONS STATISTICAL HEASUMES OP PEWORA4CE STATISTICAL MEASURES OF SEVICE NEDC

Predicting caregiver burden in general veterinary clients: Contribution of companion animal clinical signs and problem behaviors.

PubMed

Spitznagel, M B; Jacobson, D M; Cox, M D; Carlson, M D

2018-06-01

Caregiver burden, found in many clients with a chronically or terminally ill companion animal, has been linked to poorer psychosocial function in the client and greater utilization of non-billable veterinary services. To reduce client caregiver burden, its determinants must first be identified. This study examined if companion animal clinical signs and problem behaviors predict veterinary client burden within broader client- and patient-based risk factor models. Data were collected in two phases. Phase 1 included 238 companion animal owners, including those with a sick companion animal (n=119) and matched healthy controls (n=119) recruited online. Phase 2 was comprised of 602 small animal general veterinary hospital clients (n=95 with a sick dog or cat). Participants completed cross-sectional online assessments of caregiver burden, psychosocial resources (social support, active coping, self-mastery), and an item pool of companion animal clinical signs and problem behaviors. Several signs/behaviors correlated with burden, most prominently: weakness, appearing sad/depressed or anxious, appearing to have pain/discomfort, change in personality, frequent urination, and excessive sleeping/lethargy. Within patient-based risk factors, caregiver burden was predicted by frequency of the companion animal's signs/behaviors (P<.01). Within client-based factors, potentially modifiable factors of client reaction to the animal's signs/behaviors (P=.01), and client sense of control (P<.04) predicted burden. Understanding burden may enhance veterinarian-client communication, and is important due to potential downstream effects of client burden, such as higher workload for the veterinarian. Supporting the client's sense of control may help alleviate burden when amelioration of the companion animal's presentation is not feasible. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Tree Theme Method in psychosocial occupational therapy: a case study.

PubMed

Gunnarsson, A Birgitta; Jansson, Jan-Ake; Eklund, Mona

2006-12-01

This study aimed to describe the Tree Theme Method (TTM) as a method for intervention in psychosocial occupational therapy. The TTM is based on theories concerning creative activities and occupational storytelling and story making. In order to exemplify the method a case study of a treatment process with follow up was undertaken. The participant was a female client suffering from anxiety and depression. During an interview the client painted symbolic trees on five different occasions with specific variations of the tree theme: a tree symbolizing her present life, her childhood, adolescence, adulthood, and, finally, a tree representing her future. The trees were used as starting points for the client to tell her life story. The intention was that she would find new strategies for how to change her daily life. Three years later there was a follow up stage where the client painted new trees and told her story. Some life themes were identified. The TTM appears suitable for intervention in psychosocial occupational therapy. In future studies the TTM should be subjected to evaluation research based on several clients in order to develop a deeper understanding of the process and what kind of results changes in the TTM intervention may provide.

The Lifestyle Engagement Activity Program (LEAP): Implementing Social and Recreational Activity into Case-Managed Home Care.

PubMed

Low, Lee-Fay; Baker, Jessica Rose; Harrison, Fleur; Jeon, Yun-Hee; Haertsch, Maggie; Camp, Cameron; Skropeta, Margaret

2015-12-01

The Lifestyle Engagement Activity Program (LEAP) incorporates social support and recreational activities into case-managed home care. This study's aim was to evaluate the effect of LEAP on engagement, mood, and behavior of home care clients, and on case managers and care workers. Quasi-experimental. Five Australian aged home care providers, including 2 specializing in care for ethnic minorities. Clients (n = 189) from 5 home care providers participated. The 12-month program had 3 components: (1) engaging support of management and staff; (2) a champion to drive practice change; (3) staff training. Case managers were trained to set meaningful social and/or recreational goals during care planning. Care workers were trained in good communication, to promote client independence and choice, and in techniques such as Montessori activities, reminiscence, music, physical activity, and humor. Data were collected 6 months before program commencement, at baseline, and 6 and 12 months. The Homecare Measure of Engagement Staff report and Client-Family interview were primary outcomes. Secondary outcomes were the Cohen-Mansfield Agitation Inventory; apathy, dysphoria, and agitation subscales of the Neuropsychiatric Inventory-Clinician Rating; the geriatric depression scale; UCLA loneliness scale; and home care satisfaction scale. Staff provided information on confidence in engaging clients and the Utrecht Work Engagement Scale. Twelve months after program commencement, clients showed a significant increase in self- or family-reported client engagement (b = 5.39, t[113.09] = 3.93, P < .000); and a significant decrease in apathy (b = -0.23, t(117.00) = -2.03, P = .045), dysphoria (b = -0.25, t(124.36) = -2.25, P = .026), and agitation (b = -0.97, t(98.15) = -3.32, P = .001) on the Neuropsychiatric Inventory-Clinician. Case managers and care workers both reported significant increases in their confidence to socially and recreationally engage clients (b = 0.52, t(21.33) = 2.80, P = .011, b = 0.29, t(198.69) = 2.58, P = .011, respectively). There were no significant changes in care worker-rated client engagement or client or family self-complete measures of depression or loneliness (P > .05). Client and family self-rated apathy increased over 12 months (b = 0.04, t(43.36) = 3.06, P = .004; b = 3.63, t(34.70) = 2.20, P = .035) CONCLUSIONS: LEAP demonstrated that home care providers can incorporate social and recreational care into usual practice for older clients, and that this benefits clients' engagement, dysphoria, and agitation. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Do brief motivational interventions reduce drinking game frequency in mandated students? An analysis of data from two randomized controlled trials.

PubMed

Fernandez, Anne C; Yurasek, Ali M; Merrill, Jennifer E; Miller, Mary Beth; Zamboanga, Byron L; Carey, Kate B; Borsari, Brian

2017-02-01

College students frequently engage in drinking games (DGs) and experience a variety of consequences as a result. It is currently unknown whether brief motivational interventions (BMIs) that provide feedback on DG participation can reduce this high risk behavior. This study examined outcome data from 2 randomized clinical trials to examine whether BMIs facilitate change in DG frequency and how these changes may occur. Mandated college students (Trial 1, N = 198, 46% female; Trial 2, N = 412; 32% female) were randomized to BMI or comparison control conditions. Hierarchical linear modeling (HLM) was used to compare the BMI and comparison groups to determine whether the BMI reduced DG participation over time. Percent change talk (PCT) during the discussion of DG during the session was examined as a predictor of change in DG frequency, and gender was examined as a moderator of treatment effects. Controlling for regular drinking frequency, participants who received a BMI did not significantly reduce their DG frequency relative to the comparison group in either sample, and the BMI was equally ineffective at reducing DG behavior for men and women. DG-related PCT during the BMI was associated with lower DG frequency at the second follow-up in both trials. In Trial 1, PCT during the BMI was associated with less steep increases in DG frequency across the course of all follow-ups. Effects of PCT on DG behavior were not moderated by gender. Findings did not support hypothesized reductions in DG participation following a BMI. Future research should explore whether targeted DG-specific interventions could reduce DG participation and the role of in-session client language in facilitating such change. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Mechanisms of action of brief alcohol interventions remain largely unknown - a narrative review.

PubMed

Gaume, Jacques; McCambridge, Jim; Bertholet, Nicolas; Daeppen, Jean-Bernard

2014-01-01

A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions.

Do Brief Motivational Interventions Reduce Drinking Game Frequency in Mandated Students? An analysis of data from two randomized controlled trials

PubMed Central

Fernandez, Anne C.; Yurasek, Allison M.; Merrill, Jennifer E.; Miller, Mary Beth; Zamboanga, Byron L.; Carey, Kate B.; Borsari, Brian

2016-01-01

Purpose College students frequently engage in drinking games (DG) and experience a variety of consequences as a result. It is currently unknown whether brief motivational interventions (BMI) that provide feedback on DG participation can reduce this high risk behavior. This study examined outcome data from two randomized clinical trials to examine whether BMIs facilitate change in DG frequency and how these changes may occur. Methods Mandated college students (Trial 1, N = 198, 46% female; Trial 2, N = 412; 32% female) were randomized to BMI or comparison control conditions. Hierarchical linear modeling (HLM) was used to compare the BMI and comparison groups to determine whether the BMI reduced DG participation over time. Percent change talk (PCT) during the discussion of DG during the session was examined as a predictor of change in DG frequency, and gender was examined as a moderator of treatment effects. Results Controlling for regular drinking frequency, participants who received a BMI did not significantly reduce their DG frequency relative to the comparison group in either sample, and the BMI was equally ineffective at reducing DG behavior for men and women. DG-related PCT during the BMI was associated with lower DG frequency at the second follow-up in both Trials. In Trial 1, PCT during the BMI was associated with less steep increases in DG frequency across the course of all follow-ups. Effects of PCT on DG behavior were not moderated by gender. Conclusions Findings did not support hypothesized reductions in DG participation following a BMI. Future research should explore whether targeted DG-specific interventions could reduce DG participation and the role of in-session client language in facilitating such change. PMID:27936818

Silence and Policy Talk: Historical Puzzles about Gender and Education.

ERIC Educational Resources Information Center

Tyack, David; Hansot, Elisabeth

1988-01-01

The complexities of institutional change and stability in terms of gender policies are analyzed. The following three questions are central to the discussion: (1) why did some policy changes take place with only minor controversy? (2) why did vehement policy talk affect practice so little? and (3) how did gender reforms alter educational…

Hybrid Rendering with Scheduling under Uncertainty

PubMed Central

Tamm, Georg; Krüger, Jens

2014-01-01

As scientific data of increasing size is generated by today’s simulations and measurements, utilizing dedicated server resources to process the visualization pipeline becomes necessary. In a purely server-based approach, requirements on the client-side are minimal as the client only displays results received from the server. However, the client may have a considerable amount of hardware available, which is left idle. Further, the visualization is put at the whim of possibly unreliable server and network conditions. Server load, bandwidth and latency may substantially affect the response time on the client. In this paper, we describe a hybrid method, where visualization workload is assigned to server and client. A capable client can produce images independently. The goal is to determine a workload schedule that enables a synergy between the two sides to provide rendering results to the user as fast as possible. The schedule is determined based on processing and transfer timings obtained at runtime. Our probabilistic scheduler adapts to changing conditions by shifting workload between server and client, and accounts for the performance variability in the dynamic system. PMID:25309115

Self-Talk Repertoire of Physical Education Teachers: Awareness, Reflection and Action

ERIC Educational Resources Information Center

Cutton, David M.; Killion, Lorraine; Burt, Daniel

2015-01-01

Self-talk (ST) is a strategy that has been found to change behavior by decreasing interference or distractions to better face challenges related to an impending task. Self-talk is typically a dynamic use of words, phrases or cues that may be positive, negative, instructional or motivational in nature. Physical education teachers and coaches have…

Motivational Interviewing to prevent dropout from an education and employment program for young adults: A randomized controlled trial.

PubMed

Sayegh, Caitlin S; Huey, Stanley J; Barnett, Elizabeth; Spruijt-Metz, Donna

2017-07-01

This study tested the efficacy of Motivational Interviewing for improving retention at a "second chance" program in the United States for unemployed young adults who had not graduated high school (ages 18-24; 60% male). We investigated how Motivational Interviewing effects might be mediated by change talk (i.e., arguments for change) and moderated by preference for consistency (PFC). Participants (N = 100) were randomly assigned to (1) Motivational Interviewing designed to elicit change talk, (2) placebo counseling designed not to elicit change talk, or (3) no additional treatment. Motivational Interviewing sessions increased change talk, but did not increase program retention or diploma earning. PFC was a significant moderator of Motivational Interviewing's impact on program retention; Motivational Interviewing was most effective at increasing 8 week retention for high PFC participants, and least effective for low PFC participants. These results suggest that Motivational Interviewing could be a useful tool for improving retention in education and employment programs, but clinicians should be attentive to how participant characteristics might enhance or diminish Motivational Interviewing effects. Copyright © 2017 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

The Personality of Caregiving and the Three Transformational Steps to Move from Conflict to Collaboration.

PubMed

Kieffer, Lon

2015-01-01

There are books and experts that use slogans and sayings that claim to affect workplace employee engagement. However, healthcare is unique. None of these experts seem particularly focused on or remotely interested in, or even able to recognize, the unique opportunity we have in a healthcare setting when it comes to engagement. The differentiation is the personalities of the people who migrate to healthcare careers and professions. The personalities of the family caregivers that fill our lobbies, cubicles, and exam tables need to be considered when we talk about "engagement." This article briefly describes three transformational steps to begin moving healthcare employees and customers/clients from motivations of self-actualization to team engagement.

The social pharmacist: tweeting and posting the way to success.

PubMed

Kaldy, Joanne

2010-01-01

Social networking sites such as Twitter, Facebook, and LinkedIn attract millions of users each day. People of all ages, backgrounds, and interests sign onto these sites daily to share observations, seek answers, offer information and links, talk to friends and family, and network with colleagues. For senior care pharmacists, social networking sites present an opportunity to connect with consumers, hold virtual meetings, manage projects, offer value-added services for current customers, and market to potential clients. Many have joined these online communities and use them regularly. At the same time, some pharmacists are hesitant to use these sites because they don't understand them, are worried about privacy or other issues, or they just don't need them.

Negative attentional bias for positive recovery-related words as a predictor of treatment success among individuals with an alcohol use disorder.

PubMed

Rettie, Hannah C; Hogan, Lee M; Cox, W Miles

2018-09-01

This study assessed relationships between clients' attentional bias (AB) for different types of stimuli and their treatment outcomes. Alcohol AB during detoxification has previously been shown to predict relapse, but further research was needed to clarify this relationship. The current study determined whether AB for recovery-related words would also predict treatment outcome. Participants were 45 clients undergoing alcohol detoxification, and a control group of 36 staff members. They rated words for personal relevance in four categories (alcohol-related, neutral, positive change-related, and negative change-related). Participants completed an individualized Stroop task containing their chosen words. They were also assessed on readiness-to-change, difficulties with emotion regulation, drinking problems, anxiety, and depression. Clients were interviewed at a three-month follow-up to determine their treatment outcome. As predicted, questionnaire measures did not predict clients' treatment outcome (p > .05). A logistic regression model indicated that the best predictor of treatment outcome was AB for positive change-related words (p = .048), with successful individuals having less AB for these words than for the other word categories. Although this finding was unexpected, it was supported by significant relationships between positive change-related interference scores and continuous measures of drinking at follow-up [i.e. number of units drunk (p = .039) and number of drinking days (p = .018)]. The results suggest that positive change-related words are a better predictor of treatment outcome than are either alcohol-related words or negative change-related words. Copyright © 2018 Elsevier Ltd. All rights reserved.

Improvements in Health-related Quality of Life among Methadone Maintenance Clients in Dar es Salaam, Tanzania

PubMed Central

Ubuguyu, Omary; Tran, Olivia C.; Bruce, R. Douglas; Masao, Frank; Nyandindi, Cassian; Sabuni, Norman; McCurdy, Sheryl; Mbwambo, Jessie

2016-01-01

Background Injection of heroin has become widespread in Dar es Salaam, Tanzania and is spreading throughout the country. To prevent potential bridging of HIV epidemics, the Tanzanian government established a methadone maintenance treatment (MMT) clinic in February 2011. We assess the effect of MMT on health-related quality of life (HRQOL) and examine factors, particularly HIV infection and methadone dose, associated with changes in HRQOL. Methods This study utilized routine data on clients enrolling in methadone from February 2011 to April 2012 at Muhimbili National Hospital. Change in physical (PCS) and mental health (MCS) composite scores, as measured by the SF-12 tool, were the primary outcomes. Backward stepwise linear regression, with a criterion of p<0.2 was used to identify baseline exposure variables for inclusion in multivariable models, while adjusting for baseline scores. Results A total of 288 MMT clients received baseline and follow-up assessments. Mean methadone dose administered was 45 mg (SD±25) and 76(27%) were confirmed HIV-positive. Significant improvements were observed in PCS and MCS, with mean increases of 15.7 and 3.3, respectively. In multivariable models, clients who had previous poly-substance use with cocaine [p=0.040] had a significantly higher mean change in PCS. Clients who were living with HIV [p=0.002]; satisfied with current marital situation [p=0.045]; had a history of suicidal thoughts [p=0.021]; and previously experienced cognitive difficulties [p=0.012] had significantly lower mean change in PCS. Clients with shorter history of heroin use [p=0.012] and who received higher methadone doses [p=0.028] had significantly higher mean change in MCS, compared to their counterparts. Discussion Aspects of mental and physical health, risk behaviors and quality of life among drug users are intertwined and complex. Our research revealed positive short-term effects of MMT on HRQOL and highlights the importance of sustained retention for optimal benefits. Comprehensive supportive services in addition to provision of methadone are needed to address the complex health needs of people who inject drugs. PMID:27017376

Money Sense Makes a Difference.

ERIC Educational Resources Information Center

Varcoe, Karen P.; Wright, Joan

1990-01-01

Assesses the degree to which clients completing the Money Sense program adopted its family resource management techniques. Finds that, among 190 low income clients from rural California counties and military bases, there were significant positive changes in food shopping and money management behaviors and significant decreases in financial…

The Experience of Counseling Among a Singaporean Elderly Population: A Qualitative Account of What Clients Report as Beneficial.

PubMed

Mathews, Mathew

2016-09-01

Adjustments that accompany ageing pose a challenge to the mental health of the elderly. Psychologically based counseling has been documented in Western societies as an appropriate intervention for elderly persons with depressive episodes. There is however very little research documenting how Asian elderly populations experience and benefit from counseling. This study addresses this research gap through a qualitative study based on post-counseling interviews with a sample of 41 elderly persons who received counseling at a dedicated organisation catering to the elderly in Singapore. The qualitative data revealed that clients benefitted from counseling through better emotional management - they received emotional support, found emotional healing and learnt to deal with the emotions associated with grief and loss. Clients also reported that counseling assisted them in decision making processes - older persons were able to conceive of alternatives to their predicament, obtained insights to embark on change, were enabled to take the perspective of others and found validation for their decisions. While many elderly clients greatly appreciated and benefitted from this service, citing demonstrable changes, among the very old such changes were uncommon. Cultural explanations for these differential reports and possible directions for much needed future research are provided.

Sacred changes: Spiritual conversion and transformation.

PubMed

Mahoney, Annette; Pargament, Kenneth I

2004-05-01

We use Pargament's (1997) definition of religion-"the search for significance in ways related to the sacred"-as a framework to understand spiritual conversion. Like other life-changing transformations, spiritual conversion alters the destinations that clients perceive to be of greatest importance in life (significance) and the pathways by which clients discover what is most significant in life (search). Unlike other transformative experiences, however, spiritual conversion incorporates the third element of religion, "the sacred," into the content of change. To illustrate these points, we discuss two theological models of spiritual conversion rooted in Christianity: a traditional model based on classic western theology and an alternative model based on feminist theology. We then compare processes of spiritual conversion to nonreligious models of transformation. We also highlight the importance for clinical work of the fit between the context of a client's life and the type of spiritual conversion experienced. Copyright 2004 Wiley Periodicals, Inc.

[Motivational interviewing with alcohol-dependent patients].

PubMed

Spaeth, Michael; Bleich, Stefan; Hillemacher, Thomas

2017-09-01

Motivational interviewing with alcohol-dependent patients Alcohol-dependent patients do not need to be motivated from the outside. They are mostly ambivalent, and the inner voice, which already speaks for change (change talk), is heard through motivational interviewing, carefully strengthened and developed together with the patient. The practitioner has to deal with the human spirit of motivational interviewing and should be able to communicate with empathy, respect, congruence, and openness. The patient's autonomy should always be maintained. Advice is only given upon request. The conversation style is directive-guiding instead of authoritariansteering. OARS and the EPE principle are the motivational interviewing basics, which are consistently applied over 4 processes of motivational interviewing: engaging, focusing, evocing, and planning. The likelihood of change talk increases as soon as discrepancies between life goals and alcohol consumption emerge. An increased rate of change talk makes a change in behavior more likely. If a patient argues against change (sustain talk), one should not confront, but should consistently work with reflections, reframing, and an emphasis on autonomy. Motivational interviewing can be applied in different settings and populations, should be learned by the entire team (best professional guidance) in teamwork, and be subjected to a critical and constant evaluation. Georg Thieme Verlag KG Stuttgart · New York.

A regional technology transfer program. [North Carolina Industrial Applications Center for the Southeast

NASA Technical Reports Server (NTRS)

1979-01-01

The proliferation of online searching capabilities among its industrial clients, changes in marketing staff and direction, use of Dun and Bradstreet marketing service files, growth of the Annual Service Package program, and services delivered to clients at the NASA funded North Carolina Science and Technology Research Center are described. The library search service was reactivated and enlarged, and a survey was conducted on the NC/STRC Technical Bulletin's effectiveness. Several quotations from clients assess the overall value of the Center's services.

Influence of Organizational Functioning on Client Engagement in Treatment

PubMed Central

Greener, Jack M.; Joe, George W.; Simpson, D. Dwayne; Rowan-Szal, Grace A.; Lehman, Wayne E. K.

2007-01-01

The present study focused on the relationship between organizational functioning factors measured in a staff survey using the TCU Organizational Readiness for Change (ORC) assessment and client-level engagement measured by the TCU Client Evaluation of Self and Treatment (CEST) in drug treatment programs. The sample consisted of 531 clinical and counseling staff and 3475 clients from 163 substance abuse treatment programs located in 9 states from three regional Addiction Technology Transfer Centers (ATTC). Measures of client engagement in treatment (rapport, satisfaction, and participation) were shown to be higher in programs with more positive staff ratings of organizational functioning. In particular, these programs had fewer agency needs and more favorable ratings for their resources, staff attributes, and climate. These findings help establish the importance of addressing organizational factors as part of an overall strategy for improving treatment effectiveness. PMID:17433863

Vulnerability re-assessed: the changing face of sex work in Guntur district, Andhra Pradesh.

PubMed

Beattie, Tara S H; Bradley, Janet E; Vanta, Uma Devi; Lowndes, Catherine M; Alary, Michel

2013-01-01

We conducted a qualitative study to examine the impact of an HIV prevention programme on female sex workers' lives in Guntur district, Andhra Pradesh. The study found evidence that, in addition to the HIV prevention programme, structural and environmental factors had recently changed the way sex work was being practiced. Recent closure of the brothels and implementation of a late-night street curfew by the police meant sex work had become more hidden, with clients often solicited using mobile phones from home or their work place (e.g., in the fields or factories). Sex work had become safer, with violence by non-regular partners rarely reported. Women understood the risks of unprotected vaginal sex and reported using condoms with their clients. However, clients were more frequently requesting anal sex, possibly due to recent exposure to pornography following increased accessibility to modern technologies such as mobile phones and the Internet. Anal sex with clients was common but women were often unaware of the associated risks and reported unprotected anal sex. HIV positive and/or older women faced severe financial hardship and difficulty soliciting sufficient clients, and reported unprotected vaginal and anal sex to earn enough to survive. Taken together, the findings from this study suggest changing vulnerability to HIV in this setting. It will be important for HIV prevention programmes to be flexible and creative in their approaches if they are to continue to reach this target community effectively.

The Association between Freedom of Choice and Effectiveness of Home Care Services.

PubMed

Steffansson, Marina; Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka

2016-03-31

The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients' subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients' opinions and to thereby improve the effectiveness of home care services.

Use of sexual risk assessment and feedback at intake to promote counselor awareness of subsequent client risk behavior during early treatment.

PubMed

Hartzler, Bryan; Beadnell, Blair; Calsyn, Donald A

2014-08-01

Sexual risk is an important, oft-neglected area in addiction treatment. This report examines computerized sexual risk assessment and client feedback at intake as means of enhancing counselor awareness of client risk behavior during early treatment, as well as any clinical impact of that counselor awareness. In 2009-2011, new clients at both opiate treatment and drug-free treatment programs endorsed in a computer-assisted assessment at intake 90-day retrospective indices for: being sexually active, having multiple partners, having sex under drug influence, and inconsistently using condoms. Clients were randomly assigned in a 2:1 ratio to receive or not receive a personal feedback report, and those receiving a report chose if a counselor copy was also distributed. Ninety days later, retained clients (N = 79) repeated the assessment and their counselors concurrently reported perceptions of recent client risk behavior. Based on client reports, pretreatment risk behaviors were prevalent among men and women and remained so during treatment. A general linear model revealed greater counselor awareness of subsequent client risk behavior with mutual distribution of intake feedback reports to client and counselor, and at the opiate treatment program. A repeated-measures analysis of variance indicated that counselor awareness did not predict change in temporally stable patterns of sexual risk behavior. CONCLUSIONS/IMPORTANCE: Findings document that computerized intake assessment of sexual risk and mutually distributed feedback reports prompt greater counselor awareness of clients' subsequent risk behavior. Future research is needed to determine how best to prepare counselors to use such awareness to effectively prompt risk reduction in routine care.

Hsp90 Promotes Kinase Evolution

PubMed Central

Lachowiec, Jennifer; Lemus, Tzitziki; Borenstein, Elhanan; Queitsch, Christine

2015-01-01

Heat-shock protein 90 (Hsp90) promotes the maturation and stability of its client proteins, including many kinases. In doing so, Hsp90 may allow its clients to accumulate mutations as previously proposed by the capacitor hypothesis. If true, Hsp90 clients should show increased evolutionary rate compared with nonclients; however, other factors, such as gene expression and protein connectivity, may confound or obscure the chaperone’s putative contribution. Here, we compared the evolutionary rates of many Hsp90 clients and nonclients in the human protein kinase superfamily. We show that Hsp90 client status promotes evolutionary rate independently of, but in a small magnitude similar to that of gene expression and protein connectivity. Hsp90’s effect on kinase evolutionary rate was detected across mammals, specifically relaxing purifying selection. Hsp90 clients also showed increased nucleotide diversity and harbored more damaging variation than nonclient kinases across humans. These results are consistent with the central argument of the capacitor hypothesis that interaction with the chaperone allows its clients to harbor genetic variation. Hsp90 client status is thought to be highly dynamic with as few as one amino acid change rendering a protein dependent on the chaperone. Contrary to this expectation, we found that across protein kinase phylogeny Hsp90 client status tends to be gained, maintained, and shared among closely related kinases. We also infer that the ancestral protein kinase was not an Hsp90 client. Taken together, our results suggest that Hsp90 played an important role in shaping the kinase superfamily. PMID:25246701

Client/Server Architecture Promises Radical Changes.

ERIC Educational Resources Information Center

Freeman, Grey; York, Jerry

1991-01-01

This article discusses the emergence of the client/server paradigm for the delivery of computer applications, its emergence in response to the proliferation of microcomputers and local area networks, the applicability of the model in academic institutions, and its implications for college campus information technology organizations. (Author/DB)

Intervening with High Risk Youth: A Program Model.

ERIC Educational Resources Information Center

Davis, Ruth B.; And Others

1994-01-01

Describes a program for older adolescents exhibiting substance use problems. After initial assessment and referral, most patients enter outpatient treatment groups. Groups fulfill three purposes: (1) Staff monitors clients; (2) Help clients recognize the promise of recovery; and (3) Change behavior. Difficulties of working with multiple community…

Ethics and Strategic Therapy: A Proposed Ethical Direction.

ERIC Educational Resources Information Center

Solovey, Andrew D.; Duncan, Barry L.

1992-01-01

Presents ethical directions in two broad areas often seen as inherent in strategic approach (conscious deception and intervention outside client awareness). Emerging from a discussion of the clinical implications of a constructivist view and a meaning system vocabulary of client change, five ethical presuppositions are exemplified. Discusses…

Using Family Photographs to Explore Life Cycle Changes.

ERIC Educational Resources Information Center

Gerace, Laina M.

1989-01-01

The author introduced discussions about family photographs as a clinical technique with depressed clients. During therapy, clients were encouraged to discuss the photos in an open-ended manner. Methods and themes elicited by photo-interview are presented. Comments on the clinical application of phototherapy are included. (CH)

Changing the Way to Teach Maths: Preservice Primary Teachers' Reflections on Using Exploratory Talk in Teaching Mathematics

ERIC Educational Resources Information Center

Murphy, Carol

2016-01-01

This paper reports on the reflections of twenty-one primary preservice teachers following a microteaching experience that focused on the use of talk and collaborative group work, as part of a primary mathematics specialist education programme. Based on the didactic strategies of exploratory talk, the experience intended to develop knowledge for…

Recovery from depression among clients transitioning out of poverty.

PubMed

Ali, Alisha; Hawkins, Robert L; Chambers, Debbie Ann

2010-01-01

The objective of this study was to investigate whether a program designed to change the economic conditions of clients' lives could also have an impact on reducing their level of depression. The study focused on a sample of men and women attending a program designed to transition clients out of poverty through microlending and peer support. Results revealed that 40.5% of participants who met diagnostic criteria for major depression before beginning the program were no longer clinically depressed after participating in the program for 6 months. The results also revealed that the clients who reported that they felt a strong sense of interpersonal connection within the program were the most likely to recover from depression.

Plain Talk About...Aging. Plain Talk Series.

ERIC Educational Resources Information Center

Kay, Ruth, Ed.

Aging is a state of mind as well as body. The stereotypic image of old age is changing with the increasing variety of living patterns and lifestyles of the elderly. The physical and mental indicators of aging are also varied and do not necessarily keep pace with chronological age. The elderly face changes which challenge their physical and mental…

The clinical effectiveness of healing touch.

PubMed

Wilkinson, Dawn S; Knox, Pamela L; Chatman, James E; Johnson, Terrance L; Barbour, Nilufer; Myles, Yvonne; Reel, Antonio

2002-02-01

(1) to determine the clinical effectiveness of Healing Touch (HT) on variables assumed to be related to health enhancement; (2) to determine whether practitioner training level moderates treatment effectiveness. Mixed-method repeated measures design with quasi-experimental and naturalistic approaches, paired with nomothetic and idiographic analyses. Practitioner's offices or client's home. Twenty-two (22) clients who had never experienced HT. Three treatment conditions: no treatment (NT), HT only (standard HT care), and HT+ (Standard HT care plus music plus guided imagery). Secretory immunoglobulin A (sIgA) concentrations in saliva, self-reports of stress levels, client perceptions of health enhancement, and qualitative questionnaires about individual effects. Clients of practitioners with more training experienced statistically significant positive sIgA change over the HT treatment series, while clients of practitioners with less experience did not. Clients reported a statistically significant reduction of stress level after both HT conditions. Perceived enhancement of health was reported by 13 of 22 clients (59%). Themes of relaxation, connection, and enhanced awareness were identified in the qualitative analysis of the HT experience. Pain relief was reported by 6 of 11 clients (55%) experiencing pain. The data support the clinical effectiveness of HT in health enhancement, specifically for raising sIgA concentrations, lowering stress perceptions and relieving pain. The evidence indicates that positive responses were not exclusively as a result of placebo, that is, client beliefs, expectations, and behaviors regarding HT.

