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In this case study we present an example of a modification of the chair work technique, called 'chair work with the empathic other', and examine the process of emotional change of the participant. We find that talking directly to the empathic other supports the participant's emotional engagement with the task and guides her emotional processing through the four necessary components of successful empty chair work, specified in previous research: experiential access and intense expression of primary adaptive emotion, expression of thwarted need, and a shift in the representation of self and the other. Drawing on self-determination theory, we conceptualize the trainer's person-centered communication as a basic need-supporting therapeutic action. Throughout the chair work process, the need-supporting positioning of the 'empathic other', provided by the trainer, consistently engages the participant in the emotional processing of unfinished business: it deepens and widens her emotional exploration, leads her to express thwarted need, and finally, to change representation of self and other. We discuss the findings within the framework of self-determination theory and in relation to research on emotional change and therapeutic practice. Previous research has pointed out the difficulties many clients face with engaging in chair work. Introducing need-supportive communication, drawing on self-determination theory, we suggest that the modified technique is a possible intervention to facilitate engagement in chair work and emotional change. [ABSTRACT FROM AUTHOR]

This study uses adoption and usage data on the client and firm–client interactions across four technology generations of new-age products/services from 13 developed and emerging markets over an eight-year period to describe how multigenerational service (MGS) adoption behavior influences direct (purchases) and indirect (references and feedback) global client engagement and whether this relationship is moderated by product/service failures and cultural factors. The authors propose metrics to measure the number of generations adopted (MGD), the number of products and features within a generation (MGFs), and the adoption time between generations (MGT). They find that client usage revenue (CUR) is enhanced by greater MGD and higher MGFs combined with lower MGT. However, CUR varies by differences in the needs of clients' own customers, failures, and culture. Greater direct engagement affects reference and feedback behavior, moderated by cultural differences in individualism, power distance, and masculinity. For a typical client in the United States and Canada, a one-unit improvement in MGD and MGFs and a one-year improvement in MGT enhance CUR by $8,150, $5,200, and $2,310 per client, respectively, versus a corresponding enhancement of $4,820, $3,640, and $1,620, respectively, per client in Colombia and Mexico. These findings provide several implications for executives who manage multigenerational innovations across countries regarding client engagement, launching MGS, market entry, and failure recovery. [ABSTRACT FROM AUTHOR]

Nurse-Family Partnership (NFP) is a home visiting program designed to improve pregnancy outcomes, child health and development, and life course outcomes for families facing socioeconomic inequalities through support and education provided by nurses to first-time mothers during pregnancy and up to 2 years postpartum. Studies show that home visiting programs like NFP have positive outcomes, but attrition remains a concern which may impact the desired health equity goals. Black mothers are more likely to withdraw from the NFP program, and research is lacking regarding their experiences in home visiting programs despite facing maternal health inequities rooted in racism. The present study aimed to understand factors that influenced program continuation and provide insights for program improvement. Semi-structured qualitative interviews were conducted with 21 Black NFP clients from multiple sites. Key findings include the importance of the nurse-client relationship, access to reliable health information, and racial concordance in the nurse-client pairing. Clients valued supportive, nonjudgmental nurses who provided dependable support and education. Racially concordant partnerships were perceived as more comfortable and understanding, fostering trust and open communication. Clients also suggested that invasion of privacy during home visits and a lack of connection with their nurse could contribute to program discontinuation. Efforts to increase program retention of Black clients should focus on fostering a strong nurse-client alliance. Recommendations include increasing racial diversity in the nurse workforce, implementing a nurse-client matching system, and allowing clients to request a new nurse if needed. [ABSTRACT FROM AUTHOR]

