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At least 19 recordsLinked to original sources
PubMed2000

Measuring client clinical progress in therapeutic community treatment. The therapeutic community Client Assessment Inventory, Client Assessment Summary, and Staff Assessment Summary.

The therapeutic community (TC) Client Assessment Inventory (CAI), Client Assessment Summary (CAS), and Staff Assessment Summary (SAS) are instruments developed from a comprehensive theory of TC treatment and recovery. They measure client self-report and staff evaluation of client progress along 14 domains of behavior, attitude, and cognitive change. The present article reports on the development of the instruments and findings from an analysis of data on 346 clients in TC treatment; including scale properties and cross-sectional client differences by treatment tenure. The instruments were administered over a 1-year period at two residential TC facilities. Findings indicate that both client and staff instruments reliably differentiate client clinical changes during treatment and client self-ratings are initially consistently higher than staff ratings. Clarifying and measuring changes in the individual during treatment is the first step in the effort to understand the change process and what steps can be taken to improve treatment effectiveness.

Adult↗
PubMed2000

Client perspectives on occupational therapy practice: are we truly client-centred?

In Canada, the guidelines for the practice of occupational therapy are named and framed as client-centred. Two in-depth interviews were conducted with clients of mental health services about their experiences with a hospital-based occupational therapy service. These occupational therapy clients described their experiences as prescriptive, and as less than client-centred. With the publication of Enabling occupation: A Canadian occupational therapy perspective (Canadian Association of Occupational Therapists [CAOT], 1997) and an increasingly refined focus on being client-centred, these interviews highlight the challenges of a client-centred practice within the current health care environment. These occupational therapy clients raise issues of importance for occupational therapy. The participants stated that the prescription of 'activity', a lack of choice, and a focus upon the illness as opposed to the individual, served to diminish any collaborative partnership with the client and eliminate the client from any decision-making process. This distancing from the client, in their opinion, served to greatly diminish any therapeutic value of occupation. The participants recommended a greater focus upon occupational choice, consideration of the individual within the client, providing accepting, supportive environments, and using professional expertise on occupation to guide the client towards participation in meaningful occupation. These recommendations are strikingly similar to the most recent guidelines for the client-centred practice of occupational therapy in Canada. A discussion of the implications of these findings for the client-centred practice of occupational therapy is offered.

Canada↗
PubMed1984

The relationship of rehabilitation center staff and client endorsement of appropriate client behaviors to outcome.

Clients who enroll in comprehensive rehabilitation centers but fail to complete their planned programs tend to be, at follow-up, less well adjusted than clients who do complete their planned program. Consequently, much research has been directed at understanding why clients fail and at identifying those clients most likely to fail. This study analyzed the relationship of client and staff expectations toward important client behaviors to outcome. Using a two-dimensional scaling technique, staff (n = 74) and clients (n = 268), at a large comprehensive rehabilitation center were asked to judge their acceptance of clients exhibiting either independent or dependent behaviors. Results indicated that both clients and staff approved of independence over dependence, that there was no difference between types of staff in their perceptions of appropriate client behaviors, that there were no significant differences between client program completers and noncompleters in perceptions toward appropriate behaviors, but that there were significant differences between clients and staff in the degree of approval of select client behaviors. Implications for rehabilitation practice and future research are discussed.

Assertiveness↗
PubMed1990

The congruence of elderly client and nurse perceptions of the clients' self-care agency.

Congruence of client and nurse perceptions is vital to mutual goal-setting as a means of achieving self-care in the elderly. The purpose of this descriptive, correlational study was to explore the relationship between nurse and elderly client perceptions of the clients' self-care agency. A sample of 40 elderly client subjects and registered nurses' selected from two community health agencies, completed a questionnaire consisting of three instruments: (a) a demographic sheet; (b) the appraisal of Self-Care Agency Scale; and (c) the Perceived Health Status. Pearson product moment correlation coefficients were significant for the relationships between: (a) client and nurse perceptions of clients' self-care agency (r = 0.42, P less than 0.01); (b) client and nurse perceptions of clients' health status (r = 0.38, P less than 0.01; and (c) nurse perceptions of clients' self-care agency and nurse perceptions of clients' health status (r = 0.44, P less than 0.01). With increasing emphasis on health promotion of the elderly in the community, identified relationships may have potential implications for gerontological and community nursing practice.

