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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" bu...
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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.
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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...
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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.
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This study contributes to the debate on the motives for auditor changes by examining the relationship between client retention and one of the many factors that potentially influence client retention, engagement-level pricing. We f...
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This study contributes to the debate on the motives for auditor changes by examining the relationship between client retention and one of the many factors that potentially influence client retention, engagement-level pricing. We find for a sample of public and private audit engagements that the difference between realized realization rates (the ratio of the audit fee billed to the standard audit fee) and expected realization rates is positively associated with client retention over a five-year window. Our findings suggest pricing pressure is more than an isolated occurrence and the incumbent auditor's inability to recover unexpectedly high labor usage is associated with the severing of the auditor-auditee relationship.
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Client engagement has been associated with positive psychotherapeutic outcomes, yet it is relatively under-theorized. The aims of this review were to establish how client engagement with psychotherapeutic interventions targeting p...
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Client engagement has been associated with positive psychotherapeutic outcomes, yet it is relatively under-theorized. The aims of this review were to establish how client engagement with psychotherapeutic interventions targeting psychological or behavioral change has been operationally defined and assessed, and the associated client characteristics, therapist characteristic, and treatment factors. Seventy-nine studies were selected for review, revealing inconsistent definitions and assessments of engagement and a broad array of client characteristics and treatment factors investigated. Attendance was frequently used as a proxy for engagement, but may not be reliable. Participation or involvement in conjunction with homework compliance which reflects clients' efforts within and between sessions may more reliably reflect engagement. The findings of associations between client characteristics and engagement variables were equivocal, although clients' capacities to address their problems tended to be positively associated with engagement Nearly all therapist characteristics, particularly therapists' interpersonal skills, and most treatment factors, particularly strengths-based approaches and the therapeutic relationship, were positively associated with engagement. A theory of engagement that characterizes the function and inter-relations of variables across different psychotherapeutic settings is needed. (C) 2014 Elsevier Ltd. All rights reserved.
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We examine determinants of audit engagement profitability using proprietary data from the national office of a Big 4 public accounting firm in Canada. We verify through interviews with senior audit partners that the audit realizat...
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We examine determinants of audit engagement profitability using proprietary data from the national office of a Big 4 public accounting firm in Canada. We verify through interviews with senior audit partners that the audit realization rate is the primary measure used to assess engagement-level profitability, and use the former to proxy for engagement profitability in our archival analysis. We find that engagement profitability is positively associated with the firm's assignment of lead senior audit managers, as identified by the national office, and its delivery of intangible client service dimensions, such as communication, customization, and responsiveness (obtained from satisfaction surveys of client management and audit committee chairs). We find no evidence that audit quality, measured by discretionary accruals and audit adjustments, is sacrificed to attain higher engagement profitability. We discuss implications for regulation and competition in audit markets.
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A great deal of clinical research has sought to describe and suggest remedies for the client dropout phenomenon. However, few studies have addressed the equally pervasive, yet often ignored, non-engagement problem. An exploratory ...
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A great deal of clinical research has sought to describe and suggest remedies for the client dropout phenomenon. However, few studies have addressed the equally pervasive, yet often ignored, non-engagement problem. An exploratory study was conducted to understand why many clients fail to engage in family therapy services after they have completed the initial intake. The results of the study suggest that therapist gender and experience level, clinic policies regarding videotaping sessions, family concerns, and changes in the presenting problem prior to the first session, had an impact on potential clients’ decision to engage in therapy. Implications and future research are discussed.
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Purpose/Objectives: This article describes a client advocacy model for use by case managers. It delineates necessary competencies for the case manager and shares important strategies for effective client advocacy. Primary Practice...
