Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders: a qualitative systematic review of randomised controlled trials

The purpose of this paper is to conduct a qualitative review of randomised controlled trials in relation to the treatment of adults with co-occurring mental health and substance use disorder (MH/SUD). In particular, integrated approaches are compared with non-integrated approaches to treatment. Ten articles were identified for inclusion in the review. The findings are equivocal with regard to the superior efficacy of integrated approaches to treatment, although the many limitations of the studies need to be considered in our understanding of this finding. Clearly, this is an extremely challenging client group to engage and maintain in intervention research, and the complexity and variability of the problems render control particularly difficult. The lack of available evidence to support the superiority of integration is discussed in relation to these challenges. Much remains to be investigated with regard to integrated management and care for people with co-occurring and MH/SUD, particularly for specific combinations of dual diagnosis and giving consideration to the level of inter-relatedness between the disorders. (C) 2004 Elsevier Ltd. All rights reserved.

Working with involuntary clients: Perceptions and experiences of outreach social workers in Hong Kong

The outreach social work service is one of the dominant youth work approaches in dealing with delinquents and youths 'at-risk' in Hong Kong. Yet this approach presents particular challenges. Outreach social workers usually play an active role in initiating and establishing contacts with young people, yet young people are reluctant to engage with the outreach social workers and are resistant towards therapeutic change. To date, little is known about what strategies and techniques are most effective in dealing with client resistance in this context. The aims of this paper are to gain a better understanding of the common resistant behaviours that outreach social workers usually encounter in their day-to-day practice, and to investigate how the outreach social workers respond to their clients' resistance with reference to case examples given in the in-depth interviews. The findings of this study provide evidence that whilst client resistance is common in the outreach social work setting, social workers' patience as well as sensitivity are essential in resolving resistance and building up a rapport with clients.

Feel it and deal with it: mental health practitioners' experiences of exposure to the trauma of survivor clients

Empathic engagement by the trauma therapist with another person's traumatic experiences is believed to create risks for the helping professional. Much attention has been focused upon the mental health professional experiencing symptoms of distress as a result of their exposure to the material of clients who survive traumatic incidents. This thesis contains the findings of a qualitative study that centres on a group of male mental health professionals and their experiences of exposure to the trauma material of survivor clients. The participants of the study practise within an internal Employee Assistance Program that provides, among other duties, a 24 hour, 7 day response to critical incidents to a heavy transport industry. Using semi-structured, in-depth interviews, the effects on the trauma therapists are explored by analysing their reactions to their survivor clients' accounts, the impact of these experiences upon their psychological schema, the organisational culture in which they practise and its influence upon their experiences and the methods participants use to cope with the psychological effects of exposure to trauma material. Participants' experiences are closely examined for critical comparisons with vicarious traumatization. Therapists' responses reveal their continued ability and motivation to empathically engage with the trauma material of survivor clients despite the potential risks.

Marital counselling: follow-up study of marriage guidance clients: perceptions of the agency, the process and outcomes. Available in 2 volumes.

This study is a consumer-survey conducted with former Marriage Guidance Council clients. The objectives were to identify and examine why they chose the agency, what their expectations and experiences were of marital counselling and whether anything was achieved. The material was derived from tape recorded interviews with 51 former M.G. clients (17 men and 34 women) from 42 marriages and with 21 counsellors; data from written material and a card-sort completed by the research sample; and the case record sheets of the research population (174 cases). The results from the written data of clients showed that 49% were satisfied with counselling, 25.5% were satisfied in some ways but not in others, and 25.5% were dissatisfied. Forty-six percent rated they had benefited from counselling, either a great deal or to some degree, 4% were neutral and 50% recorded they had not benefited. However the counsellors' assessments were more optimistic. It was also ascertained that 50% of the research sample eventually separated or divorced subsequent to counselling. A cross-check revealed that the majority who rated they were satisfied with counselling were those who remained married, whilst dissatisfied clients were the ones who unwillingly separated or divorced. The study then describes, discusses and assesses the experiences of clients in the light of these findings on a number of dimensions. From this it was possible to construct a summary profile of a "successful" client describing the features which would contribute to "success". Two key themes emerged from the data. (1) the discrepancy between clients expectations and the counselling offered, which included mis­ match over the aims and methods of counselling, and problem definition; and (2) the importance of the client/counsellor relationship. The various implications for the agency are then discussed which include recommendations on policy, the training of counsellors and further research.

