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Articles 31 - 60 of 79
Full-Text Articles in Medicine and Health Sciences
Lgbt+ Teens, Social Media Use & Depressive Symptoms, Megan Curtis, Danielle Ryder
Lgbt+ Teens, Social Media Use & Depressive Symptoms, Megan Curtis, Danielle Ryder
Thinking Matters Symposium Archive
Sexual and gender minority youth are statistically more likely to face severe mental health challenges than their cisgender, heterosexual peers; they consistently comprise a disproportionate percentage of youth who report experiencing depression, suicide ideation and attempted suicide in the United States every year (e.g. Abreu & Kinney, 2018). The aim of this study was to fill a gap in the current literature base by investigating the effects of social media use on sexual and gender minority youth mental health. The researchers conducted an online anonymous questionnaire targeted toward American LGBT+ (Lesbian, Gay, Bisexual, Transgender, etc.) youth ages 14 to 18, …
A Thematic Analysis Of Adults’ Reflection On Childhood Experiences Being Parented By An Adult With Mental Health Issues, Jennifer Luja, Meg O'Malley
A Thematic Analysis Of Adults’ Reflection On Childhood Experiences Being Parented By An Adult With Mental Health Issues, Jennifer Luja, Meg O'Malley
Thinking Matters Symposium Archive
Children are impacted by their relationships with caregivers. The objective of this research was to develop awareness of the impact on children being cared for by caregivers with mental health issues by examining the experiences of individuals who had a caregiver with severe and persistent mental health issues during childhood. Researchers also gained insight on how social workers can be more supportive to children in these circumstances. The researchers conducted interviews with five participants, the recordings of which were then transcribed and coded to identify themes. Prevalent themes include critiques of available services, resiliency and challenges of family members as …
Perceptions Of Mental Health: Eight Conversations With Mainers From Africa, Teresa Sosa, Emelda Ogweta
Perceptions Of Mental Health: Eight Conversations With Mainers From Africa, Teresa Sosa, Emelda Ogweta
Thinking Matters Symposium Archive
As of 2016, 42 million refugees from around the world had been forced to flee their homes due to war, persecution, or natural disaster (George & Jettner, 2016). Due to these factors, as well as relocation and resettlement, refugees are at a significant risk for trauma and other mental health issues (George & Jettner, 2016). While the literature consistently validates this heightened risk for mental illness in refugees, more research is needed into refugee's perspectives on mental health. Through analysis of semi-structured interviews with eight refugees from Africa, this phenomenological study investigated refugee's perceptions of mental health and mental illness. …
Bridging The Gap: Supporting Transition-Age Youth Living With Mental Health Conditions, Oreoluwa Dasylva, Abbie Ensrud, Brittany Kruse, Cindy Schulz
Bridging The Gap: Supporting Transition-Age Youth Living With Mental Health Conditions, Oreoluwa Dasylva, Abbie Ensrud, Brittany Kruse, Cindy Schulz
Master of Social Work Student Policy Advocacy Briefs
The transition from adolescence to adulthood is a crucial time in a person’s life. For young people living with mental health conditions, becoming an independent, well-functioning, and productive adult can be especially challenging. It is imperative that supports be put in place to ensure transition-age youth have a smooth passage from child to adult mental health services. Nearly half of all life-long diagnosable conditions present by age 14. The Substance Abuse and Mental Health Services Administration (SAMHSA) finds the co-occurrence of serious illnesses and substance use disorders exist among transition-age youth more than any other developmental age. When left untreated, …
Yoga-Specific Enhancement Of Quality Of Life Among Women With Breast Cancer: Systematic Review And Exploratory Meta-Analysis Of Randomized Controlled Trials, Daline El-Hashimi, Kevin M. Gorey
Yoga-Specific Enhancement Of Quality Of Life Among Women With Breast Cancer: Systematic Review And Exploratory Meta-Analysis Of Randomized Controlled Trials, Daline El-Hashimi, Kevin M. Gorey
Social Work Publications