Erognomic education on housework for women with upper limb repetitive strain injury (RSI): a conceptual representation of therapists' clinical reasoning.

PubMed

Cheung, Therma W C; Clemson, Lindy; O' Loughlin, Kate; Shuttleworth, Russell

2017-09-18

Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession's knowledge. To construct a conceptual representation of how occupational therapists make clinical decisions for such program. Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection. Therapists made clinical decisions based on their perceptions of their clients' behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed. The present study indicates the importance of therapists' understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment. Implications for Rehabilitation This study used qualitative research to demonstrate the process of translating therapists' tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists' awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists. It is important for therapists to actively listen to their clients. Active listening will enable the therapists to understand and consider the personal meanings that these women attach to housework in order to facilitate a behavior change. Client-therapist interactions to facilitate clients' willingness to change should become a major focus in such a program. Similar research should be conducted in other clinical areas to develop explicit clinical reasoning frameworks to facilitate learning of novice therapists and reflection of experienced therapists to address any gap in their clinical reasoning.

Qualitative Assessment of the Feasibility, Usability, and Acceptability of a Mobile Client Data App for Community-Based Maternal, Neonatal, and Child Care in Rural Ghana.

PubMed

Rothstein, Jessica D; Jennings, Larissa; Moorthy, Anitha; Yang, Fan; Gee, Lisa; Romano, Karen; Hutchful, David; Labrique, Alain B; LeFevre, Amnesty E

2016-01-01

Mobile phone applications may enhance the delivery of critical health services and the accuracy of health service data. Yet, the opinions and experiences of frontline health workers on using mobile apps to track pregnant and recently delivered women are underreported. This evaluation qualitatively assessed the feasibility, usability, and acceptability of a mobile Client Data App for maternal, neonatal, and child client data management by community health nurses (CHNs) in rural Ghana. The mobile app enabled CHNs to enter, summarize, and query client data. It also sent visit reminders for clients and provided a mechanism to report level of care to district officers. Fourteen interviews and two focus groups with CHNs, midwives, and district health officers were conducted, coded, and thematically analyzed. Results indicated that the app was easily integrated into care, improved CHN productivity, and was acceptable due to its capacity to facilitate client follow-up, data reporting, and decision-making. However, the feasibility and usability of the app were hindered by high client volumes, staff shortages, and software and device challenges. Successful integration of mobile client data apps for frontline health workers in rural and resource-poor settings requires real-time monitoring, program investments, and targeted changes in human resources.

Qualitative Assessment of the Feasibility, Usability, and Acceptability of a Mobile Client Data App for Community-Based Maternal, Neonatal, and Child Care in Rural Ghana

PubMed Central

Jennings, Larissa; Moorthy, Anitha; Yang, Fan; Gee, Lisa; Romano, Karen; Hutchful, David; Labrique, Alain B.; LeFevre, Amnesty E.

2016-01-01

Mobile phone applications may enhance the delivery of critical health services and the accuracy of health service data. Yet, the opinions and experiences of frontline health workers on using mobile apps to track pregnant and recently delivered women are underreported. This evaluation qualitatively assessed the feasibility, usability, and acceptability of a mobile Client Data App for maternal, neonatal, and child client data management by community health nurses (CHNs) in rural Ghana. The mobile app enabled CHNs to enter, summarize, and query client data. It also sent visit reminders for clients and provided a mechanism to report level of care to district officers. Fourteen interviews and two focus groups with CHNs, midwives, and district health officers were conducted, coded, and thematically analyzed. Results indicated that the app was easily integrated into care, improved CHN productivity, and was acceptable due to its capacity to facilitate client follow-up, data reporting, and decision-making. However, the feasibility and usability of the app were hindered by high client volumes, staff shortages, and software and device challenges. Successful integration of mobile client data apps for frontline health workers in rural and resource-poor settings requires real-time monitoring, program investments, and targeted changes in human resources. PMID:28070186

Stockpile Stewardship at Los Alamos(U)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Webster, Robert B.

2012-06-29

Stockpile stewardship is the retention of nuclear weapons in the stockpile beyond their original design life. These older weapons have potential changes inconsistent with the original design intent and military specifications. The Stockpile Stewardship Program requires us to develop high-fidelity, physics-based capabilities to predict, assess, certify and design nuclear weapons without conducting a nuclear test. Each year, the Lab Directors are required to provide an assessment of the safety, security, and reliability our stockpile to the President of the United States. This includes assessing whether a need to return to testing exists. This is a talk to provide an overviewmore » of Stockpile Stewardship's scientific requirements and how stewardship has changed in the absence of nuclear testing. The talk is adapted from an HQ talk to the War college, and historical unclassified talks on weapon's physics.« less

Correlates of Self-efficacy for Condom Use among Male Clients of Female Sex Workers in Tijuana, Mexico

PubMed Central

Volkmann, Tyson; Wagner, Karla D.; Strathdee, Steffanie A.; Semple, Shirley J.; Ompad, Danielle C.; Chavarin, Claudia V.; Patterson, Thomas L.

2013-01-01

Male clients of female sex workers (FSWs) in Tijuana, Mexico engage in high levels of unprotected sex. While behavioral change theories posit that self-efficacy predicts condom use, correlates of self-efficacy for condom use remain largely unstudied. We examined these correlates among male clients of FSWs in Tijuana. Eligible male clients were at least 18 years of age, HIV-negative, lived in Tijuana or San Diego, reported unprotected sex with a Tijuana FSW at least once in the past four months, and agreed to be treated for sexually transmitted infections (STIs). Participants completed an interviewer-administered questionnaire including demographics, substance use, psychosocial and psychosexual characteristics (e.g., outcome expectancies for negotiation of safer sex, social support, and sexual sensation seeking), and sexual behaviors. Participants also underwent HIV/STI testing. A stepwise hierarchical multiple regression analysis identified correlates of self-efficacy for condom use. Of 393 male clients, median age was 37 years. Participants were mostly Spanish-speaking and employed. Factors independently associated with higher self-efficacy for condom use were higher positive outcome expectancies for negotiation of safer sex, lower sexual sensation seeking scores, and higher social support scores. Both psychosocial and psychosexual factors may influence self-efficacy for condom use among male clients of FSWs. These factors represent central constructs in sociocognitive models that explain behavioral change and could be intervention targets for improving self-efficacy for condom use and, ultimately, safer sex behavior. PMID:23842786

Correlates of self-efficacy for condom use among male clients of female sex workers in Tijuana, Mexico.

PubMed

Volkmann, Tyson; Wagner, Karla D; Strathdee, Steffanie A; Semple, Shirley J; Ompad, Danielle C; Chavarin, Claudia V; Patterson, Thomas L

2014-05-01

Male clients of female sex workers (FSWs) in Tijuana, Mexico engage in high levels of unprotected sex. While behavioral change theories posit that self-efficacy predicts condom use, correlates of self-efficacy for condom use remain largely unstudied. We examined these correlates among male clients of FSWs in Tijuana. Eligible male clients were at least 18 years of age, HIV-negative, lived in Tijuana or San Diego, reported unprotected sex with a Tijuana FSW at least once in the past 4 months, and agreed to be treated for sexually transmitted infections (STIs). Participants completed an interviewer-administered questionnaire including demographics, substance use, psychosocial and psychosexual characteristics (e.g., outcome expectancies for negotiation of safer sex, social support, and sexual sensation seeking), and sexual behaviors. Participants also underwent HIV/STI testing. A stepwise hierarchical multiple regression analysis identified correlates of self-efficacy for condom use. Of 393 male clients, median age was 37 years. Participants were mostly Spanish-speaking and employed. Factors independently associated with higher self-efficacy for condom use were higher positive outcome expectancies for negotiation of safer sex, lower sexual sensation seeking scores, and higher social support scores. Both psychosocial and psychosexual factors may influence self-efficacy for condom use among male clients of FSWs. These factors represent central constructs in sociocognitive models that explain behavioral change and could be intervention targets for improving self-efficacy for condom use and, ultimately, safer sex behavior.

The Relationship between Socioeconomic Status and Counseling Outcomes

ERIC Educational Resources Information Center

Hawley, Lisa D.; Leibert, Todd W.; Lane, Joel A.

2014-01-01

In this study, we examined the relationship between various indices of socioeconomic status (SES) and counseling outcomes among clients at a university counseling center. We also explored links between SES and three factors that are generally regarded as facilitative of client change in counseling: motivation, treatment expectancy and social…

Developing Partnerships To Meet Clients' Needs in Changing Government Organizations: A Consultative Process.

ERIC Educational Resources Information Center

Borgen, William A.

2000-01-01

Outlines the development of partnerships across three employment-related government ministries, in a context of organizational restructuring and downsizing. Describes a consultation process regarding effective collaboration to assess unemployed clients' employability needs. In meetings, the workers developed a process that involved the cooperation…

Letter Writing as a Tool To Increase Client Motivation To Change: Application to an Inpatient Crisis Unit.

ERIC Educational Resources Information Center

Tubman, Jonathan G.; Montgomery, Marilyn J.; Wagner, Eric F.

2001-01-01

Describes the application of a letter writing exercise as a motivational technique for group counseling in contemporary crisis unit settings. Discusses guidelines and implications for clinical practice with clients with multiple, chronic problems. (Contains 37 references and 1 table.) (GCP)

Counseling across Sexual Orientation: A Gay Male Therapist Reflects on His Work with Heterosexual Clients.

ERIC Educational Resources Information Center

Hopcke, Robert H.

1990-01-01

Describes homosexual male counselor's experiences as marriage, family, and child counselor. Claims, because of counselor's comfort and openness to alternative roles, parenting situations, and identities, client couples are freed to dialogue about making role changes. Concludes homophobia often obscures valuable contributions homosexual men and…

Individualistic and Collective Group Counseling: Effects with Korean Clients.

ERIC Educational Resources Information Center

Lee, In-Ja; Kelly, Eugene W., Jr.

1996-01-01

In a study of 20 female and 21 male Korean clients with three group counseling approaches (individualistic, collective, and combination of both), no treatment effects were found for social commitment or perceptions of counselor effectiveness. Significant changes were seen in individualism-collectivism congruent with different treatments. (Author)

Solution-Focused Therapy as a Culturally Acknowledging Approach with American Indians

ERIC Educational Resources Information Center

Meyer, Dixie D.; Cottone, R. Rocco

2013-01-01

Limited literature is available applying specific theoretical orientations with American Indians. Solution-focused therapy may be appropriate, given the client-identified solutions, the egalitarian counselor/client relationship, the use of relationships, and the view that change is inevitable. However, adaption of scaling questions and the miracle…

Effectiveness of the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) dissemination project: a science to prenatal care practice partnership.

PubMed

Windsor, Richard; Clark, Jeannie; Cleary, Sean; Davis, Amanda; Thorn, Stephanie; Abroms, Lorien; Wedeles, John

2014-01-01

This study evaluated the effectiveness of the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Program selected by the West Virginia-Right From The Start Project for state-wide dissemination. A process evaluation documented the fidelity of SCRIPT delivery by Designated Care Coordinators (DCC), licensed nurses and social workers who provide home-based case management to Medicaid-eligible clients in all 55 counties. We implemented a quasi-experimental, non-randomized, matched Comparison (C) Group design. The SCRIPT Experimental E Group (N = 259) were all clients in 2009-2010 that wanted to quit, provided a screening carbon monoxide (CO), and received a SCRIPT home visit. The (C) Group was derived from all clients in 2006-2007 who had the same CO assessments as E Group clients and reported receiving cessation counseling. We stratified the baseline CO of E Group clients into 10 strata, and randomly selected the same number of (C) Group clients (N = 259) from each matched strata to evaluate the effectiveness of the SCRIPT Program. There were no significant baseline differences in the E and (C) Group. A Process Evaluation documented a significant increase in the fidelity of DCC delivery of SCRIPT Program procedures: from 63 % in 2006 to 74 % in 2010. Significant increases were documented in the E Group cessation rate (+9.3 %) and significant reduction rate (+4.5 %), a ≥50 % reduction from a baseline CO. Perinatal health case management staff can deliver the SCRIPT Program, and Medicaid-supported clients can change smoking behavior, even very late in pregnancy. When multiple biases were analyzed, we concluded the SCRIPT Dissemination Project was the most plausible reason for the significant changes in behavior.

Smoking-related outcomes and associations with tobacco-free policy in addiction treatment, 2015-2016.

PubMed

Guydish, Joseph; Yip, Deborah; Le, Thao; Gubner, Noah R; Delucchi, Kevin; Roman, Paul

2017-10-01

This study assessed changes in smoking-related outcomes in two cross-sectional samples of clients enrolled in addiction treatment and whether tobacco-free grounds policies were associated with smoking-related outcomes. Clients in 25 programs were surveyed in 2015 (N=1176) and 2016 (N=1055). The samples were compared on smoking prevalence, cigarettes per day (CPD), thinking of quitting, past year quit attempts, staff and clients smoking together, attitudes towards quitting, and tobacco-related services. Second, programs with (n=6) and without (n=17) tobacco-free grounds at both time points were compared on smoking-related outcomes. Last, we examined changes in these measures for two programs that adopted tobacco-free grounds between 2015 and 2016. There was one difference across years, such that the mean score for the tobacco Program Service scale increased from 2.37 to 2.48 (p=0.043, effect size=0.02). In programs with tobacco-free grounds policies, compared to those without, both CPD and the rate of staff and clients smoking together were significantly lower. In the two programs where tobacco-free grounds were implemented during study years, client smoking prevalence decreased (92.5% v. 67.6%, p=0.005), the rate of staff and clients smoking together decreased (35.6% v. 4.2%, p=0.031), mean CPD decreased (10.62v. 8.24, p<0.001) and mean tobacco services received by clients increased (2.08v. 3.05, p<0.001). Addiction treatment programs, and agencies responsible for licensing, regulating and funding these programs, should implement tobacco-free grounds policies. Copyright © 2017 Elsevier B.V. All rights reserved.

Situation analysis study establishes baseline for future assessment of progress in Senegal.

PubMed

1995-08-01

A situation analysis study was conducted by the National Family Planning Program of the Senegalese Ministry of Health and Social Action, with technical assistance from the Population Council's Africa OR/TA Project II, to evaluate the availability, functioning, and quality of family planning (FP) services at all 180 functional Service Delivery Points (SDPs) of Senegal's ten regions. Almost one-third of the SDPs had not received a supervisory visit in the seven months prior to the study, and an additional one-fifth had had no supervisory visits at all. 6% had written job descriptions for their personnel, 8% had a plan of activities, and 2% had an objective in terms of the number of clients to serve. Clinic infrastructure was generally satisfactory, although electricity and water were lacking in 30% of SDPs in rural areas. Six out of 87 SDPs in the urban sector had the minimum equipment needed. The majority of FP providers were midwives whose formal training had been limited to the management of pills and IUDs; 32% of providers had no training in administering injectables. Information, education, and communication materials were unavailable at most SDPs. 6% featured FP talks on site on the day of the research visit; six out of ten lacked a visible sign indicating the availability of FP services. On average, FP services were available four days a week, but 53% of the SDPs started services an hour late on the day of the research visit, and many were limited to four hours of service per day. 67% provided injectables, and 78% supplied IUDs. Inadequate management of contraceptive stock was partly responsible for method shortages. Records were incomplete. 81% of new clients had access to and obtained their preferred contraceptive method; however, other appropriate methods were not discussed during consultations, and counseling on method side effects was inadequate. 56% of new clients were asked about their reproductive intentions. Counseling regarding sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) was practically nonexistent. Health problems found during FP consultations were rarely addressed. Non-medical barriers to the utilization of contraceptive methods existed in terms of age, parity, and marital status. Client waiting time was long, while consultation time was short. Most women had follow-up dates on their identification cards; 95% were told to return for supplies. The majority of clients were generally satisfied.

What Do U.S. Army Field Grade Officers Perceive as Their Role in Building Resilience in Soldiers?

DTIC Science & Technology

2012-12-14

on was job satisfaction. The study also found that there was little change in the training group scores from their posttest data collection to the...reviewed the topics that were concerned, talked about the numbers in the Army. This is a one-star general talking to us, so it was very broad-based. The...how to do anything. It reviewed the topics that were concerned, talked about the numbers in the Army. This is a one-star general talking to us, so

Allosteric Regulation of the Hsp90 Dynamics and Stability by Client Recruiter Cochaperones: Protein Structure Network Modeling

PubMed Central

Blacklock, Kristin; Verkhivker, Gennady M.

2014-01-01

The fundamental role of the Hsp90 chaperone in supporting functional activity of diverse protein clients is anchored by specific cochaperones. A family of immune sensing client proteins is delivered to the Hsp90 system with the aid of cochaperones Sgt1 and Rar1 that act cooperatively with Hsp90 to form allosterically regulated dynamic complexes. In this work, functional dynamics and protein structure network modeling are combined to dissect molecular mechanisms of Hsp90 regulation by the client recruiter cochaperones. Dynamic signatures of the Hsp90-cochaperone complexes are manifested in differential modulation of the conformational mobility in the Hsp90 lid motif. Consistent with the experiments, we have determined that targeted reorganization of the lid dynamics is a unifying characteristic of the client recruiter cochaperones. Protein network analysis of the essential conformational space of the Hsp90-cochaperone motions has identified structurally stable interaction communities, interfacial hubs and key mediating residues of allosteric communication pathways that act concertedly with the shifts in conformational equilibrium. The results have shown that client recruiter cochaperones can orchestrate global changes in the dynamics and stability of the interaction networks that could enhance the ATPase activity and assist in the client recruitment. The network analysis has recapitulated a broad range of structural and mutagenesis experiments, particularly clarifying the elusive role of Rar1 as a regulator of the Hsp90 interactions and a stability enhancer of the Hsp90-cochaperone complexes. Small-world organization of the interaction networks in the Hsp90 regulatory complexes gives rise to a strong correspondence between highly connected local interfacial hubs, global mediator residues of allosteric interactions and key functional hot spots of the Hsp90 activity. We have found that cochaperone-induced conformational changes in Hsp90 may be determined by specific interaction networks that can inhibit or promote progression of the ATPase cycle and thus control the recruitment of client proteins. PMID:24466147

Allosteric regulation of the Hsp90 dynamics and stability by client recruiter cochaperones: protein structure network modeling.

PubMed

Blacklock, Kristin; Verkhivker, Gennady M

2014-01-01

The fundamental role of the Hsp90 chaperone in supporting functional activity of diverse protein clients is anchored by specific cochaperones. A family of immune sensing client proteins is delivered to the Hsp90 system with the aid of cochaperones Sgt1 and Rar1 that act cooperatively with Hsp90 to form allosterically regulated dynamic complexes. In this work, functional dynamics and protein structure network modeling are combined to dissect molecular mechanisms of Hsp90 regulation by the client recruiter cochaperones. Dynamic signatures of the Hsp90-cochaperone complexes are manifested in differential modulation of the conformational mobility in the Hsp90 lid motif. Consistent with the experiments, we have determined that targeted reorganization of the lid dynamics is a unifying characteristic of the client recruiter cochaperones. Protein network analysis of the essential conformational space of the Hsp90-cochaperone motions has identified structurally stable interaction communities, interfacial hubs and key mediating residues of allosteric communication pathways that act concertedly with the shifts in conformational equilibrium. The results have shown that client recruiter cochaperones can orchestrate global changes in the dynamics and stability of the interaction networks that could enhance the ATPase activity and assist in the client recruitment. The network analysis has recapitulated a broad range of structural and mutagenesis experiments, particularly clarifying the elusive role of Rar1 as a regulator of the Hsp90 interactions and a stability enhancer of the Hsp90-cochaperone complexes. Small-world organization of the interaction networks in the Hsp90 regulatory complexes gives rise to a strong correspondence between highly connected local interfacial hubs, global mediator residues of allosteric interactions and key functional hot spots of the Hsp90 activity. We have found that cochaperone-induced conformational changes in Hsp90 may be determined by specific interaction networks that can inhibit or promote progression of the ATPase cycle and thus control the recruitment of client proteins.

A Qualitative Study of Client-Clinician Text Exchanges in a Mobile Health Intervention for Individuals With Psychotic Disorders and Substance Use.

PubMed

Aschbrenner, Kelly A; Naslund, John A; Gill, Lydia E; Bartels, Stephen J; Ben-Zeev, Dror

2016-01-01

Mobile health (mHealth) approaches have the potential to transform prevention, wellness, and illness management for people with dual diagnosis consisting of co-occurring mental illness and substance use disorders by providing timely and cost-effective interventions in clients' natural environments. However, little is known about how clients interact with mHealth interventions to manage their illness. This qualitative study explored the content of mobile phone text messages between clients with dual diagnosis and a clinician who engaged them in daily assessment and intervention text exchanges. Seventeen participants with psychotic disorders and substance use were enrolled in a 12-week single-arm trial of an mHealth intervention focusing on illness management. The clinician (i.e., mobile interventionist) sent daily text messages to participants' privately owned mobile phones to assess their medication adherence and clinical status. The clinician provided other illness management and wellness suggestions flexibly, in response to participants' needs and preferences. In this qualitative study we conducted a thematic analysis of the client-clinician text exchanges that occurred over the course of the intervention. Seven major content themes in client-clinician text message exchanges were identified: mental health symptoms; mental health coping strategies; mental health treatment and management; lifestyle behaviors; social relationships and leisure activities; motivation and personal goal setting; and independent living. Participants were interested in discussing strategies for coping with mental health symptoms (e.g., cognitive restructuring, social support) and health behavior change (e.g., increased physical activity, dietary changes). Our findings suggest that client-centered text messaging has the potential to be an important component of illness management for people with dual diagnosis. This approach is able to offer coping strategies that are tailored to clients' needs and preferences in real time when help is needed.

A big data approach for climate change indicators processing in the CLIP-C project

NASA Astrophysics Data System (ADS)

D'Anca, Alessandro; Conte, Laura; Palazzo, Cosimo; Fiore, Sandro; Aloisio, Giovanni

2016-04-01

Defining and implementing processing chains with multiple (e.g. tens or hundreds of) data analytics operators can be a real challenge in many practical scientific use cases such as climate change indicators. This is usually done via scripts (e.g. bash) on the client side and requires climate scientists to take care of, implement and replicate workflow-like control logic aspects (which may be error-prone too) in their scripts, along with the expected application-level part. Moreover, the big amount of data and the strong I/O demand pose additional challenges related to the performance. In this regard, production-level tools for climate data analysis are mostly sequential and there is a lack of big data analytics solutions implementing fine-grain data parallelism or adopting stronger parallel I/O strategies, data locality, workflow optimization, etc. High-level solutions leveraging on workflow-enabled big data analytics frameworks for eScience could help scientists in defining and implementing the workflows related to their experiments by exploiting a more declarative, efficient and powerful approach. This talk will start introducing the main needs and challenges regarding big data analytics workflow management for eScience and will then provide some insights about the implementation of some real use cases related to some climate change indicators on large datasets produced in the context of the CLIP-C project - a EU FP7 project aiming at providing access to climate information of direct relevance to a wide variety of users, from scientists to policy makers and private sector decision makers. All the proposed use cases have been implemented exploiting the Ophidia big data analytics framework. The software stack includes an internal workflow management system, which coordinates, orchestrates, and optimises the execution of multiple scientific data analytics and visualization tasks. Real-time workflow monitoring execution is also supported through a graphical user interface. In order to address the challenges of the use cases, the implemented data analytics workflows include parallel data analysis, metadata management, virtual file system tasks, maps generation, rolling of datasets, and import/export of datasets in NetCDF format. The use cases have been implemented on a HPC cluster of 8-nodes (16-cores/node) of the Athena Cluster available at the CMCC Supercomputing Centre. Benchmark results will be also presented during the talk.

'Imagine if I gave up smoking ...': a qualitative exploration of Aboriginal participants' perspectives of a self-management pilot training intervention.

PubMed

Chapple, Kimberley; Kowanko, Inge; Harvey, Peter; Chong, Alwin; Battersby, Malcolm

2016-01-01

This paper reports on a pilot qualitative study investigating Aboriginal participants' perspectives of the Flinders Living Well Smoke Free (LWSF) 'training intervention'. Health workers nationally have been trained in this program, which offers a self-management approach to reducing smoking among Aboriginal clients. A component of the training involves Aboriginal clients volunteering their time in a mock care-planning session providing the health workers with an opportunity to practise their newly acquired skills. During this simulation, the volunteer clients receive one condensed session of the LWSF intervention imitating how the training will be implemented when the health workers have completed the training. For the purpose of this study, 10 Aboriginal clients who had been volunteers in the mock care-planning process, underwent a semi-structured interview at seven sites in Australia, including mainstream health services, Aboriginal community controlled health services and remote Aboriginal communities. The study aimed to gauge their perspectives of the training intervention they experienced. Early indications suggest that Aboriginal volunteer clients responded positively to the process, with many reporting substantial health behaviour change or plans to make changes since taking part in this mock care-planning exercise. Enablers of the intervention are discussed along with factors to be considered in the training program.

Body Movement Synchrony in Psychotherapeutic Counseling: A Study Using the Video-Based Quantification Method

NASA Astrophysics Data System (ADS)

Nagaoka, Chika; Komori, Masashi

Body movement synchrony (i. e. rhythmic synchronization between the body movements of interacting partners) has been described by subjective impressions of skilled counselors and has been considered to reflect the depth of the client-counselor relationship. This study analyzed temporal changes in body movement synchrony through a video analysis of client-counselor dialogues in counseling sessions. Four 50-minute psychotherapeutic counseling sessions were analyzed, including two negatively evaluated sessions (low evaluation groups) and two positively evaluated sessions (high evaluation groups). In addition, two 50-minute ordinary advice sessions between two high school teachers and the clients in the high rating group were analyzed. All sessions represent role-playing. The intensity of the participants' body movement was measured using a video-based system. Temporal change of body movement synchrony was analyzed using moving correlations of the intensity between the two time series. The results revealed (1) A consistent temporal pattern among the four counseling cases, though the moving correlation coefficients were higher for the high evaluation group than the low evaluation group and (2) Different temporal patterns for the counseling and advice sessions even when the clients were the same. These results were discussed from the perspective of the quality of client-counselor relationship.

Suicide trends in an expanding mental health service in Auckland.

PubMed

Argyle, Nick

2010-10-01

Suicide is a global health priority. It is important to analyse the effects of investment in mental health services on suicide rates. This paper presents and discusses recent changes in suicide rates and diagnostic mix among clients of the mental health service in Auckland during a time of service growth. Details of suicides among current clients were analysed for the years 1993 to 2006, comparing the periods 1993-1999 and 2000-2006. These periods were compared with the local population and national figures. The local population suicide rate decreased significantly with the rate among clients increasing slightly so the proportion occurring among clients increased (up to 31%). There was an increase in non-psychotic diagnoses. As access to services expands the proportion of suicides that occur in known clients will paradoxically increase. Service expansion may have contributed to the falling population suicide rate in Auckland.

Design and Development of a Web-Based Self-Monitoring System to Support Wellness Coaching.

PubMed

Zarei, Reza; Kuo, Alex

2017-01-01

We analyzed, designed and deployed a web-based, self-monitoring system to support wellness coaching. A wellness coach can plan for clients' exercise and diet through the system and is able to monitor the changes in body dimensions and body composition that the client reports. The system can also visualize the client's data in form of graphs for both the client and the coach. Both parties can also communicate through the messaging feature embedded in the application. A reminder system is also incorporated into the system and sends reminder messages to the clients when their reporting is due. The web-based self-monitoring application uses Oracle 11g XE as the backend database and Application Express 4.2 as user interface development tool. The system allowed users to access, update and modify data through web browser anytime, anywhere, and on any device.

Mediators of Change in the Child/Adolescent Anxiety Multimodal Treatment Study

PubMed Central

Kendall, Philip C.; Cummings, Colleen M.; Villabø, Marianne A.; Narayanan, Martina K.; Treadwell, Kimberli; Birmaher, Boris; Compton, Scott; Piacentini, John; Sherrill, Joel; Walkup, John; Gosch, Elizabeth; Keeton, Courtney; Ginsburg, Golda; Suveg, Cindy; Albano, Anne Marie

2015-01-01

Objective Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). Method Participants were 488 youth (ages 7-17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met DSM-IV criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up. Results Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms. Conclusions The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator. PMID:26460572

[Forensic (flexible) assertive community treatment: client characteristics and treatment outcomes].

PubMed

Neijmeijer, L; Verwoerd, J; van Vugt, M; Place, C; Kroon, H

(Flexible) Assertive community treatment ((f)act) is applied increasingly to forensic psychiatric clients. However, evidence about the effectiveness of forensic (f)act is scanty. To investigate to what extent (subgroups of) clients receiving care from forensic (f)act teams show, after a year, changes in their social and psychological functioning and are subjected to fewer justicial outcome measures. Between 2009 and 2011, eight forensic (f)act teams collected, at two measurement moments separated by an average of 12 months, data relating to client characteristics and outcomes of care. The study involved 202 clients. After a year clients showed significant improvements in psychological and social functioning, and had fewer confrontations with the police and the law. They were detained less often and for shorter periods and were considered to be less likely to reoffend. The number of admissions to mental health care and to addiction and forensic care remained constant. Clients with a psychiatric disorder and likely to display criminal behaviour showed improvement while being treated by forensic (f)act teams. Further research is needed to prove whether forensic (f)act treatment will have the desired effects in the longer term and will enjoy the status of being regarded as evidence based practice.

Suicide risk of your client: initial identification and management for the allied health professional.

PubMed

Donley, Euan

2013-01-01

Allied health professionals treat clients in varying degrees of distress with complex needs in a wide range of services. A client could be experiencing a chronic or life-changing illness, have a trauma from a critical event, have preexisting mental illness, be dealing with significant health or personal loss, be using substances, or experiencing a depression. At some point an allied health professional will treat a client who may have a diagnosed depression, appear depressed, or have thoughts of suicide. Mental health of clients is everyone's responsibility, especially those working in health. This article aims to increase allied health professionals' understanding of some risk factors and clinical features a client at risk may have and will discuss some initial options of management. It is recommended the allied health professional and organisation be aware of risk factors for suicide but not rely too heavily on risk screening. The worker should have basic skills in recognising poor mood and have a list of useful questions to ask in a crisis. Know your local crisis and supportive mental health services, create links with them, have ongoing professional education and protocols for managing clients at-risk, and be acutely aware of your role and limitations.