Development of an education resource for families and clients navigating through end-of-life care with at-home palliation

Background: Community health nurses (CHNs) play a pivotal role in providing end-of-life care to clients diagnosed with a life-threatening illness. Providing quality end-of-life care is an ethical obligation. Eastern Health’s palliative end-of-life care program (PEOLC) offers nursing care, equipment, services, and support. However, the caregiver’s need for practical information about end-of-life issues is not addressed. Purpose: To develop an educational resource to assist clients and families during end-of-life and to provide a framework for new CHNs in home palliation. Methods: An informal Needs Assessment, a literature review, an environmental scan, and consultations with four CHNs involved with home palliation. Results: An educational resource was developed to address the practical end-of-life issues identified in the literature review and consultations. Conclusion: An improved delivery of care for at-home palliation in the community for clients and families, and a framework for new CHNs.

Commercial sex, clients, and Christian morals: Paying for sex in Ireland

This article reports on the results of a study on men who pay for sex across Ireland. In presenting a detailed picture of the diverse group of sex workers’ clients, their motives and attitudes, we debunk the prevalent stereotypes about men who pay for sex, as continuously used in the public discourse about sex work on both sides of the Irish border: we show that the majority of clients do not fit the image of violent, careless misogynists. We argue that these debates about commercial sex as well as the experiences of those who pay for sex are shaped and nurtured by the specific local context, by conservative Christian morals and the dominant sex-negative culture across Ireland. Finally, we argue that the criminalization of paying for sex which came into effect in Northern Ireland in 2015 and is being discussed in the Republic of Ireland will likely not stop the majority of clients from paying for sex and thus fail to achieve its aim to reduce or abolish sex work.

Measuring function and mobility among clients with diabetes in Samoa

The aim of the thesis was to collect baseline data and to investigating suitable physical tests and a self-rapport questionnaire. Collected data was used to find a routine measurement when investigating foot health, function and mobility among clients suffering from diabetes in Samoa. Twenty-one participants suffering from diabetes were included in the study. Clients answered the Foot function index (FFI) questionnaire and performed physical tests, consisting of Bergs balance scale (BBS) and Time up and go (TUG). Results from the physical tests revealed a great balance disturbance and mobility limitations among the majority of the clients. General high weight and BMI was measured among both genders. Subjects with the highest BMI performed lowest time during TUG test. The statistic analyze revealed a strong correlation between the two physical tests, indicating that one of the tests could be applied as a routine measurement in the future, when evaluating function and mobility in Samoa. The compilation of self-report questionnaires indicated a general good foot health with a low amount of pain, disabilities and activity limitations.

Facilitators of recovery for step-up and step-down clients of a sub-acute residential mental health service

Effects of Organic and Inorganic Fertilizers on the Growth of NH-Ae 47-4 Variety of Okra

The paper evaluates the effects of organic and inorganic fertilizers on the growth of okra (variety NH-Ae 47-4. Organic fertilizers (cow dung and poultry droppings) and inorganic (NPK 15:15:15 and Urea 64:0) fertilizers were used for the experiment. The fertilizers were weighed and applied at 5g, 10g and 15g and were replicated three times and each having a control. Vegetative growth parameters taken include, shoot fresh weight (g), dry weight (g), plant height (cm), leaf number, stem girth (cm), leaf area (cm2). The results obtained from the experiment showed that the effect of the treatments were significantly difference from the control for all the parameters accessed with urea fertilizer having least effect. Plants treated with poultry litters have best performance by recording the highest fresh and dry weight (0.39g) at 4 weeks after planting (WAP); highest stem height 29.33cm for all the concentrations applied. Similarly, it has highest leaf area and stem girth (64.67cm2and 2.23cm respectively) at 8WAP.

Tree structure and richness in an Atlantic Forest fragment: distance from anthropogenic and natural edges

Approximately 7.2% of the Atlantic rainforest remains in Brazil, with only 16% of this forest remaining in the State of Rio de Janeiro, all of it distributed in fragments. This forest fragmentation can produce biotic and abiotic differences between edges and the fragment interior. In this study, we compared the structure and richness of tree communities in three habitats - an anthropogenic edge (AE), a natural edge (NE) and the fragment interior (FI) - of a fragment of Atlantic forest in the State of Rio de Janeiro, Brazil (22°50'S and 42°28'W). One thousand and seventy-six trees with a diameter at breast height > 4.8 cm, belonging to 132 morphospecies and 39 families, were sampled in a total study area of 0.75 ha. NE had the greatest basal area and the trees in this habitat had the greatest diameter:height allometric coefficient, whereas AE had a lower richness and greater variation in the height of the first tree branch. Tree density, diameter, height and the proportion of standing dead trees did not differ among the habitats. There was marked heterogeneity among replicates within each habitat. These results indicate that the forest interior and the fragment edges (natural or anthropogenic) do not differ markedly considering the studied parameters. Other factors, such as the age from the edge, type of matrix and proximity of gaps, may play a more important role in plant community structure than the proximity from edges.