Home visiting programs have been found to improve parenting practices and to reduce negative child outcomes. The 2019 coronavirus disease (COVID-19) resulted in an abrupt transition to telehealth services for many home visiting services. Limited research has examined the impacts of delivering home visiting services via telehealth, and the effects of this abrupt transition during COVID-19 is understudied as well. This study examined the impact of the abrupt transition to telehealth as a result of COVID-19 on home visiting service provision in one mid-sized midwestern community from the perspective of clients and providers. We conducted semi-structured interviews with both home visiting clients and providers (N = 26) in prevention-focused home visiting services. Although some benefits to telehealth were reported, providers discussed challenges with regard to engaging clients in services and difficulties in completing important home visiting tasks (i.e., assessment of child development, teaching parent-child interaction). Providers and clients also noted that they missed face-to-face interactions. Effective use of telehealth in home visiting requires provision of devices that allow for video-chatting as well as development of effective methods to engage in observation and teaching tasks. [ABSTRACT FROM AUTHOR]

Little is known about the relationship between treatment organization characteristics and client outcomes or drug-related harms in community opiate substitution therapy. In the absence of sufficient scientific evidence, the organizational configuration of addiction treatment services is often decided on an ad hoc and sometimes politically motivated basis as the evaluation of the impact of policies or practices on clients at the organizational level is limited. The objective of this multi-site cross-sectional study was to identify and understand how client characteristics and staff perceptions of organizational functioning related to client engagement in community-based opiate substitution therapy services in Ireland. This paper reports on a cross-sectional survey of clients (n = 262) and staff (n = 132) questionnaires across 12 discrete community-based prescribing service providers (organizations) in Ireland. Measures of client engagement in treatment were shown to be higher in organizations with more positive staff ratings of organizational functioning. In particular, in organizations where staff reported having greater job autonomy, clients reported better overall engagement. Specifically, greater staff autonomy in organizations related to greater levels of treatment participation (p = 0.034), treatment satisfaction (p < 0.001), and better rapport with staff (p < 0.001). Clients who were the longest in treatment expressed significantly poorer rapport with staff (p = 0.44) and were less likely to seek out support from peers (p = 0.023), while those in stable accommodation reported greater participation in treatment (p = 0.009). Levels of peer support were not related to organizational characteristics, but clients with lower levels of education (p = 0.002) and those in early treatment (p = 0.017) were more likely to seek support from peers. The findings establish the importance of assessing organizational and client attributes as part of an overall strategy for enhancing the quality of treatment. This paper provides valuable information for policymakers and provides an ample basis for further exploration of how treatment organizations work, and not just that they work. Policymakers and planners need to consider introducing specific interventions for clients or staff in the context of a 'whole systems' approach. From an organizational and planning perspective, this should involve further consideration of measures that relate to increasing staff's sense of autonomy. This paper provides further evidence that the success of policy-making or planning relating to treatment organizations can be successfully measured at the client and organizational levels. [ABSTRACT FROM AUTHOR]

Problem definition: Clients and service providers alike often consider one-on-one service delivery to be ideal, assuming, perhaps unquestioningly, that devoting individualized attention best improves client outcomes. In contrast, in shared service delivery, clients are served in batches and the dynamics of group interaction could lead to increased client engagement, which could improve outcomes. However, the loss of privacy and personal connection might undermine engagement. The engagement dynamics in one-on-one and shared delivery models have not been rigorously studied. To the extent that shared delivery may result in comparable or better engagement than one-on-one delivery, service providers in a broad array of contexts may be able to create more value for clients by delivering service in batches. Methodology/results: We conducted a randomized controlled trial with 1,000 patients who were undergoing glaucoma treatment over a three-year period at a large eye hospital. Using verbatim and behavioral transcripts from more than 20,000 minutes of video recorded during our trial, we examine how shared medical appointments (SMAs), in which patients are served in batches, impact engagement. On average, a patient who experienced SMAs asked 33.3% more questions per minute and made 8.6% more nonquestion comments per minute. Because there were multiple patients in an SMA, this increase in engagement at the individual patient level resulted in patients hearing far more comments in the group setting. Patients in SMAs also exhibited higher levels of nonverbal engagement across a wide array of measures (attentiveness, positivity, head wobbling, or "thalai aattam" in Tamil: a South Indian gesture to signal agreement or understanding, eye contact, and end-of-appointment happiness), relative to patients who attended one-on-one appointments. Managerial implications: These results shed light on the potential for shared service delivery models to increase client engagement and thus enhance service performance. Funding: This work was supported by the Wheeler Institute at London Business School (WIBAD Ramdas_Sonmez CFP19), the Institute of Entrepreneurship and Private Capital at London Business School (IIE_3432_2019), Aravind Eye Hospital, and Harvard Business School. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2021.0012. [ABSTRACT FROM AUTHOR]