Share Data with OPeNDAP Hyrax: New Features and Improvements

NASA Technical Reports Server (NTRS)

Gallagher, James

2016-01-01

During the upcoming Summer 2016 meeting of the ESIP Federation (July 19-22), OpenDAP will hold a Developers and Users Workshop. While a broad set of topics will be covered, a key focus is capitalizing on recent EOSDIS-sponsored advances in Hyrax, OPeNDAPs own software for server-side realization of the DAP2 and DAP4 protocols. These Hyrax advances are as important to data users as to data providers, and the workshop will include hands-on experiences of value to both. Specifically, a balanced set of presentations and hands-on tutorials will address advances in 1. server installation, 2. server configuration, 3. Hyrax aggregation capabilities, 4. support for data-access from clients that are HTTP-based, JSON-based or OGC-compliant (especially WCS and WMS), 5. support for DAP4,6.use and extension of server-side computational capabilities, and7.several performance-affecting matters. Topics 2 through 7 will be relevant to data consumers, data providers and notably, due to the open-source nature of all OPeNDAP software to developers wishing to extend Hyrax, to build compatible clients and servers, and/or to employ Hyrax as middleware that enables interoperability across a variety of end-user and source-data contexts. A session for contributed talks will elaborate the topics listed above and embrace additional ones.

Advancing the Power and Utility of Server-Side Aggregation

NASA Technical Reports Server (NTRS)

Fulker, Dave; Gallagher, James

2016-01-01

During the upcoming Summer 2016 meeting of the ESIP Federation (July 19-22), OpenDAP will hold a Developers and Users Workshop. While a broad set of topics will be covered, a key focus is capitalizing on recent EOSDIS-sponsored advances in Hyrax, OPeNDAPs own software for server-side realization of the DAP2 and DAP4 protocols. These Hyrax advances are as important to data users as to data providers, and the workshop will include hands-on experiences of value to both. Specifically, a balanced set of presentations and hands-on tutorials will address advances in1.server installation,2.server configuration,3.Hyrax aggregation capabilities,4.support for data-access from clients that are HTTP-based, JSON-based or OGC-compliant (especially WCS and WMS),5.support for DAP4,6.use and extension of server-side computational capabilities, and7.several performance-affecting matters.Topics 2 through 7 will be relevant to data consumers, data providers andnotably, due to the open-source nature of all OPeNDAP softwareto developers wishing to extend Hyrax, to build compatible clients and servers, andor to employ Hyrax as middleware that enables interoperability across a variety of end-user and source-data contexts. A session for contributed talks will elaborate the topics listed above and embrace additional ones.

Demonstration of Data Interactive Publications

NASA Astrophysics Data System (ADS)

Domenico, B.; Weber, J.

2012-04-01

This is a demonstration version of the talk given in session ESSI2.4 "Full lifecycle of data." For some years now, the authors have developed examples of online documents that allowed the reader to interact directly with datasets, but there were limitations that restricted the interaction to specific desktop analysis and display tools that were not generally available to all readers of the documents. Recent advances in web service technology and related standards are making it possible to develop systems for publishing online documents that enable readers to access, analyze, and display the data discussed in the publication from the perspective and in the manner from which the author wants it to be represented. By clicking on embedded links, the reader accesses not only the usual textual information in a publication, but also data residing on a local or remote web server as well as a set of processing tools for analyzing and displaying the data. With the option of having the analysis and display processing provided on the server (or in the cloud), there are now a broader set of possibilities on the client side where the reader can interact with the data via a thin web client, a rich desktop application, or a mobile platform "app." The presentation will outline the architecture of data interactive publications along with illustrative examples.

Recovery-oriented perceptions as predictors of reincarceration.

PubMed

De Leon, George; Melnick, Gerald; Cao, Yan; Wexler, Harry K

2006-07-01

The present prospective study explored whether a specific class of client subjective assessments predicts later recovery. Measures of client perceptions of self-change in substance abusers were obtained a year after release from a prison-based therapeutic community. Analyses assessed the contribution of these perceptions-along with motivation, age, and risk index of social deviancy-in predicting reincarceration at 3-year follow-up. Results showed that two factors (Individual Growth and Socialization) significantly differentiated reincarceration and nonreincarceration at 1-year postrelease and significantly predicted reincarceration at 3-year follow-up. Findings underscore the relevance of perceptions of self-change early in recovery to later recovery behaviors. Research on recovery factors needs a uniform assessment protocol, which organizes client perceptions, beliefs, and attributions in accordance with a recovery stage framework.

Analysing change in music therapy interactions of children with communication difficulties.

PubMed

Spiro, Neta; Himberg, Tommi

2016-05-05

Music therapy has been found to improve communicative behaviours and joint attention in children with autism, but it is unclear what in the music therapy sessions drives those changes. We developed an annotation protocol and tools to accumulate large datasets of music therapy, for analysis of interaction dynamics. Analysis of video recordings of improvisational music therapy sessions focused on simple, unambiguous individual and shared behaviours: movement and facing behaviours, rhythmic activity and musical structures and the relationships between them. To test the feasibility of the protocol, early and late sessions of five client-therapist pairs were annotated and analysed to track changes in behaviours. To assess the reliability and validity of the protocol, inter-rater reliability of the annotation tiers was calculated, and the therapists provided feedback about the relevance of the analyses and results. This small-scale study suggests that there are both similarities and differences in the profiles of client-therapist sessions. For example, all therapists faced the clients most of the time, while the clients did not face back so often. Conversely, only two pairs had an increase in regular pulse from early to late sessions. More broadly, similarity across pairs at a general level is complemented by variation in the details. This perhaps goes some way to reconciling client- and context-specificity on one hand and generalizability on the other. Behavioural characteristics seem to influence each other. For instance, shared rhythmic pulse alternated with mutual facing and the occurrence of shared pulse was found to relate to the musical structure. These observations point towards a framework for looking at change in music therapy that focuses on networks of variables or broader categories. The results suggest that even when starting with simple behaviours, we can trace aspects of interaction and change in music therapy, which are seen as relevant by therapists. © 2016 The Authors.

Factors influencing utilization of intermittent preventive treatment for pregnancy in the Gushegu district, Ghana, 2013.

PubMed

Stephen, Atasige Awin-Irigu; Wurapa, Frederick; Afari, Edwin Andrew; Sackey, Samuel Oko; Malm, Keaziah Laurencia; Nyarko, Kofi Mensah

2016-01-01

The coverage of adequate (≥2 doses) IPTp-SP in Ghana is below the national target of 80% and that is a threat to reducing the incidence of malaria in pregnancy. The primary objective of the study was to determine the client and facility related factors associated with adequate uptake of IPTp-SP and suggest approaches for increased uptake. A cross sectional study was conducted among ANC clients and staff in Gushegu, questionnaires was administered to 330 conveniently sampled nursing mothers and all ANC staff present. A checklist and observation were used to collect health facility data. Data was analyzed descriptively and associations between the related factors and adequate uptake of IPTp-SP were determined. A total of 91.5% and 8.5% of respondents took adequate (≥2doses) and inadequate (≤1dose) IPTp-SP respectively. 85.4% respondents were early first ANC attendance and 80% were multiple gravidae. Mean ANC visits was 5.0 (standard deviation = 2.2). The key determinants for inadequate uptake of IPTp were Unemployment [OR= 4.9 95% CI (1.9-13.1], single gravidae [OR= 3.4 95% CI (1.5-7.6)] and late first ANC visit [OR= 6.8 95% CI (3.0-15.4)]. DOT practice, good staff attitude and health talk at the facility were observed and confirmed by ANC clients as satisfactory. adequate uptake of SP among respondents was high. Majorities were unemployed, have had multiple pregnancies and made early first ANC visits. Unemployment and late first ANC visits are significantly associated with taking inadequate SP dose. Adequate uptake of SP among respondents was high. Majorities were unemployed, have had multiple pregnancies and made early first ANC visits. Unemployment and late first ANC visits are significantly associated with taking inadequate SP dose.

More than reflections: Empathy in motivational interviewing includes language style synchrony between therapist and client

PubMed Central

Lord, Sarah Peregrine; Sheng, Elisa; Imel, Zac E.; Baer, John; Atkins, David C.

2016-01-01

Empathy is a basic psychological process that involves the development of synchrony in dyads. It is also a foundational ingredient in specific, evidence-based behavioral treatments like motivational interviewing (MI). Ratings of therapist empathy typically rely on a gestalt, “felt sense” of therapist understanding and the presence of specific verbal behaviors like reflective listening. These ratings do not provide a direct test of psychological processes like behavioral synchrony that are theorized to be an important component of empathy in psychotherapy. To explore a new objective indicator of empathy, we hypothesized that synchrony in language style (i.e., matching how statements are phrased) between client and therapists would predict gestalt ratings of empathy over and above the contribution of reflections. We analyzed 122 MI transcripts with high and low empathy ratings based on the Motivational Interviewing Treatment Integrity (MITI) global rating scale. Linguistic inquiry and word count was used to estimate language style synchrony (LSS) of adjacent client and therapist talk turns. High empathy sessions showed greater LSS across 11 language style categories compared to low empathy sessions (p < .01), and overall, average LSS was notably higher in high empathy vs. low empathy sessions (d = 0.62). Regression analyses showed that LSS was predictive of empathy ratings over and above reflection counts; a 1 SD increase in LSS is associated with 2.4 times increase in the odds of a high empathy rating, controlling for therapist reflections (odds ratio = 2.4, 95% CI: 1.36, 4.24, p < .01). These findings suggest empathy ratings are related to synchrony in language style, over and above synchrony of content as measured by therapist reflections. Novel indicators of therapist empathy may have implications for the study of MI process as well as the training of therapists. PMID:25892166

GenExp: an interactive web-based genomic DAS client with client-side data rendering.

PubMed

Gel Moreno, Bernat; Messeguer Peypoch, Xavier

2011-01-01

The Distributed Annotation System (DAS) offers a standard protocol for sharing and integrating annotations on biological sequences. There are more than 1000 DAS sources available and the number is steadily increasing. Clients are an essential part of the DAS system and integrate data from several independent sources in order to create a useful representation to the user. While web-based DAS clients exist, most of them do not have direct interaction capabilities such as dragging and zooming with the mouse. Here we present GenExp, a web based and fully interactive visual DAS client. GenExp is a genome oriented DAS client capable of creating informative representations of genomic data zooming out from base level to complete chromosomes. It proposes a novel approach to genomic data rendering and uses the latest HTML5 web technologies to create the data representation inside the client browser. Thanks to client-side rendering most position changes do not need a network request to the server and so responses to zooming and panning are almost immediate. In GenExp it is possible to explore the genome intuitively moving it with the mouse just like geographical map applications. Additionally, in GenExp it is possible to have more than one data viewer at the same time and to save the current state of the application to revisit it later on. GenExp is a new interactive web-based client for DAS and addresses some of the short-comings of the existing clients. It uses client-side data rendering techniques resulting in easier genome browsing and exploration. GenExp is open source under the GPL license and it is freely available at http://gralggen.lsi.upc.edu/recerca/genexp.

GenExp: An Interactive Web-Based Genomic DAS Client with Client-Side Data Rendering

PubMed Central

Gel Moreno, Bernat; Messeguer Peypoch, Xavier

2011-01-01

Background The Distributed Annotation System (DAS) offers a standard protocol for sharing and integrating annotations on biological sequences. There are more than 1000 DAS sources available and the number is steadily increasing. Clients are an essential part of the DAS system and integrate data from several independent sources in order to create a useful representation to the user. While web-based DAS clients exist, most of them do not have direct interaction capabilities such as dragging and zooming with the mouse. Results Here we present GenExp, a web based and fully interactive visual DAS client. GenExp is a genome oriented DAS client capable of creating informative representations of genomic data zooming out from base level to complete chromosomes. It proposes a novel approach to genomic data rendering and uses the latest HTML5 web technologies to create the data representation inside the client browser. Thanks to client-side rendering most position changes do not need a network request to the server and so responses to zooming and panning are almost immediate. In GenExp it is possible to explore the genome intuitively moving it with the mouse just like geographical map applications. Additionally, in GenExp it is possible to have more than one data viewer at the same time and to save the current state of the application to revisit it later on. Conclusions GenExp is a new interactive web-based client for DAS and addresses some of the short-comings of the existing clients. It uses client-side data rendering techniques resulting in easier genome browsing and exploration. GenExp is open source under the GPL license and it is freely available at http://gralggen.lsi.upc.edu/recerca/genexp. PMID:21750706

A qualitative meta-analysis examining clients' experiences of psychotherapy: A new agenda.

PubMed

Levitt, Heidi M; Pomerville, Andrew; Surace, Francisco I

2016-08-01

This article argues that psychotherapy practitioners and researchers should be informed by the substantive body of qualitative evidence that has been gathered to represent clients' own experiences of therapy. The current meta-analysis examined qualitative research studies analyzing clients' experiences within adult individual psychotherapy that appeared in English-language journals. This omnibus review integrates research from across psychotherapy approaches and qualitative methods, focusing on the cross-cutting question of how clients experience therapy. It utilized an innovative method in which 67 studies were subjected to a grounded theory meta-analysis in order to develop a hierarchy of data and then 42 additional studies were added into this hierarchy using a content meta-analytic method-summing to 109 studies in total. Findings highlight the critical psychotherapy experiences for clients, based upon robust findings across these research studies. Process-focused principles for practice are generated that can enrich therapists' understanding of their clients in key clinical decision-making moments. Based upon these findings, an agenda is suggested in which research is directed toward heightening therapists' understanding of clients and recognizing them as agents of change within sessions, supporting the client as self-healer paradigm. This research aims to improve therapists' sensitivity to clients' experiences and thus can expand therapists' attunement and intentionality in shaping interventions in accordance with whichever theoretical orientation is in use. The article advocates for the full integration of the qualitative literature in psychotherapy research in which variables are conceptualized in reference to an understanding of clients' experiences in sessions. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Evaluating healing for cancer in a community setting from the perspective of clients and healers: a pilot study.

PubMed

Vaghela, C; Robinson, N; Gore, J; Peace, B; Lorenc, A

2007-11-01

The real-life practice of 'healing' for cancer in the community as perceived by clients and healers was investigated in a multi-method pilot study. Fifteen clients received six weekly healing sessions. Pre- and post-changes in perception towards well-being and client experience were assessed by EuroQol (EQ-5D), measure yourself concerns and well-being (MYCaW) and a client satisfaction tool. Qualitative methods, including focus groups, explored the perceived effects of healing in more depth and the participants' experience of taking part in research. The study was not designed to test the effect of healing on disease. Quantitative data showed perceived significant improvements in 'concerns/problems' for which clients wanted help (p<0.01), well-being (p<0.01) and anxiety/depression (p<0.05) over the course of healing. Significant effects were not seen in all areas of quality of life. Qualitative analysis showed clients mainly sought help for psychological and emotional concerns and reported only beneficial effects of healing. Clients attributed many of the quantitative improvements to healing itself. Despite some concerns, healers and clients engaged fully with the research process, and were enthusiastic about the importance of research into healing. Our study suggests that, while there are some confounding issues and study limitations to address, clients and healers perceive healing to have a range of benefits, particularly in terms of coping with cancer, and regard it as a useful approach that can be applied in a community setting alongside conventional medicine.

Confirming, Validating, and Norming the Factor Structure of Systemic Therapy Inventory of Change Initial and Intersession.

PubMed

Pinsof, William M; Zinbarg, Richard E; Shimokawa, Kenichi; Latta, Tara A; Goldsmith, Jacob Z; Knobloch-Fedders, Lynne M; Chambers, Anthony L; Lebow, Jay L

2015-09-01

Progress or feedback research tracks and feeds back client progress data throughout the course of psychotherapy. In the effort to empirically ground psychotherapeutic practice, feedback research is both a complement and alternative to empirically supported manualized treatments. Evidence suggests that tracking and feeding back progress data with individual or nonsystemic feedback systems improves outcomes in individual and couple therapy. The research reported in this article pertains to the STIC(®) (Systemic Therapy Inventory of Change)-the first client-report feedback system designed to empirically assess and track change within client systems from multisystemic and multidimensional perspectives in individual, couple, and family therapy. Clients complete the STIC Initial before the first session and the shorter STIC Intersession before every subsequent session. This study tested and its results supported the hypothesized factor structure of the six scales that comprise both STIC forms in a clinical outpatient sample and in a normal, random representative sample of the U.S. This study also tested the STIC's concurrent validity and found that its 6 scales and 40 of its 41 subscales differentiated the clinical and normal samples. Lastly, the study derived clinical cut-offs for each scale and subscale to determine whether and how much a client's score falls in the normal or clinical range. Beyond supporting the factorial and concurrent validity of both STIC forms, this research supported the reliabilities of the six scales (Omegahierarchical ) as well as the reliabilities of most subscales (alpha and rate-rerate). This article delineates clinical implications and directions for future research. © 2015 Family Process Institute.

Ten Year Plan for the Redevelopment of Intellectual Disability Services. Final Report.

ERIC Educational Resources Information Center

Neilson Associates Pty. Ltd., Melbourne (Australia).

This report recommends a 10-year plan for changes in services to people with intellectual disabilities in Victoria, Australia. Intended key outcomes of the plan include: increases in the numbers of clients receiving direct residential support in community-based accommodations; reductions in numbers of adult clients resident in large scale…

Management Development for Education: The Changing Role of Higher Education.

ERIC Educational Resources Information Center

Watson, Leonard E.

This paper considers trends in the relationship between English institutions of higher education and those who participate in them. It is suggested that a move from a client-professional toward a customer-provider relationship has occurred. A drawback of the client-professional model is the creation of unequal power relationships; the…

Effects of Intergenerational Massage on Future Caregivers' Attitudes toward Aging, the Elderly, and Caring for the Elderly.

ERIC Educational Resources Information Center

Ward, Christopher R.; Duquin, Mary E.; Streetman, Heidi

1998-01-01

Fourteen students in a therapeutic massage course practiced with elderly clients. Interviews and student journals showed a very positive shift in attitudes toward aging and working with older clients. The kinesthetic experience and the intensity of the interaction influenced the attitude change. (SK)

Psychotherapy in Caribbean Cultures.

ERIC Educational Resources Information Center

Lefley, Harriet P.; Bestman, Evalina W.

Caribbean mental health professionals are concerned with the types of psychotherapy that are relevant to the needs of their clients, and with the uses of psychotherapy in a political context. They appear to be divided into two schools: one seeking to promote in clients a change from a traditional world view to a modern one, and the other seeking…

Evaluation of the Recognizing and Responding to Suicide Risk Training

ERIC Educational Resources Information Center

Jacobson, Jodi Michelle; Osteen, Philip; Jones, Andrea; Berman, Alan

2012-01-01

Changes in attitudes, confidence, and practice behaviors were assessed among 452 clinicians who completed the training, Recognizing and Responding to Suicide Risk, and who work with clients at risk for suicide. Data were collected at three time points. Scores on measures of attitudes toward suicide prevention and confidence to work with clients at…

Treating the Purple Menace: Ethical Considerations of Conversion Therapy and Affirmative Alternatives.

ERIC Educational Resources Information Center

Tozer, Erinn E.; McClanahan, Mary K.

1999-01-01

Outlines the ethical considerations for sexual orientation conversion therapy for lesbian, gay, and bisexual individuals. There are numerous reasons not to acquiesce to a client's desire to change his or her sexual orientation. Presents guidelines for responding to a client seeking reorientation and evaluating one's biases regarding lesbian, gay,…

[Patients, clients, doctors and providers: is it just a question of terminology?].

PubMed

Ayuzo Del Valle, Cipatli

2016-01-01

With the modernization of healthcare and management of a Hospital as a bussiness, There is the risk of changing the words "patient" and "doctor" into "client" and "provider", risking the humanitarian care, thrustworthiness, and doctor-patient relationship. Using first and last names could be an option for communication.

Improving the Work Performance of Mentally Retarded Clients in a Sheltered Workshop.

ERIC Educational Resources Information Center

Starke, Mary C.; Wright, Jaice

1986-01-01

Twenty-three mentally retarded workshop clients were assigned to experimental or control groups in a 10-day intervention. The introduction of music as a reinforcer and elimination of distractions were among easily implemented, cost-effective program changes which resulted in significantly higher productivity rates for the experimental groups.…

Using the APA Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients in Education and Training.

ERIC Educational Resources Information Center

Browning, Christine

The American Psychological Association's adoption of the Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients has the potential to change the education and training approaches in psychology graduate programs and internship settings. Current research suggests that many graduate students do not receive adequate information about…

The Key to Me: Seniors' Perceptions of Relationship-Building with In-Home Service Providers

ERIC Educational Resources Information Center

Gantert, Thomas W.; McWilliam, Carol L.; Ward-Griffin, Catherine; Allen, Natalie J.

2008-01-01

Changing demographics and hospital downsizing have placed increasing demands on the home care sector. Many of those receiving in-home care are seniors whose chronic conditions require a collaborative approach. Both providers' paternalistic orientations toward senior clients and seniors' passivity within provider-client interactions have the…

Theory and Practice of Positive Feminist Therapy: A Culturally Responsive Approach to Divorce Therapy with Chinese Women

ERIC Educational Resources Information Center

Tzou, Jean Yuh-Jin; Kim, Eunha; Waldheim, Kim

2012-01-01

Positive Feminist Therapy (PFT) is a strength-based culturally responsive therapy model specifically designed for helping Chinese women facing marital conflicts and divorce, integrating Empowerment Feminist Therapy, systems theory, and positive psychology. To help clients become change agents, PFT uses clients' existing strengths to develop…

75 FR 75650 - Temporary Rule Regarding Principal Trades With Certain Advisory Clients

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-06

....m. and 3 p.m. All comments received will be posted without change; we do not edit personal... became subject to the Advisers Act with respect to those accounts, and the client relationship became... section 206(3)'s transaction-by-transaction written disclosure and consent requirements without the...

The Challenge of Developing a Universal Case Conceptualization for Functional Analytic Psychotherapy

ERIC Educational Resources Information Center

Bonow, Jordan T.; Maragakis, Alexandros; Follette, William C.

2012-01-01

Functional Analytic Psychotherapy (FAP) targets a client's interpersonal behavior for change with the goal of improving his or her quality of life. One question guiding FAP case conceptualization is, "What interpersonal behavioral repertoires will allow a specific client to function optimally?" Previous FAP writings have suggested that a therapist…

An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial).

PubMed

Laws, Rachel A; Chan, Bibiana C; Williams, Anna M; Davies, Gawaine Powell; Jayasinghe, Upali W; Fanaian, Mahnaz; Harris, Mark F

2010-02-23

Lifestyle risk factors, in particular smoking, nutrition, alcohol consumption and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care (PHC) has been shown to be an effective setting to address lifestyle risk factors at the individual level. However much of the focus of research to date has been in general practice. Relatively little attention has been paid to the role of nurses working in the PHC setting. Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time, providing the opportunity to offer intervention and enhance motivation through repeated contacts. The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients' SNAP risk factors. The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia. Services have been randomly allocated to an 'early intervention' group or 'late intervention' (comparison) group. 'Early intervention' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations. 'Late intervention site' provide usual care and will be offered the study intervention following the final data collection point. A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites. Data collection consists of 1) telephone surveys with clients at baseline, three months and six months to examine change in SNAP risk factors and readiness to change 2) nurse survey at baseline, six and 12 months to examine changes in nurse confidence, attitudes and practices in the assessment and management of SNAP risk factors 3) semi-structured interviews/focus with nurses, managers and clients in 'early intervention' sites to explore the feasibility, acceptability and sustainability of the intervention. The study will provide evidence about the effectiveness and feasibility of brief lifestyle interventions delivered by generalist community nurses as part of routine practice. This will inform future community nursing practice and PHC policy. ACTRN12609001081202.

Corrective emotional experience in an integrative affect-focused therapy: Building a preliminary model using task analysis.

PubMed

Nakamura, Kaori; Iwakabe, Shigeru

2018-03-01

The present study constructed a preliminary process model of corrective emotional experience (CEE) in an integrative affect-focused therapy. Task analysis was used to analyse 6 in-session events taken from 6 Japanese clients who worked with an integrative affect-focused therapist. The 6 events included 3 successful CEEs and 3 partially successful CEEs for comparison. A rational-empirical model of CEE was generated, which consisted of two parallel client change processes, intrapersonal change and interpersonal change, and the therapist interventions corresponding to each process. Therapist experiential interventions and therapist affirmation facilitated both intrapersonal and interpersonal change processes, whereas his relational interventions were associated with the interpersonal change process. The partially successful CEEs were differentiated by the absence of the component of core painful emotions or negative beliefs in intrapersonal change process, which seemed crucial for the interpersonal change process to develop. CEE is best represented by a preliminary model that depicts two parallel yet interacting change processes. Intrapersonal change process is similar to the sequence of change described by the emotional processing model (Pascual-Leone & Greenberg, ), whereas interpersonal change process is a unique contribution of this study. Interpersonal change process was facilitated when the therapist's active stance and use of immediacy responses to make their relational process explicit allowed a shared exploration. Therapist affirmation bridged intrapersonal change to interpersonal change by promoting an adaptive sense of self in clients and forging a deeper emotional connection between the two. Copyright © 2017 John Wiley & Sons, Ltd.

Criminal Justice Outcomes after Engagement in Outpatient Substance Abuse Treatment

PubMed Central

Garnick, Deborah W.; Horgan, Constance M.; Acevedo, Andrea; Lee, Margaret T.; Panas, Lee; Ritter, Grant A.; Dunigan, Robert; Bidorini, Alfred; Campbell, Kevin; Haberlin, Karin; Huber, Alice; Lambert-Wacey, Dawn; Leeper, Tracy; Reynolds, Mark; Wright, David

2013-01-01

The relationship between engagement in outpatient treatment facilities in the public sector and subsequent arrest is examined for clients in Connecticut, New York, Oklahoma and Washington. Engagement is defined as receiving another treatment service within 14 days of beginning a new episode of specialty treatment and at least two additional services within the next 30 days. Data are from 2008 and survival analysis modeling is used. Survival analyses express the effects of model covariates in terms of “hazard ratios,” which reflect a change in the likelihood of outcome because of the covariate. Engaged clients had a significantly lower hazard of any arrest than non-engaged in all four states. In NY and OK, engaged clients also had a lower hazard of arrest for substance-related crimes. In CT, NY, and OK engaged clients had a lower hazard of arrest for violent crime. Clients in facilities with higher engagement rates had a lower hazard of any arrest in NY and OK. Engaging clients in outpatient treatment is a promising approach to decrease their subsequent criminal justice involvement. PMID:24238717

Communication techniques for improved acceptance and adherence with therapeutic footwear.

PubMed

van Netten, Jaap J; Francis, Anthony; Morphet, Ashley; Fortington, Lauren V; Postema, Klaas; Williams, Anita

2017-04-01

Clients' acceptance and adherence with orthoses can be influenced by a clinician's communication skills. In this clinical note, we describe two communication techniques, in the context of therapeutic footwear. Person-centred communication involves engaging with and listening to the attitudes of the client towards their condition, as well as discussing acceptance and expectations, in a structured consultation. Building a relationship is crucial and requires clients to feel heard and understood. An important influence on the acceptance and adherence is that a client makes a conscious decision to receive their device. This active receipt can be facilitated through shared decision making, wherein clinicians give clear, relevant and meaningful examples, based on clinical evidence, and ensure this is understood. Two communication techniques for clinicians providing therapeutic footwear are described. These can be adapted for use with provision of other assistive technologies to improve client acceptance and adherence. Clinical relevance Small changes in how clinicians communicate to their clients in daily practice can have a big influence on the subsequent acceptance and adherence with therapeutic footwear and indeed other prescribed assistive technologies.

Telecommunication Support System Using Keywords and Their Relevant Information in Videoconferencing — Presentation Method for Keeping Audience's Concentration at Distance Lectures

NASA Astrophysics Data System (ADS)

Asai, Kikuo; Kondo, Kimio; Kobayashi, Hideaki; Saito, Fumihiko

We developed a prototype system to support telecommunication by using keywords selected by the speaker in a videoconference. In the traditional presentation style, a speaker talks and uses audiovisual materials, and the audience at remote sites looks at these materials. Unfortunately, the audience often loses concentration and attention during the talk. To overcome this problem, we investigate a keyword presentation style, in which the speaker holds keyword cards that enable the audience to see additional information. Although keyword captions were originally intended for use in video materials for learning foreign languages, they can also be used to improve the quality of distance lectures in videoconferences. Our prototype system recognizes printed keywords in a video image at a server, and transfers the data to clients as multimedia functions such as language translation, three-dimensional (3D) model visualization, and audio reproduction. The additional information is collocated to the keyword cards in the display window, thus forming a spatial relationship between them. We conducted an experiment to investigate the properties of the keyword presentation style for an audience. The results suggest the potential of the keyword presentation style for improving the audience's concentration and attention in distance lectures by providing an environment that facilitates eye contact during videoconferencing.

Efficiently Serving HDF5 Products via OPeNDAP

NASA Technical Reports Server (NTRS)

Yang, Kent

2017-01-01

Hyrax OPeNDAP services are widely used by the Earth Science data centers in NASA, NOAA and other organizations to serve end users. In this talk, we will present some key features added in the HDF5 Hyrax OPeNDAP handler that can help data centers to better serve the HDF5netCDF-4 data products. Among these new features, we will focus on the following:1.The DAP4 support 2.The memory cache and the disk cache support that can reduce the service access time 3.The enhancement that makes the swath-like HDF5 products visualized by CF-client tools. We will also discuss the role of the HDF5 handler in-depth in the recent study of the Hyrax service in the cloud environment.

HIV Risk Perception, Sexual Behavior, and HIV Prevalence among Men-Who-Have-Sex-with-Men at a Community-Based Voluntary Counseling and Testing Center in Kuala Lumpur, Malaysia.

