Pilot test of a measure to assess clients’ perceptions of their home visitors

Home visiting services for caregivers of infants and young children have been found to be an effective method for promoting child development. Unfortunately, such services suffer from high rates of attrition, suggesting the need to identify factors related to client retention in services. Research has indicated that the client-provider relationship is an important predictor of client retention in home visiting services; however, measures to assess this relationship are limited. This study reports on a pilot test of the Client Perceptions of Home Visitors Questionnaire, developed to assess home visiting clients’ perceptions of their relationship with their home visitor. The measure was completed by 39 diverse home visiting clients during pregnancy in a midwestern town in the United States. The scale was found to have good internal consistency. Validity analyses found that the scale was positively associated with client satisfaction with services and perceived provider cultural sensitivity. The scale was also positively associated with retention in services at an 8-month follow-up. Additional research should examine the measure's psychometrics with larger samples.     

Quality home visits: Activities to promote meaningful interactions

Examination of and support for specific practices that promote high-quality home visiting are essential as family support programs continue to expand across the country. The current study used direct observation of 91 home visits across 41 home visitors to examine relations among interaction partners, content of the interactions, the home-visitors’ activities, and quality of home-visitors’ practices and family-members’ engagement within programs funded by the Maternal, Infant, and Early Childhood Home Visiting program. More time spent in triadic interactions focused on child-related content, as measured by the Home Visit Rating Scale-Revised, was related to higher quality of family engagement in home visits, as measured with the Home Visit Observation Rating Scales. Time spent in adult-focused interactions and administrative tasks, however, was related to lower quality of home-visiting practices and family engagement. Implications for research and practice are discussed.     

PREDICTORS OF SELF‐REPORTED GAINS IN A RELATIONSHIP‐BASED HOME‐VISITING PROJECT FOR MOTHERS AFTER CHILDBIRTH

We assessed mothers’ self‐reported gains from a postpartum home‐visiting (HV) project in which home visitors are volunteer mothers from the community. Hypotheses were that gains are positively related to (a) mothers’ felt‐closeness with their home visitor, (b) mothers’ level of sociodemographic risk, and (c) the home visitors’ preproject training in support services for families or children (Professionalism). One hundred sixty‐four clients returned written evaluations of the HV project. Items assessing gains were reduced to two factors: Improved Well‐Being (“Self”) and Improved Infant Care (“Infant”). Repeated measures general linear models, with Gains (Self, Infant) as the repeated measure, and multiple regression analyses evaluated the hypotheses. Across the sample, gains on both factors were moderate, although gain scores were higher regarding Self than for Infant. Results show that (a) Mothers’ felt‐closeness with their volunteer was strongly related to mothers’ gains; (b) high‐risk mothers gained more from the project than did mothers of lower risk, particularly regarding Infant Care; and (c) mothers visited by volunteers who were professionals reported more substantial gains than did mothers visited by volunteers who were not professionals. Findings can help explain variance in mothers’ gains from such projects and could be useful in improving their efficacy.     

The Value of Curiosity and Naiveté for the Cross-Cultural Psychotherapist

Therapists today face a dramatic increase in the cultural diversity of their client populations. Cultural literacy, long the dominant model for preparing to do cross-cultural therapy, advocates study of the prospective client's history and culture. This model, however, poses logistical problems, emphasizes scholarship over the experiential and phenomenological, and risks seeing clients as their culture and not as themselves. In this essay, we argue that teaching culture alone can obscure therapists’ view of human diversity. To balance the cognitive model of preparation, a process-oriented approach is considered, whereby the therapists’ attitudes of cultural naiveté and respectful curiosity are given equal importance to knowledge and skill. We begin from a concern with clients’ vulnerability in the power distribution that inevitably exists in therapy, especially with immigrant and marginalized populations. The use of acculturation narratives, which the therapist explores with naiveté and curiosity, helps clients to find their voices.     

Family functioning and involvement in home visiting: Examining program characteristics as moderators to support retention in services

Developing strategies to improve retention in home visiting programs is critical to their success. The purpose of the study is to examine how the content provided during home visits moderates the association between family risks (economic, household functioning, and conflict) and retention in services. Parents (n = 1,322) voluntarily enrolled in Healthy Families America (n = 618) and Parents as Teachers (n = 704). Family characteristics were collected using the Family Map Inventories. Multilevel analyses showed a moderating impact of the time home visitors spent supporting parent–child interaction for all family risks examined. Moderating effects demonstrated a stronger positive association between focusing on the parent–child relationship and retention at 6 and 12 months for parents demonstrating greater needs. There were no moderating effects of child development content or case management activities with retention at 6 and 12 months. Together, families were more likely to stay in services when home visitors focused on parent–child interaction and child development, but less likely retained with more case management. Parents with greater risks were more likely to remain in services with more time focused on supporting parent–child interactions. Findings suggest the need to support our home visiting workforce in their work to promote healthy parent–child relationships.     