Aged↗
PubMed1997

Homeless mentally ill clients' and providers' perceptions of service needs and clients' use of services.

OBJECTIVE: Clients' and providers' perceptions of clients' needs were compared in 18 community treatment programs participating in the Access to Community Care and Effective Services and Supports program of the Center for Mental Health Services, a national demonstration project on treatment of homeless persons with mental illness. The study sought to determine whether perceptions differed and whether assessed needs for services were related to service use. METHODS: A total of 1,482 clients contacted through community outreach who entered the case management phase of the program after an average of 32 days were given an evaluation interview at entry into the program. The clients and outreach workers identified clients' needs in seven core domains-mental health, general health, substance abuse, public financial support, housing assistance and support, dental care, and employment. Use of related services in the 60 days before the case management evaluation was determined. RESULTS: The greatest differences between clients' and providers' perceptions of service needs were in dental and medical services, which were more frequently identified as needs by clients, and in substance abuse and mental health services, which were more frequently identified by providers. Clients' and providers' assessments of need were significantly, but not strongly, correlated with each other, and both were correlated with use of mental health and substance abuse services. CONCLUSIONS: Mental health service providers are less likely than clients to identify needs for services other than mental health services. Service use, at least in the short run, is related to both clients' and providers' assessments of need.

Adult↗
PubMed2000

Client empowerment in psychiatry and the professional abuse of clients: where do we stand?

OBJECTIVE: There is a considerable imbalance of power in psychiatry that sits in favor of professionals. The abuse and discrimination of the mentally ill are not just restricted to the mental health system but may also exist in the primary care sector. This article aims to evaluate the effects of power imbalance on discrimination and abuse of people with mental illness by professionals. METHODS: A literature search was carried out on MEDLINE using the key words consumerism, client empowerment, abuse, and mental illness. Publications of two leading British consumer organizations: MIND and the Sainsbury Centre for Mental Health were hand searched. Relevant cross-references from the papers reviewed were consulted. Studies with information on the reasons for power imbalance and prevalence of discrimination and abuse of clients were critically reviewed. Explanations are offered as to why abuse and discrimination of clients by professionals may still occur despite the onset of the client empowerment movement. RESULTS AND DISCUSSION: The available evidence suggests that reasons for abuse of mental health clients fall under two broad categories: 1) direction from the imbalance of power and 2) those pertinent to the nature of physical or sexual abuse. Different grades of client empowerment and ways of strengthening it are described. CONCLUSIONS: There appears to be a link between power imbalance and abuse of clients with mental illness by professionals in all health care sectors. Client empowerment may help rectify the power imbalance. Prospective studies are required to establish whether client empowerment can reduce discrimination and abuse of clients and whether abuse is a consequence of power imbalance. Recommendations for future studies are made.

Humans↗
PubMed1986

Comparisons of perceptions of the environments of adolescent drug treatment residential and outpatient programs by staff versus clients and by sex of staff and clients.

The Moos Community Oriented Program Environment Scale (COPES) was administered to 482 adolescent clients and 291 drug counselors in 30 outpatient and 27 residential drug treatment programs. Both clients and staff of residential programs were found to rate their programs more positively than did clients and staff of outpatient programs in the following specific ways: "encourage and provide more support"; "provide more practical help", such as training; "more concern with clients' personal problems"; and "encourage clients to argue, express anger, and display aggressive behavior". The only COPES factor on which the outpatient programs were perceived as superior to residential programs was "spontaneity" ("The program encourages clients to act openly and to express their feelings openly"). Across both types of programs, staff perceived the programs significantly more positively than did clients. The male staff ratings were the most positive of the ratings of the four subgroups. Female clients rated the program environments more positively than did male clients, but female staff did not rate the program environments more positively relative to male staff. Since the female staff ratings tend to be somewhat more similar to the ratings of the clients, both male and female, than did the male staff ratings, it might seem reasonable to hypothesize that the female staff ratings are more valid than the male staff ratings.