The purpose of this study is to determine the role of the therapeutic alliance in treatment effectiveness through mediation of client engagement. Individuals who had approached counseling centers of welfare organization, oil company, and Tabriz municipality in 2019 were selected as the statistical population. The statistical sample of the present study consists of 324 participants (225 women and 99 men) who were selected through purposive sampling based on entry and exit criteria, after obtaining their consent. The Working Alliance Inventory-Short Revised (WAI-SR), Client Engagement (CES), Client Satisfaction (CSQ), and Client Outcome (COM) questionnaires were used to collect data, and the data were analyzed using structural equation modeling and Amos24 software. Results showed that therapeutic alliances with client engagement mediation were able to explain changes in treatment effectiveness. In addition, the results of the mediation test showed that client engagement partially mediated the relationship between the therapeutic alliance and treatment outcome, but fully mediated the relationship between the therapeutic alliance and client satisfaction. The results of the fit indices indicated that the measured model was in good agreement with the theoretical research model. In conclusion, this study showed that client engagement was a mediating variable in explaining treatment efficacy, so therapists should pay special attention to the role of client engagement in treatment efficacy in addition to selecting appropriate treatment approaches.

Abstract Background Community health worker (CHW) programs have been positioned as a way to meet the needs of those who experience marginalization and inequitable access to health care, and current global health narratives also emphasize their adaptable nature to meet growing health burdens in low-income settings. However, as CHW programs adopt more technical roles, the value of CHWs in building relationships with clients tends to be overlooked. More importantly, these programs are often reframed and redeployed without attending to the interests and needs of program clients themselves. We set out to gather perspectives of program and CHW engagement from clients of a maternal and child health program in rural South Africa. Methods We conducted 26 interviews with pregnant or recently-delivered clients of the Enable Mentor Mother program between February–March 2018. After obtaining informed consent, a trained research assistant conducted all interviews in the clients’ home language, isiXhosa. Interviews, translated and transcribed into English, were organized and coded using ATLAS.ti software and thematically analyzed. Results We found that clients’ home-based interactions with Mentor Mothers were generally positive, and that these engagements were characterized by two core themes, instructive roles and supportive relationships.. Instructive roles facilitated the transfer of knowledge and uptake of new information for behavior change. Relationships were developed within the home visit setting, but also extended beyond routine visits, especially when clients required further instrumental support. Clients further discussed a sense of agency gained through these interactions, even in cases where they chose not to, or were unable to, heed their Mentor Mother’s advice. Conclusions These findings highlight the important roles that CHWs can assume in providing both instructive and supportive care to clients; as deepening relationships may be key for encouraging behavior change, these findings pinpoint the need to bolster training and support for CHWs in similar programs. They also emphasize the importance of integrating more channels for client feedback into existing programs, to ensure that clients’ voices are heard and accounted for in shaping ongoing engagement within the communities in which these programs operate.