PubMed

Koh, Kwee Choy; Yong, Lit Sin

2014-01-01

We describe the HIV risk perception, sexual behavior, and HIV prevalence among 423 men-who-have-sex-with-men (MSM) clients who received voluntary counseling and testing (VCT) services at a community-based center in Kuala Lumpur, Malaysia. The mean age was 29 years old. One hundred one (23.9%) clients rated themselves as low risk, 118 (27.9%) as medium risk, 36 (8.5%) as high risk, and 168 (39.7%) were unsure of their risk. Twenty-four (9.4%) clients tested HIV positive (4 (4%) low risk, 9 (7.6%) medium risk, 11 (30.6%) high risk, and 13 (7.7%) unsure risk). We found a positive correlation between risk perception and HIV infection in this study. Clients with high HIV risk perception have 17x the odds of testing HIV positive compared to low risk clients. High HIV risk perception was significantly associated with multiple sex partners, multiple types of sex partners, alcohol use before intercourse, unprotected sex beyond 6 months, and inconsistent condom use during anal sex compared to low risk clients. There were no statistically significant differences between medium risk and unsure risk clients compared to low risk clients. Strategies should be targeted towards change in sexual practices among those who are perceived to be at high risk.

Reassessing Rogers' necessary and sufficient conditions of change.

PubMed

Watson, Jeanne C

2007-09-01

This article reviews the impact of Carl Rogers' postulate about the necessary and sufficient conditions of therapeutic change on the field of psychotherapy. It is proposed that his article (see record 2007-14630-002) made an impact in two ways; first, by acting as a spur to researchers to identify the active ingredients of therapeutic change; and, second, by providing guidelines for therapeutic practice. The role of the necessary and sufficient conditions in process-experiential therapy, an emotion-focused therapy for individuals, and their limitations in terms of research and practice are discussed. It is proposed that although the conditions are necessary and important in promoting clients' affect regulation, they do not take sufficient account of other moderating variables that affect clients' response to treatment and may need to be balanced with more structured interventions. Notwithstanding, Rogers highlighted a way of interacting with clients that is generally acknowledged as essential to effective psychotherapy practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Training to use motivational interviewing techniques for depression: a cluster randomized trial.

PubMed

Keeley, Robert D; Burke, Brian L; Brody, David; Dimidjian, Sona; Engel, Matthew; Emsermann, Caroline; deGruy, Frank; Thomas, Marshall; Moralez, Ernesto; Koester, Steve; Kaplan, Jessica

2014-01-01

The goal of this study was to assess the effects of training primary care providers (PCPs) to use Motivational Interviewing (MI) when treating depressed patients on providers' MI performance and patients' expressions of interest in depression treatment ("change talk") and short-term treatment adherence. This was a cluster randomized trial in urban primary care clinics (3 intervention, 4 control). We recruited 21 PCPs (10 intervention, 11 control) and 171 English-speaking patients with newly diagnosed depression (85 intervention, 86 control). MI training included a baseline and up to 2 refresher classroom trainings, along with feedback on audiotaped patient encounters. We report summary measures of technical (rate of MI-consistent statements per 10 minutes during encounters) and relational (global rating of "MI Spirit") MI performance, the association between MI performance and number of MI trainings attended (0, 1, 2, or 3), and rates of patient change talk regarding depression treatments (physical activity, antidepressant medication). We report PCP use of physical activity recommendations and antidepressant prescriptions and patients' short-term physical activity level and prescription fill rates. Use of MI-consistent statements was 26% higher for MI-trained versus control PCPs (P = .005). PCPs attending all 3 MI trainings (n = 6) had 38% higher use of MI-consistent statements (P < .001) and were over 5 times more likely to show beginning proficiency in MI Spirit (P = .036) relative to control PCPs. Although PCPs' use of physical activity recommendations and antidepressant prescriptions was not significantly different by randomization arm, patients seen by MI-trained PCPs had more frequent change talk (P = .001). Patients of MI-trained PCPs also expressed change talk about physical activity 3 times more frequently (P = .01) and reported more physical activity (3.05 vs 1.84 days in the week after the visit; P = .007) than their counterparts visiting untrained PCPs. Change talk about antidepressant medication and fill rates were similar by randomization arm (P > .05 for both). MI training resulted in improved MI performance, more depression-related patient change talk, and better short-term adherence. © Copyright 2014 by the American Board of Family Medicine.

Advancing Climate Change Education: Student Engagement and Teacher Talk in the Classroom

NASA Astrophysics Data System (ADS)

Holthuis, N.; Saltzman, J.; Lotan, R.; Mastrandrea, M. D.; Diffenbaugh, P.; Gray, S.; Kloser, M.

2011-12-01

Stanford's Global Climate Change: Professional Development for K-12 Teachers is a unique collaboration between the Stanford School of Education and School of Earth Sciences to provide teacher professional development on the science of global climate change, pedagogical strategies, and curriculum materials. Scientists and education specialists developed a curriculum for middle and high school science classrooms. It addresses the fundamental issues of climate science, the impacts of climate change on society and on global resources, mitigation and adaptation strategies. This project documents in detail the full circle of curriculum development, teacher professional development, classroom implementation, analysis of student achievement data, and curriculum revision. Ongoing evaluation has provided understanding of the unique conditions and requirements of climate change education. In a sample of 750 secondary students in 25 Bay Area classrooms, we found statistically significant differences between post- (x=11.56, sd=4.75) and pre- (x=8.64, sd=4.58) test scores on standardized items and short open-ended essay questions. Through systematic classroom observations (300 observations in 25 classrooms), we documented student engagement and interactions, and the nature of teachers' talk in the classroom. We found that on average, 73.4% of the students were engaged, 14.4% were interacting with peers, and about 12.1% were disengaged. We also documented teacher talk (165 observations) and found that on the average, teachers delivered factual content and talked about classroom processes and spent less time on scientific argumentation, reasoning and/ or analysis. We documented significant differences in the quality of implementation among the teachers. Our study suggests that in addition to strengthening content knowledge and pedagogical content knowledge, professional development for teachers needs to include classroom management strategies, explicit modeling of collaborative work, and greater attention to the quality of teachers' questions and interactions with the students to enhance the quality of student talk and understanding. In our final year of the project, we will focus our observations more tightly on the nature of teacher and student talk to explore student understanding of climate change.

Replicating and extending the good-enough level model of change: considering session frequency.

PubMed

Reese, Robert J; Toland, Michael D; Hopkins, Nathaniel B

2011-09-01

The good-enough level (GEL) model posits that the rate of change in psychotherapy is related to the total dose of therapy. The psychotherapy dose-response literature has typically measured dose as number of sessions attended without considering the number of days or weeks it takes to complete the sessions (session frequency). The current study sought to replicate the GEL model and explore if session frequency moderates the influence that the number of sessions has on the rate of change in psychotherapy. An archived naturalistic data set with a US university counseling center sample (n=1,207), with treatment progress measured using the Outcome Questionnaire-45 (Lambert et al., 1996), was used. Our results are consistent with the GEL model (i.e., clients who attended fewer sessions evidenced faster rates of change), but extended it by showing that the rate of change was also influenced by session frequency (i.e., clients who attended more sessions on average per week demonstrated more rapid improvement). Evidence suggests that clinicians and researchers should give consideration to session frequency, both in their work with clients and how "dose" is operationalized in psychotherapy research.

Achieving Sub-Second Search in the CMR

NASA Astrophysics Data System (ADS)

Gilman, J.; Baynes, K.; Pilone, D.; Mitchell, A. E.; Murphy, K. J.

2014-12-01

The Common Metadata Repository (CMR) is the next generation Earth Science Metadata catalog for NASA's Earth Observing data. It joins together the holdings from the EOS Clearing House (ECHO) and the Global Change Master Directory (GCMD), creating a unified, authoritative source for EOSDIS metadata. The CMR allows ingest in many different formats while providing consistent search behavior and retrieval in any supported format. Performance is a critical component of the CMR, ensuring improved data discovery and client interactivity. The CMR delivers sub-second search performance for any of the common query conditions (including spatial) across hundreds of millions of metadata granules. It also allows the addition of new metadata concepts such as visualizations, parameter metadata, and documentation. The CMR's goals presented many challenges. This talk will describe the CMR architecture, design, and innovations that were made to achieve its goals. This includes: * Architectural features like immutability and backpressure. * Data management techniques such as caching and parallel loading that give big performance gains. * Open Source and COTS tools like Elasticsearch search engine. * Adoption of Clojure, a functional programming language for the Java Virtual Machine. * Development of a custom spatial search plugin for Elasticsearch and why it was necessary. * Introduction of a unified model for metadata that maps every supported metadata format to a consistent domain model.

Lessons learned from starting Rochester Precision Optics

NASA Astrophysics Data System (ADS)

Hurley, William P.

2014-12-01

Thank you very much for coming to attend this talk. I see a few familiar faces in the crowd that have had their own journeys, and if you're thinking of starting your own optics business, this is not the authoritative talk on how to do. It's just a talk on what I've learned from my journey and some of my own stories on Lessons Learned. It does tie into some of the previous talks, and I do give credit to some mentors. The developments I've been involved with do make use of the ability to adapt and change, and there have been Bumps in the Road here and there, and I'll tell you a little bit more about that during this Talk.

Readiness to change as a moderator of outcome in transdiagnostic treatment

PubMed Central

BOSWELL, JAMES F.; SAUER, SHANNON E.; GALLAGHER, MATTHEW W.; DELGADO, NICOLE; BARLOW, DAVID H.

2012-01-01

Initial symptom severity is a client characteristic associated with psychotherapy outcome, although this relationship is not well-understood. Readiness to change is a factor that may influence this relationship. This study tested readiness as a moderator of the relationship between initial severity and symptom change. Data were derived from an RCT examining the efficacy of a transdiagnostic CBT treatment. Readiness was assessed with the URICA, and symptom and functioning outcomes were assessed. Multiple regression models indicated that severity was associated with less overall change, yet readiness moderated this relationship. At higher levels of readiness, the effect of initial severity on outcome was essentially reversed; for clients with higher initial readiness, higher levels of severity were associated with greater change. PMID:22607634

The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice.

PubMed

Sparks, Jacqueline A; Duncan, Barry L

2018-03-09

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Partners for Change Outcome Management System (PCOMS), along a normative (standardized measurement) to communicative (conversational) continuum, highlighting PCOMS' origins in everyday clinical practice. The authors contend that PCOMS represents "both/and," providing a valid signal of client progress while facilitating communicative process particularly prized by family therapists steeped in relational traditions. The article discusses application of PCOMS in systemic practice and describes how it actualizes time-honored family therapy approaches. The importance of giving voice to individualized client experience is emphasized. © 2018 Family Process Institute.

The Evolving Risk of Climate Change and National Security: People not Polar Bears

NASA Astrophysics Data System (ADS)

Titley, D.

2014-12-01

This talk will provide a general overview of climate change and discuss why this is a national security issue. Climate change is about people, about water, and about change itself. Understanding the rate of climate change, relative to the abilities of both humans and ecosystems to adapt is critical. I will briefly describe the multiple, independent lines of evidence that the climate is changing, and that the primary cause of this change is a change in atmospheric composition caused by the burning of fossil fuels. I will cover the history of climate change as seen within the U.S. Department of Defense and U.S. Navy, how this challenge is being addressed from budgetary, policy, and political angles, and what are the greatest challenges to national security that arise from climate change and in particular, the associated changes in the Arctic. I will conclude with an assessment of future challenges and opportunities regarding climate change, from science, policy, and political perspectives, and why we know enough to take significant action now, even if we don't know every detail about the future. In addition, this talk will address how to effectively talk about climate change through the use of analogies, plain, non-jargon English, and even a little humor.

Client characteristics and the cost of home care in the prospective payment system.

PubMed

Livesay, Jody L; Hanson, Kathleen S; Anderson, Mary Ann; Oelschlaeger, Mary

2003-01-01

There has been much speculation in the literature about the effect of the prospective payment system (PPS) on the home care industry but few reports of systematic investigation. Clearly, comprehension of client characteristics is essential for categorizing home care clients into the correct Home Health Resource Groups, for allocating resources appropriately, and for implementing necessary organizational changes to accommodate clients who require variations in the amount of resources predicted by the PPS. The purposes of this study were to compare the characteristics of home health clients that resulted in a financial gain or a financial loss for one agency under the PPS with those of the interim payment system. A secondary data analysis of 140 cases compiled by one not-for-profit hospital-affiliated home care organization was completed. Results suggested that client characteristics of the projected loss group had more recertifications on admission and at the end of the 60-day episode, a longer stay (3 weeks), and more visits, particularly from skilled nursing. Comprehension of client characteristics and the subsequent ability to adjust for the proper case mix will be crucial if home care agencies are to remain financially viable under the PPS. Replication of this project needs to be done using more variables and multiple sites.

Client-provider relationships in a community health clinic for people who are experiencing homelessness.

PubMed

Oudshoorn, Abe; Ward-Griffin, Catherine; Forchuk, Cheryl; Berman, Helene; Poland, Blake

2013-12-01

Recognizing the importance of health-promoting relationships in engaging people who are experiencing homelessness in care, most research on health clinics for homeless persons has involved some recognition of client-provider relationships. However, what has been lacking is the inclusion of a critical analysis of the policy context in which relationships are enacted. In this paper, we question how client-provider relationships are enacted within the culture of community care with people who are experiencing homelessness and how clinic-level and broader social and health policies shape relationships in this context. We explore these questions within a critical theoretical perspective utilizing a critical ethnographic methodology. Data were collected using multiple methods of document review, participant observation, in-depth interviews and focus groups. The participants include both clients at a community health clinic, and all clinic service providers. We explore how clients and providers characterized each other as 'good' or 'bad'. For providers, this served as a means by which they policed behaviours and enforced social norms. The means by which both providers' and clients' negotiated relationships are explored, but this is couched within both local and system-level policies. This study highlights the importance of healthcare providers and clients being involved in broader policy and systemic change. © 2013 John Wiley & Sons Ltd.

Evaluation of a Communication Skills Training Program for Companion-Animal Veterinarians: A Pilot Study Using RIAS Coding.

PubMed

McArthur, Michelle; Fitzgerald, Jennifer

2016-01-01

Effective veterinarian communication skills training and the related key outcomes provided the impetus for this study. We implemented a pre-experimental pre-test/post-test single-group design with a sample of 13 veterinarians and their 71 clients to evaluate the effects of a 6.5-hour communication skills intervention for veterinarians. Consultations were audiotaped and analyzed with the Roter Interaction Analysis System (RIAS). Clients completed the Consultation and Relational Care Measure, a global satisfaction scale, a Parent Medical Interview Satisfaction Scale, and the Adherence Intent measure. Veterinarians completed a communication confidence measure and a workshop satisfaction scale. Contrary to expectation, neither veterinarian communication skills nor their confidence improved post-training. Despite client satisfaction and perceptions of veterinarians' relational communication skills not increasing, clients nevertheless reported an increased intent to adhere to veterinarian recommendations. This result is important because client adherence is critical to managing and enhancing the health and well-being of animals. The results of the study suggest that while the workshop was highly regarded, either the duration of the training or practice opportunities were insufficient or a booster session was required to increase veterinarian confidence and integration of new skills. Future research should utilize a randomized control study design to investigate the appropriate intervention with which to achieve change in veterinarian communication skills. Such change could translate to more effective interactions in veterinarians' daily lives.

Commentary on Dinger et al.: Therapist's attachment, interpersonal problems and alliance development over time in inpatient psychotherapy.

PubMed

Holmes, Jeremy

2009-09-01

This short article is a commentary on a research study investigating therapist and client attachment styles and their relationship to alliance development in a 12-week psychodynamic psychotherapy program for nonpsychotic inpatients. The relationship is complex; unsurprisingly, securely attached therapists with less distressed clients formed the strongest alliances. A significant proportion of therapists were insecure, almost entirely in the preoccupied or hyperactivating mode. It is argued that collusive relationships between such therapists and similarly overaroused clients may be common. Therapists need both to accommodate to their client's attachment style and to confound it if positive change is to result. Therapist self-scrutiny is likely to be a precondition for such positive outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Improving Readability of an Evaluation Tool for Low-Income Clients Using Visual Information Processing Theories

ERIC Educational Resources Information Center

Townsend, Marilyn S.; Sylva, Kathryn; Martin, Anna; Metz, Diane; Wooten-Swanson, Patti

2008-01-01

Literacy is an issue for many low-income audiences. Using visual information processing theories, the goal was improving readability of a food behavior checklist and ultimately improving its ability to accurately capture existing changes in dietary behaviors. Using group interviews, low-income clients (n = 18) evaluated 4 visual styles. The text…

A Group Counseling Approach for Persons Who Work With Sickle Cell Anemia Clients.

ERIC Educational Resources Information Center

Calvin, Richmond

Although many workshops on sickle cell anemia have been held, it is still difficult to implement a comprehensive training program for sickle cell anemia clients in many communities. Research data on the topic are somewhat nebulous and insufficient political and social pressure have been exerted to change attitudes and take action towards the…

Chaos Theory as a Model for Life Transitions Counseling: Nonlinear Dynamics and Life's Changes

ERIC Educational Resources Information Center

Bussolari, Cori J.; Goodell, Judith A.

2009-01-01

Chaos theory is presented for counselors working with clients experiencing life transitions. It is proposed as a model that considers disorder, unpredictability, and lack of control as normal parts of transition processes. Nonlinear constructs from physics are adapted for use in counseling. The model provides a method clients can use to…

An Original Behavior Modification Program for Weight Reduction: Minimal Intervention and Permanent Habit Change.

ERIC Educational Resources Information Center

Lublin, Irwin; Kirkish, Patricia

This description of a weight reduction program, based on generalizations derived from eight years of work with overweight persons, discusses the clients' rationalization of overeating behaviors. In this behavior modification program, the client is required to permanently give up one high calorie food and to write down all foods eaten before actual…

The Impact of MSW Education on Social Worker Empowerment and Commitment to Client Empowerment through Social Justice Advocacy

ERIC Educational Resources Information Center

Van Voorhis, Rebecca Morrison; Hostetter, Carol

2006-01-01

This study examined changes among graduate students (N=52) in perception of social worker empowerment and commitment to client empowerment through social justice advocacy. Pre-post data showed that most entering MSW students possessed important beliefs about empowerment for themselves as social workers and for members of oppressed population…

Understanding Online Counseling Services through a Review of Definitions and Elements Necessary for Change.

ERIC Educational Resources Information Center

Tyler, J. Michael; Guth, Lorraine J.

In a relatively brief period of time, many clinicians and agencies have sought to use the World Wide Web as a means to access clients, impart information, advertise, or educate. Increasingly, counselors and other mental health professionals are seeking to provide or to supplement client services over the Internet. Unfortunately, amidst all the…

Case of the Drunken Holon: An Integral Performative Co-Inquiry

ERIC Educational Resources Information Center

Fisher, R. Michael; Davis, Tess

2012-01-01

A postmodern and integral co-inquiry led by the authors, with Lucinda as "client," offered a unique unconventional and postconventional perspective on a client's case review. Utilizing integral theory (Wilber) as a guideline for a theory of holons and change, the co-investigators reflect upon and trans(per)form a learning experiment around the…

77 FR 62185 - Temporary Rule Regarding Principal Trades With Certain Advisory Clients

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-12

... a.m. and 3:00 p.m. All comments received will be posted without change; we do not edit personal... became subject to the Advisers Act with respect to those accounts, and the client relationship became... directed the Comptroller General of the United States to study the feasibility of forming an self...

Using real objects to teach about climate change: an ethnographic perspective

NASA Astrophysics Data System (ADS)

Conner, L.; Perin, S.; Coats, V.; Sturm, M.

2017-12-01

Informal educators frequently use real objects to connect visitors with science content that can otherwise seem abstract. Our NSF-funded project, "Hot Times in Cold Places," leverages this premise to teach about climate change through real objects associated with the nation's only permafrost tunnel, located in Fox, Alaska. We posit that touching real ice, holding Pleistocene bones, and seeing ice wedges in context allows learners to understand climate change in a direct and visceral manner. We are conducting ethnographic research to understand visitor experience at both the tunnel itself and at a permafrost museum exhibit that we are creating as part of the project. Research questions include: 1) What is the nature of visitor talk with respect to explanations about permafrost, tipping points, climate change, and geological time? 2) How do attributes of "realness" (scale, resolution, uniqueness, history and adherence to an original) affect visitor's experience of objects, as perceived through the senses and emotions? We use naturalistic observation, interviews, and videotaping to answer these questions. Analysis focuses on child-to-child talk, reciprocal talk between educator and child, and reciprocal talk between parent and child. Our results elucidate the value of real, vs. replicated and virtual objects, in informal learning, especially in the context of climate change education. An understanding of these factors can help informal learning educators make informed choices about program and exhibit design.

A three-talk model for shared decision making: multistage consultation process

PubMed Central

Durand, Marie Anne; Song, Julia; Aarts, Johanna; Barr, Paul J; Berger, Zackary; Cochran, Nan; Frosch, Dominick; Galasiński, Dariusz; Gulbrandsen, Pål; Han, Paul K J; Härter, Martin; Kinnersley, Paul; Lloyd, Amy; Mishra, Manish; Perestelo-Perez, Lilisbeth; Scholl, Isabelle; Tomori, Kounosuke; Trevena, Lyndal; Witteman, Holly O; Van der Weijden, Trudy

2017-01-01

Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design Multistage consultation process. Setting Key informant group, communities of interest, and survey of clinical specialties. Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on “team talk,” “option talk,” and “decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences. PMID:29109079

Using Program Data to Improve Access to Family Planning and Enhance the Method Mix in Conflict-Affected Areas of the Democratic Republic of the Congo

PubMed Central

Ho, Lara S; Wheeler, Erin

2018-01-01

Unmet need for family planning in the conflict-affected area of eastern Democratic Republic of the Congo (DRC) has been reported to be as high as 38%, and women in such conflict settings are often the most at risk for maternal mortality. The International Rescue Committee implements the Family Planning and Post-Abortion Care in Emergencies program in 3 provinces of eastern DRC to provide women and couples access to family planning, including long-acting reversible contraceptives (LARCs). This article presents routine program data from June 2011 through December 2013 from 2 health zones as well as results from a qualitative assessment of family planning clients and of male and female non-users, conducted in 2013. It then describes how these findings were used to make program adjustments to improve access to family planning services and client informed choice and assesses the effects of the program design changes on family planning uptake and method mix using routine program data from January 2014 through December 2016. Between 2011 and 2013, 8,985 clients adopted family planning, with an average 14 clients adopting a method per facility, per month. The method mix remained stable during this period, with implants dominating at 48%. Barriers to uptake identified from the qualitative research were both supply- and demand-related, including misconceptions about certain modern contraceptive methods on the part of providers, users, and other community members. The program implemented several program changes based on the assessment findings, including clinical coaching and supportive supervision to improve provider skills and attitudes, introduction of immediate postpartum insertion of the intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS), and behavior change communication campaigns to raise awareness about family planning. After these program changes, the mean number of clients adopting modern family planning per facility, per month increased from 14 to 37 and the percentage of family planning adopters choosing LARCs increased from 50% to 66%. While implants continued to be the most dominant method, reaching 60% of the method mix in 2016, the percentage of clients adopting IUDs increased each year, from 3% in 2014 to 13% in 2016. In total, 39,399 clients started family planning methods during the post-program design change period (2014–2016). Our experience in eastern DRC demonstrates that women and their partners affected by conflict want family planning, and that it is feasible to deliver the full range of modern contraceptive methods when programs are adapted and sensitive to the local context. PMID:29602870

Health knowledge, attitudes and practices of family planning service providers and clients in Akwapim North District of Ghana.

PubMed

Atuahene, Margaret Duah; Afari, Esther Oku; Adjuik, Martin; Obed, Samuel

2016-01-01

Family planning services help save lives by reducing women's exposure to risks of child birth and abortion. While family planning services provide measures to prevent unintended pregnancies and time the formation of families, the acceptability and coverage is still very low worldwide. Some of the reasons for this include poor quality of service, unavailability of range of methods, fear of opposition from partners, side effects and health concerns among others.About 40 % of the world's 215,000 annual deaths in childbirth occur in the Sub-Saharan region. In Ghana, urban-rural fertility differences range from two to three children. The acceptability and coverage of family planning are still low and in the study area in particular. We sought to examine factors that contribute to low acceptability and coverage of family planning services in a sub-urban community with a design of quantitative cross-sectional. Ethical approval was given by the Ghana Health Service. Midwives and community health nurses who provide family planning services were interviewed. Exit-interview was also conducted with women receiving a variety of outpatient services. Most of the women in this study (48.7 %) were in the 25-34 age range and were either married (42.8 %) or cohabiting (40.5 %). Majority of these women (67.7 %) have middle/Junior high level of formal education with a modal parity of two. Sixty eight (68) clients were identified as current family planning users. About 6.0 % and 4.5 % were dissatisfied about auditory and visual privacy during counselling respectively. This was confirmed by providers who attributed it to inappropriate facility layout. Most of the clients (79.1 %) were not given educational materials although 88.8 % were talked to about family planning and this could be due to unavailability of these hand-outs.Though clients show satisfaction of services received, providers did not follow standard protocols with as much as 73.7 % faced with challenges in provision of services which were attributed to improper facility layout and lack of furniture. About 77.2 % were willing to provide short term methods, while 91.2 % wanted to provide long term methods. As much as 93.3 % of the women said they would have liked providers give more detailed information on family planning. While most of the women (88.3 %) used injectables, only 6.1 % and 0.9 % used Implants and IUD respectively. Finding ways to improve client privacy through good facility layout will ensure visual and auditory privacy to enhance family planning service provision and uptake. Continuous competency training will assist providers design innovative action plans and meet client satisfaction needs.

Client Accounts of Corrective Experiences in Psychotherapy: Implications for Clinical Practice.

PubMed

Angus, Lynne; Constantino, Michael J

2017-02-01

The Patient Perceptions of Corrective Experiences in Individual Therapy (PPCEIT; Constantino, Angus, Friedlander, Messer, & Moertl, 2011) posttreatment interview guide was developed to provide clinical researchers with an effective mode of inquiry to identify and further explore clients' firsthand accounts of corrective and transformative therapy experiences and their determinants. Not only do findings from the analysis of client corrective experience (CE) accounts help identify what and how CEs happen in or as a result of psychotherapy, but the measure itself may also provide therapists with an effective tool to further enhance clients' awareness, understanding, and integration of transformative change experiences. Accordingly, we discuss in this afterword to the series the implications for clinical practice arising from (a) the thematic analysis of client CE accounts, drawn from a range of clinical samples and international research programs and (b) the clinical effect of completing the PPCEIT posttreatment interview inquiry. We also identify directions for future clinical training and research. © 2016 Wiley Periodicals, Inc.

Predicting treatment noncompliance among criminal justice-mandated clients: a theoretical and empirical exploration.

PubMed

Sung, Hung-En; Belenko, Steven; Feng, Li; Tabachnick, Carrie

2004-01-01

Compliance with therapeutic regimens constitutes an important but infrequently studied precursor of treatment engagement and is a necessary condition of successful treatment. This study builds on recent treatment process research and provides a theory-driven analysis of treatment compliance. Five hypotheses are formulated to predict treatment noncompliance among criminal justice-mandated clients. These hypotheses tap different determinants of treatment progress, including physical prime, supportive social network, conventional social involvement, treatment motivation, and risk-taking propensity. Data from 150 addicted felons participating in a diversion program are analyzed to test the hypotheses. Predictors related to these hypotheses correctly identify 58% of the fully compliant clients and 55-88% of the noncompliant clients. Most hypotheses are at least partially corroborated and a few strong correlates emerge across analyses. Clients in their physical prime, those with poorer social support, and those lacking internal desires for change were found especially likely to violate treatment program rules. Clinical implications are discussed.

Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment.

PubMed

Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti

2017-04-05

Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients' homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs' work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) ( p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs' job is feasible and can effectively promote HCAs' health, especially among older HCAs.

Coaching the Multiplicity of Mind: A Strengths-based Model

PubMed Central

2013-01-01

Professional health and wellness coaches are passionate about helping people learn, change, and grow. We are lifelong students of what enables humans to perform at our best. The phrase coaching the whole person is common coaching parlance; full engagement in self-care often requires that clients shift a spectrum of beliefs, motives, and perspectives in order to make changes that are sustainable. Just as important is the need for coaches to fully engage in their own self-care in order to best serve their clients. PMID:24416685

A qualitative exploration of health workers' and clients' perceptions of barriers to completing four antenatal care visits in Morogoro Region, Tanzania.

PubMed

Callaghan-Koru, Jennifer A; McMahon, Shannon A; Chebet, Joy J; Kilewo, Charles; Frumence, Gasto; Gupta, Shivam; Stevenson, Raz; Lipingu, Chrisostom; Baqui, Abdullah H; Winch, Peter J

2016-10-01

Antenatal care (ANC) remains an important contact point on the continuum of care for mothers and children in low- and middle-income countries. In Tanzania, the proportion of pregnant women completing at least four ANC visits (ANC-4) dropped from 70% to 43% between 1999 and 2010. To identify potential causes of the decline in the number of ANC visits, we conducted qualitative research at 18 health centres in Morogoro Region, exploring providers' communication about ANC visits and clients' and providers' perceptions of changes in ANC services and barriers to completing four visits. We also observed counselling messages delivered during 203 ANC consultations. Our results indicate that provider communication about ANC visit recommendations is inadequate, and confusion exists among clients about when and how often they should attend. Participants highlighted how the scale up of Prevention of Mother-to-Child Transmission, with routine human immunodeficiency virus testing for women and their male partners, presents additional barriers for some women. Changes to the timing and content of ANC services following the adoption of the Focused ANC model was described by participants as changing women's perceptions and decisions in how they utilize ANC services. In particular, condensed delivery of technical interventions fostered a sense among clients that multiple visits are unnecessary. Other barriers that may contribute to declining ANC-4 include changing norms about family planning and birth spacing, out-of-pocket costs for clients and informal practices adopted by health facilities and providers such as turning women away who attend early in pregnancy or are not accompanied by male partners. Further research is needed to determine the role and extent that these barriers may be contributing to declining ANC-4. Issues of poor communication, supply inadequacies and informal practices, deserve immediate attention from the health system. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

From WHAT We Know to HOW We Know It: Students Talk about Climate Change

NASA Astrophysics Data System (ADS)

Holthuis, N.; Lotan, R.; Saltzman, J.; Mastrandrea, M. D.

