Unnoticed,Untapped, and Underappreciated: Clients' Perceptions of their Public Defenders

The challenge of providing high-quality public defense services continues to be a concern at federal, state, and local levels. Some scholars have alluded to a potential solution in client-centered representation, but research in this area is sparse at best. Such a lack of understanding leaves in its place speculation, particularly as to the potential importance of client perceptions in shaping broader system legitimacy. To fill this gap and create an empirical platform for future research, an exploratory pilot study was launched with the Hamilton County, Ohio Public Defender's Office, which used mixed methodologies to assess client attitudes toward public defenders as a potential resource for aiding the improvement of indigent representation. Findings from this pilot study suggest that there are five factors a public defense attorney should address that may prove to be very important in obtaining client satisfaction and cooperation: engaging the client for input, listening to the client, examining the prosecutor's evidence, focusing on the client's case during meetings, and informing the client of potential consequences. Implications for practice and future research are discussed. Copyright © 2015 John Wiley & Sons, Ltd.     

Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.