Physical activities during and after cancer treatment have favorable psychosocial effects. Increasingly, yoga has become a popular approach to improving the quality of life (QoL) of women with breast cancer. However, the extant synthetic evidence on yoga has not used other exercise comparison conditions. This meta-analysis aimed to systematically assess yoga-specific effects relative to any other physical exercise intervention (eg, aerobics) for women with breast cancer. QoL was the primary outcome of interest. Eight randomized controlled trials with 545 participants were included. The sample-weighted synthesis at immediate postintervention revealed marginally statistically and modest practically significant differences suggesting yoga’s potentially greater …
Examining Cultural Humility And Intersectionality In Mental Health Treatment, Sandra Y. Herrera-Spinelli
Examining Cultural Humility And Intersectionality In Mental Health Treatment, Sandra Y. Herrera-Spinelli
Walden Dissertations and Doctoral Studies
Cultural awareness is an ethical standard in the social work profession and, as the diversity in the United States continues to grow, it is a social work practice problem when cultural awareness is not implemented in mental health settings. The National Association of Social Workers revised the cultural awareness standards to include cultural humility and intersectionality as practice indicators. The purpose of this action research study was to examine how clinical social workers demonstrated cultural humility and intersectionality in mental health settings. Person-centered theory guided this study and a total of 17 clinical social workers in New Mexico participated in …
Efficacy Of A Va Residential Treatment Program For Co-Occurring Disorders, Kathrin Hohenstern
Efficacy Of A Va Residential Treatment Program For Co-Occurring Disorders, Kathrin Hohenstern
Walden Dissertations and Doctoral Studies
The problem of co-occurring substance abuse and mental health disorders among the veteran population can impact numerous aspects of a veteran's life, including self-esteem, relationships, employment, and legal issues. The Mental Health Residential Rehabilitation Treatment Program (MH RRTP) at the Saint Cloud, Minnesota VA Healthcare System is a program that provides residential treatment for this population. Identifying practical and beneficial treatment methods promotes better coping mechanisms for veterans and impacts social change by providing timely and cost-efficient care for veterans, while also leading the way for overall changes and improvements in other VA residential treatment programs. This study identified how …
Referral Patterns And Service Provision In Child Protective Services: Child, Caregiver, And Case Predictors, Hannah Mead Holbrook
Referral Patterns And Service Provision In Child Protective Services: Child, Caregiver, And Case Predictors, Hannah Mead Holbrook
Graduate College Dissertations and Theses
Child maltreatment, and recurrent maltreatment in particular, occurs at an alarmingly high rate. Frequency of reports to Child Protective Services (CPS) is associated with negative psychological outcomes, and children whose reports are unsubstantiated experience similar risk of behavioral, emotional, and substance use disorders as those whose reports are substantiated. Prior research has demonstrated that children with no CPS reports and children with one CPS report showed no significant differences in rates of maltreatment perpetration or substance use in adulthood, suggesting that prevention efforts after one report may have strong merit in reducing negative outcomes in adulthood. However, patterns and risk …
Evaluation Of A Youth Emergency Room Enhancement Program For Behavioral Health, Anne Thatcher
Evaluation Of A Youth Emergency Room Enhancement Program For Behavioral Health, Anne Thatcher
Dissertations
Problem. Pediatric mental health complaints and subsequent hospitalizations have been steadily increasing. The Behavioral Health Network (BHN) developed an intensive outreach case management program aimed at reducing youth mental health emergency department (ED) visits and inpatient psychiatric admissions. The Youth Emergency Room Enhancement (YERE) program was a process improvement initiative to provide immediate case management to youth and caregivers for mental health care.