A meta‐analysis of home visiting programs: Moderators of improvements in maternal behavior

A meta‐analysis of home visiting programs for at‐risk families (K = 35, N = 6,453) examined differences in the effects of programs on maternal behavior. On average, programs with more frequent visitation had higher success rates. The frequency of home visits explained significant variance of effect sizes among studies in the United States, with two visits per month predicting a small, substantive effect. Intensive programs or programs with at least three visits per month were more than twice as effective as were less intensive programs. Home visiting programs using nurses or mental health professionals as providers were not significantly more effective than were programs using paraprofessionals. In general, programs showed a positive effect on maternal behavior, but programs with frequent home visits were more successful.     

Designing Post-Visit Action Resources for Families Visiting Wildlife Tourism Sites

ABSTRACT

Interpretation at zoos, aquariums, and other wildlife tourism sites is generally designed to raise visitors’ awareness and appreciation of natural resources and alert them to the impact of human activities on wildlife populations. However, there has been little investigation of what prompts visitors to adopt conservation actions, and whether reinforcing on-site messages with post-visit support can assist in this process. The aim of the present research was to firstly, design family learning materials to support and extend the learning that occurs as a result of viewing wildlife; and secondly, to ask families visiting a turtle rookery in Queensland, Australia to use the resources and report on their effectiveness. One hundred Australian families were sampled at the site; 3 months later 45 families returned questionnaires relating to the impact of the support materials on their long-term conservation knowledge, attitudes, and behavior. Components that were rated as particularly effective are presented and the importance of providing post-visit updates that connect visitors directly back to their viewing experience is discussed.     

Client Report of Delivery of Common Elements in Usual Care and the Association to Satisfaction

Recently, scholars have advocated for the use of a new flexible approach to evidence-based practice through the use of “common elements”, which are treatment procedures that are utilized in a variety of evidence-based mental health interventions. The objective of this study was to describe the extent to which clinicians are using common elements of evidence-based treatment (EBT) in routine mental health care for children and if they are utilizing more of the elements associated with their client’s diagnosis. A second objective was to determine whether use of these elements was associated with client satisfaction. The Youth Services Survey was administered to a diverse sample of youth and their caregivers (total sample = 1075) to measure satisfaction with services and use of both talk-based and skill-based common elements. More than 74 % of caregivers indicated that their child’s clinician utilized the talk-based common elements frequently or almost always. Additionally, at least 69 % of youth agreed with this finding. Youth and caregivers reported that the common elements related to skill building were utilized less frequently. A Generalized Estimating Equation approach was used to examine the relationship between use of common elements and client diagnosis and satisfaction. The results for diagnosis were mixed and varied by parent and youth report. Finally, the more clinicians discussed and practiced common elements of EBT with their clients, both youth and caregivers were more likely to be satisfied. Due to clients’ reporting that on average clinicians utilized skill building common elements less often, targeted clinician training may be important, since practicing skill-building therapeutic elements is key to adopting new methods of managing behavior and emotions. Further, if families are more satisfied with a common elements approach, then clinicians may be more likely to utilize it.     

Does Motivational Interviewing (MI) Work With Nonaddicted Clients? A Controlled Study Measuring the Effects of a Brief Training in MI on Client Outcomes

This study investigated the relationships between motivational interviewing (MI) and client symptoms, attendance, and satisfaction. Seventy‐nine clients attending a university‐based counseling center were purposefully assigned to treatment or control conditions. Statistical analyses revealed client symptoms in both groups improved. However, clients assigned to treatment conditions attended more sessions and missed fewer sessions than clients in the control group. Implications for using MI and suggestions for additional research are explored within the study.     