2012-12-01

The climate change community has begun to look carefully at how the public understands, or fails to understand, climate change data and the scientific claims made based on these data. Researchers (Bowen et al, 2008) have found that a deficit model of knowledge doesn't fully explain why people continue to disagree about climate change or are unwilling to change their behaviors. "Deniers" do not become "acceptors" simply by filling up their cognitive data banks with more information. This suggests that teachers need to provide scaffolding that supports not only students' understanding of how climate systems work or the causes and effects of climate change but includes how we know what we know. That is, instruction shifts from an exclusive focus on content knowledge to one that aims to develop critical analytic skills and scientific habits of mind. For example, students need to not only understand the effects of human activity on climate change, but also learn to identify and analyze the evidence for anthropogenic climate change and how that evidence has built over time. They can then evaluate the evidence as well as whether the claims made are justified given the data. Climate literacy then includes content knowledge as well as understanding of the scientific practices that lead to building that knowledge. In this study, we report on the research and evaluation of the NASA-funded Stanford Global Climate Change: Professional Development for K-12 Teachers. We focus on data from the last year of a three-year project in which climate scientists and science educators collaborated to develop curriculum and provide professional development for secondary school teachers on the science and the pedagogy of global climate change. As teachers implemented the curriculum in their classrooms, we collected pre- and post-tests, classroom observations, video recordings, and post-implementation interviews with the teachers. Our analyses serve to document: 1) how students talk about HOW we know about climate change, 2) in what ways the curriculum and the teaching practices support this type of student talk, 3) how the quantity and quality of student talk leads to a greater understanding of both WHAT we know about climate change and HOW we know it. Through systematic classroom observations, we documented student engagement and interactions. In-depth analysis of video recordings revealed more about the nature of these interactions and how students talk with each other and the teacher about how we know. From pre- and post-tests of 756 middle school and high school students in 30 classrooms, we found statistically significant differences (t=-19.78, p<0.001) between total scores on the pre-test (68.1 % correct) and post-test (79.1% correct). At the classroom level, these data served to create portraits of classrooms where "how do we know talk" was prevalent and where teaching practices supported such talk. In these classrooms, students showed significant gains in both content knowledge and analytic skills. We argue that these students became climate literate and thus better equipped to critically distinguish between climate science and non-science they might encounter via the internet, the media, or other sources.

Unraveling the concept of race in Brazil: issues for the Rio de Janeiro Cooperative Agreement site.

PubMed

Surratt, H L; Inciardi, J A

1998-01-01

Scholars throughout the Americas have spent much of the 20th century studying race and its meaning in Brazil. Racial identities in Brazil are dynamic concepts which can only be understood if situated and explored within the appropriate cultural context. Empirical evidence of the fluidity of racial identification quickly came to the authors' attention within the context of a prevention initiative targeting segments of the Rio de Janeiro population at high risk for HIV/AIDS. Because the main objective of this program was to slow the spread of AIDS through an intervention designed to promote behavioral change, comparisons of client data at the baseline and follow-up assessments form the core of the analyses. Through quality control procedures used to link client information collected at different points in time, it was revealed that 106 clients, or 12.5% of the follow-up sample, had changed their racial self-identification. The authors' attempts to engage project staff in a dialogue about the fluidity of racial identity among these clients have provided some insight into what might be called the "contextual redefinition" of race in Brazil. Within the framework of this study, the ramifications of this phenomenon are clear. Racial comparisons of HIV risk, sexual activity, drug use, and behavioral change, which are part and parcel of U.S.-based research, would appear to be of little utility in this setting.

Why Ineffective Psychotherapies Appear to Work: A Taxonomy of Causes of Spurious Therapeutic Effectiveness.

PubMed

Lilienfeld, Scott O; Ritschel, Lorie A; Lynn, Steven Jay; Cautin, Robin L; Latzman, Robert D

2014-07-01

The past 40 years have generated numerous insights regarding errors in human reasoning. Arguably, clinical practice is the domain of applied psychology in which acknowledging and mitigating these errors is most crucial. We address one such set of errors here, namely, the tendency of some psychologists and other mental health professionals to assume that they can rely on informal clinical observations to infer whether treatments are effective. We delineate four broad, underlying cognitive impediments to accurately evaluating improvement in psychotherapy-naive realism, confirmation bias, illusory causation, and the illusion of control. We then describe 26 causes of spurious therapeutic effectiveness (CSTEs), organized into a taxonomy of three overarching categories: (a) the perception of client change in its actual absence, (b) misinterpretations of actual client change stemming from extratherapeutic factors, and (c) misinterpretations of actual client change stemming from nonspecific treatment factors. These inferential errors can lead clinicians, clients, and researchers to misperceive useless or even harmful psychotherapies as effective. We (a) examine how methodological safeguards help to control for different CSTEs, (b) delineate fruitful directions for research on CSTEs, and (c) consider the implications of CSTEs for everyday clinical practice. An enhanced appreciation of the inferential problems posed by CSTEs may narrow the science-practice gap and foster a heightened appreciation of the need for the methodological safeguards afforded by evidence-based practice. © The Author(s) 2014.

A Randomized Controlled Trial of Cognitive-Behavioral Treatment of Posttraumatic Stress Disorder in Severe Mental Illness

PubMed Central

Mueser, Kim T.; Rosenberg, Stanley D.; Xie, Haiyi; Jankowski, M. Kay; Bolton, Elisa E.; Lu, Weili; Hamblen, Jessica L.; Rosenberg, Harriet J.; McHugo, Gregory J.; Wolfe, Rosemarie

2014-01-01

A cognitive-behavioral therapy (CBT) program for PTSD was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared to treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than clients in TAU at blinded post-treatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. PMID:18377122

Client predictors of employment outcomes in high-fidelity supported employment: a regression analysis.

PubMed

Campbell, Kikuko; Bond, Gary R; Drake, Robert E; McHugo, Gregory J; Xie, Haiyi

2010-08-01

Research on vocational rehabilitation for clients with severe mental illness over the past 2 decades has yielded inconsistent findings regarding client factors statistically related to employment. The present study aimed to elucidate the relationship between baseline client characteristics and competitive employment outcomes-job acquisition and total weeks worked during an 18-month follow-up-in Individual Placement and Support (IPS). Data from 4 recent randomized controlled trials of IPS were aggregated for within-group regression analyses. In the IPS sample (N = 307), work history was the only significant predictor for job acquisition, but receiving Supplemental Security Income-with or without Social Security Disability Insurance-was associated with fewer total weeks worked (2.0%-2.8% of the variance). In the comparison sample (N = 374), clients with a diagnosis of mood disorder or with less severe thought disorder symptoms were more likely to obtain competitive employment. The findings confirm that clients with severe mental illness interested in competitive work best benefit from high-fidelity supported employment regardless of their work history and sociodemographic and clinical background, and highlight the needs for changes in federal policies for disability income support and insurance regulations.

The impact of a reproductive health franchise on client satisfaction in rural Nepal.

PubMed

Agha, Sohail; Karim, Ali Mehryar; Balal, Asma; Sosler, Steve

2007-09-01

This study evaluates the impact of a nurse and paramedic reproductive health franchise in rural Nepal on client satisfaction and utilization of services. A quasi-experimental study design, with baseline and follow-up measurements on nonequivalent control groups, was used to assess the effects of the intervention. The study collected data from exit interviews with male and female clients at clinics and from household interviews with married women. Our assessment covers the project's performance for about a year of actual implementation. Client satisfaction with the quality of services increased across a range of indicators at intervention clinics but not at control clinics. Overall satisfaction with services also increased only at intervention clinics but not at control clinics. Consistent with these changes, loyalty increased among clients of franchised clinics. The analysis showed a positive relationship between client satisfaction and loyalty. Although the project's implementation was examined over a relatively short period of time, there appears to have been a net positive effect of the intervention on obtaining family planning products from medical stores/pharmacies. The study shows that franchising reproductive health services increases a provider's interest in delivering better quality services in rural areas of a developing country.

Asymmetric Partner Pronoun Use and Demand-Withdraw Interaction in Couples Coping with Health Problems

PubMed Central

Rentscher, Kelly E.; Rohrbaugh, Michael J.; Shoham, Varda; Mehl, Matthias R.

2014-01-01

Recent research links first-person plural pronoun use (we-talk) by individual romantic partners to adaptive relationship functioning and individual health outcomes. To examine a possible boundary condition of adaptive we-talk in couples coping with health problems, we correlated asymmetric couple-level we/I-ratios (more we-talk relative to I-talk by the spouse than the patient) with a concurrent pattern of directional demand-withdraw (D-W) interaction in which the spouse demands change while the patient withdraws. Couples in which a partner who abused alcohol (n = 65), smoked cigarettes despite having heart or lung disease (n = 24), or had congestive heart failure (n = 58) discussed a health-related disagreement during a video-recorded interaction task. Transcripts of these conversations provided measures of pronoun use for each partner, and trained observers coded D-W patterns from the recordings. As expected, partner asymmetry in we/I-ratio scores predicted directional demand-withdraw, such that spouses who used more we-talk (relative to I-talk) than patients tended to assume the demand role in concurrent D-W interaction. Asymmetric I-talk rather than we-talk accounted for this association, and asymmetric you-talk contributed independently as well. In contrast to previous studies of we-talk by individual partners, the present results identify dyad-level pronoun patterns that clearly do not mark beneficent processes: asymmetric partner we/I-ratios and you-talk reflect problematic demand-withdraw interaction. PMID:24098961

An evaluation of the effectiveness of psychological therapy in reducing general psychological distress for adults with autism spectrum conditions and comorbid mental health problems.

PubMed

Blainey, Sarah H; Rumball, Freya; Mercer, Louise; Evans, Lauren Jayne; Beck, Alison

2017-11-01

To investigate the effectiveness of psychological therapy in reducing psychological distress for adults with autism spectrum conditions (ASC) and co-morbid mental health conditions in routine clinical practice. To explore the effect of individual characteristics and service factors on change in general distress. In a specialist psychological therapies service for adults with ASC, the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) self-report questionnaire of psychological distress is completed by clients at start and end of therapy. Change over time and reliable and clinical change was assessed for 81 of a total of 122 clients (66.4%). Factors which may influence change over time were explored using available clinical information. Overall, there was a significant reduction in CORE-OM score during therapy with a small effect size. Most clients showed an improvement in psychological distress over therapy (75.4% improved, with 36.9% of these showing reliable changes). Significant and comparable reductions from pre-therapy to post-therapy were seen across the sample, showing that individual differences did not mediate therapy effectiveness. CORE-OM scores mediate the association between age of ASD diagnosis and hours of therapeutic input required, with greater age at diagnosis and higher distress associated with longer therapy duration. Our preliminary findings suggest that psychological therapy may be effective in reducing general distress for clients with ASC and co-morbid mental health conditions and should be routinely offered. Individuals who are diagnosed with ASD in adulthood are likely to require a longer course of therapy when their general distress scores are high. Copyright © 2017 John Wiley & Sons, Ltd.

The introduction of buprenorphine-naloxone film in opioid substitution therapy in Australia: Uptake and issues arising from changing buprenorphine formulations.

PubMed

Larance, Briony; Dietze, Paul; Ali, Robert; Lintzeris, Nicholas; White, Nancy; Jenkinson, Rebecca; Degenhardt, Louisa

2015-11-01

Buprenorphine-naloxone (BNX) film for opioid dependence treatment was introduced in Australia in 2011. A key difference in State policy approaches saw transfer from BNX tablets to BNX film mandated in South Australia (SA) with New South Wales (NSW) and Victoria (VIC) having less stringent policies. This study examined (i) how initiations and transfers were implemented, (ii) the profile and predictors of adverse effects as self-reported by BNX film clients, and (iii) dosing issues. Survey of 334 buprenorphine (BPN), BNX tablet and BNX film clients and semi-structured interviews with 39 key experts (KEs) in 2012. Comparisons are made between clients interviewed in SA versus NSW and VIC combined. Among the 180 current BNX film clients, 23% started treatment on BNX film, 18% requested a transfer to BNX film and 59% (n = 106) reported their clinic/prescriber recommended transfer to BNX film. Among clients who were offered but refused a transfer to BNX film (n = 66), the most common reason was 'I am happy with my current treatment and do not see a reason to change' (53%). Some opioid substitution therapy clients and KE viewed transfers as 'forced' (i.e. no choice of buprenorphine formulation). Multivariable regression showed residing in SA (vs. NSW/VIC) and a shorter length of current treatment episode were associated with more BNX film-attributed adverse effects but clinic/prescriber-recommended transfer was not. The introduction of BNX film in Australia varied across States. A perception of restricted choice in medication may have undermined initial acceptance in SA. © 2015 Australasian Professional Society on Alcohol and other Drugs.

A retrospective, descriptive study of shoulder outcomes in outpatient physical therapy.

PubMed

Millar, A Lynn; Lasheway, Philip A; Eaton, Wendy; Christensen, Frances

2006-06-01

A retrospective, descriptive study of clients with shoulder dysfunction referred to physical therapy. To (1) describe the clinical and functional outcomes of clients with shoulder dysfunction following outpatient physical therapy, and (2) to compare the outcomes by type of shoulder dysfunction. Although individuals with shoulder dysfunction are commonly referred to physical therapy few large descriptive studies regarding outcomes following physical therapy are available. Data for 878 clients (468 female, 410 male) were retrieved and analyzed. This database was developed between 1997 and 2000 and included 4 outpatient facilities from 1 healthcare system in the southwest corner of Michigan. Clients were classified by type of shoulder dysfunction, and standardized tests were performed upon admittance and discharge to physical therapy. Descriptive and inferential statistics were calculated for all data. Of all clients, 55.1% had shoulder impingement, while 18.3% had postoperative repair, 8.9% had a frozen shoulder, 7.6% had a rotator cuff tear, 3.0% had shoulder instability, 2.1% were post fracture, and the remaining 4.9% had miscellaneous diagnoses. The average (+/-SD) age of the patients was 53.6 +/- 16.4 years, with an average (+/-SD) number of treatment sessions of 13.7 +/- 11.0. All groups showed significant changes following physical therapy intervention. Clients with diverse types of shoulder dysfunction demonstrated improvement in both clinical and functional measures at the conclusion of physical therapy, although it is not possible to determine whether these changes were due to the interventions or due to time. The type of shoulder dysfunction appears to affect the prognosis, thus expected outcomes should be based upon initial diagnosis and specific measures.

The Role of Early Symptom Trajectories and Pretreatment Variables in Predicting Treatment Response to Cognitive Behavioral Therapy

ERIC Educational Resources Information Center

Lewis, Cara C.; Simons, Anne D.; Kim, Hyoun K.

2012-01-01

Objective: Research has focused on 2 different approaches to answering the question, "Which clients will respond to cognitive behavioral therapy (CBT) for depression?" One approach focuses on rates of symptom change within the 1st few weeks of treatment, whereas the 2nd approach looks to pretreatment client variables (e.g., hopelessness) to…

Plain Talk about K.I.D.S. (Kids Inclined toward Difficulty in School). A Summit on Educational Change: Transforming Crisis into Success. Proceedings (New Orleans, Louisiana, March 3-5, 1997).

ERIC Educational Resources Information Center

Thomas, Alice P., Ed.

The "Plain Talk about K.I.D.S. (Kids Inclined toward Difficulty in School)" summit is a biennial conference that addresses the challenges of educational change from several strategic directions at once, combining theory and research with concrete strategies and solutions from the educational, medical, judicial, business, and parental professions.…

A three-talk model for shared decision making: multistage consultation process.

PubMed

Elwyn, Glyn; Durand, Marie Anne; Song, Julia; Aarts, Johanna; Barr, Paul J; Berger, Zackary; Cochran, Nan; Frosch, Dominick; Galasiński, Dariusz; Gulbrandsen, Pål; Han, Paul K J; Härter, Martin; Kinnersley, Paul; Lloyd, Amy; Mishra, Manish; Perestelo-Perez, Lilisbeth; Scholl, Isabelle; Tomori, Kounosuke; Trevena, Lyndal; Witteman, Holly O; Van der Weijden, Trudy

2017-11-06

Objectives  To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design  Multistage consultation process. Setting  Key informant group, communities of interest, and survey of clinical specialties. Participants  19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results  After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions  The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Home Oxygen Program review: Regionalization in Vancouver Coastal Health and British Columbia.

PubMed

Sandberg, Dan

2015-01-01

Since its inception in the 1980s, the Home Oxygen Program in British Columbia was centrally managed by the Ministry of Health. Initially a small program with few clients across the province, it soon became a large program with many clients and increasing expenditures. A pilot program started in Victoria (British Columbia) in 1996 demonstrated that managing the program locally could offer better client care, better contract management and significant cost savings. In 2002, the pilot's model and recommendations were implemented in British Columbia's five health authorities. The present review details the experiences of regionalizing the program in the Vancouver Coastal Health authority. After fine adjustments to the model were developed and new contracts and criteria changes made, better care for clients was provided than the previous centralized model at a reduced cost to the taxpayer.

Breast skin and nipple changes

MedlinePlus

Inverted nipple; Nipple discharge; Breast feeding - nipple changes; Breastfeeding - nipple changes ... provider will talk to you about your medical history and recent changes you have noticed in your ...

Leaving Distress Behind: A Randomized Controlled Study on Change in Emotional Processing in Borderline Personality Disorder.

PubMed

Berthoud, Laurent; Pascual-Leone, Antonio; Caspar, Franz; Tissot, Hervé; Keller, Sabine; Rohde, Kristina B; de Roten, Yves; Despland, Jean-Nicolas; Kramer, Ueli

2017-01-01

The marked impulsivity and instability of clients suffering from borderline personality disorder (BPD) greatly challenge therapists' understanding and responsiveness. This may hinder the development of a constructive therapeutic relationship despite it being of particular importance in their treatment. Recent studies have shown that using motive-oriented therapeutic relationship (MOTR), a possible operationalization of appropriate therapist responsiveness, can enhance treatment outcome for BPD. The overall objective of this study is to examine change in emotional processing in BPD clients following the therapist's use of MOTR. The present paper focuses on N = 50 cases, n = 25 taken from each of two conditions of a randomized controlled add-on effectiveness design. Clients were either allocated to a manual-based psychiatric-psychodynamic 10-session version of general psychiatric management (GPM), a borderline-specific treatment, or to a 10-session version of GPM augmented with MOTR. Emotional states were assessed using the Classification of Affective-Meaning States (Pascual-Leone & Greenberg, 2005) at intake, midtreatment, and in the penultimate session. Across treatment, early expressions of distress, especially the emotion state of global distress, were shown to significantly decrease (p = .00), and adaptive emotions were found to emerge (p < .05). Between-condition differences of change were found, including a significant increase in emotional variability and stronger outcome predictors in the MOTR condition. The findings indicate initial emotional change in BPD clients in a relatively short time frame and suggest the addition of MOTR to psychotherapeutic treatments as promising. Clinical implications are discussed.

Shared written case formulations and weight change in outpatient therapy for anorexia nervosa: a naturalistic single case series.

PubMed

Gladwin, Alice M; Evangeli, Michael

2013-01-01

The therapeutic effects of written shared case formulations are underexplored and have not been examined in anorexia nervosa. This study explored the relationship between (a) the delivery (b) the quality of a shared written case formulation and weight in outpatient psychological therapy for anorexia nervosa. A naturalistic single case series approach was used to examine the case notes of women who had attended a specialist eating disorders service over a 2-year period. The case notes of 15 adult women who had undergone outpatient psychological therapy for anorexia nervosa with a shared written case formulation component were reviewed. The impact of the quality of the case formulation on weekly weight was examined for 14 of the clients where the case formulation was available. The nature of the relationship between the delivery of the written shared case formulation and weight was examined for all 15 clients. There was some evidence to support an association between delivery of the shared written case formulation and weight changes (both weight gain [five out of 15 clients] and weight loss [three out of 15 clients]) in individual cases. Higher case formulation quality was related to cases where weight change did not occur. The delivery of case formulations can be associated with important therapeutic change (both beneficial and potentially harmful) in anorexia nervosa. Future research into the causal mechanisms associated with sharing formulations will face the challenge of adopting strategies that allow for an in-depth exploration of complex therapy variables whilst overcoming methodological challenges. Copyright © 2012 John Wiley & Sons, Ltd.

The ICF-CY and Goal Attainment Scaling: benefits of their combined use for pediatric practice.

PubMed

McDougall, Janette; Wright, Virginia

2009-01-01

There is much heterogeneity and disconnect in the approaches used by service providers to conduct needs assessments, set goals and evaluate outcomes for clients receiving pediatric rehabilitation services. The purpose of this article is to describe how the International Classification of Functioning, Disability and Health-Child and Youth (ICF-CY) can be used in combination with Goal Attainment Scaling (GAS), an individualised measure of change, to connect the various phases of the therapeutic process to provide consistent clinical care that is family-centred, collaborative, well directed and accountable. A brief description of both the ICF-CY and GAS as they pertain to pediatric rehabilitation is provided as background. An explanation is given of how the ICF-CY offers a framework through which clients, families and service providers can together identify the areas of clients' needs. In addition, the article discusses how the use of GAS facilitates translation of clients' identified needs into distinct, measurable goals set collaboratively by clients, their families and service providers. Examples of integrated GAS goals set for the various components of the ICF-CY are provided. The utility of GAS as a measure of clinical outcomes for individual clients is also discussed. Used in combination, the ICF-CY and GAS can serve to coordinate, simplify and standardise assessment and outcome evaluation practices for individual clients receiving pediatric rehabilitation services.

Detrimental role of humoral signalling in cardio-renal cross-talk.

PubMed

Cantaluppi, Vincenzo; Dellepiane, Sergio; Quercia, Alessandro D; Ferrario, Silvia

2014-01-22

In critically ill patients, any acute organ injury is associated with a sudden change of circulating factors that may play a role in distant organ dysfunction through a complex cross-talk. In this issue, Virzì and colleagues discuss the relevance of humoral signalling between heart and kidney, focusing on type 1 and type 3 cardio-renal syndrome. We herein review the mechanisms of heart-kidney cross-talk, discussing the role of circulating detrimental mediators in the pathogenetic mechanisms of cardio-renal syndrome.

Telerehabilitation - a new model for community-based stroke rehabilitation.

PubMed

Lai, Jerry C K; Woo, Jean; Hui, Elsie; Chan, W M

2004-01-01

Community resources for stroke clients are underdeveloped in Hong Kong and stroke survivors often face difficulties in community reintegration. We have examined the feasibility of using videoconferencing for community-based stroke rehabilitation. The sample comprised 21 stroke patients living at home. All the subjects participated in an eight-week intervention programme at a community centre for seniors. The intervention, which comprised educational talks, exercise and psychosocial support, was conducted by a physiotherapist via a videoconference link. The Berg Balance Scale (BBS), State Self-Esteem Scale (SSES), Medical Outcomes Study 36-item Short Form (SF-36) and a stroke knowledge test were administered at the start and end of the programme. In addition, at the start of the study the Geriatric Depression Scale 15-item Short Form, the Elderly Mobility Scale and the Lawton Instrumental Activities of Daily Living Scale were used to assess subjects' baseline status, and a focus group was also held at the end of the programme to gather qualitative findings. Nineteen subjects completed the eight-week intervention. The baseline functional status was high, although 52% had symptoms of depression. After the intervention, there were significant improvements in BBS, SSES and knowledge test scores and scores on all subscales of the SF-36. All the subjects accepted the use of videoconferencing for delivery of the intervention. The pilot study demonstrated the feasibility, efficacy and high level of acceptance of telerehabilitation for community-dwelling stroke clients.

IPython: components for interactive and parallel computing across disciplines. (Invited)

NASA Astrophysics Data System (ADS)

Perez, F.; Bussonnier, M.; Frederic, J. D.; Froehle, B. M.; Granger, B. E.; Ivanov, P.; Kluyver, T.; Patterson, E.; Ragan-Kelley, B.; Sailer, Z.

2013-12-01

Scientific computing is an inherently exploratory activity that requires constantly cycling between code, data and results, each time adjusting the computations as new insights and questions arise. To support such a workflow, good interactive environments are critical. The IPython project (http://ipython.org) provides a rich architecture for interactive computing with: 1. Terminal-based and graphical interactive consoles. 2. A web-based Notebook system with support for code, text, mathematical expressions, inline plots and other rich media. 3. Easy to use, high performance tools for parallel computing. Despite its roots in Python, the IPython architecture is designed in a language-agnostic way to facilitate interactive computing in any language. This allows users to mix Python with Julia, R, Octave, Ruby, Perl, Bash and more, as well as to develop native clients in other languages that reuse the IPython clients. In this talk, I will show how IPython supports all stages in the lifecycle of a scientific idea: 1. Individual exploration. 2. Collaborative development. 3. Production runs with parallel resources. 4. Publication. 5. Education. In particular, the IPython Notebook provides an environment for "literate computing" with a tight integration of narrative and computation (including parallel computing). These Notebooks are stored in a JSON-based document format that provides an "executable paper": notebooks can be version controlled, exported to HTML or PDF for publication, and used for teaching.

Intro and Recent Advances: Remote Data Access via OPeNDAP Web Services

NASA Technical Reports Server (NTRS)

Fulker, David

2016-01-01

During the upcoming Summer 2016 meeting of the ESIP Federation (July 19-22), OpenDAP will hold a Developers and Users Workshop. While a broad set of topics will be covered, a key focus is capitalizing on recent EOSDIS-sponsored advances in Hyrax, OPeNDAPs own software for server-side realization of the DAP2 and DAP4 protocols. These Hyrax advances are as important to data users as to data providers, and the workshop will include hands-on experiences of value to both. Specifically, a balanced set of presentations and hands-on tutorials will address advances in1.server installation,2.server configuration,3.Hyrax aggregation capabilities,4.support for data-access from clients that are HTTP-based, JSON-based or OGC-compliant (especially WCS and WMS),5.support for DAP4,6.use and extension of server-side computational capabilities, and7.several performance-affecting matters. Topics 2 through 7 will be relevant to data consumers, data providers and notably, due to the open-source nature of all OPeNDAP software to developers wishing to extend Hyrax, to build compatible clients and servers, and/or to employ Hyrax as middleware that enables interoperability across a variety of end-user and source-data contexts. A session for contributed talks will elaborate the topics listed above and embrace additional ones.

The experience of mental health professionals using neuro emotional technique in psychotherapeutic practice

NASA Astrophysics Data System (ADS)

Marriage, Amanda Lynn

This study reviewed how Neuro Emotional Technique (NET) is used in psychotherapeutic practice, and how it is understood and experienced by the practitioners who use it. Participants included 18 mental health professionals who have obtained the certification-level of training in NET and have incorporated NET into their professional practice. A qualitative method was used to explore NET providers' experiences through an online survey. Data from these surveys was analyzed using the constant comparative method. Six categories containing 18 themes emerged as a result of this analysis. These categories included: (1) practitioners currently employing NET; (2) technique utilization; (3) participant estimation of the efficacy of NET; (4) talking about NET; (5) clients most likely to benefit from NET; and (6) clients least likely to benefit from NET. The 18 themes that emerged within these categories represent important components of the integration of NET into psychological treatment. These themes were compared with existing literature to serve as valuable information for psychologists and other mental health professionals seeking to incorporate NET into their professional practices. This study helps to fill the current void in the area of research on NET as a psychological intervention, or more specifically, as a holistic mind-body approach to self-betterment and the amelioration of symptoms for humans who are healing from a broad spectrum of traumatic and stressful experiences.

Effects of price manipulations on consumer behavior in sheltered workshop token economy.

PubMed

Schroeder, S R; Barrera, F J

1976-09-01

The consumer behavior of institutionalized retarded clients in a sheltered workshop token economy were evaluated by changing prices in the workshop store. In the first experiment we found that clients displayed elasticity of demand in that raising the prices of frequently purchased goods reduced the frequency and amount spent on more expendable items. Results from the second experiment showed that this change in spending pattern was not due to the relative modal unit price of item classes. The regulation of demand for consumer goods is a potentially useful way to maintain economic balance and effectiveness of a token economy.

Talking Classrooms: Shaping Children's Learning through Oral Language Instruction.

ERIC Educational Resources Information Center

Smith, Patricia G., Ed.

This book offers a variety of viewpoints relevant to teachers and researchers who are interested in the practical application of the theory and philosophy behind oral language instruction. Through an assortment of international essays, the authors demonstrate the changing nature of children's talk in the writing circle, reading conference, English…

National CrossTalk. Volume 12, Number 4, Fall 2004

ERIC Educational Resources Information Center

Trombley, William, Ed.

2004-01-01

The primary purpose of "National CrossTalk" is to stimulate informed discussion and debate of higher education issues. This issue contains the following articles: (1) Code of Conduct: Air Force Academy Adopts Changes in Response to 2003 Sexual Assault Scandal (Kathy Witkowsky); (2) Political Football: Partisan Politics Could Determine…

Prenatal screening for congenital anomalies: exploring midwives' perceptions of counseling clients with religious backgrounds.

PubMed

Gitsels-van der Wal, Janneke T; Manniën, Judith; Gitsels, Lisanne A; Reinders, Hans S; Verhoeven, Pieternel S; Ghaly, Mohammed M; Klomp, Trudy; Hutton, Eileen K

2014-07-19

In the Netherlands, prenatal screening follows an opting in system and comprises two non-invasive tests: the combined test to screen for trisomy 21 at 12 weeks of gestation and the fetal anomaly scan to detect structural anomalies at 20 weeks. Midwives counsel about prenatal screening tests for congenital anomalies and they are increasingly having to counsel women from religious backgrounds beyond their experience. This study assessed midwives' perceptions and practices regarding taking client's religious backgrounds into account during counseling. As Islam is the commonest non-western religion, we were particularly interested in midwives' knowledge of whether pregnancy termination is allowed in Islam. This exploratory study is part of the DELIVER study, which evaluated primary care midwifery in The Netherlands between September 2009 and January 2011. A questionnaire was sent to all 108 midwives of the twenty practices participating in the study. Of 98 respondents (response rate 92%), 68 (69%) said they took account of the client's religion. The two main reasons for not doing so were that religion was considered irrelevant in the decision-making process and that it should be up to clients to initiate such discussions. Midwives' own religious backgrounds were independent of whether they paid attention to the clients' religious backgrounds. Eighty midwives (82%) said they did not counsel Muslim women differently from other women. Although midwives with relatively many Muslim clients had more knowledge of Islamic attitudes to terminating pregnancy in general than midwives with relatively fewer Muslim clients, the specific knowledge of termination regarding trisomy 21 and other congenital anomalies was limited in both groups. While many midwives took client's religion into account, few knew much about Islamic beliefs on prenatal screening for congenital anomalies. Midwives identified a need for additional education. To meet the needs of the changing client population, counselors need more knowledge of religious opinions about the termination of pregnancy and the skills to approach religious issues with clients.