Objective: Adults with serious mental health conditions (SMHC) experience higher rates of disengagement from treatment. Factors associated with engagement in treatment in general for this population include therapeutic alliance, provider empathy, and perceived coercion. This cross-sectional exploratory study addressed the question: To what extent do client perceptions of therapeutic alliance, therapist empathy, and perceived coercion explain the degree of engagement in outpatient therapy for adults with SMHC? Method: An anonymous online survey measuring study variables was completed by 131 participants. The relationship between variables was tested using multivariate regression analysis with hierarchical blocks. Results: After separating therapeutic alliance and therapist empathy in the analysis due to multicollinearity and accounting for the influence of control variables, therapeutic alliance (B =.43, p <.01) and therapist empathy (B =.25, p <.01), but not perceived coercion, were associated with the degree of client engagement. Conclusions and Implications for Practice: For adults with SMHC enrolled in outpatient therapy, therapeutic alliance explained the greatest variation in the degree of engagement. Participants appeared to use outpatient therapy as a main strategy for pursuing recovery, and engagement in therapy may be increased if providers utilize strategies to strengthen expressions of empathy and bolster alliance. Additional research is needed to enhance understanding of engagement in therapy for this population and to develop more sensitive measures for evaluating these constructs. Impact and Implications: This study found that greater degrees of therapeutic alliance and therapist empathy were associated with enhanced engagement in outpatient therapy for adults with serious mental health conditions (SMHC). Providers may improve the degree of engagement in outpatient therapy for adults with SMHC by strengthening expressions of empathy and purposefully incorporating strategies to foster alliance. Given the reliance on outpatient therapy as a main strategy to pursue recovery for participants in this research, engagement in therapy is a paramount goal to support overall well-being and promote personal recovery. [ABSTRACT FROM AUTHOR]

Background: Professional services firms utilise knowledge management tools, for example, IBM and Oracle solutions and toolkits, in their day-to-day client-facing operations. The effectiveness of toolkits must be evaluated to establish their actual value. Objectives: This article evaluates the current toolkit used by the South African client-facing professionals of a global multinational corporation. Method: Pragmatism philosophy was used because of the various perspectives needed to interpret the data. Data were collected from 30 participants who adhered to sample eligibility criteria. An interview was used to collect data to help determine which tools worked well and what had to be improved on. Results: The most value-adding tool was the Experience Tool, whereas the Collaboration Tool ranked the least valuable. The Collaboration Tool showed the most potential to increase its value. The results gave a clear indication of areas of improvement that will enable a professional services firm to strategically position its knowledge management toolkit towards adding value for client engagements. Conclusion: The study contributes towards evaluating the knowledge management toolkit, analysing areas of improvement, and recommending components such as machine learning, online collaboration and other activities that would enhance the knowledge management toolkit.

Objective: Client engagement in behavioral and mental health services has been strongly linked to improved outcomes and treatment completion. Animal-assisted interventions (AAIs) are increasingly used to improve client engagement, for example, by involving a dog in therapy to support a client's sense of safety. Although existing research suggests that human-animal interactions may promote engagement, further research is needed to understand the underlying mechanisms, identify procedures needed for treatment fidelity, and determine the populations in which this intervention would be most effective. The aim was to identify the existing knowledge base to inform future research and practice in these areas.Methods: A review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines to answer three questions: What research has been completed regarding the use of animals to affect client engagement, including measurement of potential processes of change? How have interventions that use animals been structured and protocolized? How is engagement operationally defined by these studies?Results: Ten studies were identified for review. Preliminary evidence indicates that AAIs may support client engagement in behavioral and mental health services. A wide range of conceptualizations in which populations and settings could benefit from AAIs were identified, but it remains unclear who would benefit most. The review did not substantively address the efficacy of AAIs for increasing engagement or factors that may drive engagement.Conclusions: Further research is needed to quantify the impact of AAIs on service engagement and to identify mechanisms of change. [ABSTRACT FROM AUTHOR]

Background: Professional services firms utilise knowledge management tools, for example, IBM and Oracle solutions and toolkits, in their day-to-day client-facing operations. The effectiveness of toolkits must be evaluated to establish their actual value. Objectives: This article evaluates the current toolkit used by the South African client-facing professionals of a global multinational corporation. Method: Pragmatism philosophy was used because of the various perspectives needed to interpret the data. Data were collected from 30 participants who adhered to sample eligibility criteria. An interview was used to collect data to help determine which tools worked well and what had to be improved on. Results: The most value-adding tool was the Experience Tool, whereas the Collaboration Tool ranked the least valuable. The Collaboration Tool showed the most potential to increase its value. The results gave a clear indication of areas of improvement that will enable a professional services firm to strategically position its knowledge management toolkit towards adding value for client engagements. Conclusion: The study contributes towards evaluating the knowledge management toolkit, analysing areas of improvement, and recommending components such as machine learning, online collaboration and other activities that would enhance the knowledge management toolkit. [ABSTRACT FROM AUTHOR]

