Leaders in the field of home visiting and family support research have indicated that the inclusion of home visiting in comprehensive services for low-income families with young children can play a key role in improving a wide variety of outcomes for at-risk children and their families. These recommendations have been based in part on selected empirical findings from the home visiting literature. However, synthesis of empirical findings has proven difficult, due to the heterogeneity of this population and the diverse applications of home visiting as a service delivery strategy. The present meta-analysis examined a representative sample of the peer-reviewed literature to provide a comprehensive, quantified description of the features and findings of this literature. The four research questions addressed by the meta-analysis provide a framework for this description. The first research question concerned a description of research designs and methodological features found in the literature. The second and third research questions concerned, respectively, descriptions of the samples and interventions employed in primary studies. The final research question concerned the examination of those domains in which primary studies measured outcomes, and the quantification of outcomes in terms of standardized mean difference effect sizes. Summarization of primary studies' methodological features illustrated specific issues that may be addressed in the design of future home visiting research, and laid a basis for the examination of meta-analysis findings. The composition of primary studies' samples reflected the heterogeneity expected from a population defined by a parameter as broad as "low-income," yet included lacunae that may represent subgroups among the poor that are not being studied. Data providing an assessment of several types of intervention features have implications for questions of treatment efficacy, and for future home visiting research. Mean effect sizes in several domains were found to have a magnitude of practical significance for child and family outcomes. Findings of this project provide a structure for continued meta-analysis of this body of literature, and highlight potential areas for further primary research. Meta-analysis data lend support to previous recommendations, as well as point out gaps in our knowledge.

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Recent accounting research has indicated that not only do auditors form relational bonds with their clients, but they also tend to acquiesce to their client’s perspective because of that bond. As a result, professional skepticism is often compromised. Accounting research has suggested auditor rotation as a potential solution with mixed results. This may be explained by psychology research showing how quickly bonds can form. Using Social Identity Theory, I predict and find that increasing accountability as operationalized by increasing the salience of any potential client bond before the auditor makes an audit judgment can mitigate the impact of this bond on the auditor’s likelihood to acquiesce to the client’s point of view. This accountability mitigation could be implemented in practice regardless of auditor tenure or auditor rotation. This research provides an intervention that helps to maintain auditor independence while being both cost-effective and practical as it does not require the auditor to discontinue working at their client’s office.

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This qualitative study was designed to produce a theoretical model to illustrate disadvantaged clients' social class-related experiences in therapy. Clients' perceptions of therapist behaviors that positively and negatively influenced the quality of their therapy were also explored. Individual interviews were conducted with 18 adult clients (13 females, 5 males; age range: 18 to 64 years) at urban and rural community agencies primarily serving individuals who are considered economically disadvantaged. Participant-clients' disadvantaged status was based on their income below the cutoff for Medicaid eligibility in the state of Illinois and need for reduced fees or reliance on Medicaid coverage to pay for therapy services. Participants reported diverse ethnic backgrounds, including European American (n = 8), Hispanic American (n = 5), African American (n = 3), Jewish American (n = 1), and biracial (European and Native American; n = 1). Most participants reported a yearly household income less than $10,000 (n = 11), and that they were either unemployed or not in the labor force due to disability (n = 16). They reported varied religious/spiritual affiliations, educational levels, and socioeconomic backgrounds. The grounded theory method (Glaser & Strauss, 1967; Strauss & Corbin, 1998; Charmaz, 2000) was utilized to collect and analyze the data. The emergent theory, categories, and direct quotes from the participants are presented in order to illustrate clients' social class-related experiences in therapy. Results are consistent with existing empirical and theoretical literature on social class and therapy, and identify ways that disadvantaged social class affects individuals' therapy experiences. Implications for clinicians working with this population and public policies are discussed.

Client outcome research focuses primarily on three specific aspects of therapy: therapist technique, client behaviors and therapeutic interaction. The term "therapeutic interaction" focuses on the relationship between the counselor and the client, and is often ignored in client outcome research. Counselor specific contributions to the therapeutic process are called therapist characteristics may be an innovative way to assess how counselors' impact clients' outcomes in counseling. For the purposes of this study administering the Five Factor Wellness Evaluation of Lifestyle and the Outcome Questionnaire to master's level student counselors assessed therapist characteristics. The Outcome Questionnaire was administered to clients at a community-counseling clinic at two points and a delta score was calculated to create the variable "client outcome." In order to test the research hypotheses, 70 master's level counseling students completed both the Five Factor Wellness Evaluation of Lifestyle and the Outcome Questionnaire. These scores were then matched with master's level counseling students' client delta scores, which created the dependent variable. The results of the multiple regression analysis indicated no statistically significant relationship; therefore the null hypotheses were accepted as the constructs student counselor wellness and client outcomes were not related. Results of the study were summarized and discussed, limitations of the study were explored and recommendations for future research were proposed.

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This research takes the initial steps of evaluating resource planning for service operations in which the client is a direct resource in the service system. First, this research examines the effects of client involvement on resource planning decisions when a service firm is faced with efficiency and quality considerations. We develop a non-linear, deterministic, single-stage planning model that allows for examination of trade-offs among client involvement, efficiency and quality. Policy recommendations give service firms better insights into setting workforce, client intensity, and service generation levels. Second, we examine the sensitivity of estimates of technology functions to data analysis and make policy recommendations to service providers on how to allocate resources when there are technology function uncertainties and uncontrollable inputs. Results show that resources are allocated to compensate for technology function uncertainties. Third, we gain insights as to how resource decisions are made for multiple stages and for multiple clients. We extrapolate theoretical findings from the single-stage planning study to determine resource allocations across multiple services and stages. Results show that when the dynamic program in the single-stage study is extended there is trade-off between the cost of capacity changes and profits across multiple stages. / Ph. D.

Researchers and clinicians report that they think the client is the most influential component in determining the outcome of therapy. Although a variety of studies have examined the impact of various client factors on the outcome of couple therapy, this research is not cohesive and produces inconsistent results. The purpose of this multi-method study is to present a sense of the range and depth of client factors that influence the outcome of couple therapy. The use of qualitative and quantitative methods allowed the data to build on existing research while expanding the range of client factors considered. Data were gathered using a dynamic, web-based survey which assigned participants to discuss a case of successful or unsuccessful couple therapy. Participants provided their own descriptions of influential client characteristics. Participants also rated how important they thought several literature-based client factors were. Quantitative data analysis utilized descriptive statistics, principal components analysis, and logistic regression. Qualitative data were analyzed in two stages, using content analysis. Results indicated that couples can be conceptualized by five arenas of couple focus; these arenas accurately predicted whether participants were discussing a successful or unsuccessful case of couple therapy 85.9% of the time. Regarding individual client characteristics, in general, clients whose couple therapy was successful tended to be open to each other and committed to the relationship and to therapy. Unsuccessful couple therapy tended to focus on a greater number of individual issues. Couple dynamics characteristics differed according to outcome groups; participants described four types of couple dynamics that influenced couple therapy to be unsuccessful. Data showed that many client factors influenced the outcome of couple therapy, and that uncommon client characteristics could be vital to the outcome of some cases. Participants described a client's life events as impacting the outcome of couple therapy by increasing one person's vulnerability to his or her partner. If the partner acted in a way that created a sense of connection or support, this contributed to successful couple therapy. The results are presented in connection to previous research, when possible. Finally, implications for theory, research, and clinical work with couples are discussed. / Ph. D.