Adolescent↗
PubMed1996

Clinicians' hypotheses regarding clients' problems: are they less likely to hypothesize sexual abuse in male compared to female clients?

Sixty-one clinical psychologists completed a questionnaire about a detailed case summary of an adult client which incorporated a number of indicators that the client may have been sexually abused. The gender of the client was manipulated. Significantly more clinicians hypothesized that the female client (compared to the male client) had been sexually abused in childhood. Clinicians who were more recently qualified, and clinicians who identified their predominant theoretical orientation as psychodynamic (rather than cognitive-behavioral), were more likely to hypothesize sexual abuse, although these effects were only statistically significant for the female clients. The majority of clinicians hypothesizing sexual abuse in the female client rated the abuse as the most important issue to address in therapy; this was not the case for the male client. These findings are discussed in relation to the literature suggesting that the apparent low number of male victims of sexual abuse currently being seen by the helping professions may in part be accounted for by a lack of awareness in clinicians as to the possibility that males, including their male clients, are sexually abused.

Adolescent↗
PubMedDate not supplied

Routine voluntary HIV screening in STD clinic clients: characterization of infected clients.

Since January 25, 1988, the Baltimore City Health Department has offered routine, confidential, human immunodeficiency virus (HIV) testing to clients of the city's two sexually transmitted disease (STD) clinics. During the first 11 months of the program, testing was offered at 20,843 patient visits and was accepted at 15,181 (73%) of these; 612 (4%) individual clients had results that were positive for HIV. Four hundred thirty-seven (71%) seropositive clients returned for test results, post-test counseling, and further evaluation. Most HIV-infected clients were single, and black men accounted for 75% of seropositive individuals. HIV-infected women tended to be younger than infected men (7% of the female clients were adolescents). Although homosexual activity, intravenous drug use, and sex with a partner at risk were common risk factors for seropositive clients, after two interviews 17% of men and 38% of infected women did not report traditional risk factors for HIV infection. Most clients were asymptomatic or had generalized lymphadenopathy at the time of HIV diagnosis. Health care resources for these individuals were limited; 62% of men and 85% of women either had no health insurance or received public assistance. Routine, voluntary, confidential HIV counseling and testing is a practical, effective means to identify HIV-infected individuals among clients being treated at STD clinics. Identification of these individuals early in the course of infection provides opportunities to implement early follow-up and therapy, to counsel clients to help prevent further spread of infection, and to obtain useful information for projecting future health care needs and policy.

AIDS Serodiagnosis↗
PubMed1982

Analyses of client variables in a series of psychotherapy sessions with two child clients.

Studied the process of child psychotherapy by means of analyses of client verbal behaviors. Audio-video recordings were made of nine intermittent psychotherapy sessions with 2 child clients, aged 8 and 12. A randomized mastertape of 4-minute segments was rated for self-exploration by means of the Carkhuff scale. Transcripts were categorized by means of an extended Snyder system and a preliminary set of grammatical variables. Transcripts then were minutized, and all client variables were intercorrelated and factor-analyzed. According to the research expectations, a high level of interrater reliability for the Carkhuff scale and high levels of interjudge agreement for the extended Snyder system were found. Analyses of the client variables demonstrated the nature of each client's verbal responding as well as their pattern of change across successive therapy sessions. The overall verbal response behavior of each client was summarized best through the factor analyses. Communalities and individual differences between the clients were discussed. Future directions for the study of client variables in child psychotherapy process research were suggested.

