INCREASING ENGAGEMENT IN DAILY ACTIVITIES BY OLDER ADULTS WITH DEMENTIA

This study analyzed the effects of nursing assistants' use of prompts and praise to increase the engagement of older adults with dementia in daily living activities. The multiple baseline design across morning and afternoon work shifts showed consistent increases in engagement by each of the 5 residents during the intervention. These results suggest that increasing prompts and praise by nursing assistants may, in turn, increase the rate of engagement of older adults with dementia.     

Evaluating the influence of time of day on activity engagement in persons with dementia

Dementia is a serious disease affecting a growing number of people. With the onset of dementia comes a decline in social activity engagement that can negatively impact multiple aspects of a person's life. Research suggests that time of day may influence a person with dementia's behavior, including activity engagement, but such research is limited. The purpose of this study was to evaluate the influence of time of day on engagement in activities in persons diagnosed with dementia. An alternating treatments design was used with three participants to measure activity engagement during two times of day, morning and afternoon, and during two activities, a moderately preferred and a low preferred. Results showed no differentiation in engagement between morning and afternoon activities for all three participants, with high levels of engagement during both times of day. For two participants, results showed no differentiation in engagement between moderately preferred and low preferred activities. For one participant, levels of engagement were higher during moderately preferred activities than during low preferred activities.     

Navigating into,through, and beyond the middle grades: The role of middle grades attendance in staying on track for high school graduation

In this longitudinal study, we investigated the use of attendance during middle school as a behavioral indicator of engagement to predict whether students are on track toward high school graduation. We used administrative data from four cohorts of students in New York City schools (N = 303,845) to (a) explore patterns of change in attendance between Grades 4 and 8 and (b) determine the extent to which changes in attendance between Grades 4 and 8 predict which students are on track in Grade 9 for going on to graduate from high school. Results of latent growth modeling indicated that students demonstrate the most substantial declines in attendance during Grade 8 and that attendance changes are most variable in this year, with some students demonstrating much more dramatic declines than others. In addition, these changes in attendance were robust predictors of whether students were on track for high school graduation. To identify students who are at risk for not graduating for the purposes of providing appropriate interventions, educators should pay attention to their commonly collected data on attendance rates as a behavioral indicator of engagement.     

Wearable activity schedules to promote independence in young children

Activity schedules consist of a series of visual discriminative stimuli, arranged in booklets or binders, which function as prompts for appropriate behavior. Although activity schedules are useful, their typical presentation in binders can be cumbersome and stigmatizing, placing additional barriers for independence and inclusion. The purpose of the present studies was to evaluate the usefulness of a wearable activity schedule and determine whether prompts provided by it would be sufficient to support completion of a complex chain of behaviors by young children. In Experiment 1, the Octopus watch® provided prompts to children of typical development to complete a morning routine independently. In Experiment 2, the usefulness of the watch was evaluated in children with autism spectrum disorder engaged in play activities in a clinical setting. In both experiments, children reliably displayed a greater proportion of independent engagement in target behaviors when prompts were delivered by the watch compared to control conditions.     

An experimental analysis of anti-litter procedures

This study evaluates the differential effectiveness of six different anti-litter procedures in two neighborhood theaters. The procedures used to encourage individuals in attendance to pick up litter and deposit it properly included: providing litterbags, providing litterbags with instructions to use them, providing extra trash cans, showing a special anti-litter film before the feature film, and providing incentives for the appropriate deposit of litter. In both theaters, the incentive procedures resulted in the removal of over 90% of all litter by the children in attendance, a figure far above that achieved by the other procedures investigated.     

The Effects of Prompts on Minority Children's Screening Attendance at a Community Mental Health Center

This study examined the impact of prompts upon the screening attendence rate at a children's community mental health center (CMHC) serving lower socioeconomic urban minority clients. Subjects (274 children under age 18 and their adult caretakers who contacted the CMHC for screening appointments) were assigned to one of three conditions: (a) a phone prompt one day before the appointment, (b) a letter prompt one to two days before the appointment, and (c) a no-intervention control group. Both phone and letter prompts produced significantly greater attendance than the no-intervention condition. The phone prompt group evidenced a tendency toward greater attendance than the letter prompt group. A cost analysis indicated that the phone prompt generated more net revenue than the other two conditions and had a lower total cost and per subject than the conditon. The data suggest that prompts can be effectively used by mental health facilities to engage minority clients in the intial phase of the treament process.     