Family Treatment Drug Courts are multidisciplinary teams that engage child welfare families in substance use treatment and reunification court services. This quasi‐experimental study evaluates the impact of engagement strategies with 36 participants. Participants experienced high levels of engagement with the court, child welfare workers, and their clinical providers. There were significant differences in engagement by race as well. Participants who successfully graduated the program had higher rates of engagement compared to those who dropped out. This study demonstrates the importance of measuring engagement with multiple providers for client success. Implications for practice and research are discussed. [ABSTRACT FROM AUTHOR]

Background: Many adolescent clients come to treatment reluctantly, at the initiative of others. Adolescents also quit therapy prematurely more often than adult clients do. This points to the value of finding good ways to engage adolescent clients in treatment and understanding more of what therapists do to achieve this task.Methods: We used focus group methodology to explore therapist strategies and behaviors to engage adolescent clients who come to therapy at the initiative of others. Ten focus group interviews with a total of 51 therapists were conducted with existing treatment teams from seven different clinics in community mental health care for children and youth. Reflexive thematic analysis was used as a framework to guide the analytical process.Findings: Navigating a position allowing the therapist and adolescent to meet and work toward a shared understanding of the situation and what could help was considered the main gateway to client engagement. To do this, therapists had to manage the pull between system requirements and their obligation to the individual adolescent client, represented by the theme Managing system requirements. The process of working with the adolescent to ensure engagement is represented by the four themes: Counteracting initial obstacles for client engagement – “You are not trapped here”; Sharing definitional power – “What does it look like to you?”; Practicing transparency – “I want you to know what I see”; and Tailoring as ideal – “I will design this therapy for you.”Implication and conclusion: Therapists want to understand their adolescent clients’ position better, and subsequently adjust the treatment goals and techniques to establish sufficient common ground to allow both the therapist and adolescent to find the therapeutic project worthwhile. However, system requirements and service organization were found to obstruct and influence these processes in several ways, pointing to the significance of exploring the interplay between system organization and therapeutic practice more thoroughly. There was also a variation between therapist behaviors described by different therapists within the same treatment teams, as well as systematic differences between treatment teams, pointing to the importance of future research differentiating wanted from unwanted variation in treatment.

Background: Many adolescent clients come to treatment reluctantly, at the initiative of others. Adolescents also quit therapy prematurely more often than adult clients do. This points to the value of finding good ways to engage adolescent clients in treatment and understanding more of what therapists do to achieve this task. Methods: We used focus group methodology to explore therapist strategies and behaviors to engage adolescent clients who come to therapy at the initiative of others. Ten focus group interviews with a total of 51 therapists were conducted with existing treatment teams from seven different clinics in community mental health care for children and youth. Reflexive thematic analysis was used as a framework to guide the analytical process. Findings: Navigating a position allowing the therapist and adolescent to meet and work toward a shared understanding of the situation and what could help was considered the main gateway to client engagement. To do this, therapists had to manage the pull between system requirements and their obligation to the individual adolescent client, represented by the theme Managing system requirements. The process of working with the adolescent to ensure engagement is represented by the four themes: Counteracting initial obstacles for client engagement – "You are not trapped here"; Sharing definitional power – "What does it look like to you?"; Practicing transparency – "I want you to know what I see"; and Tailoring as ideal – "I will design this therapy for you." Implication and conclusion: Therapists want to understand their adolescent clients' position better, and subsequently adjust the treatment goals and techniques to establish sufficient common ground to allow both the therapist and adolescent to find the therapeutic project worthwhile. However, system requirements and service organization were found to obstruct and influence these processes in several ways, pointing to the significance of exploring the interplay between system organization and therapeutic practice more thoroughly. There was also a variation between therapist behaviors described by different therapists within the same treatment teams, as well as systematic differences between treatment teams, pointing to the importance of future research differentiating wanted from unwanted variation in treatment. [ABSTRACT FROM AUTHOR]