Methods. A Plan-Do-Study-Act (PDSA) method utilizing a retrospective case record review occurred over a six-month period. A convenience sample of youth aged 6-20 years presenting to one of eight healthcare facilities for either ED or inpatient hospitalization …
The Impact Of Mental Health Issues On Academic Achievement In High School Students, Patricia Lea Sutherland
The Impact Of Mental Health Issues On Academic Achievement In High School Students, Patricia Lea Sutherland
Electronic Theses, Projects, and Dissertations
An adolescent’s time in school is not merely academic; they are developing socially, physically, and emotionally. Prior research has demonstrated a correlation between a student’s poor academic performance and his/her need for emotional and mental health support. This research project sought to answer the following research questions: 1) Do mental health services in a high school setting help facilitate students’ academic achievement? and 2) Does a focus on mental health issues improve overall health and well-being in high school students? Participants for this study are 10 staff members (including teachers, administrators, counselors, and others) of a high school in San …
An Examination Of The Impact Traumatic Events Has On Psychosocial Impairment In Eating Disorder Patients, Jennifer Parker Hackett
An Examination Of The Impact Traumatic Events Has On Psychosocial Impairment In Eating Disorder Patients, Jennifer Parker Hackett
Electronic Theses, Projects, and Dissertations
Research suggests that trauma has an impact on eating disorders. While prior research has demonstrated that the trauma from abuse has a significant impact on eating disorders, research has failed to explore other types of trauma. In addition, previous studies have stopped short of examining the impact trauma has on functioning among individuals with an eating disorder. This study aimed to address that gap in the literature. The purpose of this study is to examine whether traumatic life events impact psychosocial functioning among individuals living with an eating disorder. Furthermore, this study aimed to identify which traumas are shown to …
Overwhelmed: A Qualitative Study Of The Mental Health Experiences Of Mothers Of Minor Children After Release From Jail And Prison, Ann Elizabeth Stanton
Overwhelmed: A Qualitative Study Of The Mental Health Experiences Of Mothers Of Minor Children After Release From Jail And Prison, Ann Elizabeth Stanton
Theses and Dissertations
Mass incarceration in US jails and prisons is a major public health concern. Over one million women are released from US jails and prisons each year. Incarcerated women experience disproportionately high rates of mental health issues and most incarcerated women are mothers of minor children. Mothers of minor children who leave jails and prisons with mental health issues face increased risks of experiencing substance use, risky behaviors, homelessness, and recidivism. Their children are also at increased risk for adverse mental health, behavioral, and social outcomes. The purpose of this study was to explore the mental health experiences of mothers of …
Launch-Ing Minnesota Early Childhood Mental Health Into The Future, Molly Abdo, Alyssa Baker, Elizabeth Holz
Launch-Ing Minnesota Early Childhood Mental Health Into The Future, Molly Abdo, Alyssa Baker, Elizabeth Holz
Master of Social Work Student Policy Advocacy Briefs
What is Social-Emotional Development? The foundation for lifelong mental health, including social and emotional development, is established early in life and shaped by children's relationships with parents, caregivers, and peers. This foundation is critical to all aspects of healthy development and growth in early childhood. Social-emotional development can be defined as "the capacity to form secure relationships; experience, express, and manage a range of emotions; and learn and explore one's environment."
Why is it Important? When children fail to develop social-emotionally, mental health symptoms begin to emerge and can "cause distress, interfere with relationships, limit the child's participation in daily …
Perinatal Depression: Investing In Our Mothers Before It's Too Late, Katelin Dietel, Anna Garbers, Kailee Hrubetz
Perinatal Depression: Investing In Our Mothers Before It's Too Late, Katelin Dietel, Anna Garbers, Kailee Hrubetz
Master of Social Work Student Policy Advocacy Briefs
Currently, there is no consistent, universal screening process within the United States healthcare system that considers the mental health of a new mother. Mandatory screening for perinatal depressive symptoms would improve the lives of new mothers, children, and their families nationwide. Home-visiting programs, such as the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program supported by Healthy Families America, should be universal and available in every locale in the U.S. Individual state policies within these programs should be tailored to meet the needs of each unique mother, child, and family. Early, nurturing relationships are critical to a child's development. …