Affective Symptoms↗
PubMed1997

Enhancing client competence: melding professional and client knowledge in public health nursing practice.

Providing health information is an important aspect of public health nursing. This article describes how public health nurses (PHNs) give information to enhance client competence. The findings are part of a larger study that explored PHNs perspectives and experiences of their practice. The study employed an exploratory descriptive qualitative research design. Data were gathered through in-depth individual and focus group interviews with 28 PHNs in Alberta, Canada. Content analysis revealed that nurses work to enhance client competence by sharing professional knowledge and by building on the client's experiential knowledge. Nurses provide information to assist clients with immediate concerns and for future use, PHNs use three main strategies to deal with immediate concerns: being direct, providing options, and presenting a different view. Information for future use focused on enhancing development and forestalling future problems. Nurses build on clients' experiential knowledge by acknowledging their present situation, giving positive feedback, being there, and gently persuading. The authors suggest that the melding of professional and client knowledge is foundational to health promotion approaches that enhance client competence. There is a need for further research that explores the intricacies of developing partnerships between professionals and clients that embrace a sharing of professional and experiential knowledge.

Alberta↗
PubMedDate not supplied

A comparison of verbal evaluation of clients with limited English proficiency and English-speaking clients in physical rehabilitation settings.

OBJECTIVES: Recent literature has emphasized collaborative goal setting between therapists and clients and has sought to increase therapists' awareness of treating in cross-cultural settings. How occupational therapists verbally evaluate clients with limited English proficiency (LEP) is important to these topics and underdeveloped in the literature. METHOD: Seventy-four occupational therapists working with adult clients with LEP in physical rehabilitation settings in large U.S. metropolitan areas were surveyed to discover the time taken, methods used, and themes surrounding verbal evaluation, including use of translators and respondents' linguistic abilities. A follow-up telephone interview of 12 survey respondents clarified these discoveries. RESULTS: Respondents reported taking 11.5 min more to verbally evaluate clients with LEP than for English-speaking clients and reported understanding the treatment needs of clients with LEP after verbal evaluation less well. Respondents with higher abilities in second languages reported better understanding of clients" needs than monolingual respondents. CONCLUSION: Methods for cross-lingual verbal evaluation need to be identified so that therapists can collaborate with clients with LEP in planning culturally sensitive treatment.

Adult↗
PubMed1989

Identification of problems and strengths of the hospice client by clients, caregivers, and nurses. Implications for nursing.

This exploratory study included instrument development as well as testing. The purpose of the study was to ascertain whether primary caregivers and hospice nurses identified the same problems and strengths of individual clients as did clients themselves. The instrument, a 27-item modified Q-sort, was based on review of literature on the concept Quality of Life. Dembo's Insider versus Outsider Perspective was the theoretical framework. Using the instrument, participants identified the problems and strengths of the client in the current time frame. Twenty consenting hospice clients, their primary caregiver, and their assigned hospice nurse were studied. No significant differences were found between clients, nurses, and caregivers when Total instrument means were compared (F = 1.38, p = 0.26). Three of the 27 items showed significant differences in the means of the three groups. Reliability coefficients showed high internal consistency on the Total instrument (0.87). Nurses and caregivers were found to identify problems and strengths of the client as perceived by the client. Findings corroborated Dembo's theory. Support of the hospice concept as the appropriate method of care for terminally ill clients was suggested.

Adult↗
PubMed1997

Factors associated with client-reported HIV infection among clients entering methadone treatment.