Strong clinical competence is required for the successful engagement of clients in public child welfare. Successful engagement is associated with increasing positive outcomes for families. Three universities partnered to implement a simulation based learning (SBL) project to better prepare Title IV-E students in engagement competence when working with clients in public child welfare. Over three years, 70 students participated in a two scenario Objective Structured Clinical Exam (OSCE) interviewing an adolescent and her mother regarding an allegation of abuse with post interview reflection and feedback. The project was assessed using standardized rating tools and post interview reflection responses. Students consistently performed better with the adolescent than with the mother who presented with more resistance. Performance improved when completing the OSCE twice during an academic year and when specific learning modules were added. Student management of emotional regulation, interviewing challenges, and inconsistent awareness of diversity emerged as themes from student responses. Findings suggest transfer of learning from classroom to practice situations continues to be challenging. SBL can provide an important bridge by creating practice scenarios that challenge student emotional regulation, interviewing skills, and application of culturally responsive practice in a safe and controlled environment while providing rich opportunities for student learning and development. Increased collaboration between the academy and field internship sites are needed to maximize the potential of the SBL experience. [ABSTRACT FROM AUTHOR]

Counselling supervisors and educators have yet to reach a consensus about standard measures for evaluating the performance of graduate student therapists. Compared to self‐reports and rater judgements, client attendance records provide low‐inference behavioural data partially reflective of clients' engagement with therapists. This naturalistic study evaluates client attendance data using archival records of 92 doctoral students in beginning and advanced counselling practica who produced data for 771 clients, 3,949 scheduled sessions and 3,186 attended sessions. Providing evidence of the sample representativeness for clinicians, results indicated that the mean number of sessions attended per client for student therapists (5.65) was very similar to that reported in the literature for outpatient therapists (<6). As expected because of structural differences in client assignment, beginning and advanced students evidenced statistically significant differences on attendance variables such as number of clients and scheduled sessions. In contrast, attendance ratios were equivalent across counsellor experience, suggesting that these individual difference variables could be useful for evaluation of therapist competencies related to client engagement. [ABSTRACT FROM AUTHOR]

Healthcare in Canada is undergoing a paradigm shift, moving away from a prescriptive approach to care delivery to one that prioritizes clients and their families at the center of their care. In the homecare sector, this approach is commonly referred to as client- and family-centred care (CFCC), a philosophy emphasizing the need for point-of-care providers to partner with those receiving care and their families in a way that is respectful and attuned to their individual needs and goals. This philosophy helps homecare agencies like VHA Home HealthCare deliver care to families that embraces what is most important to them. At VHA Home HealthCare, CFCC is well established through education sessions delivered to staff. Despite these efforts, there is limited evidence to confirm whether this education aligns with what is important to clients and families. To address this gap, this study engaged a unique homecare population - parents of children with complex medical needs - to understand how they experience and perceive CFCC using an arts-based approach called photovoice. Through participants’ photographs and in-depth interviews, seven core themes were identified which we refer to as ‘the little things’ of CFCC. Results of our exploration show that in some cases there is alignment between parents’ perceptions of CFCC and the organization’s, but there are also many gaps that could be filled by incorporating the unique voices of participants into the organization’s educational curriculum. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens.