Invisible No More: Bringing Awareness To Mental Health In Older Adults Living In Rural Minnesota, Abigail Schaper, Carley Ledoux, Kristry Danielson
Invisible No More: Bringing Awareness To Mental Health In Older Adults Living In Rural Minnesota, Abigail Schaper, Carley Ledoux, Kristry Danielson
Master of Social Work Student Policy Advocacy Briefs
Approximately 8 million Americans 65 years of age and older have mental health disorders. It is estimated that these numbers could reach 14.4 million by 2030. Minnesotans turning 65 in this decade (about 285,000) will be greater than the past four decades combined (Aging: MN State Demographic Center, 2018). Anxiety and depression are two of the more common mental health disorders in older adults and are associated with severe consequences, including life dissatisfaction, illness, and mortality. With this growth comes many barriers. The rural mental health system is not equipped to address this growth. The system is underfunded, largely uncoordinated, …
Mental Health And Academic Outcomes Among Adolescents In South Korean Orphanages, Hollee Ann Mcginnis
Mental Health And Academic Outcomes Among Adolescents In South Korean Orphanages, Hollee Ann Mcginnis
Arts & Sciences Electronic Theses and Dissertations
Research conducted over the past 100 years in Western nations support the adverse effects of orphanages on children’s emotional, developmental, and social well-being as well as economic costs to society (Save the Children UK, 2009; Bakermans-Kranenburg, Van IJzendoorn & Juffer, 2008; Williams & Greenberg, 2010). Globally, the number of orphaned and abandoned children is conservatively estimated to be around 143 million, of whom the majority reside in Asia, followed by Sub-Saharan Africa (UNICEF, UNAIDS, & USAID, 2004). South Korea (hereafter “Korea”) is an exemplary nation for study because it has a well-established child welfare system, including family-based alternatives (domestic and …
A Study Of Innovation In Model Project Design: Addressing Mental Health Symptoms Among Co-Occurring Substance Use And Mentally Ill Clients Who Are Homeless In A Local Community Clinic Setting, Isis Dian Martel
Graduate Theses and Dissertations
Homeless persons with co-occurring substance use combined with mental illness constitute a particularly vulnerable subgroup with complex service needs. Unfortunately, the capacity to deliver critical treatment services has been extremely limited causing many from this population to remain untreated. Untreated co-occurring disorders can lead to a host of difficulties for both the individual and the community (Bouchery, Harwood, Sacks, Simon, & Brewer, 2011). Developing community based intervention services in Arkansas is a key activity necessary in strategically addressing this problem (Barbee, Gonzales, & Shelor, 2016). In partnership with the Arkansas Division of Behavioral Health Services, a local community treatment provider …
A Mental Health Workforce Crisis: Roadmap For Enhancing Recruitment & Retention In Minnesota, Iowa & Wisconsin, Lindsay Duenow, Rebecca Kobernick, Mckenzie Sohre, Kim Wallgren
A Mental Health Workforce Crisis: Roadmap For Enhancing Recruitment & Retention In Minnesota, Iowa & Wisconsin, Lindsay Duenow, Rebecca Kobernick, Mckenzie Sohre, Kim Wallgren
Master of Social Work Student Policy Advocacy Briefs
Building and maintaining an adequate mental health workforce requires successful recruitment and retention of qualified workers. Identifying recruitment and retention factors specific to behavioral health providers is essential in determining strategies for increasing the rural health behavioral workforce. The World Health Organization estimates there are 1.18 million additional mental health workers needed to end the mental health treatment gap between patients and providers worldwide. In the U.S., there has been a nationwide shortage of mental health professionals, and this shortage is more pronounced in rural communities,with twenty percent of rural areas lacking mental health services, compared to five percent of …
{Ace}Ing Early Childhood In Minnesota, Bailey Alston, Casie Devos, Alisha Field, Renee Gasner
{Ace}Ing Early Childhood In Minnesota, Bailey Alston, Casie Devos, Alisha Field, Renee Gasner
Master of Social Work Student Policy Advocacy Briefs
Too many young children are facing ACEs that are detrimentally impacting their development and contributing to negative outcomes that persist into adulthood. There are no current policies using the ACE questions to drive mental health interventions. The Governor’s Task Force on Mental Health made nine recommendations that, if implemented, will greatly improve the mental health and well-being of children and their parents. Improving early childhood prevention and intervention programs helps ALL Minnesota’s families build healthy and rich experiences for their children.
- Expand the Early Childhood Mental Health Grant program statewide to increase early childhood mental health specialists.