Declining Inconsistent Condom Use but Increasing HIV and Syphilis Prevalence Among Older Male Clients of Female Sex Workers

PubMed Central

Chen, Yi; Abraham Bussell, Scottie; Shen, Zhiyong; Tang, Zhenzhu; Lan, Guanghua; Zhu, Qiuying; Liu, Wei; Tang, Shuai; Li, Rongjian; Huang, Wenbo; Huang, Yuman; Liang, Fuxiong; Wang, Lu; Shao, Yiming; Ruan, Yuhua

2016-01-01

Abstract Clients of female sex workers (CFSWs) are a bridge population for the spread of HIV and syphilis to low or average risk heterosexuals. Most studies have examined the point prevalence of these infections in CFSWs. Limited evidence suggests that older age CFSWs are at a higher risk of acquiring sexually transmitted diseases compared with younger clients. Thus, we sought to describe long-term trends in HIV, syphilis, and hepatitis C (HCV) to better understand how these infections differ by sex worker classification and client age. We also examined trends in HIV, syphilis, and HCV among categories of female sex workers (FSWs). We conducted serial cross-sectional studies from 2010 to 2015 in Guangxi autonomous region, China. We collected demographic and behavior variables. FSWs and their clients were tested for HIV, syphilis, and HCV antibodies. Positive HIV and syphilis serologies were confirmed by Western blot and rapid plasma regain, respectively. Clients were categorized as middle age (40–49 years) and older clients (≥50 years). FSWs were categorized as high-tier, middle-tier, or low-tier based on the payment amount charged for sex and their work venue. Chi-square test for trends was used for testing changes in prevalence over time. By 2015, low-tier FSWs (LTFSWs) accounted for almost half of all FSWs; and they had the highest HIV prevalence at 1.4%. HIV prevalence declined significantly for FSWs (high-tier FSW, P = 0.003; middle-tier FSWs; P = 0.021; LTFSWs, P < 0.001). Syphilis infections significantly declined for FSWs (P < 0.001) but only to 7.3% for LTFSWs. HCV and intravenous drug use were uncommon in FSWs. HIV prevalence increased for older age clients (1.3%–2.0%, P = 0.159) while syphilis prevalence remained stable. HCV infections were halved among older clients in 3 years (1.7%–0.8%, P < 0.001). Condom use during the last sexual encounter increased for FSWs and CFSWs. Few clients reported sex with men or intravenous drug use. Clients preferred LTFSWs, especially older clients (81.9%). Our results suggest that HIV and syphilis infections are increasing in older clients who prefer LTFSWs. HIV and syphilis are likely increasing in Guangxi Province through heterosexual transmission. PMID:27258500

Declining Inconsistent Condom Use but Increasing HIV and Syphilis Prevalence Among Older Male Clients of Female Sex Workers: Analysis From Sentinel Surveillance Sites (2010-2015), Guangxi, China.

PubMed

Chen, Yi; Abraham Bussell, Scottie; Shen, Zhiyong; Tang, Zhenzhu; Lan, Guanghua; Zhu, Qiuying; Liu, Wei; Tang, Shuai; Li, Rongjian; Huang, Wenbo; Huang, Yuman; Liang, Fuxiong; Wang, Lu; Shao, Yiming; Ruan, Yuhua

2016-05-01

Clients of female sex workers (CFSWs) are a bridge population for the spread of HIV and syphilis to low or average risk heterosexuals. Most studies have examined the point prevalence of these infections in CFSWs. Limited evidence suggests that older age CFSWs are at a higher risk of acquiring sexually transmitted diseases compared with younger clients. Thus, we sought to describe long-term trends in HIV, syphilis, and hepatitis C (HCV) to better understand how these infections differ by sex worker classification and client age. We also examined trends in HIV, syphilis, and HCV among categories of female sex workers (FSWs).We conducted serial cross-sectional studies from 2010 to 2015 in Guangxi autonomous region, China. We collected demographic and behavior variables. FSWs and their clients were tested for HIV, syphilis, and HCV antibodies. Positive HIV and syphilis serologies were confirmed by Western blot and rapid plasma regain, respectively. Clients were categorized as middle age (40-49 years) and older clients (≥50 years). FSWs were categorized as high-tier, middle-tier, or low-tier based on the payment amount charged for sex and their work venue. Chi-square test for trends was used for testing changes in prevalence over time.By 2015, low-tier FSWs (LTFSWs) accounted for almost half of all FSWs; and they had the highest HIV prevalence at 1.4%. HIV prevalence declined significantly for FSWs (high-tier FSW, P = 0.003; middle-tier FSWs; P = 0.021; LTFSWs, P < 0.001). Syphilis infections significantly declined for FSWs (P < 0.001) but only to 7.3% for LTFSWs. HCV and intravenous drug use were uncommon in FSWs. HIV prevalence increased for older age clients (1.3%-2.0%, P = 0.159) while syphilis prevalence remained stable. HCV infections were halved among older clients in 3 years (1.7%-0.8%, P < 0.001). Condom use during the last sexual encounter increased for FSWs and CFSWs. Few clients reported sex with men or intravenous drug use. Clients preferred LTFSWs, especially older clients (81.9%).Our results suggest that HIV and syphilis infections are increasing in older clients who prefer LTFSWs. HIV and syphilis are likely increasing in Guangxi Province through heterosexual transmission.

Atomistic simulations and network-based modeling of the Hsp90-Cdc37 chaperone binding with Cdk4 client protein: A mechanism of chaperoning kinase clients by exploiting weak spots of intrinsically dynamic kinase domains

PubMed Central

Czemeres, Josh; Buse, Kurt

2017-01-01

A fundamental role of the Hsp90 and Cdc37 chaperones in mediating conformational development and activation of diverse protein kinase clients is essential in signal transduction. There has been increasing evidence that the Hsp90-Cdc37 system executes its chaperoning duties by recognizing conformational instability of kinase clients and modulating their folding landscapes. The recent cryo-electron microscopy structure of the Hsp90-Cdc37-Cdk4 kinase complex has provided a framework for dissecting regulatory principles underlying differentiation and recruitment of protein kinase clients to the chaperone machinery. In this work, we have combined atomistic simulations with protein stability and network-based rigidity decomposition analyses to characterize dynamic factors underlying allosteric mechanism of the chaperone-kinase cycle and identify regulatory hotspots that control client recognition. Through comprehensive characterization of conformational dynamics and systematic identification of stabilization centers in the unbound and client- bound Hsp90 forms, we have simulated key stages of the allosteric mechanism, in which Hsp90 binding can induce instability and partial unfolding of Cdk4 client. Conformational landscapes of the Hsp90 and Cdk4 structures suggested that client binding can trigger coordinated dynamic changes and induce global rigidification of the Hsp90 inter-domain regions that is coupled with a concomitant increase in conformational flexibility of the kinase client. This process is allosteric in nature and can involve reciprocal dynamic exchanges that exert global effect on stability of the Hsp90 dimer, while promoting client instability. The network-based rigidity analysis and emulation of thermal unfolding of the Cdk4-cyclin D complex and Hsp90-Cdc37-Cdk4 complex revealed weak spots of kinase instability that are present in the native Cdk4 structure and are targeted by the chaperone during client recruitment. Our findings suggested that this mechanism may be exploited by the Hsp90-Cdc37 chaperone to recruit and protect intrinsically dynamic kinase clients from degradation. The results of this investigation are discussed and interpreted in the context of diverse experimental data, offering new insights into mechanisms of chaperone regulation and binding. PMID:29267381

Psychosocial support and resilience building among health workers in Sierra Leone: interrelations between coping skills, stress levels, and interpersonal relationships.

PubMed

Vesel, Linda; Waller, Kathryn; Dowden, Justine; Fotso, Jean Christophe

2015-01-01

In low- and middle-income countries, a shortage of properly trained, supervised, motivated and equitably distributed health workers often hinder the delivery of lifesaving interventions. Various health workforce bottlenecks can be addressed by tackling well-being and interpersonal relationships of health workers with their colleagues and clients. This paper uses data from the Helping Health Workers Cope (HHWC) project in a rural district of Sierra Leone to achieve three objectives. First, we describe the effect of counseling and psychosocial training on coping skills, stress levels, and provider-provider and provider-client relationships. Second, we examine whether a change in coping skills is associated with a change in relationships. Finally, we qualitatively identify key ways through which the uptake of coping skills is linked to a change in relationships. The HHWC project was implemented from February 2012 to June 2013 in Kono district in the Eastern province of Sierra Leone, with the neighboring district of Tonkolili selected as the control site. The evaluation followed a mixed-methods approach, which included a quantitative survey, in-depth interviews and focus group discussions with health workers and clients. Mean values of the variables of interest were compared across sub-populations, and correlation analyses were performed between changes in coping skills, stress levels, and changes in relationships. Overall, the results demonstrate that the HHWC intervention had a positive effect on coping skills, stress levels and provider-provider and provider-client relationships. Furthermore, associations were observed between changes in coping skills and changes in relationships as well as changes in stress management skills and changes in relationships. Psychosocial education can have major impacts on health worker well-being and the quality of health care delivery. Integrating psychosocial counseling and training interventions into health worker pre-service and in-service curricula would allow the positive effects of the HHWC intervention to be scaled up across Sierra Leone and beyond. A roll out of the HHWC approach alongside health system strengthening initiatives could have major implications for improving health and chances of survival.

Perceived sources of change in trainees' self-efficacy beliefs.

PubMed

Lent, Robert W; Cinamon, Rachel Gali; Bryan, Nicole A; Jezzi, Matthew M; Martin, Helena M; Lim, Robert

2009-09-01

Thought-listing procedures were used to examine the perceived incidence, size, direction, and bases of change in the session-level self-efficacy of therapists in training. Ninety-eight Master's-level trainees completed a cognitive assessment task immediately after each session with a client in their first practicum. Participants typically reported modest-sized, positive changes in their therapeutic self-efficacy at each session. Seven perceived sources of change in self-efficacy were identified. Some of these sources (e.g., trainees' performance evaluations, affective reactions) were consistent with general self-efficacy theory; others reflected the interpersonal performance context of therapy (e.g., perceptions of the therapeutic relationship and client behavior). Implications of the findings for training and future research on therapist development are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

The missing link: district nurses as social connection for older people with type 2 diabetes mellitus.

PubMed

Lucas, Sandra

2013-08-01

The relationship between social connection and health is widely recognised. However, there is a paucity of literature regarding the impact of district nursing care on social connection for people with a chronic illness such as type 2 diabetes mellitus (T2DM). Using a mixed-method approach, an exploration of the perceptions of older people living in the community with T2DM regarding their health and social connections was carried out. Findings revealed a strong relationship between the clients and the district nurse. The district nurse is an important aspect of clients' social connection. For some clients where their social connection is limited, the district nurse is a central element. When the district nurse is the major social connection, problems can arise for the client, especially when they are being discharged or changes are made to their care.

Countertransference in conflict: one client or two?

PubMed

Hill, J K

1995-01-01

The concept of countertransference (CT) reaction has undergone dramatic changes in definition since its inception at the turn of the century. No longer viewed as a hindrance to effective therapeutic interventions, it has become central to building the therapeutic alliance. However, CT can interfere with the therapeutic task, and this is especially true in forensic settings in which one must help particularly difficult clients. In these cases, the CT must split into two parts in order for the therapist to be clinically effective. The therapist reacts to the individual as both an offender who has violated a societal law and as a client who needs help, separating the client from the behavior. Although not recognized explicitly in the forensic literature, the effects of the dual CT underlie investigations of therapist-offender relationships. This article reviews the concept of CT with specific reference to forensic settings and develops the concept of dual CT.

Methods work better when couples talk.

PubMed

Keller, S

1996-01-01

Sexual partners who communicate about reproductive health issues reduce their risk of acquiring a sexually transmitted disease (STD) or of unintended pregnancy, but few couples feel comfortable talking openly about sex. AIDS prevention programs have focused on improving couple communication, but family planning programs have emphasized women-controlled contraception as more reliable than barrier methods. The effectiveness of barrier methods would likely improve, however, if clients are counseled in couple communication. Effective communication about sexual issues requires self-confidence, and strengthening a woman's self-confidence may also improve her ability to negotiate condom use. Small discussion groups held among female factory workers in Thailand in 1993-94 led to an increase from 60% to 90% in the number of women who felt confident in discussing STD risk with a partner and to an increase from 36% to 82% in those who said they would not be embarrassed to give a partner a condom. A Nigerian study also suggested that more education may also improve prospects for couple communication and contraceptive usage. A US study showed that adolescent women who communicated openly with their partners reduced their risks of unintended pregnancy and STDs, and a Kenyan study indicated that communication increases contraceptive usage among married couples. Various projects around the world are attempting to counsel women on communication and condom negotiation, and counselors are beginning the difficult task of teaching women how to convince men to use condoms.

A synchronous communication experiment within an online distance learning program: a case study.

PubMed

Boulos, Maged N Kamel; Taylor, Andrea D; Breton, Alice

2005-10-01

Student-teacher and student-student interactions in purely asynchronous distance learning courses are much lacking compared to similar interactions found in face-to-face teaching, causing learners to experience feelings of isolation, thus reducing motivation and increasing dropout rates. We used PalTalk, an Internet text and audio chat client from AVM Software, Inc. (New York, NY), to offer our students live virtual classroom sessions within a unit of our online distance learning M.Sc. program in Healthcare Informatics. On-demand replays of audio excerpts from the sessions were also provided to accommodate absenteeism and for student review. Five students completed an evaluation questionnaire. Our results highlighted the potential merits of using synchronous conferencing to assist in fostering a sense of belonging to one supportive learning community among distance learners and improve educational outcomes. Students were very positive toward the real-time human interaction and voted for a 95/5 (asynchronous/synchronous percentages) blended delivery approach for a typical unit in our program. They also praised PalTalk's voice quality and ease of use. This paper presents educational and technological perspectives about this experiment in the form of a state-of the- art review, without intending to be statistically rigorous. However, robust research evidence is still required to convince educators fully about the benefits of synchronous communication tools and help them decide on the most suitable solutions for their particular circumstances.

See no evil, hear no evil, speak no evil: why do relatively few male victims of childhood sexual abuse receive help for abuse-related issues in adulthood?

PubMed

Holmes, G R; Offen, L; Waller, G

1997-01-01

This literature review explores the reasons why comparatively few adult males with a history of childhood sexual abuse are seen by professionals for help with difficulties relating to that abuse. Two potential explanations are discounted as myths-that relatively few males are sexually abused, and that abuse has little effect on males. However, it is suggested that society (including professionals and the victims themselves) has given credence to these myths. Male victims are relatively unlikely to disclose their experience of childhood abuse, and (as a coping strategy) they deny the impact of sexual abuse on their lives. Professionals fail to hypothesise that their male clients may have been abused, and do not create the conditions that would enable males to talk about the abuse. Blumer's (1971) model of the social construction of problems is applied to account for these beliefs and behaviours on the part of victims and clinicians. It is argued that the childhood sexual abuse of males has not yet acquired legitimacy as a problem recognised by society, thus lagging behind the abuse of females. In short, the "evil' of childhood sexual abuse in the male population is not being seen or heard by clinicians, and is not being recognised or talked about by victims. Clinical implications are considered.

A theoretical and methodological proposal for the descriptive assessment of therapeutic interactions.

PubMed

Froján-Parga, María Xesús; Ruiz-Sancho, Elena M; Calero-Elvira, Ana

2016-01-01

The goal of this study is to show the development of a strategy for a descriptive assessment of the therapeutic interaction. In this study, we develop an observational methodology to analyze the dialogues that took place during 92 sessions conducted in a psychological center in Madrid, Spain, in which 19 adults were treated for various psychological problems by 9 behavioral therapists. A system was developed to codify vocal behavior of both the therapists and the clients; the software The Observer XT was used for recording. Therapeutic interactions were analyzed using sequential analysis. There are three main sequences that synthesize the therapist-client interaction: first, an utterance by the client preceded by a therapist's verbalization, specifically a question (discriminative morphology) and followed by an expression of approval (reinforcement morphology); second, verbalizations of failure or discomfort uttered by the client, followed most often by verbalizations of disapproval (punishing morphology) uttered by the therapist; and third, verbalizations uttered by the client that are discriminated by the therapist after an in-depth explanation and followed by different therapist's utterances (expressions of approval, technical information, etc.). Depending on how the client responds the results in this study present a starting point for the study of the functional sequences that form the basis of therapeutic change.

Trends in Health Insurance Coverage of Title X Family Planning Program Clients, 2005-2015.

PubMed

Decker, Emily J; Ahrens, Katherine A; Fowler, Christina I; Carter, Marion; Gavin, Loretta; Moskosky, Susan

2018-05-01

The federal Title X Family Planning Program supports the delivery of family planning services and related preventive care to 4 million individuals annually in the United States. The implementation of the 2010 Affordable Care Act's (ACA's) Medicaid expansion and provisions expanding access to health insurance, which took effect in January 2014, resulted in higher rates of health insurance coverage in the U.S. population; the ACA's impact on individuals served by the Title X program has not yet been evaluated. Using administrative data we examined changes in health insurance coverage among Title X clinic patients during 2005-2015. We found that the percentage of clients without health insurance decreased from 60% in 2005 to 48% in 2015, with the greatest annual decrease occurring between 2013 and 2014 (63% to 54%). Meanwhile, between 2005 and 2015, the percentage of clients with Medicaid or other public health insurance increased from 20% to 35% and the percentage of clients with private health insurance increased from 8% to 15%. Although clients attending Title X clinics remained uninsured at substantially higher rates compared with the national average, the increase in clients with health insurance coverage aligns with the implementation of ACA-related provisions to expand access to affordable health insurance.

New frontiers in couple-based interventions in cancer care: refining the prescription for spousal communication.

PubMed

Badr, Hoda

2017-02-01

The diagnosis and treatment of cancer is a life-altering experience that signals profound changes in a person's life. However, most people do not experience cancer in isolation or cope alone. Despite the fact that partners (i.e. spouses, significant others) provide emotional support and play a critical role in caregiving, cancer exacts a heavy toll on them and challenges their relationship with the patient by altering established communication patterns and roles. In recognition of this, a burgeoning literature involving couple-based interventions to improve patient and partner quality of life and adaptation has emerged. However, questions remain regarding how we can improve these interventions to exact greater impact on patient and partner outcomes. A narrative review of the literature on couples' communication processes in cancer was conducted in order to describe knowledge gaps and directions for future research. Most couple-based interventions have included a communication skills training component because communication is an important process through which couples make sense of cancer, engage in social support, negotiate role changes and coordinate coping responses. However, scholars still know very little about what they should instruct couples to talk about, how often they should talk and when talking (or not talking) is beneficial (and for whom - the patient, partner, or both). In order push this field forward, we need to develop a more nuanced view of couples' communication that acknowledges that there are multiple ways to talk, different aspects of the cancer experience to talk about, and preexisting communication patterns and preferences for different couples that may influence the utility of talk. Interventions that replace the unilateral and generic prescription to talk openly about cancer with targeted questions that prompt reflection on couples' unique strengths, preexisting communication patterns and support resources may thus help bolster the impact of couple-based interventions on patient and partner quality of life.

75 FR 4454 - Privacy Act of 1974

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

... new, open systems, client-server based architecture, and the change in system number will reflect organizational changes. The System Location was amended to reflect the current organization structure with... accurately identify the system and the change in number will reflect organizational changes. VA is...

Strategic Talk in Film.

PubMed

Payr, Sabine; Skowron, Marcin; Dobrosovestnova, Anna; Trapp, Martin; Trappl, Robert

2017-01-01

Conversational robots and agents are being designed for educational and/or persuasive tasks, e.g., health or fitness coaching. To pursue such tasks over a long time, they will need a complex model of the strategic goal, a variety of strategies to implement it in interaction, and the capability of strategic talk. Strategic talk is incipient ongoing conversation in which at least one participant has the objective of changing the other participant's attitudes or goals. The paper is based on the observation that strategic talk can stretch over considerable periods of time and a number of conversational segments. Film dialogues are taken as a source to develop a model of the strategic talk of mentor characters. A corpus of film mentor utterances is annotated on the basis of the model, and the data are interpreted to arrive at insights into mentor behavior, especially into the realization and sequencing of strategies.

Strategic Talk in Film

PubMed Central

Payr, Sabine; Skowron, Marcin; Dobrosovestnova, Anna; Trapp, Martin; Trappl, Robert

2017-01-01

ABSTRACT Conversational robots and agents are being designed for educational and/or persuasive tasks, e.g., health or fitness coaching. To pursue such tasks over a long time, they will need a complex model of the strategic goal, a variety of strategies to implement it in interaction, and the capability of strategic talk. Strategic talk is incipient ongoing conversation in which at least one participant has the objective of changing the other participant’s attitudes or goals. The paper is based on the observation that strategic talk can stretch over considerable periods of time and a number of conversational segments. Film dialogues are taken as a source to develop a model of the strategic talk of mentor characters. A corpus of film mentor utterances is annotated on the basis of the model, and the data are interpreted to arrive at insights into mentor behavior, especially into the realization and sequencing of strategies. PMID:29375243

The Social Process of Analyzing Real Water Resource Systems Plans and Management Policies

NASA Astrophysics Data System (ADS)

Loucks, Daniel

2016-04-01

Developing and applying systems analysis methods for improving the development and management of real world water resource systems, I have learned, is primarily a social process. This talk is a call for more recognition of this reality in the modeling approaches we propose in the papers and books we publish. The mathematical models designed to inform planners and managers of water systems that we see in many of our journals often seem more complex than they need be. They also often seem not as connected to reality as they could be. While it may be easier to publish descriptions of complex models than simpler ones, and while adding complexity to models might make them better able to mimic or resemble the actual complexity of the real physical and/or social systems or processes being analyzed, the usefulness of such models often can be an illusion. Sometimes the important features of reality that are of concern or interest to those who make decisions can be adequately captured using relatively simple models. Finding the right balance for the particular issues being addressed or the particular decisions that need to be made is an art. When applied to real world problems or issues in specific basins or regions, systems modeling projects often involve more attention to the social aspects than the mathematical ones. Mathematical models addressing connected interacting interdependent components of complex water systems are in fact some of the most useful methods we have to study and better understand the systems we manage around us. They can help us identify and evaluate possible alternative solutions to problems facing humanity today. The study of real world systems of interacting components using mathematical models is commonly called applied systems analyses. Performing such analyses with decision makers rather than of decision makers is critical if the needed trust between project personnel and their clients is to be developed. Using examples from recent and ongoing modeling projects in different parts of the world, this talk will attempt to show the dependency on the degree of project success with the degree of attention given to the communication between project personnel, the stakeholders and decision making institutions. It will also highlight how initial project terms-of-reference and expected outcomes can change, sometimes in surprising ways, during the course of such projects. Changing project objectives often result from changing stakeholder values, emphasizing the need for analyses that can adapt to this uncertainty.

Assessment of the quality of antenatal care services provided by health workers using a mobile phone decision support application in northern Nigeria: a pre/post-intervention study.

PubMed

McNabb, Marion; Chukwu, Emeka; Ojo, Oluwayemisi; Shekhar, Navendu; Gill, Christopher J; Salami, Habeeb; Jega, Farouk

2015-01-01

Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre. Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care. Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001), out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education. These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.

Learning science through talk: A case study of middle school students engaged in collaborative group investigation

NASA Astrophysics Data System (ADS)

Zinicola, Debra Ann

Reformers call for change in how science is taught in schools by shifting the focus towards conceptual understanding for all students. Constructivist learning is being promoted through the dissemination of National and State Science Standards that recommend group learning practices in science classrooms. This study examined the science learning and interactions, using case study methodology, of one collaborative group of 4 students in an urban middle school. Data on science talk and social interaction were collected over 9 weeks through 12 science problem solving sessions. To determine student learning through peer interaction, varied group structures were implemented, and students reflected on the group learning experience. Data included: field notes, cognitive and reflective journals, audiotapes and videotapes of student talk, and audiotapes of group interviews. Journal data were analyzed quantitatively and all other data was transcribed into The Ethnograph database for qualitative analysis. The data record was organized into social and cognitive domains and coded with respect to interaction patterns to show how group members experienced the social construction of science concepts. The most significant finding was that all students learned as a result of 12 talk sessions as evidenced by pre- and post-conceptual change scores. Interactions that promoted learning involved students connecting their thoughts, rephrasing, and challenging ideas. The role structure was only used by students about 15% of the time, but it started the talk with a science focus, created awareness of scientific methods, and created an awareness of equitable member participation. Students offered more spontaneous, explanatory talk when the role structure was relaxed, but did not engage in as much scientific writing. They said the role structure was important for helping them know what to do in the talk but they no longer needed it after a time. Gender bias, status, and early adolescent developmental factors influenced many of the group's interactions. Recommendations are that: collaborative group problem solving be used frequently to promote conceptual change, teachers begin with a role structure to guide interactions, create heterogeneous groups, keep the same students together for a significant period of time, and monitor, guide, and teach during group learning sessions.

Defense in Depth Added to Malicious Activities Simulation Tools (MAST)

DTIC Science & Technology

2015-09-01

cipher suites. The TLS Handshake is a combination of three components: handshake, change cipher spec, and alert. 41 (1) The Handshake ( Hello ) The...TLS Handshake, specifically the “ Hello ” portion, is designed to negotiate session parameters (cipher suite). The client informs the server of the...protocols and standards that it supports and then the server selects the highest common protocols and standards. Specifically, the Client Hello message

Cognitive therapy for performance anxiety.

PubMed

Rodebaugh, Thomas L; Chambless, Dianne L

2004-08-01

We present and illustrate the major components of cognitive therapy for performance anxiety, focusing on the performance fears of a client treated with a protocol designed for social phobia. The basic supposition of cognitive theory is that a client's thoughts and beliefs about situations maintain distressing feelings, such as anxiety. Changing these beliefs involves detection and disputation of anxiety-provoking thoughts, as well as testing of these thoughts through exposure to feared situations. Through a process of identifying existing beliefs about performance situations and challenging these beliefs, clients can gain a more realistic and less anxiety-producing perspective on performance tasks. Specific techniques, along with common difficulties and potential solutions, are presented in a detailed case study. Copyright 2004 Wiley Periodicals, Inc.

Understanding wellness center loyalty through lifestyle analysis.

PubMed

Suresh, Satya; Ravichandran, Swathi; P, Ganesan

2011-01-01

Many changes taking place at a macro-level in Indian society along with the popularity of services that are native to India, such as Yoga and Ayurveda, have generated significant interest in wellness services. To assist wellness centers in gaining loyal clients, the goal of this study was to understand the influence of customer lifestyle factors on wellness center loyalty. The activities, interests, and opinions model was used to understand the lifestyles of wellness center clients. Data were collected from clients of five wellness centers. Regression results indicate that overworked individuals and those seeking a balance between work and family life would be the most loyal to wellness centers. Managerial implications of results are discussed.

System of and method for transparent management of data objects in containers across distributed heterogenous resources

DOEpatents

Moore, Reagan W.; Rajasekar, Arcot; Wan, Michael Y.

2004-01-13

A system of and method for maintaining data objects in containers across a network of distributed heterogeneous resources in a manner which is transparent to a client. A client request pertaining to containers is resolved by querying meta data for the container, processing the request through one or more copies of the container maintained on the system, updating the meta data for the container to reflect any changes made to the container as a result processing the request, and, if a copy of the container has changed, changing the status of the copy to indicate dirty status or synchronizing the copy to one or more other copies that may be present on the system.

System of and method for transparent management of data objects in containers across distributed heterogenous resources

DOEpatents

Moore, Reagan W [San Diego, CA; Rajasekar, Arcot [Del Mar, CA; Wan, Michael Y [San Diego, CA

2007-09-11

A system of and method for maintaining data objects in containers across a network of distributed heterogeneous resources in a manner which is transparent to a client. A client request pertaining to containers is resolved by querying meta data for the container, processing the request through one or more copies of the container maintained on the system, updating the meta data for the container to reflect any changes made to the container as a result processing the re quest, and, if a copy of the container has changed, changing the status of the copy to indicate dirty status or synchronizing the copy to one or more other copies that may be present on the system.

System of and method for transparent management of data objects in containers across distributed heterogenous resources

DOEpatents

Moore, Reagan W.; Rajasekar, Arcot; Wan, Michael Y.

2010-09-21

A system of and method for maintaining data objects in containers across a network of distributed heterogeneous resources in a manner which is transparent to a client. A client request pertaining to containers is resolved by querying meta data for the container, processing the request through one or more copies of the container maintained on the system, updating the meta data for the container to reflect any changes made to the container as a result processing the request, and, if a copy of the container has changed, changing the status of the copy to indicate dirty status or synchronizing the copy to one or more other copies that may be present on the system.

Toy Talk: Simple Strategies to Create Richer Grammatical Input

ERIC Educational Resources Information Center

Hadley, Pamela A.; Walsh, Kathleen M.

2014-01-01

Purpose: The purpose of this initial feasibility study was to determine whether brief instruction in toy talk would change grammatical properties of adult language, specifically 3rd person lexical noun phrase (NP) subjects. Method: Eighteen college students participated in the study. The use of 3rd person subjects was examined before and after…

Photomontage: A New Task to Change Speaking into Talking Classrooms

ERIC Educational Resources Information Center

Hassaskhah, Jaleh; Asli, Shohreh Rahimizadeh

2015-01-01

This study introduces photomontage as a task to facilitate talking in English as a Foreign Language classrooms. Thirty-three undergraduate English major students studying at the University of Guilan were assigned to design a composite photographic image by combining images from separate photographic sources, and use it as the stimulus to initiate…

Reasons to Be Cheerful? Why Teachers' Beliefs Could yet Bring about Change in Schools

ERIC Educational Resources Information Center

Berry, Jon

2016-01-01

This article revisits Douglas Barnes's book-length exploration of the implications for teachers of a constructivist epistemology, notably in relation to the importance of small-group talk in classrooms. Empirically based consideration of small-group exploratory pupil-pupil talk enabled Barnes to reveal the learning strategies such a context…

Successful Supervision from the Student-Teachers' Perspective: An Analysis of Supervisory Talk

ERIC Educational Resources Information Center

Gulden, Ilin; Julide, Inozu; Rana, Yildirim

2007-01-01

This study aims at analyzing supervisory talk and student- teachers' interpretations of it in order to find out the qualities that characterize successful supervision which leads to a change in student- teachers' beliefs. To achieve this, supervisory feedback sessions with four supervisors were recorded, transcribed and then analyzed for…

National CrossTalk. Volume 14, Number 3, Summer 2006

ERIC Educational Resources Information Center

Trombley, William, Ed.

2006-01-01

The primary purpose of "National CrossTalk" is to stimulate informed discussion and debate of higher education issues. This issue contains the following articles: (1) The M Word: "Marketing" Has Changed from a Dirty Word to a Buzzword in Higher Education (Jon Marcus); (2) A Contrarian View of the Testing Industry: FairTest…

Health outcomes can be improved by implementing an occupational physiotherapy provider programme.