Religious Service Attendance and Religious and Secular Organizational Engagement in the United Kingdom

The study uses nationally representative data to examine whether the moral freighting Putnam and Campbell (2010) propose, based on American experiences, may apply to overall British society. Specifically, it tests whether religious service attendance increases religious or secular organizational activities, possibly due to moral freighting that encourages religious congregants to practice their faith, transcending ego boundaries and self-interest. It is also necessary to determine if engagement in religious or secular organizational activities elevates the degree of religious service attendance, thus forming a bidirectional association. The study employs the maximum likelihood-structural equation modeling (ML-SEM) method to verify the proposed reciprocity. The empirical tests confirm that a synergistic reciprocal relationship is established between religious service attendance and religious organizational engagement, and that religious service attendance increases secular organizational engagement. However, secular organizational engagement does not make a bidirectional contribution to religious service attendance.     

Check & Connect: The importance of relationships for promoting engagement with school

The purpose of this study was to examine whether the closeness and quality of relationships between intervention staff and students involved in the Check & Connect program were associated with improved student engagement in school. Participants included 80 elementary and middle school students referred to the Check & Connect program for poor attendance, an early sign of disengagement, while in elementary school. After accounting for student risk and prior attendance, student and interventionist perceptions of the closeness and quality of their relationship were found to be associated with improved engagement in terms of school attendance, and interventionist perceptions of their relationships with students were associated with teacher-rated academic engagement (e.g., prepared for class, work completion, persistence). The importance of designing and evaluating relationship-based interventions for students at-risk for school failure is discussed.     

Assessing preference in elders with dementia using multimedia and verbal pleasant events schedules

The current study compared an abbreviated oral interview version of the Pleasant Events Schedule – Alzheimer's Disease (PES‐AD) to a multimedia‐supplemented version. Both measures identified multiple preferred items and their scores were moderately correlated (r = .481). Direct observations were conducted to determine whether either of the two measures predicted subsequent engagement. For all nine individuals with dementia, items endorsed as preferred by both versions of the PES‐AD resulted in high levels of engagement and items endorsed as non‐preferred items on both measures resulted in low to moderate levels of engagement. Individuals with MMSE scores of 10 or higher had more stable and differentiated patterns of engagement than individuals with scores below 10. For individuals with higher MMSE scores, items endorsed only by the multimedia version resulted in high engagement levels (i.e., true positive) while items endorsed only on the verbal presentation resulted in low levels (i.e., false positive). Copyright © 2008 John Wiley & Sons, Ltd.     

The Effects of US Presidential Elections on Work Engagement and Job Performance

We predicted that presidential election results would spill over to influence the work domain. Individuals who voted for the winning candidate were expected to experience increased engagement, whereas individuals who voted for the losing candidate were expected to experience decreased engagement. We tested these predictions within the context of the 2016 US presidential election. Using a sample of 232 working Americans, work engagement and job performance were assessed one week prior to the election, the day after the election, and one week after the election. Contrary to our prediction, individuals who voted for Trump (the winning candidate) did not report increased work engagement, thereby providing no evidence of positive spillover. However, individuals who voted for Clinton (the losing candidate) were less engaged on the day after the election compared to baseline, demonstrating negative spillover. Downstream, work engagement was positively related to job performance. However, these effects were relatively short-lived, as engagement returned to baseline levels within one week following the election. Our results suggest that elections can have important implications for work-related outcomes. From a practical perspective we suggest that to the extent possible it may be prudent to avoid scheduling important work tasks for the days following presidential elections.     