- Create a Governor’s …
The Impact Of A Civic Service Program On Biopsychosocial Outcomes Of Post 9/11 U.S. Military Veterans, Monica M. Matthieu, Karen A. Lawrence, Emma Robertson-Blackmore
The Impact Of A Civic Service Program On Biopsychosocial Outcomes Of Post 9/11 U.S. Military Veterans, Monica M. Matthieu, Karen A. Lawrence, Emma Robertson-Blackmore
Social Work Faculty Publications
Volunteering as a health promotion intervention, improves physical health, mental health, and social outcomes particularly in older adults, yet limited research exists for veterans. We conducted a preliminary study to explore whether volunteering impacts a variety of biopsychosocial outcomes, including symptoms of post-traumatic stress disorder (PTSD) and depression, among returning military veterans from Iraq and Afghanistan. A survey enrolling a prospective cohort of United States (U.S.) veterans who served in the military after 11 September 2001 and who participated in a national civic service program was conducted. A total of 346 veterans completed standardized health, mental health, and psychosocial self-report …
Preparing To Parent: Mindfulness In Expectant Parents Exposed To Adversity, Laurel Marie Hicks
Preparing To Parent: Mindfulness In Expectant Parents Exposed To Adversity, Laurel Marie Hicks
Wayne State University Dissertations
Expectant parents who have been exposed to psychosocial risk encounter deleterious psychological (Ashley et al., 2016), and physiological (V. H. Pereira, Campos, & Sousa, 2017) effects. This not only affects the parent-to-be, but also may affect the developing fetus (E. P. Davis et al., 2011) and is linked to poorer infant development (Lefmann & Combs-Orme, 2014). However, not all risk-exposed individuals experience this, many are resilient and still thrive in the face of adversity. Understanding potential risk and resiliency factors in expectant parents is advantageous, so tailored interventions can be devised to improve outcomes. One potential resiliency factor, mindfulness, is …
Missoula’S Homeless Children: Effects Of Homelessness On Mental, Emotional And Social Health, Sarah L. Shapiro
Missoula’S Homeless Children: Effects Of Homelessness On Mental, Emotional And Social Health, Sarah L. Shapiro
Undergraduate Theses, Professional Papers, and Capstone Artifacts
Missoula’s Homeless Children: Effects of Homelessness on Mental, Emotional and Social Health
The mental, emotional, and social health of children are greatly affected by being homeless. Being homeless as a child could effect a person’s coping skills and lead to mental health issues that increase the likelihood of substance abuse , suicide attempts, or adult homelessness. The purpose of this research project is to explore the negative effects of homelessness on Missoula children, and to identify services that could be useful in combating those effects. Methods for this project, included two data collection strategies. First, a literature review was completed …
University Scholar Series: Ed Cohen, Edward Cohen
University Scholar Series: Ed Cohen, Edward Cohen
University Scholar Series
Mental Health and Cultural Context in Vietnam
On May 6, 2015, Dr. Ed Cohen spoke in the University Scholar Series hosted by Provost Andy Feinstein at the Dr. Martin Luther King, Jr. Library. In this presentation, Dr. Cohen explored current research about mental illness and approaches to treatment in Vietnam, in addition to this country’s world view about illness, wellness and emotional health. Cohen is an Associate Professor in the School of Social Work and a Co-Investigator of SJSU's Social Work Education Enhancement Program in Vietnam.
Practice Recommendations For Mental Health Professionals: Perspectives From Grandparents And Their Adolescent Grandchildren, Kendra A. O'Hora, Megan L. Dolbin-Macnab
Practice Recommendations For Mental Health Professionals: Perspectives From Grandparents And Their Adolescent Grandchildren, Kendra A. O'Hora, Megan L. Dolbin-Macnab
GrandFamilies: The Contemporary Journal of Research, Practice and Policy
Although grandfamilies are consumers of a variety of mental health services, less is known about what these families, particularly the grandchildren, want from practitioners. To gain insight into how practitioners can best meet the needs of grandfamilies, 40 custodial grandmothers and their adolescent grandchildren were interviewed. Results of a qualitative analysis indicated that grandmothers and grandchildren did not make clear distinctions between various types of services and service providers. Grandchildren, in particular, emphasized the need for mental health professionals to facilitate mentoring and to provide opportunities for grandchildren to socialize with other grandchildren who have been through similar circumstances. Grandmothers …
Metaphoric Generative Genograms: A Journey To Bring Genograms To Life Through Metaphorical Components, Elisa Garcia
Metaphoric Generative Genograms: A Journey To Bring Genograms To Life Through Metaphorical Components, Elisa Garcia
Department of Family Therapy Dissertations and Applied Clinical Projects
The purpose of this dissertation is to offer a greater understanding of the potential of genograms through my clinical work from a Bowen Family Systems lens. I account for how I processed and effectively blended metaphorical components, by examining six cases from my two-year journal entries, of bringing genograms to life in sessions. I also explain how I created a useful tool, the Metaphoric Generative Genogram, that can benefit other clinicians working with children and families in the foster care community.