PubMed

Pizzari, Tania; Davidson, Megan

2013-03-01

To evaluate the return to work and health outcomes of a physiotherapy network provider programme. A prospective case-control study was conducted with 21 clients of network occupational physiotherapy (OP) providers and 21 matched clients of non-network providers. Health outcomes and return to work were recorded 3 and 6 months following the commencement of physiotherapy. Health outcomes included the Short Form (SF)-12, return to usual activities and the global perceived effect of treatment. Within-group changes and between-group differences were analysed. Within-group changes showed the OP group improved significantly in physical functioning (p = 0.006), and the control group deteriorated in mental health status (p = 0.016) as measured by the SF-12. Mean change over time between groups from the 3-month to 6-month follow-ups showed a significant difference favouring the OP group for return to usual activities (p = 0.027) and the physical component of the SF-12 (p = 0.009). All job-attached participants returned to work following their accident, so there was no difference between the groups. The OP clients demonstrated a greater change in physical functioning health outcomes over time. This study provides preliminary support for the implementation of the OP scheme. Copyright © 2012 John Wiley & Sons, Ltd.

Body Weight Relationships in Early Marriage: Weight Relevance, Weight Comparisons, and Weight Talk

PubMed Central

Bove, Caron F.; Sobal, Jeffery

2011-01-01

This investigation uncovered processes underlying the dynamics of body weight and body image among individuals involved in nascent heterosexual marital relationships in Upstate New York. In-depth, semi-structured qualitative interviews conducted with 34 informants, 20 women and 14 men, just prior to marriage and again one year later were used to explore continuity and change in cognitive, affective, and behavioral factors relating to body weight and body image at the time of marriage, an important transition in the life course. Three major conceptual themes operated in the process of developing and enacting informants’ body weight relationships with their partner: weight relevance, weight comparisons, and weight talk. Weight relevance encompassed the changing significance of weight during early marriage and included attracting and capturing a mate, relaxing about weight, living healthily, and concentrating on weight. Weight comparisons between partners involved weight relativism, weight competition, weight envy, and weight role models. Weight talk employed pragmatic talk, active and passive reassurance, and complaining and critiquing criticism. Concepts emerging from this investigation may be useful in designing future studies of and approaches to managing body weight in adulthood. PMID:21864601

Invasion. A hospital in transition following the 1983 Grenadian intervention.

PubMed

Walker, K; DeVooght, J

1989-01-01

Stress, confusion, and a sense of loss were inevitable during the hospital relocation, especially given the large number of clients, ward communities, and staff needed to move and adjust to change. Despite the fact that the change was perceived as a positive and progressive step in psychiatric-mental health care in Grenada, there were many obstacles and much resistance to overcome. As expected, staff's and clients' fears centered around themes of impending loss and abandonment. An understanding of the transition process, along with the availability of experienced hospital staff for support and guidance, greatly aided the relocation process. Relocation still presented problems and Mt. Gay Hospital continues to struggle to carry out the lasting and beneficial changes that will best promote a therapeutic and culturally sensitive client/staff environment. Despite the fact that the hospital relocation was not entirely self-determined, but partially imposed by political circumstances, a positive resolution of the crisis occurred. The crisis brought about the change that, in this circumstance, is seen as synonymous with growth. It acted as a catalyst to bring about help from unexpected and much needed sources (U.S.A.I.D./Project Hope), which may not have otherwise been available to facilitate such a change. Richmond Hill Mental Hospital took control and advantage of a crisis situation and made it serve its immediate and pressing need for a new psychiatric hospital.

Alcohol-Adapted Anger Management Treatment: A Randomized Controlled Trial of an Innovative Therapy for Alcohol Dependence.

PubMed

Walitzer, Kimberly S; Deffenbacher, Jerry L; Shyhalla, Kathleen

2015-12-01

A randomized controlled trial for an innovative alcohol-adapted anger management treatment (AM) for outpatient alcohol dependent individuals scoring moderate or above on anger is described. AM treatment outcomes were compared to those of an empirically-supported intervention, Alcoholics Anonymous Facilitation treatment (AAF). Clients in AM, relative to clients in AAF, were hypothesized to have greater improvement in anger and anger-related cognitions and lesser AA involvement during the 6-month follow-up. Anger-related variables were hypothesized to be stronger predictors of improved alcohol outcomes in the AM treatment condition and AA involvement was hypothesized to be a stronger predictor of alcohol outcomes in the AAF treatment group. Seventy-six alcohol dependent men and women were randomly assigned to treatment condition and followed for 6 months after treatment end. Both AM and AAF treatments were followed by significant reductions in heavy drinking days, alcohol consequences, anger, and maladaptive anger-related thoughts and increases in abstinence and self-confidence regarding not drinking to anger-related triggers. Treatment with AAF was associated with greater AA involvement relative to treatment with AM. Changes in anger and AA involvement were predictive of posttreatment alcohol outcomes for both treatments. Change in trait anger was a stronger predictor of posttreatment alcohol consequences for AM than for AAF clients; during-treatment AA meeting attendance was a stronger predictor of posttreatment heavy drinking and alcohol consequences for AAF than for AM clients. Anger-related constructs and drinking triggers should be foci in treatment of alcohol dependence for anger-involved clients. Copyright © 2015 Elsevier Inc. All rights reserved.

Alcohol-adapted Anger Management Treatment: A Randomized Controlled Trial of an Innovative Therapy for Alcohol Dependence

PubMed Central

Walitzer, Kimberly S.; Deffenbacher, Jerry L.; Shyhalla, Kathleen

2015-01-01

A randomized controlled trial for an innovative alcohol-adapted anger management treatment (AM) for outpatient alcohol dependent individuals scoring moderate or above on anger is described. AM treatment outcomes were compared to those of an empirically-supported intervention, Alcoholics Anonymous Facilitation treatment (AAF). Clients in AM, relative to clients in AAF, were hypothesized to have greater improvement in anger and anger-related cognitions and lesser AA involvement during the six-month follow-up. Anger-related variables were hypothesized to be stronger predictors of improved alcohol outcomes in the AM treatment condition and AA involvement was hypothesized to be a stronger predictor of alcohol outcomes in the AAF treatment group. Seventy-six alcohol dependent men and women were randomly assigned to treatment condition and followed for six months after treatment end. Both AM and AAF treatments were followed by significant reductions in heavy drinking days, alcohol consequences, anger, and maladaptive anger-related thoughts and increases in abstinence and self-confidence regarding not drinking to anger-related triggers. Treatment with AAF was associated with greater AA involvement relative to treatment with AM. Changes in anger and AA involvement were predictive of posttreatment alcohol outcomes for both treatments. Change in trait anger was a stronger predictor of posttreatment alcohol consequences for AM than for AAF clients; during-treatment AA meeting attendance was a stronger predictor of posttreatment heavy drinking and alcohol consequences for AAF than for AM clients. Anger-related constructs and drinking triggers should be foci in treatment of alcohol dependence for anger-involved clients. PMID:26387049

Fine-grained policy control in U.S. Army Research Laboratory (ARL) multimodal signatures database

NASA Astrophysics Data System (ADS)

Bennett, Kelly; Grueneberg, Keith; Wood, David; Calo, Seraphin

2014-06-01

The U.S. Army Research Laboratory (ARL) Multimodal Signatures Database (MMSDB) consists of a number of colocated relational databases representing a collection of data from various sensors. Role-based access to this data is granted to external organizations such as DoD contractors and other government agencies through a client Web portal. In the current MMSDB system, access control is only at the database and firewall level. In order to offer finer grained security, changes to existing user profile schemas and authentication mechanisms are usually needed. In this paper, we describe a software middleware architecture and implementation that allows fine-grained access control to the MMSDB at a dataset, table, and row level. Result sets from MMSDB queries issued in the client portal are filtered with the use of a policy enforcement proxy, with minimal changes to the existing client software and database. Before resulting data is returned to the client, policies are evaluated to determine if the user or role is authorized to access the data. Policies can be authored to filter data at the row, table or column level of a result set. The system uses various technologies developed in the International Technology Alliance in Network and Information Science (ITA) for policy-controlled information sharing and dissemination1. Use of the Policy Management Library provides a mechanism for the management and evaluation of policies to support finer grained access to the data in the MMSDB system. The GaianDB is a policy-enabled, federated database that acts as a proxy between the client application and the MMSDB system.

Fall prevention in central coast community pharmacies.

PubMed

Stuart, Gina M; Kale, Helen L

2018-04-19

Fall injuries among people aged 65 years and over (older people) cause substantial health decline and cost to the health system. In 2009 in New South Wales, 25.6% of older people fell in the previous year, and 10.7% (32 000) were hospitalised. Pharmacists are trusted professionals, who interact extensively with older people and have potential to augment fall prevention in pharmacies. This brief report describes how professional development improved pharmacist's knowledge and confidence in fall prevention, encouraged implementation of fall prevention plans and facilitated the provision of brief fall prevention interventions for older clients, after identification of fall risk. In 2014, pharmacists from all Central Coast pharmacies (n = 76) were invited to free, continuing professional development (CPD) in fall prevention. It provided education and resources to identify clients' fall risk, conduct brief fall prevention interventions and implement fall prevention health promotion plans (FPHPP). Pharmacists completed written: Baseline and post-workshop questionnaires to assess changes in pharmacist's knowledge and confidence, and existing fall prevention in pharmacies. Logs of client fall risk and brief fall prevention interventions offered to clients. Four-month follow-up questionnaires to assess implementation of FPHPPs and pharmacy practice changes. Pharmacists representing 36% of pharmacies participated. At four-month follow-up, 67% had implemented FPHPPs, and 62% delivered brief interventions determined by client fall risk. Fall prevention in pharmacies can be augmented through locally provided CPD tailored for pharmacists. SO WHAT?: This model could increase fall prevention reach. It is transferable to settings where health professionals provide services to older adults and require reregistration through professional development. © 2018 Australian Health Promotion Association.

Social networks and their influence on drinking behaviors: differences related to cognitive impairment in clients receiving alcoholism treatment.

PubMed

Buckman, Jennifer F; Bates, Marsha E; Cisler, Ron A

2007-09-01

Mechanisms of behavioral change that support positive addiction treatment outcomes in individuals with co-occurring alcohol-use disorders and cognitive impairment remain largely unknown. This article combines person- and variable-centered approaches to examine the interrelated influence of cognitive impairment and social support on stability of and changes in drinking behaviors of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) outpatients and aftercare clients (N = 1,726) during the first year after their entry into treatment. Latent class analysis identified homogeneous groups of clients based on the nature and extent of social support for abstinence or drinking at treatment entry. Cognitive impairment and drinking outcomes were compared across latent classes, and the interaction between impairment and social support on drinking outcomes was examined using mixture probit regression. Three independent social support classes (frequent positive, limited positive, and negative) were identified. In the outpatient sample, the frequent positive support class had greater cognitive impairment at treatment entry versus other classes, and extent of impairment significantly predicted improved drinking outcomes in this class. In the aftercare sample, the frequent positive and negative support classes had heightened impairment, yet cognitive impairment significantly predicted relatively poorer drinking outcomes in the negative support class only. Cognitive impairment may increase the influence of the social network on the drinking outcomes of persons receiving treatment for alcohol-use disorders, but more research is needed to understand client characteristics that determine whether this influence is more likely to be manifest as increased salience of helping agents or of hindering agents in the social network.

Cultural Psychiatry: A Spotlight on the Experience of Clinical Social Workers' Encounter with Jewish Ultra-Orthodox Mental Health Clients.

PubMed

Freund, Anat; Band-Winterstein, Tova

2017-07-01

Community is a complex issue, especially in two particular populations overlap: Haredi society, which embraces cultural codes common to closed communities, and the mental health population characterized by its own unique needs. The present study explores the encounter experience of social workers with the cultural perceptions of mental health clients in the Haredi community in light of Community Cultural Psychiatry. A qualitative-phenomenological approach was adopted. In-depth semi-structured interviews were conducted with 27 social workers, mental health professionals, who are in contact with ultra-Orthodox Jewish clients. Three major themes emerged from the data analysis: (1) Exclusion vs. grace and compassion. (2) Mental health: A professional or cultural arena? (3) Mental health help-seeking changing processes. This study shows that the attitude in the Haredi community toward mental health therapy undergoes a process of change. It is important to strengthen this process, together with preserving existing community informal structures of help.

Transformative occupational therapy: We are wired to be transformers.

PubMed

Dubouloz, Claire-Jehanne

2014-10-01

Transformative learning involves critical self-reflection as the motor for transforming values, beliefs, knowledge, and feelings and discovering the new meaning of daily life following a catastrophic injury or illness. Transformation has been conceptualized in various disciplines as a transcendent experience, rebirth process, and meaning-making process and within occupational therapy as a meaning perspective process. This Muriel Driver lecture explores the concept of transformation and presents the newly developed Meaning Perspectives Transformation model, constructed from research conducted with several different rehabilitation client groups. The model is characterized by three phases: trigger, changing, and outcomes. A client's critical self-reflection acts as a catalyst for moving between the phases and is represented in the model as a moment of readiness for change leading to the development of alternative ways of performing. The Meaning Perspectives Transformation model provides a tool for being an effective occupational therapist, encouraging therapists to listen closely to their clients to identify their weakening and emerging meaning perspectives and enable their occupational evolution and transformation.

Mammalian HspB1 (Hsp27) is a molecular sensor linked to the physiology and environment of the cell.

PubMed

Arrigo, André-Patrick

2017-07-01

Constitutively expressed small heat shock protein HspB1 regulates many fundamental cellular processes and plays major roles in many human pathological diseases. In that regard, this chaperone has a huge number of apparently unrelated functions that appear linked to its ability to recognize many client polypeptides that are subsequently modified in their activity and/or half-life. A major parameter to understand how HspB1 is dedicated to interact with particular clients in defined cellular conditions relates to its complex oligomerization and phosphorylation properties. Indeed, HspB1 structural organization displays dynamic and complex rearrangements in response to changes in the cellular environment or when the cell physiology is modified. These structural modifications probably reflect the formation of structural platforms aimed at recognizing specific client polypeptides. Here, I have reviewed data from the literature and re-analyzed my own studies to describe and discuss these fascinating changes in HspB1 structural organization.

Program Capacity to Eliminate Outcome Disparities in Addiction Health Services

PubMed Central

Guerrero, Erick G.; Aarons, Gregory; Grella, Christine; Garner, Bryan R.; Cook, Benjamin; Vega, William A.

2014-01-01

We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010–2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed. PMID:25450596

Program Capacity to Eliminate Outcome Disparities in Addiction Health Services.

PubMed

Guerrero, Erick G; Aarons, Gregory A; Grella, Christine E; Garner, Bryan R; Cook, Benjamin; Vega, William A

2016-01-01

We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed.

Space to ground talking through small different areas in the top part of the air where the space-house flies.

NASA Astrophysics Data System (ADS)

Heine, T.

2015-12-01

If you look between the middle and the top of the ball of rock on which we all live, the very excited part of the top air (as high as where the space-house flies) doesn't change much on a normal day. In fact, it is very much the same in every direction. However, sometimes when there is sudden, heavy wind from the sun, the excited top air can be different and changing, becoming more or less filled up, in many directions---especially if you look at toward the top and the right of the ball of rock on which we all live. Some of the excited top air becomes suddenly filled up in one big area. Near there, there are also parts of the the excited top air that start changing in many very small places. These small changing areas sometimes make it hard to talk between space and the ground. We studied this happening on days on and around day 17 of third month of 2015 when the wind from the sun hit the ball of rock on which we all live very hard. We used things that talk from space to the ground in an area around school up to several hundred 5280 feet away. We made pictures of the changing excited top air, especially the small changing places, and looked for when they did and didn't make for good talking from space to the ground. We studied these pictures to learn when and why this sometimes happens and sometimes it doesn't. We are excited to share what we learned with you.

Psychometric Properties of the System for Coding Couples’ Interactions in Therapy - Alcohol

PubMed Central

Owens, Mandy D.; McCrady, Barbara S.; Borders, Adrienne Z.; Brovko, Julie M.; Pearson, Matthew R.

2014-01-01

Few systems are available for coding in-session behaviors for couples in therapy. Alcohol Behavior Couples Therapy (ABCT) is an empirically supported treatment, but little is known about its mechanisms of behavior change. In the current study, an adapted version of the Motivational Interviewing for Significant Others coding system was developed into the System for Coding Couples’ Interactions in Therapy – Alcohol (SCCIT-A), which was used to code couples’ interactions and behaviors during ABCT. Results showed good inter-rater reliability of the SCCIT-A and provided evidence that the SCCIT-A may be a promising measure for understanding couples in therapy. A three factor model of the SCCIT-A was examined (Positive, Negative, and Change Talk/Counter-Change Talk) using a confirmatory factor analysis, but model fit was poor. Due to poor model fit, ratios were computed for Positive/Negative ratings and for Change Talk/Counter-Change Talk codes based on previous research in the couples and Motivational Interviewing literature. Post-hoc analyses examined correlations between specific SCCIT-A codes and baseline characteristics and indicated some concurrent validity. Correlations were run between ratios and baseline characteristics; ratios may be an alternative to using the factors from the SCCIT-A. Reliability and validity analyses suggest that the SCCIT-A has the potential to be a useful measure for coding in-session behaviors of both partners in couples therapy and could be used to identify mechanisms of behavior change for ABCT. Additional research is needed to improve the reliability of some codes and to further develop the SCCIT-A and other measures of couples’ interactions in therapy. PMID:25528049

Factors influencing utilization of intermittent preventive treatment for pregnancy in the Gushegu district, Ghana, 2013

PubMed Central

Stephen, Atasige Awin-irigu; Wurapa, Frederick; Afari, Edwin Andrew; Sackey, Samuel Oko; Malm, Keaziah Laurencia; Nyarko, Kofi Mensah

2016-01-01

Introduction The coverage of adequate (≥2 doses) IPTp-SP in Ghana is below the national target of 80% and that is a threat to reducing the incidence of malaria in pregnancy. The primary objective of the study was to determine the client and facility related factors associated with adequate uptake of IPTp-SP and suggest approaches for increased uptake. Methods A cross sectional study was conducted among ANC clients and staff in Gushegu, questionnaires was administered to 330 conveniently sampled nursing mothers and all ANC staff present. A checklist and observation were used to collect health facility data. Data was analyzed descriptively and associations between the related factors and adequate uptake of IPTp-SP were determined. Results A total of 91.5% and 8.5% of respondents took adequate (≥2doses) and inadequate (≤1dose) IPTp-SP respectively. 85.4% respondents were early first ANC attendance and 80% were multiple gravidae. Mean ANC visits was 5.0 (standard deviation = 2.2). The key determinants for inadequate uptake of IPTp were Unemployment [OR= 4.9 95% CI (1.9-13.1], single gravidae [OR= 3.4 95% CI (1.5-7.6)] and late first ANC visit [OR= 6.8 95% CI (3.0-15.4)]. DOT practice, good staff attitude and health talk at the facility were observed and confirmed by ANC clients as satisfactory. adequate uptake of SP among respondents was high. Majorities were unemployed, have had multiple pregnancies and made early first ANC visits. Unemployment and late first ANC visits are significantly associated with taking inadequate SP dose. Conclusion Adequate uptake of SP among respondents was high. Majorities were unemployed, have had multiple pregnancies and made early first ANC visits. Unemployment and late first ANC visits are significantly associated with taking inadequate SP dose. PMID:28149434

The Role of the Working Alliance in Treatment for Alcohol Problems

PubMed Central

2015-01-01

Little research has been done on the role of the therapeutic working alliance in treatment for alcohol problems. This longitudinal study’s objectives were (a) to identify predictors of working alliance and (b) to investigate whether client and/or therapist reports of the working alliance predicted posttreatment motivation and then later treatment outcome. Client and therapist perceptions of the working alliance were assessed after the first treatment session using a short form of the Working Alliance Inventory (WAI) among 173 clients taking part in the United Kingdom Alcohol Treatment Trial (UKATT) and randomized to motivational enhancement therapy (MET) or social behavior and network therapy (SBNT) with complete data on all measures of interest. Structural equation models were fitted to identify predictors of WAI scores and investigate the relationships between WAI and measures of drinking during treatment, posttreatment motivation, and successful treatment outcome (abstinent or nonproblem drinker), and measures of drinks per drinking day and nondrinking days, assessed 9 months after the conclusion of treatment. Motivation to change drinking when treatment began was a strong predictor of client—adjusted coefficient = 2.21 (95% confidence interval [CI] [0.36, 4.06]—but not therapist WAI. Client WAI predicted successful treatment outcome—adjusted odds ratios (OR) = 1.09 (95% CI [1.02, 1.17])—and had effects on drinking during treatment, and on posttreatment motivation to change. There was evidence for effect modification by treatment, with strong associations between WAI and posttreatment motivation, and evidence of WAI prediction of treatment outcomes in the MET group, but no evidence of associations for SBNT. Therapist WAI was not strongly associated with treatment outcome (adjusted OR = 1.05; 95% CI [0.99, 1.10]). The working alliance is important to treatment outcomes for alcohol problems, with client evaluation of the alliance strongly related to motivation to change drinking throughout treatment for MET. It was also much more important than therapist-rated alliance in this study. PMID:25961147

Peer-based education and the integration of HIV and Sexual and Reproductive Health services for young people in Vietnam: evidence from a project evaluation.

PubMed

Ngo, Anh D; Ha, Toan H; Rule, John; Dang, Chinh V

2013-01-01

This paper reports changes in behavioral outcomes related to the use of HIV testing service of a project that employed peer-based education strategies and integration of HIV voluntary counseling and testing (VCT) and Sexual and Reproductive Health (SRH) services targeting young people aged 15-24 across 5 provinces in Vietnam. A pre-test/post-test, non-experimental evaluation design was used. Data were collected from cross-sectional surveys of youth and client exit interviews at project supported SRH clinics conducted at baseline and again at 24 months following implementation. The baseline samples consisted of 813 youth and 399 exit clients. The end line samples included 501 youths and 399 exit clients. Z test was used to assess changes in behavioral outcomes. Results show that there was a significant increase (p<0.05) in the percentage of youth who wanted to obtain a HIV test (from 33% to 51%), who had ever had a test (from 7.5% to 15%), and who had a repeat test in the last 12 months (from 54.5% to 67.5%). Exit client interviews found a nearly five-fold increase in the percentage of clients seeking HIV VCT in their current visit (5.0% vs. 24.5%) and almost two-fold increase in the percentage of those having their last test at a project supported clinic (9.3% vs. 17.8%). There were also positive changes in some aspects of youth HIV/AIDS knowledge, attitudes, and risk perceptions. This study provides preliminary evidence regarding the benefits of the integration of HIV VCT-SRH services in terms of increased access to HIV services and testing in Vietnam. Benefits of peer-based education regarding increased HIV knowledge were also identified. Further investigations, including experimental studies with assessment of health outcomes and the uptake of HIV testing services, are required to better elucidate the effectiveness and challenges of this intervention model in Vietnam.

Question/statement judgments: an fMRI study of intonation processing.

PubMed

Doherty, Colin P; West, W Caroline; Dilley, Laura C; Shattuck-Hufnagel, Stefanie; Caplan, David

2004-10-01

We examined changes in fMRI BOLD signal associated with question/statement judgments in an event-related paradigm to investigate the neural basis of processing one aspect of intonation. Subjects made judgments about digitized recordings of three types of utterances: questions with rising intonation (RQ; e.g., "She was talking to her father?"), statements with a falling intonation (FS; e.g., "She was talking to her father."), and questions with a falling intonation and a word order change (FQ; e.g., "Was she talking to her father?"). Functional echo planar imaging (EPI) scans were collected from 11 normal subjects. There was increased BOLD activity in bilateral inferior frontal and temporal regions for RQ over either FQ or FS stimuli. The study provides data relevant to the location of regions responsive to intonationally marked illocutionary differences between questions and statements.

Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness.

PubMed

Toivo, Terhi; Dimitrow, Maarit; Puustinen, Juha; Savela, Eeva; Pelkonen, Katariina; Kiuru, Valtteri; Suominen, Tuula; Kinnunen, Sirkka; Uunimäki, Mira; Kivelä, Sirkka-Liisa; Leikola, Saija; Airaksinen, Marja

2018-03-16

The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources. The study is registered in the Clinical Trials.gov ( NCT02545257 ). Registration date September 9 2015.

Changes in perceptions of quality of, and access to, services among clients of a fractional franchise network in Nepal.

PubMed

Agha, Sohail; Gage, Anastasia; Balal, Asma

2007-05-01

With declining levels of international donor funding for financing reproductive health programmes, developing country governments and international donors are looking towards private sector strategies to expand the supply of quality reproductive health services. One of the challenges of a health franchise is to improve the quality of services provided by independent private practitioners. Private providers are more likely to abide by the quality standards set by a franchiser if they see a financial benefit resulting from franchise participation. This study was conducted to measure whether (a) there were improvements in perceived quality of care and perceived access to health facilities once these facilities became part of a franchise and (b) improvements in perceived quality and perceived access were associated with increased client loyalty to franchised clinics. Franchisees were given basic reproductive health training for seven days and services marketing training for two days. Exit interviews were conducted with male and female clients at health facilities. A pre-test measurement was taken in April 2001, prior to the start of project activities. A post-test measurement was taken in February/March 2002, about 9 months after the pre-test. Multilevel regression analysis, which takes the hierarchical structure of the data into account, was used for the analysis. After taking provider-level variation into account and controlling for client characteristics, the analyses showed significant improvements in perceived quality of care and perceived access to services. Private provider participation in a franchise network helps improve client perceptions of quality of, and access to, services. Improvements in client perceptions of quality and access contribute to increased client loyalty to franchised clinics. Once increased client loyalty translates into higher client volumes, providers are likely to see the benefits of franchise participation. In turn, this should lead to increased provider willingness to remain part of the franchise and to abide by the standards of quality set by the franchiser.

South Asian immigrant women's experiences of being respected within cancer treatment settings.

PubMed

Singh-Carlson, Savitri; Neufeld, Anne; Olson, Joanne

2010-01-01

The purpose of this focused ethnographic inquiry was to examine South Asian immigrant women's experiences and perceptions of respect within health professional-client relationships in the context of a Canadian outpatient treatment clinic. Characteristics of respect described by 11 women interviewed were the meaning of respect, health professional's way of being, their way of attending to the person, and their way of talking. Language, cultural values and beliefs, along with underlying societal, individual and institutional factors that coexist with health professionals' ability to create respect were some of the dimensions that influenced how immigrant women experienced respect. Health professionals' capacity to acknowledge South Asian immigrant women as individuals helped to formulate/construct respect for their individual identities. The need to be respected for 'my social identity' as an immigrant woman with cancer was woven throughout women's stories, illustrated by their personal experiences and perspectives.

The association between waiting for psychological therapy and therapy outcomes as measured by the CORE-OM.

PubMed

Beck, Alison; Burdett, Mark; Lewis, Helen

2015-06-01

To investigate the impact of waiting for psychological therapy on client well-being as measured by the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) global distress (GD) score. Global distress scores were retrieved for all clients referred for psychological therapy in a secondary care mental health service between November 2006 and May 2013 and who had completed a CORE-OM at assessment and first session. GD scores for a subgroup of 103 clients who had completed a CORE-OM during the last therapy session were also reviewed. The study sample experienced a median wait of 41.14 weeks between assessment and first session. The relationship between wait time from referral acceptance to assessment, and assessment GD score was not significant. During the period between assessment and first session no significant difference in GD score was observed. Nevertheless 29.1% of the sample experienced reliable change; 16.0% of clients reliably improved and 13.1% reliably deteriorated whilst waiting for therapy. Demographic factors were not found to have a significant effect on the change in GD score between assessment and first session. Waiting time was associated with post-therapy outcomes but not to a degree which was meaningful. The majority of individuals (54.4%), regardless of whether they improved or deteriorated whilst waiting for therapy, showed reliable improvement at end of therapy as measured by the CORE-OM. The majority of GD scores remained stable while waiting for therapy; however, 29.1% of secondary care clients experienced either reliable improvement or deterioration. Irrespective of whether they improved, deteriorated or remained unchanged whilst waiting for therapy, most individuals who had a complete end of therapy assessment showed reliable improvements following therapy. There was no significant difference in GD score between assessment and first session recordings. A proportion of clients (29.1%) showed reliable change, either improvement or deterioration, as measured by the GD score while waiting for therapy. Of the individuals with last session CORE-OMs (54.4%) showed significant improvement following therapy regardless of whether or not they experienced change while waiting for therapy. Limitations include: Problems of data quality, the data were from a routine data set and data were lost at each stage of the analysis. A focus on the CORE-OM limits exploration of the subjective experience of waiting for psychotherapy and the impact this has on psychological well-being. © 2014 The British Psychological Society.

Counselor and Participant Perspectives of Trauma-Focused Cognitive Behavioral Therapy for Children in Zambia: A Qualitative Study

PubMed Central

Murray, Laura K.; Skavenski, Stephanie; Michalopoulos, Lynn M.; Bolton, Paul A.; Bass, Judith K.; Familiar, Itziar; Imasiku, Mwiya; Cohen, Judy

2014-01-01

Objective This study examined Zambian counselors, children, and caregivers' perceptions of an evidence-based treatment (EBT) for trauma (Trauma-Focused Cognitive Behavioral Therapy, TF-CBT) utilized in Zambia to address mental health problems in children. Method Semi-structured interviews were conducted with local counselors trained in TF-CBT (N=19; 90% of those trained; 12 Female) and children/caregivers who had received TF-CBT in a small feasibility study (N=18; 86% of the children and N=16; 76% of the caregivers) who completed TF-CBT (Total completed; N=21). Each client was asked six open-ended questions, and domain analysis was used to explore the data. Results Counselors were positive about the program, liked the structure and flexibility, reported positive changes in their clients, and discussed the cultural adaptation around activities and language. Counselors stated the training was too short, and the supervision was necessary. Challenges included client engagement and attendance, availability of location, funding, and a lack of community understanding of “therapy.” Children and caregivers stated multiple positive changes they attributed to TF-CBT, such as better family communication, reduction of problem behaviors, and ability to speak about the trauma. They recommended continuing the program. Conclusion This study brings a critical examination of providers' and clients' perspectives of the implementation of an EBT for children in a low-resource setting. Clinical implications include changing implementation methods based on responses. Research implications include future study directions such as an effectiveness trial of TF-CBT and an examination of implementation factors. PMID:24400677

Case study of how successful coordination was achieved between a mental health and social care service in Sweden.