Qualitative meta-analysis of insight events in psychotherapy

Purpose: This study reports on a qualitative meta-analysis examining the phenomenon of insight into psychotherapy. Method: Studies (n?=?7, covering 15 insight events of 15 clients) were selected that examined significant events in psychotherapy leading to insight using session recordings and Interpersonal Process Recall interviews with clients and therapists. A conceptual organization of the data using a matrix grid consisting of three domains according to data origin (client process, therapist process, and their interaction) and three domains according to events’ sequence (context, event and key intervention, and impact) was established. Results: Key processes were identified that lead to insight events in psychotherapy. Two distinct types of events according to their main impacts as reported by the clients were identified: Painful/Poignant Insight where clients realized something that was painful, often evoking feelings of sadness or undifferentiated upset containing sadness and hurt; and Self-Asserting/Empowering Insight that led to an impact characterized by a sense of self-assertion and empowerment on the client’s part. A reasonably good alliance and vulnerability on the client’s part represent the context for insight events as does the client’s quest for self-understanding. The therapists’ key interventions in the event leading to poignant/painful insight contain either empathic reflection or collaborative interpretation. In empowerment/self-assertive insight events the therapists offer supportive, validating reframing promoting positive experience. In both types of events the therapist and the client work on consolidating insight. In some events, therapists emphasized cognitive or problem solution focused impacts, while clients emphasized emotional impacts. Some events contained emotional avoidance on the part of the client or therapist thus not realizing the full potential of the event.     

Broaching the Subjects of Race,Ethnicity, and Culture During the Counseling Process

The authors define broaching as the counselor's ability to consider how sociopolitical factors such as race influence the client's counseling concerns. The counselor must learn to recognize the cultural meaning clients attach to phenomena and to subsequently translate that cultural knowledge into meaningful practice that facilitates client empowerment, strengthens the therapeutic alliance, and enhances counseling outcomes. A continuum of broaching behavior is described, and parallels are drawn between the progression of broaching behavior and the counselor's level of racial identity functioning.     

Career counseling meets motivational interviewing: A sequential analysis of dynamic counselor–client interactions

Motivational Interviewing (MI) is a client-centered communication style with the aim to resolve client ambivalence within a change-related counseling. Its potential benefit for career counseling has been discussed by several scholars but no empirical research has investigated MI in this context so far. The current study used process measures from MI to investigate dynamic interactions within a career counseling intervention. Overall, we analyzed two videotaped sessions of 14 unique counselor–client dyads. Verbal behavior of counselors and clients were coded with two observational coding schemes from MI (one for counselors and one for clients, respectively). Behavior profiles of counselors were compared with benchmarks of good MI. Furthermore, client verbal ambivalence was compared between sessions. Finally, we conducted lag sequential analyses to analyze temporal dynamics between counselor behavior and immediate client verbal responses across N = 6883 behavioral events. Our results showed, first, behavior profiles of career counselors did significantly differ from recommended counseling benchmarks of good MI practice. Second, as assumed on the basis of past studies, client ambivalence decreased across sessions. Third, MI consistent counselor behaviors showed a positive sequential association with client positive career talk, whereas MI inconsistent counselor behaviors showed the reverse pattern. Our results suggest that counseling behaviors recommended from MI are facilitating career interventions. We discuss how trainings in MI could amend career counseling interventions and provide ethical implications when integrating MI into career counseling programs.     

A qualitative content analysis of ChatGPT's client simulation role-play for practising counselling skills

Role-play is often used as a pedagogical technique by counsellor educators to help counsellors-in-training (CITs) learn and practise counselling skills. This study used qualitative content analysis to assess the effectiveness of Chat Generative Pre-Trained Transformer (ChatGPT), an artificial intelligence (AI) chatbot, in simulating client role-play to facilitate practising counselling skills. The author used 10 case vignettes to conduct a simulated role-play where ChatGPT was asked to simulate the client and author as counsellor. The results indicated that ChatGPT demonstrated authenticity, consistency, appropriate emotional expression, cultural sensitivity, empathy and self-awareness while portraying the client. However, at times, ChatGPT's responses to the counsellor's questions appeared overly idealised, lacking the authenticity typically observed in real clients. Furthermore, ChatGPT, as a simulated client, lacked non-verbal cues, limiting the overall experience of counselling skill practice. Recommendations for CITs and future research are discussed.     

