Assessing the Quality of Counseling Services: Developing Accountable Helping Systems

Hope and Humor: Using the Hope Scale in Outcome Studies

Hope has been identified as a factor measured by the Hope Scale to evaluate effectiveness of treatment in outcome studies. Hope is defined as a goal-oriented cognitive construct comprised of two components, (a) the Pathways component is the individual's sense of planning strategies to reach goals and (b) the Agency component is the individual's determination to implement these goal-focused strategies. Using a Solomon Four-Group design, the relationship of the Hope Scale pretest to the posttest scores was evaluated. This study also explored the use of humor (a source of hope) in elevating total Hope Scale scores, the Agency component scores, and the Pathways component scores. 80 undergraduate students (57 women, 23 men) were ran domly assigned to one of four groups. Analysis indicated that administering the Hope Scale prior to treatment was not significantly associated with posttest scores, and the one-time 15-min. exposure to the humor intervention of reading Far Side comics was not sufficient to elevate scores on the Hope Scale.

Ensuring quality of services in HIV prevention research settings: findings from a multi-center quality improvement pilot in East Africa

Quality improvement (QI) has been widely implemented in health services but has not been widely applied in HIV prevention research. Most prevention research centers have commonly employed traditional approaches (e.g., checklists) to quality control that document what has been done but not the quality of what has been done. Unlike other health settings, prevention research settings have unique characteristics and ethical requirements that require the development or adaptation of specific quality indicators. A QI model for health services was adapted for use in prevention research settings and was piloted between August 2006 and July 2007 at three research centers in East Africa. Four hundred and twenty-six volunteers exit interviews were administered in two cycles. Quantitative and qualitative data were analyzed using Excel worksheets. QI meeting reports and QI plans were used to complement data from exit interviews. On average, 52% of total enrolled volunteers participated in the exit interview. The designed QI plans successfully helped reduce volunteers' reported waiting time to see counselors (p<0.001) and pharmacists (p<0.001). It also increased the percentage of interviewed volunteers who reported being counseled on family planning at clinical trials (from 66 to 93%; p=0.02) at follow-up visits, and who were refreshed on informed consent at follow-up visits (from 90 to 96%; p=0.009). The percentage of interviewed volunteers that expressed satisfaction with services received from counselors increased (from 87 to 94%; p=0.009) while the percentage of volunteer satisfied with services from trial physicians remained constant (93%). The majority of volunteers interviewed reported satisfaction with other major components of research such as confidentiality, understanding of trial objectives, benefits and risks of participation, and risk reduction counseling. However, satisfaction with services from community outreach workers and other staff at research centers dropped over the course of the study (from 88% in Cycle 1 to 74% in Cycle 3; p= < 0.001). Increased commitment to QI is crucial in ensuring quality of services and ethical conduct of HIV prevention research centers.

Predicting premature termination from counseling using the Butcher Treatment Planning Inventory

This investigation examined the extent to which premature termination from counseling could be predicted from selected scales on the Butcher Treatment Planning Inventory (BTPI). Ninety-five new clients at a university counseling center agreed to participate in the study and completed the BTPI as part of the intake evaluation. Premature termination occurred when a participant missed a scheduled appointment and unilaterally dropped out of counseling. Higher scores on Closed-Mindedness, Problems in Relationship Formation, Somatization of Conflict, Self-Oriented/Narcissism, Perceived Lack of Environmental Support, and the Treatment Difficulty Composite were associated with premature termination. The General Pathology Composite, a general index of symptomatic distress, also enhanced the prediction of premature termination by suppressing irrelevant variance in other BTPI scales. The results provide support for the validity of the BTPI in identifying clients at risk for premature termination from counseling.