To determine demographic and behavioral factors associated with client-reported HIV infection among new enrollees in methadone maintenance treatment programs (MMTPs) in Massachusetts and Connecticut, we examined ethnographic data and interview data from MMTP clients (N = 674). Clients responded to questions about behaviors in the 30 days before drug treatment. ETHNOGRAPH was used to analyze qualitative data, and logistic regression analysis was used to identify variables associated with client-reported HIV infection. Statistical significance was set at p < .05. The client-reported HIV infection rate was 20% (132/674). Odds ratios for factors associated with client-reported HIV infection were being white (0.53), increase in age (1.07), use of non-injected heroin (0.12), use of injected heroin (6.24), cocaine injection (1.78), sharing of "works" with strangers (2.15), and "safer sex" behavior (4.04). Additionally, 35% of those who did not use illicit drugs reported being seropositive. The qualitative data suggested HIV positive clients were concerned about protecting sex partners, and learning of HIV infection motivated some to stop using drugs. Although some clients engaged in low-risk behaviors, others did not, therefore the potential for HIV transmission among injection drug users (IDUs) in Connecticut and Massachusetts exists. HIV prevention and drug treatment program personnel should reinforce and build on the low-risk behaviors that are acceptable and adopted by some in this population.

Adult↗
PubMed1999

Effects of client interviewers on client-reported satisfaction with mental health services.

A study at two outpatient facilities compared two methods of collecting data on client satisfaction with mental health services provided by case managers and by physicians. A satisfaction survey instrument was developed with input from clients. A total of 120 clients were randomly assigned to be interviewed by either a staff member or a client. Clients from both facilities reported high levels of satisfaction regardless of the type of interviewer. Clients gave a significantly greater number of extremely negative responses when they were interviewed by client interviewers. No difference between the two groups was found in overall satisfaction with services received from case managers or physicians.

Adolescent↗
PubMed1981

Client satisfaction in a health maintenance organization: providers' perceptions compared to clients' reports.

This study seeks to compare clients' reports of satisfaction/dissatisfaction with an HMO and its medical care program to providers' perceptions of client satisfaction. The main conclusion is that providers are fairly aware of medical care system attributes with which clients are highly satisfied and dissatisfied. Those with direct patient contact, especially physicians and nurses, are most accurate in their perceptions. Personnel without direct patient contact are about equally accurate in their perceptions of client satisfaction, though personnel without patient contact perceive relatively more dissatisfaction than clients report. Most approaches to medical care evaluation examine costs and efficiency and, more recently, the technical quality of care. Less attention has been given to the assessment of client satisfaction, and almost no attention has been given to what providers perceive as the assessment of clients. Clearly, HMOs' viability is determined largely by their ability to identify and correct major problems affecting their enrollments.

Attitude of Health Personnel↗
PubMed1994

Assessing client strengths: clinical assessment for client empowerment.

The proposition that client strengths are central to the helping relationship is simple enough and seems uncontroversial as an important component of practice. Yet deficit, disease, and dysfunction metaphors are deeply rooted in clinical social work, and the emphasis of assessment has continued to be diagnosing abnormal and pathological conditions. This article argues that assessment in clinical practice, among other things, is a political activity. Assessment that focuses on deficits provides obstacles to client exercise of personal and social power and reinforces those social structures that generate and regulate unequal power relationships that victimize clients. Clinical practice based on metaphors of client strengths is also political in that it is congruent with the potential for client empowerment. This article discusses the importance of a client strengths perspective for assessment and proposes 12 practice guidelines that foster a strengths perspective.

Humans↗
PubMed1988

A comparison of data from dental charts, client interview, and client mail survey.

Dental records and client survey reports were compared as sources of data for dental research. Further, two forms of the client survey were completed, a mail survey and telephone interview. A random sample of 271 clients of a dental group practice based within a university health service was selected. The Kappa values indicated a reasonable level of agreement of client survey and dental record with regard to the types of services received but no with regard to actual number of visits. Responses to the mail and the telephone versions of the client survey were compared for service satisfaction, hygiene behavior, and attitude and belief variables. Two potential sources of bias: nonrespondent/respondent bias and other response biases, such as acquiescent responses, were detected. The study illustrates the importance of weighing which source of response bias is more crucial to the general validity of a study based on the research questions to be addressed.

Dental Health Surveys↗