Community-delivered infant–parent psychotherapy improves maternal sensitive caregiving: Evaluation of the Michigan model of infant mental health home visiting

The current study evaluated the effectiveness of a home-based psychotherapeutic Infant Mental Health Home Visiting (IMH-HV) intervention for enhancing parenting sensitivity; a secondary aim was to evaluate whether the use of video feedback was associated with greater treatment response. Participants were N = 78 mothers and their children (age at entry ranged from prebirth to 24-month old (M = 9.8, SD = 8.4), who were initiating IMH-HV services with community mental health-based therapists (N = 51). Dyads were assessed during extended home visits via standardized interviews and observational and questionnaire methods within the first month of treatment (baseline), and again 6 and 12 months thereafter. Following each of these extended home visits, study evaluators completed a standard Q-sort to capture observations of maternal sensitivity during the visit. Therapists completed fidelity checklists used to derive the total number of IMH-HV sessions received (i.e., dosage) and frequency with which therapists provided video feedback. Results indicated a dose–response relationship between number of sessions and maternal sensitivity, and that video review with parents independently contributed to improved maternal sensitivity. Discussion focuses on the effectiveness of this community-based psychotherapeutic home visiting model for enhancing parenting, as well as the value of video feedback as a specific therapeutic strategy.     

Parent education home visitation program: adolescent and nonadolescent mother comparison after six months of intervention

This study examined the effect of an intervention over a 6-month period to improve first time mothers knowledge about parenting and safety in the home. The sample included 61 mothers who completed a baseline and follow-up survey. Mothers were first time adolescent (38) and nonadolescent (22) mothers recruited from rural county health departments for participation in a voluntary home visitation intervention program. Four hypotheses were tested that associated home visitation with greater parenting skill and child development knowledge and safety. Adolescent mothers were expected to make greater gains but to lag behind nonadolescent mothers in child development knowledge, parenting skills knowledge, household safety, and use of community resources. The sample included 32% with a high school degree and 12% African American. 83% were in school. 85% lived at or below the US federal poverty level. Parent Educators provided weekly in-home education based on a manual and individualized curriculum. Parenting skills knowledge was measured by the Adolescent-Adult Parenting Inventory (Bavolek, 1984). Home safety was measured by Culp's Home Safety Checklist. Educators recorded use of 13 community services. Analysis of variance revealed that infant knowledge increased to the same level among all mothers regardless of adolescents' lesser knowledge at baseline. Parenting skill knowledge of child roles increased for both ages, but older mothers scored higher. Parenting skill knowledge of alternatives to corporal punishment increased similarly for both ages. No age or interactive effects were related to improvement in safety or use of community services.     

Can Counselor Trainees Apply Their Skills in Actual Client Interviews?

The authors compared a skill-based training method (Carkhuff's human relations development model) with a conceptual-based training method by measuring (a) trainees' skill application in actual client interviews and (b) client outcomes. Participants were 14 male and 34 female master's degree trainees. Counseling skills were measured by rating segments of audiotaped sessions with field placement clients. Interrater reliabilities of .94 and above were achieved. A self-report instrument measured client outcome. Although the groups did not differ in responding skills at pretest, the skill-based group exhibited greater skill application in client interviews and superior client outcome ratings at posttest. Results support the use of skill-based training methods to increase trainees' skill application in applied settings.     

We have travelled a long distance and sorted out the mess in the drawers: Metaphors for moving towards the end in psychotherapy

Aim: To explore the process of ending in psychotherapy, in particular how clients and therapists draw on their notions of client improvements and prepare for the upcoming end. Data: The data comes from an intensive process‐outcome study at the University of Oslo, Norway. The study includes audio‐recording from all sessions and separate post‐therapy interviews with clients and therapists. Twelve psychotherapy dyads were selected because they had reached a ‘good enough’ ending. Therapy duration ranged from 7–43 months. The number of sessions ranged from 10–67. Method and analysis: A hermeneutical‐phenomenological approach analysed and combined the observational and reflexive data. The analysis was carried out using a method for systematic text condensation and through reflexive dialogues with the material and between the researchers. Findings and discussion: The language of improvement towards the end of treatment seemed packed with metaphors conveying growth in both affective and relational management. Metaphors based on travel (how they have moved); cleaning (how they have cleaned up and sorted out things); sensing (how the clients have grown stronger, got their heads above water and see things differently); and the clients’ feeling of having received something (gifts or tools) are widely used. Such metaphors are created in the interaction with a mutual sensitivity to their capacity to confirm and regulate affect towards the end. In this sense, the metaphors celebrate accomplishments in a way that exceeds therapy, and the client can keep them to use afterwards.     

A Review of “Beyond Postmodernism: New Dimensions in Clinical Theory and Practice”

Social workers have always advocated for outreach to clients in their environments. As early as 1893, Mary Richmond was instructing the first social workers, known then as "friendly visitors" in the value of this approach. Such advice remains valuable for modern independent social workers. In this article, the aothor's use of home visits in private clinical social work practice demonstrates the relevancc of thc earliest thcories and traditions of the profession. This rediscovery celebrates one hundred years of friendly visiting.