PubMed

Hansson, Johan; Øvretveit, John; Brommels, Mats

2012-01-01

This paper summarises the findings from an empirical longitudinal study of a health and social care consortium for people with mental health problems in one area in Stockholm. The aim was to describe the formation and structure of coordination within the consortium, and to assess the intermediate impact on care processes and client outcomes. A multiple-method case study design, theoretically informed by the Pettigrew and Whipp model of strategic change (1993) was applied. Data was gathered from interviews with informants from different organisations at different times in the development of the consortium, and from administrative documents, plans and service statistics showing some of the intermediate changes and client outcomes. The findings revealed activities and factors both helping and hindering the formation of coordination arrangements. One of the most significant hindering factors was the central county purchasing organisation focusing more on volume and costs, with payments for specific units and services, and with less emphasis on quality of the services. Few studies have described implementation of changes to improve coordination with reference to context over a long period of time, as well as assessing different results. This study contributes to knowledge about improved methods for this type of research, as well as knowledge about developing coordination between public health and welfare services. One lesson for the current policy is that, where full structural integration is not possible, then client-level coordination roles in each sector are useful to connect sector services for shared clients. Copyright © 2011 John Wiley & Sons, Ltd.

Changing Teachers' Practices through Exploratory Talk in Mathematics: A Discursive Pedagogical Perspective

ERIC Educational Resources Information Center

Murphy, Carol

2015-01-01

This paper presents data collected as part of an intervention research project to develop exploratory talk and collaborative group work with six and seven year-old students in mathematics. A discursive approach was used to analyse and interpret variations in the way that three case-study teachers, involved in the project, managed the group work…

Changing Hearts and Minds: The Quest for Open Talk about Race in Educational Leadership

ERIC Educational Resources Information Center

Rusch, Edith A.; Horsford, Sonya Douglass

2009-01-01

Purpose: The purpose of this paper is to seek to conceptualize a theory of self-contribution as a framework for understanding and demonstrating the dispositions and skills academics and educational leaders need to break the silence and engage in constructive talk about race across color lines. Design/methodology/approach: Brian Fay's framework for…

Talking about Mental Illness: A Guide for Developing an Awareness Program for Youth. Community Guide.

ERIC Educational Resources Information Center

2001

This guide contains all of the information, support and tools that community members need to implement "Talking About Mental Illness" in their community--an awareness program proven to be effective in bringing about positive change in young people's knowledge about mental illness, and in reducing stigma that surrounds mental illness. The…

Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome.

PubMed

Anderson, Timothy; Crowley, Mary Ellen J; Himawan, Lina; Holmberg, Jennifer K; Uhlin, Brian D

2016-09-01

Therapist effects, independent of the treatment provided, have emerged as a contributor to psychotherapy outcomes. However, past research largely has not identified which therapist factors might be contributing to these effects, though research on psychotherapy implicates relational characteristics. The present Randomized Clinical Trial tested the efficacy of therapists who were selected by their facilitative interpersonal skills (FIS) and training status. Sixty-five clients were selected from 2713 undergraduates using a screening and clinical interview procedure. Twenty-three therapists met with 2 clients for 7 sessions and 20 participants served in a no-treatment control group. Outcome and alliance differences for Training Status were negligible. High FIS therapists had greater pre-post client outcome, and higher rates of change across sessions, than low FIS therapists. All clients treated by therapists improved more than the silent control, but effects were greater with high FIS than low FIS therapists. From the first session, high FIS therapists also had higher alliances than low FIS therapists as well as significant improvements on client-rated alliance. Results were consistent with the hypothesis that therapists' common relational skills are independent contributors to therapeutic alliance and outcome.

A Microfinance Program Targeting People Living with HIV in Uganda: Client Characteristics and Program Impact.

PubMed

Linnemayr, Sebastian; Buzaalirwa, Lydia; Balya, James; Wagner, Glenn

HIV has disproportionately affected economically vulnerable populations. HIV medical care, including antiretroviral therapy, successfully restores physical health but can be insufficient to achieve social and economic health. It may therefore be necessary to offer innovative economic support programs such as providing business training and microcredit tailored to people living with HIV/AIDS. However, microfinance institutions have shown reluctance to reach out to HIV-infected individuals, resulting in nongovernment and HIV care organizations providing these services. The authors investigate the baseline characteristics of a sample of medically stable clients in HIV care who are eligible for microcredit loans and evaluate their business and financial needs; the authors also analyze their repayment pattern and how their socioeconomic status changes after receipt of the program. The authors find that there is a significant unmet need for business capital for the sample under investigation, pointing toward the potentially beneficial role of providing microfinance and business training for clients in HIV care. HIV clients participating in the loans show high rates of repayment, and significant increases in (disposable) income, as well as profits and savings. The authors therefore encourage other HIV care providers to consider providing their clients with such loans.

Development of a Nutrition Education Intervention for Food Bank Clients.

PubMed

Dave, Jayna M; Thompson, Deborah I; Svendsen-Sanchez, Ann; McNeill, Lorna Haughton; Jibaja-Weiss, Maria

2017-03-01

The focus of this article is the development of a nutrition education intervention for food bank clients. Formative research using mixed-methods (qualitative and quantitative) and community-based participatory research principles was conducted to assess the nutrition education needs of clients obtaining service from the Houston Food Bank (HFB). Participants were HFB and pantry staff and clients. Interview data were coded and analyzed using grounded theory approach. Themes were then identified. Quantitative data were analyzed for frequencies and descriptives. Data were used to tailor the curriculum to the target population. Six HFB staff, 49 pantry staff from 17 pantries, and 54 clients from 10 pantries participated in interviews and focus groups and completed questionnaires. The participants provided opinion on the current nutrition education provided via the food bank and made suggestions on strategies for development of an intervention. Their feedback was used to develop the six-session intervention curriculum to be delivered over 6 months. This research provides evidence that it is critical for members of the target audience be included in formative research to develop behavior change programs that are relevant and appealing and target their needs and interests.

Mediators of exposure therapy for youth obsessive-compulsive disorder: specificity and temporal sequence of client and treatment factors.

PubMed

Chu, Brian C; Colognori, Daniela B; Yang, Guang; Xie, Min-ge; Lindsey Bergman, R; Piacentini, John

2015-05-01

Behavioral engagement and cognitive coping have been hypothesized to mediate effectiveness of exposure-based therapies. Identifying which specific child factors mediate successful therapy and which therapist factors facilitate change can help make our evidence-based treatments more efficient and robust. The current study examines the specificity and temporal sequence of relations among hypothesized client and therapist mediators in exposure therapy for pediatric Obsessive Compulsive Disorder (OCD). Youth coping (cognitive, behavioral), youth safety behaviors (avoidance, escape, compulsive behaviors), therapist interventions (cognitive, exposure extensiveness), and youth anxiety were rated via observational ratings of therapy sessions of OCD youth (N=43; ages=8 - 17; 62.8% male) who had received Exposure and Response Prevention (ERP). Regression analysis using Generalized Estimation Equations and cross-lagged panel analysis (CLPA) were conducted to model anxiety change within and across sessions, to determine formal mediators of anxiety change, and to establish sequence of effects. Anxiety ratings decreased linearly across exposures within sessions. Youth coping and therapist interventions significantly mediated anxiety change across exposures, and youth-interfering behavior mediated anxiety change at the trend level. In CLPA, youth-interfering behaviors predicted, and were predicted by, changes in anxiety. Youth coping was predicted by prior anxiety change. The study provides a preliminary examination of specificity and temporal sequence among child and therapist behaviors in predicting youth anxiety. Results suggest that therapists should educate clients in the natural rebound effects of anxiety between sessions and should be aware of the negatively reinforcing properties of avoidance during exposure. Copyright © 2015. Published by Elsevier Ltd.

Art for the Smart: Paper and oral presentation assignments for an Earth Materials course

NASA Astrophysics Data System (ADS)

Wetzel, L. R.

2011-12-01

A letter from the fictional Art for the Smart company addresses students in the Earth Materials course: "You might be wondering why an artist needs a geology consultant. I am creating a sculpture garden filled with mythical beings. I would like each student to recommend two unique minerals for one of these sculptures..." For this project students randomly select a mythical being, two mineral groups, and a mineral characteristic. For example, a student might be assigned the goddess Freya, a sulfate, a vanadate, and twinning. Students then choose a specific mineral from each group, describe their physical and chemical characteristics, and recommend how the minerals could be incorporated into the sculpture. Reports are presented in short oral presentations and two-page business letters with accompanying bibliography and illustrations. The letter format provides a concise way to communicate results to the Art for the Smart "client" while preparing students for their job-hunting days ahead. The oral presentations are structured as features for a news program. Talks are limited to three to five minutes and four slides: title page, mineral #1, mineral #2, and mythical being. The strict limits help students concentrate on scientific content and smooth delivery rather than flashy visual aids. The student audience and the professor evaluate each in-class presentation. This has become a popular assignment because it engages student imaginations to relate minerals to mythical beings and creatively design a sculpture. Each project is unique and therefore more interesting for both students and faculty to evaluate. The projects are nearly impossible to plagiarize from previous years or from internet sources. Earth Materials is a sophomore level course for Geoscience and Marine Science majors at Eckerd College. The Art for the Smart project leads into an assignment for the second half of the semester featuring building stones. A new "client" sends a letter to the class explaining the situation: "I own a building in downtown St. Petersburg adorned with natural building stone. I am planning to expand my business to your hometown. I would like your professional opinion on whether or not I should use the same stone on my new building..." In this case, students examine thin sections and hand specimens to identify building stones. Each student chooses one building stone and conducts literature research to explain the advantages and disadvantages of using the rock on a building. The ultimate goal is not only to describe the rock and its geologic origins, but also to persuade the "client" to use or not use the building stone in a new location. In addition to writing a business letter and giving an in-class presentation, students give a short talk in the "field" at the downtown location featuring the building stone. In completing the two Earth Materials projects over the course of the semester, students progress from recognizing minerals in hand specimens to identifying rocks using thin sections and developing theories regarding their geologic origins.

How to Structure University/Industry Cooperation for Maximum Mutual Benefit

NASA Astrophysics Data System (ADS)

Sommer, Klaus H.

2000-03-01

Research in the technical industries has changed dramatically in the past twenty years. As part of the change, many companies have shifted their long-term research from within company labs to university labs using a variety of mechanisms for such "cooperations." This talk focuses on how Bayer Corporation uses contract research, unrestricted funds, consortia, and government contracts to supplement in-house research programs. The talk emphasizes the importance of careful tailoring of these mechanisms in order to achieve maximum success for both the company and its university partners.

Experiences of treatment decision making for young people diagnosed with depressive disorders: a qualitative study in primary care and specialist mental health settings

PubMed Central

2011-01-01

Background Clinical guidelines advocate for the inclusion of young people experiencing depression as well as their caregivers in making decisions about their treatment. Little is known, however, about the degree to which these groups are involved, and whether they want to be. This study sought to explore the experiences and desires of young people and their caregivers in relation to being involved in treatment decision making for depressive disorders. Methods Semi-structured interviews were carried out with ten young people and five caregivers from one primary care and one specialist mental health service about their experiences and beliefs about treatment decision making. Interviews were audio taped, transcribed verbatim and analysed using thematic analysis. Results Experiences of involvement for clients varied and were influenced by clients themselves, clinicians and service settings. For caregivers, experiences of involvement were more homogenous. Desire for involvement varied across clients, and within clients over time; however, most clients wanted to be involved at least some of the time. Both clients and caregivers identified barriers to involvement. Conclusions This study supports clinical guidelines that advocate for young people diagnosed with depressive disorders to be involved in treatment decision making. In order to maximise engagement, involvement in treatment decision making should be offered to all clients. Involvement should be negotiated explicitly and repeatedly, as desire for involvement may change over time. Caregiver involvement should be negotiated on an individual basis; however, all caregivers should be supported with information about mental disorders and treatment options. PMID:22151735

A spiritual framework in incest survivors treatment.

PubMed

Beveridge, Kelli; Cheung, Monit

2004-01-01

Through an examination of recent incest treatment development, this article emphasizes the theoretical concept of integration within the treatment process for female adult incest survivors. Spirituality as a therapeutic foundation is discussed with examples of therapeutic techniques. A case study illustrates the psycho-spiritual process of treating a 29-year-old female incest survivor and describes how self-integration has helped this client heal from trauma and change her worldview. Significant outcomes of treatment include the client's gaining of self-awareness and freeing herself from emotional blindness. The recommended practice framework includes a three-step healing process of building alliance with the client in a safe environment, disputing faulty religious assumptions in a learning process, and affirming the needs for reconnection and continuous spiritual support.

Preferences of content of psychological reports for community placement programs.

PubMed

VandeCreek, L; Smith, B E

1983-01-01

With the shift toward community-based care for mentally retarded persons has come a change in programming goals aimed more at habilitation. The information from psychological reports is frequently used as one type of information for decision making about clients although such reports have frequently been criticized for not providing relevant data. Staff members of community programs in Pennsylvania were surveyed to elicit their preferences for various types of report data. Of the categories of information included in this survey, personality dynamics information and descriptions of general emotional and personality factors were rated as less useful than was information regarding academic achievement, vocational achievement, adaptive skills, and client-examiner interaction. Implications of these findings for psychologists who assess mentally retarded clients are discussed.

Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention.

PubMed

Markle-Reid, Maureen F; McAiney, Carrie; Forbes, Dorothy; Thabane, Lehana; Gibson, Maggie; Hoch, Jeffrey S; Browne, Gina; Peirce, Thomas; Busing, Barbara

2011-08-25

Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. ClinicalTrials.gov: NCT01407926.

Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention

PubMed Central

2011-01-01

Background Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. Methods/Design This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Discussion Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. Trial Registration ClinicalTrials.gov: NCT01407926 PMID:21867539

Improving Client-Centered Brain Injury Rehabilitation Through Research-Based Theater

PubMed Central

Kontos, Pia C.; Miller, Karen-Lee; Gilbert, Julie E.; Mitchell, Gail J.; Colantonio, Angela; Keightley, Michelle L.; Cott, Cheryl

2013-01-01

Traumatic brain injury often results in physical, behavioral, and cognitive impairments perceived by health care practitioners to limit or exclude clients’ full participation in treatment decision making. We used qualitative methods to evaluate the short- and long-term impact of “After the Crash: A Play About Brain Injury”, a research-based drama designed to teach client-centered care principles to brain injury rehabilitation staff. We conducted interviews and observations with staff of two inpatient neurorehabilitation units in Ontario, Canada. Findings demonstrate the effectiveness of the play in influencing practice through the avoidance of medical jargon to improve clients’ understanding and participation in treatment; newfound appreciation for clients’ needs for emotional expression and sexual intimacy; increased involvement of family caregivers; and avoidance of staff discussions as if clients were unaware. These findings suggest that research-based drama can effect reflexivity, empathy, and practice change to facilitate a client-centered culture of practice in brain injury rehabilitation. PMID:22941919

Moving from affirmation to liberation in psychological practice with transgender and gender nonconforming clients.

PubMed

Singh, Anneliese A

2016-11-01

While affirmative approaches with transgender and gender nonconforming (TGNC) clients are gaining momentum within psychological practice (American Counseling Association, 2010; American Psychological Association, 2015), there is a simultaneous and pressing need to move beyond TGNC-affirmative to TGNC-liberatory approaches to more fully address how societal gender binaries influence both psychologist and client. Psychologists may use the lens of liberation psychology (Martín-Baró, 1996) to transform the ways they work with TGNC clients. Using this perspective, psychologists can reflect on their own gender journey and experiences, identify how cisgender privilege influences counseling and psychological practice, and advocate for TGNC people to be better served in the settings in which they work. Psychologists are then able to engage in social change on behalf of, and in collaboration with, TGNC people in ways that simultaneously liberate psychologists from their own gender oppression experiences. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment

PubMed Central

Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti

2017-01-01

Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients’ homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs’ work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) (p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs’ job is feasible and can effectively promote HCAs’ health, especially among older HCAs. PMID:28379207

Cognitive behaviour therapy territory model: effective disputing approach.

PubMed

Lam, D

1997-06-01

This paper proposes a disputing model (territory model) which is particularly useful and effective for disputing clients who persistently hold on to their dysfunctional thinking and/or core irrational beliefs. Their 'stubbornness' to change is compounded by unhealthy negative emotions during sessions. The intense emotion makes it difficult to access the belief system, and therefore any attempt to dispute it often proves futile. This model advocates the shift of disputing onto a different 'territory/ground' where the client can be facilitated to acquire higher, abstract and objective thinking, and at the same time his/her emotional level is susceptible to rational and logical arguments. The new thinking would act as a catalyst for the client to reflect on his/her dysfunctional thought/irrational beliefs. In this paper, the author uses a case example to illustrate and discuss the ineffectiveness of the 'traditional' way of disputing the dysfunctional thinking/core beliefs of a difficult and emotional client. This is contrasted with the 'territory' model.

Psychosocial implications of tubal ligation in a rural health district: a phenomenological study.

PubMed

Lutala, Prosper M; Hugo, Jannie F; Luhiriri, Levi N

2011-12-16

Tubal ligation is the most popular family planning method worldwide. While its benefits, such as effectiveness in protecting against pregnancies, minimal need for long-term follow-up and low side-effects profile are well documented, it has many reported complications. However, to date, these complications have not been described by residents in Congo. Therefore, the study aimed at exploring the experience of women who had undergone tubal ligation, focusing on perceptions of physical, psychological and contextual experiences of participants. This qualitative study used a semi-structured questionnaire in a phenomenological paradigm to collect data. Fifteen participants were purposefully selected among sterilized women who had a ligation procedure performed, were aged between 30 and 40 years, and were living within the catchment area of the district hospital. Data were collected by two registered nurses, tape-recorded, and transcribed verbatim. Reading and re-reading cut and paste techniques, and integration were used to establish codes, categories, themes, and description. Diverse and sometimes opposite changes in somatic symptoms, psychological symptoms, productivity, ecological relationships, doctor-client relationships, ethical issues, and change of life style were the major problem domains. Clients reported conflicting experiences in several areas of their lives after tubal sterilization. Management, including awareness of the particular features of the client, is needed to decrease the likelihood of psychosocial morbidity and/or to select clients in need of sterilization.

Therapeutic use of "prizing" and its effect on self-concept of elderly clients in nursing homes and group homes.

PubMed

Williams-Barnard, C L; Lindell, A R

1992-01-01

The purpose of this study was to ascertain the effect of nurse high prizing and nurse low prizing during group therapy in changing the self-concept of institutionalized aged persons. The hypothesis tested was that institutionalized aged clients participating in group therapy who receive nurse high prizing will show an increase in self-concept as measured by the Tennessee Self-Concept Scale (TSCS) when compared with those aged clients in the same settings participating in group therapy who receive nurse low prizing or those aged clients constituting the matched control groups. The study used an existing data source generated from the research of Williams and Lindell to conduct a secondary analysis of a variable not previously investigated. Mean difference scores from the posttest total self-concept score and subscales of the TSCS were analyzed in conjunction with the levels of prizing within the experimental and control groups. Using the Scale for Rating Prizing, two nurse raters judged the degree of prizing on 40 randomly extracted video segments. The findings indicated that 47.1% of those subjects who received low prizing decreased in self-concept; 68.4% of those who received high prizing increased in self-concept. No change in self-concept was noted in the control group. Findings were significant at the .0001 level. Investigating the effect of nurse high and low levels of prizing on client self-concept completes the Rogerian trilogy of therapist-offered conditions with this same sample of subjects. Extension of previous studies adds to the ever-growing body of nursing knowledge and increases the certitude, casualty, and generalizability of such investigations.

Effect of divided attention on gait in subjects with and without cognitive impairment.

PubMed

Pettersson, Anna F; Olsson, Elisabeth; Wahlund, Lars-Olof

2007-03-01

The aim of this study was to investigate the influence of cognition on motor function using 2 simple everyday tasks, talking and walking, in younger subjects with Alzheimer's disease and mild cognitive impairment. A second aim was to evaluate reliability for the dual-task test Talking While Walking. Walking speed during single and dual task and time change between single and dual task were compared between groups. The test procedure was repeated after 1 week. Subjects with AD had lower walking speed and greater time change between single and dual task compared with healthy controls. Reliability for Talking While Walking was very good. The results show that motor function in combination with a cognitive task, as well as motor function alone, influences subjects with Alzheimer's disease in a negative way and that decreased walking speed during single- and dual-task performance may be an early symptom in Alzheimer's disease.

Testing commercial sex workers for sexually transmitted infections in Victoria, Australia: an evaluation of the impact of reducing the frequency of testing.

PubMed

Chow, Eric P F; Fehler, Glenda; Chen, Marcus Y; Bradshaw, Catriona S; Denham, Ian; Law, Matthew G; Fairley, Christopher K

2014-01-01

The frequency of testing sex workers for sexually transmitted infections (STIs) in Victoria, Australia, was changed from monthly to quarterly on 6 October 2012. Our aim was to determine the impact of this change to the clients seen at the Melbourne Sexual Health Centre (MHSC). Computerised medical records of all clients attending at MHSC from 7 October 2011 to 7 October 2013 were analysed. Comparing between the monthly and quarterly testing periods, the number of consultations at MSHC with female sex workers (FSW) halved from 6146 to 3453 (p<0.001) and the consultation time spent on FSW reduced by 40.6% (1942 h to 1153 h). More heterosexual men (p<0.001), and women (p<0.001) were seen in the quarterly testing period. The number of STIs diagnosed in the clinic increased from 2243 to 2589 from the monthly to quarterly period, respectively [15.4% increase (p<0.001)]. Up to AU$247,000 was saved on FSW testing after the shift to quarterly testing. The change to STIs screening frequency for sex workers from monthly to quarterly resulted in a 15% increase in STI diagnoses in the clinic and approximate a quarter of a million dollars was diverted from FSW testing to other clients. Overall the change in frequency is likely to have had a beneficial effect on STI control in Victoria.

William James's "Talks to Teachers" (1899) and McKeachie's "Teaching Tips" (1999)

ERIC Educational Resources Information Center

McKeachie, Wilbert J.

2003-01-01

What has changed and what has stayed the same in the years since the first publication of James's "Talks to Teachers on Psychology: And to Students on some of Life's Ideals" (1899) and the 10 editions of McKeachie's "Teaching Tips"? Although research and theory have given us better understanding of learning, memory, cognition, and motivation, much…

Absence of Copula and the Notion of Simplicity: A Study of Normal Speech, Baby Talk, Foreigner Talk and Pidgins.

ERIC Educational Resources Information Center

Ferguson, Charles A.

For the linguist interested in typology and language universals, this paper suggests the usefulness of a taxonomy of copula and copula-like constructions in the world's languages and the elaboration of hypotheses of synchronic variation and diachronic change in this part of language. For the linguist interested in child language development, the…

Developing Interactive Mathematical Talk: Investigating Student Perceptions and Accounts of Mathematical Reasoning in a Changing Classroom Context

ERIC Educational Resources Information Center

Hunter, Jodie

2017-01-01

In recent years there has been an increased focus on the need for teachers to develop learning communities where all students have opportunities to engage in interactive discourse. However, there are few studies that focus on student perceptions and accounts of mathematical reasoning in classrooms with interactive mathematical talk as a focus of…

Trending toward Reform: Teachers Speak on Unions and the Future of the Profession. Education Sector Reports

ERIC Educational Resources Information Center

Rosenberg, Sarah; Silva, Elena

2012-01-01

Over the past decade, teachers have seen changes in both their conditions of employment--from pay to retirement benefits--and their practice. Far too often, these policies have been made by people who talk "about" teachers, rather than talking "to" them. Last fall, Education Sector surveyed a nationally representative random sample of more than…

Effectiveness of motivational interviewing on lifestyle modification and health outcomes of clients at risk or diagnosed with cardiovascular diseases: A systematic review.

PubMed

Lee, Windy W M; Choi, K C; Yum, Royce W Y; Yu, Doris S F; Chair, S Y

2016-01-01

Clinically, there is an increasing trend in using motivational interviewing as a counseling method to help clients with cardiovascular diseases to modify their unhealthy lifestyle in order to decrease the risk of disease occurrence. As motivational interviewing has gained increased attention, research has been conducted to examine its effectiveness. This review attempts to identify the best available evidence related to the effectiveness of motivational interviewing on lifestyle modification, physiological and psychological outcomes for clients at risk of developing or with established cardiovascular diseases. Systematic review of studies incorporating motivational interviewing in modifying lifestyles, improving physiological and psychological outcomes for clients at risk of or diagnosed with cardiovascular diseases. Major English and Chinese electronic databases were searched to identify citations that reported the effectiveness of motivational interviewing. The searched databases included MEDLINE, British Nursing Index, CINAHL Plus, PsycINFO, SCOPUS, CJN, CBM, HyRead, WanFang Data, Digital Dissertation Consortium, and so on. Two reviewers independently assessed the relevance of citations based on the inclusion criteria. Full texts of potential citations were retrieved for more detailed review. Critical appraisal was conducted by using the standardized critical appraisal checklist for randomized and quasi-randomized controlled studies from the Joanna Briggs Institute - Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStaRI). After eligibility screening, 14 articles describing 9 studies satisfied the inclusion criteria and were included in the analysis. Only certain outcomes in certain studies were pooled for meta-analysis because of the large variability of the studies included, other findings were presented in narrative form. For lifestyle modification, the review showed that motivational interviewing could be more effective than usual care on altering smoking habits. For physiological outcomes, the review showed that motivational interviewing positively improved client's systolic and diastolic blood pressures but the result was not significant. For psychological outcomes, the review showed that motivational interviewing might have favorable effect on improving clients' depression. For other outcomes, the review showed that motivational interviewing did not differ from usual care or usual care was even more effective. The review showed that motivational interviewing might have favorable effects on changing clients' smoking habits, depression, and three SF-36 domains. For the other outcomes, most of the results were inconclusive. Further studies should be performed to identify the optimal format and frequency of motivational interviewing. Primary research on the effectiveness of motivational interviewing on increasing clients' motivation and their actual changes in healthy behavior is also recommended. Copyright © 2015 Elsevier Ltd. All rights reserved.

Talking Cure Models: A Framework of Analysis

PubMed Central

Marx, Christopher; Benecke, Cord; Gumz, Antje

2017-01-01

Psychotherapy is commonly described as a “talking cure,” a treatment method that operates through linguistic action and interaction. The operative specifics of therapeutic language use, however, are insufficiently understood, mainly due to a multitude of disparate approaches that advance different notions of what “talking” means and what “cure” implies in the respective context. Accordingly, a clarification of the basic theoretical structure of “talking cure models,” i.e., models that describe therapeutic processes with a focus on language use, is a desideratum of language-oriented psychotherapy research. Against this background the present paper suggests a theoretical framework of analysis which distinguishes four basic components of “talking cure models”: (1) a foundational theory (which suggests how linguistic activity can affect and transform human experience), (2) an experiential problem state (which defines the problem or pathology of the patient), (3) a curative linguistic activity (which defines linguistic activities that are supposed to effectuate a curative transformation of the experiential problem state), and (4) a change mechanism (which defines the processes and effects involved in such transformations). The purpose of the framework is to establish a terminological foundation that allows for systematically reconstructing basic properties and operative mechanisms of “talking cure models.” To demonstrate the applicability and utility of the framework, five distinct “talking cure models” which spell out the details of curative “talking” processes in terms of (1) catharsis, (2) symbolization, (3) narrative, (4) metaphor, and (5) neurocognitive inhibition are introduced and discussed in terms of the framework components. In summary, we hope that our framework will prove useful for the objective of clarifying the theoretical underpinnings of language-oriented psychotherapy research and help to establish a more comprehensive understanding of how curative language use contributes to the process of therapeutic change. PMID:28955286

Evaluation of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

PubMed Central

Roets-Merken, Lieve M; Vernooij-Dassen, Myrra J F J; Zuidema, Sytse U; Dees, Marianne K; Hermsen, Pieter G J M; Kempen, Gertrudis I J M; Graff, Maud J L

2016-01-01

Objectives To gain insights into the process of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. Design Qualitative study alongside a cluster randomised controlled trial. Setting 17 long-term care homes spread across the Netherlands. Participants 34 licensed practical nurses supporting 54 dual sensory impaired older adults. Intervention A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care. Primary outcomes Nurses’ perceptions on relevance and feasibility of the self-management programme collected from nurses’ semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers’ reports. Results Nurses’ initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults’ autonomy needs. However, nurses’ initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not. Conclusions Longitudinal data collection enabled exploration of nurses’ changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond ‘protocol thinking’, discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time. Trial registration number NCT01217502, Post-results. PMID:27856482

Evaluation of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study.

PubMed

Roets-Merken, Lieve M; Vernooij-Dassen, Myrra J F J; Zuidema, Sytse U; Dees, Marianne K; Hermsen, Pieter G J M; Kempen, Gertrudis I J M; Graff, Maud J L

2016-11-17

To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. Qualitative study alongside a cluster randomised controlled trial. 17 long-term care homes spread across the Netherlands. 34 licensed practical nurses supporting 54 dual sensory impaired older adults. A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care. Nurses' perceptions on relevance and feasibility of the self-management programme collected from nurses' semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers' reports. Nurses' initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults' autonomy needs. However, nurses' initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not. Longitudinal data collection enabled exploration of nurses' changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond 'protocol thinking', discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time. NCT01217502, Post-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Reliable Change and Outcome Trajectories Across Levels of Care in a Mental Health System for Youth.

PubMed

Jackson, David S; Keir, Scott S; Sender, Max; Mueller, Charles W

2017-01-01

Knowledge of mental health treatment outcome trajectories across various service types can be valuable for both system- and client-level decision-making. Using longitudinal youth functional impairment scores across 2807 treatment episodes, this study examined outcome trajectories and estimated the number of months required for reliable change across nine major services (or levels of care). Results indicate logarithmic improvement trajectories for a majority of levels of care and significant differences in time until improvement ranging from 4 to 12 months. Findings can guide system-level policies on lengths of treatment and service authorizations and provide expected treatment response data for client-level treatment decisions.

Delivery of Training Programs: Changing Design.

ERIC Educational Resources Information Center

Dhanarajan, Gajaraj

This paper explains how worldwide economic, social, and technological changes are necessitating changes in the way vocational education is delivered. Vocational programs are encountering a whole new range of clients, including the following: people who are functionally illiterate, physically challenged, or long-term unemployed; out-of-work youth;…