Background: Community health worker (CHW) programs have been positioned as a way to meet the needs of those who experience marginalization and inequitable access to health care, and current global health narratives also emphasize their adaptable nature to meet growing health burdens in low-income settings. However, as CHW programs adopt more technical roles, the value of CHWs in building relationships with clients tends to be overlooked. More importantly, these programs are often reframed and redeployed without attending to the interests and needs of program clients themselves. We set out to gather perspectives of program and CHW engagement from clients of a maternal and child health program in rural South Africa. Methods: We conducted 26 interviews with pregnant or recently-delivered clients of the Enable Mentor Mother program between February–March 2018. After obtaining informed consent, a trained research assistant conducted all interviews in the clients' home language, isiXhosa. Interviews, translated and transcribed into English, were organized and coded using ATLAS.ti software and thematically analyzed. Results: We found that clients' home-based interactions with Mentor Mothers were generally positive, and that these engagements were characterized by two core themes, instructive roles and supportive relationships.. Instructive roles facilitated the transfer of knowledge and uptake of new information for behavior change. Relationships were developed within the home visit setting, but also extended beyond routine visits, especially when clients required further instrumental support. Clients further discussed a sense of agency gained through these interactions, even in cases where they chose not to, or were unable to, heed their Mentor Mother's advice. Conclusions: These findings highlight the important roles that CHWs can assume in providing both instructive and supportive care to clients; as deepening relationships may be key for encouraging behavior change, these findings pinpoint the need to bolster training and support for CHWs in similar programs. They also emphasize the importance of integrating more channels for client feedback into existing programs, to ensure that clients' voices are heard and accounted for in shaping ongoing engagement within the communities in which these programs operate. [ABSTRACT FROM AUTHOR]

Although there many factors outside of the human service context that influence client motivation, the label of an "unmotivated client" obscures the fact that in some significant measure the problem is not "unmotivated clients" but a missed opportunity for the social worker/counselor to engage the client. Assigning culpability for disengagement to the client, rather than the context, disinclines social workers to explore opportunities to support motivation. Reframing motivation as an attribute contingent on counseling practices provides opportunities to influence client motivation. This paper examines the implications for human service practices. [ABSTRACT FROM AUTHOR]

A two-station (scenario) Objective Structured Clinical Examination (OSCE) was developed and tested for validity and reliability for assessing social work engagement skills in public child welfare. The simulated scenario was designed to allow for demonstration of skill with an involuntary adolescent and parent presenting as resistant. Independent raters assessed participants comprised of BSW students, MSW students, and experienced public child protection social workers (n = 17, station one, n = 16 station two). Scales demonstrated high internal consistency, inter-rater reliability, and initial discriminate groups validity. Findings suggest a promising approach for directly assessing social worker skill in engagement of clients. Implications for use of OSCE in child welfare are discussed. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of a motivational interviewing (MI) training designed to improve rehabilitation counselors' counseling skills to promote clients' engagement in return-to-work behaviors and to establish strong working alliance. Participants: The target population for this study was counselors who work for the state vocational rehabilitation (VR) program and their clients. Data were collected from a total of 347 participants (67 counselors and 280 clients) in the experimental and comparison groups, during the pre-and-posttests. Study Method: A randomized controlled trial was used in this study. The counselors in the experimental group received a 4-hr standardized MI training and a 4-week follow-up coaching sessions. Results: The counselors in the experimental group demonstrated significant gains in their MI competence scores compared to the comparison group. The clients of the experimental group's counselors improved their engagement in VR services and working alliance with their counselors. Conclusions: The findings of this research indicated a need for carefully developed counseling trainings and incorporation of the evidence-based practices in the VR programs to provide better quality of rehabilitation services. [ABSTRACT FROM AUTHOR]

Sudden gains—substantial stable symptom improvements between consecutive therapy sessions—are a common phenomenon. As condensed points of change, examination of sudden gains can provide insight into mechanisms of therapeutic change. This study investigated the association between sudden gains and cognitive change, therapeutic alliance, and/or client engagement in transdiagnostic group cognitive-behavioural therapy for anxiety disorders. Of 58 treatment initiators, 21% (n = 12) exhibited a sudden gain. Consistent with previous research, sudden gainers demonstrated significantly greater pre- to post-treatment symptom improvement than non-sudden gainers. Observational coding of therapy sessions found that sudden gains were associated with elevated levels of cognitive change and client engagement in the pre-gain session, and elevated levels of cognitive change and therapeutic alliance in the post-gain session. However, these results varied by use of within- and between-subject control comparisons, highlighting the value using a dual control methodology. In context of previous research, the results on cognitive change replicate previous findings in depressive populations, and clarify mixed findings in anxiety populations. The results on therapeutic alliance replicate previous findings for the first time in an anxiety sample, although the between-subject control comparisons revealed complexity previously undetected. This study was also the first to investigate and thus establish the relation between client engagement and sudden gains. [ABSTRACT FROM AUTHOR]