Time-Limited Case Management For Homeless Mothers With Mental Health Problems: Effects On Caregiver Mental Health., Judith Samuels, Patrick J. Fowler, Andrea Ault-Brutus, Dein-In Tang, Katherine Marcal
Time-Limited Case Management For Homeless Mothers With Mental Health Problems: Effects On Caregiver Mental Health., Judith Samuels, Patrick J. Fowler, Andrea Ault-Brutus, Dein-In Tang, Katherine Marcal
Brown School Faculty Publications
Objective: In this study we test the effect of a time-limited case management model targeting homeless mothers who are experiencing mental health problems. Adapted from an empirically informed intervention to prevent recurrent homelessness among individuals, the Family Critical Time Intervention (FCTI) supports mothers with children for a 9-month period as they move from homeless shelters into affordable housing. The case management team uses a structured intervention to encourage mothers to create and maintain necessary connections in the community for key family supports. Method: We use a longitudinal randomized controlled trial (N = 210) to test whether homeless mothers referred to …
Clinical Social Work In A Digital Environment: Ethical And Risk-Management Challenges, Frederic G. Reamer
Clinical Social Work In A Digital Environment: Ethical And Risk-Management Challenges, Frederic G. Reamer
Faculty Publications
Clinical social workers’ use of digital and other technology to provide distance counseling services is proliferating. Increasing numbers of contemporary practitioners are using video counseling, email chat, social networking websites, text messaging, smartphone apps, avatar-based websites, self-guided web-based interventions, and other technology to provide clinical services to clients, some of whom they may never meet in person. The advent of this technology has produced a wide range of ethical challenges related to social workers’ application of traditional social work ethics concepts: client informed consent; client privacy and confidentiality; boundaries and dual relationships; conflicts of interest; practitioner competence; records and documentation; …
Perspectives Of Social Work Students On Nutrition And The Nutrition Effects On Mental Health, Diana Tran
Perspectives Of Social Work Students On Nutrition And The Nutrition Effects On Mental Health, Diana Tran
Electronic Theses, Projects, and Dissertations
Nutrition is related to the mental well-being of clients. However, the nutritional views and practices of social workers in the mental health field have not been thoroughly explored. By using the post-positivist paradigm, 15 mental health social work students were interviewed for their perspectives regarding nutrition and nutrition’s effect on stress. Their main ideas were identified, connected, and organized to develop a theoretical statement. The resulting theory focused on the development of social work students' perspectives in applying nutrition into their mental health practice. The students were influenced by a variety of background factors, including their education, barriers to applying …
Dsm-Iv-Tr/Dsm-5, An Evidence-Based Comparative Analysis With Focus On The Cultural Context Of Mental Health Illness Of: Bipolar Disorders, Depression, Autism Disorders, Anxiety And Adhd., Claudia Zendejas-Finley
Dsm-Iv-Tr/Dsm-5, An Evidence-Based Comparative Analysis With Focus On The Cultural Context Of Mental Health Illness Of: Bipolar Disorders, Depression, Autism Disorders, Anxiety And Adhd., Claudia Zendejas-Finley
All Graduate Theses, Dissertations, and Other Capstone Projects
The DSM-5 presents many changes in the criteria and categories used in the clinical diagnosis of clients. In addition, the proposed changes within the DSM-5 also attempts to address some of the concerns regarding the lack of a contextual assessment process regarding the role of culture within the lives of clients (Warren, 2013). This research aims to create a comparison between the DSM-IV-TR and the DSM-5 of some of the most common diagnosis used by Family Service Rochester including: bipolar disorder, depression, autism disorder, anxiety and ADHD. In addition, this project also intends to develop a comprehensive cultural analysis of …
Responding To A Community Need: Mobile Crisis Program Training Manuals, Kelsey Tollefson
Responding To A Community Need: Mobile Crisis Program Training Manuals, Kelsey Tollefson
All Graduate Theses, Dissertations, and Other Capstone Projects
The purpose of this project was to develop a training curriculum for the South Central Mobile Crisis Program, which is a part of Horizon Homes, Inc. Continued education and training is required for all mental health professionals, mental health practitioners, and rehabilitative staff. Because of the requirements outlined in Minnesota statute 256B.0944, 256B.0624,and the Department of Human Services, all staff within this program must receive at least thirty hours of crisis-related training prior to working with clients.