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Purpose/Objectives: This article describes a client advocacy model for use by case managers. It delineates necessary competencies for the case manager and shares important strategies for effective client advocacy. Primary Practice Setting(s): All practice settings across the continuum of health and human services and case managers of diverse professional backgrounds.Findings and Conclusion: Advocacy is a primary role and necessary competency of professional case managers functioning in various care settings. It is rooted in ethical theory and principles. Successful case managers apply ethical principles of advocacy at every step of the case management process and in the decisions they make. Part II of this two-part article presents a client advocacy model for case managers to apply in their practice, describes the role of advocacy in client engagement, and identifies important strategies and a set of essential competencies for effective case management advocacy. Part 1 already explored the ethical theories and principles of advocacy, the perception of case management-related professional organizations of advocacy, and the common types of advocacy based on scope, complexity, impact, and reach. Implications for Case Management: Acquiring foundational knowledge, skills, and competencies in what advocacy is and how to effectively enact its related behaviors is essential for success of case managers and for achieving desired outcomes for both the clients and health care agencies/providers alike. Case management leaders are urged to use the knowledge shared in this article to develop advocacy training and competency management programs for their case managers.
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Background: Client engagement in substance misuse treatment programs is directly associated with positive treatment outcomes. The nature of these programs means there are often difficulties engaging and retaining clients, but auth...
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Background: Client engagement in substance misuse treatment programs is directly associated with positive treatment outcomes. The nature of these programs means there are often difficulties engaging and retaining clients, but authors have consistently found a strong therapeutic alliance is associated with client engagement. While research has focused on the association between the alliance and engagement, the factors that influence the therapeutic alliance have received less attention. Objective: To examine therapists' characteristics, namely therapists' stress and empathy levels, as potential predictors of client engagement and the therapeutic alliance, within an adolescent substance misuse group treatment program. Method: The sample included 84 adolescent clients and 14 therapists from a Secure Training Centre in England. Client engagement in the treatment program was observed, while self-reporting measures assessed the therapeutic alliance (client and therapist-rated), and therapists' stress and empathy levels. Results: Multiple regression analysis revealed that therapists' stress levels negatively influenced the therapeutic alliance and had a curvilinear relationship with client engagement, indicating that stress is not exclusively negatively related to engagement. Although stress was found to negatively impact both cognitive and affective empathy, neither cognitive nor affective empathy were significantly related to client engagement or the therapeutic alliance. Conclusions: This study demonstrates the importance of therapist characteristics on client engagement and the therapeutic alliance. Within practice stress can have a positive impact on clients' engagement. Nevertheless, therapists may need additional support to deal with stress effectively. Therapists' empathy may too be fundamental to client engagement, but only it if is perceived by clients.
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This study of 33 mental health therapists and 30 case managers examined the relationship between practitioners' assessments of the importance of potential treatment barriers and their use of engagement strategies to overcome those...
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This study of 33 mental health therapists and 30 case managers examined the relationship between practitioners' assessments of the importance of potential treatment barriers and their use of engagement strategies to overcome those barriers and improve treatment participation. Results confirmed the hypothesis that workers who viewed treatment barriers as more important were significantly more active in their reported efforts to engage clients (r = .28, p < .05). Although no significant differences between the two groups were found in overall use of engagement strategies, we found a significant interaction effect between position and types of strategies used, with therapists employing more discussion strategies while case managers were more likely to employ practical engagement strategies (F = 35.79, p < .001). Findings suggest the desirability of enhancing mental health workers' sensitivity to the range of barriers that clients may experience, and expanding the repertoire of engagement strategies they use to encourage client retention.
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This paper aims to explicate the essence of spiritual engagement from the perspective of palliative care clients and their caregivers. Van Manen's hermeneutic phenomenological approach guided this study. In-depth interviews of 14 ...
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This paper aims to explicate the essence of spiritual engagement from the perspective of palliative care clients and their caregivers. Van Manen's hermeneutic phenomenological approach guided this study. In-depth interviews of 14 rural Australian participants with experience of a life-limiting condition provided rich discourse of the lived experience of spiritual engagement. This research highlights spiritual engagement represented in a relational model developed from a creative synthesis of the emerging themes. Spiritual engagement is associated with 'personal transformation', 'human values of love, compassion and altruism', 'maintaining relationships', 'participating in religious practices' and 'culture'. The findings of this research are supported by Mayes' observations on spirituality, that is, the 'pursuit of a trans-personal and trans-temporal reality that serves as the ontological ground for an ethic of compassion and service'.
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