Background/aim: Client‐centred goal setting is fundamental to occupational therapy practice and has been increasingly embraced by all rehabilitation practioners. Goal setting in clinical practice is a highly individualised process and may be more challenging with people with acquired brain injury. However, research examining practice is limited. We developed the Client‐Centred Goal Setting Practice Framework to explain how client‐centred goals are developed in brain injury rehabilitation. This framework was based on interview data and may reflect practitioner's theoretical knowledge rather than goal setting processes used in routine practice. The aims of this study were to explore the application of the framework to every‐day practice, examine the extent to which goal setting was client‐centred and refine the framework. Methods: A mixed methods approach was employed. Participants were community dwelling clients with ABI and their practitioners, drawn from a hospital outpatient service and community private practices. The communication exchange between practitioners and clients during routine goal setting was audio‐recorded, transcribed verbatim and analysed using framework analysis. Quantitative measures evaluated the client‐centredness of goals. Results: A total of 65 goal setting sessions with 36 clients and 17 practitioners (n = 8 occupational therapists) were analysed. The three goal setting phases of the framework and associated processes and strategies were represented. The 'establishing trust' process was interwoven throughout all phases and an additional strategy, 'social connection' was identified. Conclusion: The framework provides preliminary evidence about the core processes and strategies which uses establishing trust to engage clients with ABI in goal setting, and may be a useful tool to guide client‐centred goal setting practice in similar services. [ABSTRACT FROM AUTHOR]

Abstract Objectives Although turnover, defined as when a therapist leaves his/her organization, occurs frequently in public mental health organizations, its impact on clients is understudied. This study examined the effects of turnover on client engagement among youth receiving services in one public mental health agency. Methods Data were abstracted through a retrospective chart review of 76 clients who initiated outpatient trauma-focused treatment with 30 therapists between June 2013 and January 2016 at one agency in Philadelphia. Client demographic information, client session attendance, and therapist for each session was abstracted from each chart. The dependent variable (i.e., client engagement) was operationalized as client attendance to scheduled sessions. Mixed-effects regression analyses were used. Results Youth who experienced therapist turnover were 86% more likely to miss a future scheduled therapy session. When exploring this effect by diagnosis, youth without a Post-Traumatic Stress Disorder (PTSD) diagnosis were more likely to miss a scheduled session following therapist turnover than those with a PTSD diagnosis (p <.05). Conclusions Therapist turnover is a strong predictor of client engagement among youth receiving trauma-focused treatment, and a PTSD diagnosis may be a protective factor against missing sessions. Implications for treatment planning in the face of therapist turnover are discussed. Highlights • Therapist turnover is a predictor of reduced client attendance to sessions • PTSD found to be a protective factor against client non-attendance post turnover • Therapist turnover should be targeted to improve client engagement in session [ABSTRACT FROM AUTHOR]

Resistance can be a substantive problem that limits treatment efficacy in cognitive behavioral therapy (CBT). Resistance often arises in a context of client ambivalence about change and has been consistently found to be exacerbated by directive responses and reduced by supportive ones. When not properly managed, resistance can have detrimental consequences for the therapeutic alliance and both proximal (e.g., engagement, homework compliance) and distal (e.g., symptom severity) treatment outcomes. Given its impact, resistance should be considered a key process marker in CBT. Motivational interviewing (MI) provides strategies for ‘rolling with resistance’ and there is mounting evidence that it can be successfully integrated with CBT to improve overall treatment response. This paper will review the research on resistance and ambivalence, particularly research conducted in the context of CBT. MI and its ability to successfully address these impasses will be outlined in detail, together with a clinical illustration. [ABSTRACT FROM AUTHOR]