Ethnicity differences in child and parental outcomes following involvement the PACE program

This study investigated ethnic differences in the extent to which engagement (i.e., attendance and quality of participation) in the PACE (Parenting our Children to Excellence) program predicted positive child and parent outcomes. PACE is an 8-week preventive intervention aimed at parents of preschool children. The study investigated the relation of engagement to outcomes in an ethnically diverse sample of 298 African American and 280 European American parents. Overall results demonstrated that engagement in PACE significantly improved child and parent outcomes for both African American and European American participants. Some improvements were evident at post-assessment already and were maintained or became stronger at a one-year follow-up assessment, whereas others only became evident at follow-up. Specifically, results revealed that attendance in PACE significantly improved child coping competence and parenting stress for both the African American and European American samples. PACE attendance also significantly improved child behavior problems, parental satisfaction and parental efficacy for the European American sample. Findings indicate that PACE is a promising intervention for parents of African American and Caucasian preschoolers; although further research and program refinement is necessary in order to understand the mechanisms with the PACE intervention that seem to vary for African American compared to Caucasian families.     

TEACHING CHILDREN WITH AUTISM TO USE PHOTOGRAPHIC ACTIVITY SCHEDULES: MAINTENANCE AND GENERALIZATION OF COMPLEX RESPONSE CHAINS

We used a graduated guidance procedure to teach 4 boys with autism to follow photographic activity schedules to increase on-task and on-schedule behavior. The multiple baseline across participants design included baseline, teaching, maintenance, resequencing of photographs, and generalization to novel photographs phases. The results indicated that photographic activity schedules (albums depicting after-school activities) produced sustained engagement, and skills generalized to a new sequence of photographs and to new photographs. The acquisition of schedule-following skills enabled these children with severe developmental disabilities to display lengthy response chains, independently change activities, and change activities in different group home settings in the absence of immediate supervision and prompts from others.     

Client attendance measures in counselling psychology trainees

Counselling supervisors and educators have yet to reach a consensus about standard measures for evaluating the performance of graduate student therapists. Compared to self‐reports and rater judgements, client attendance records provide low‐inference behavioural data partially reflective of clients’ engagement with therapists. This naturalistic study evaluates client attendance data using archival records of 92 doctoral students in beginning and advanced counselling practica who produced data for 771 clients, 3,949 scheduled sessions and 3,186 attended sessions. Providing evidence of the sample representativeness for clinicians, results indicated that the mean number of sessions attended per client for student therapists (5.65) was very similar to that reported in the literature for outpatient therapists (<6). As expected because of structural differences in client assignment, beginning and advanced students evidenced statistically significant differences on attendance variables such as number of clients and scheduled sessions. In contrast, attendance ratios were equivalent across counsellor experience, suggesting that these individual difference variables could be useful for evaluation of therapist competencies related to client engagement.     

Group Cognitive-Behavioral Therapy via Telebehavioral Health for Those With Psychotic Spectrum Disorders: A Case Series

Telebehavioral health emerged as an important practice during the coronavirus disease 2019 (COVID-19) pandemic as an opportunity for continued evidence-based mental health intervention, while minimizing exposure to coronavirus contagion. Though preliminary research suggests feasibility and positive outcomes of telebehavioral health practice for people with schizophrenia spectrum and other psychotic disorders, there is limited research about implementation and effectiveness of this practice (Kasckow et al., 2014). This case series highlights the transition from in-person to telebehavioral health practice of a Cognitive Behavioral Social Skills Training for Schizophrenia group due to the COVID-19 pandemic. This article summarizes: (a) the staff procedures needed to transition the group from in-person to telebehavioral health, (b) participant outcome data, (c) session attendance data, and (d) survey results from facilitators and participants about barriers and facilitators of the transition to telebehavioral health, and about how the virtual platform altered the therapeutic relationship and engagement. Participant outcome and engagement data suggest that, not only were two participants able to transition to telehealth and complete the program, but both participants also showed notable improvement in treatment engagement, goal progress, and skill acquisition. Surveys of six facilitators and one participant highlight how the transition to telebehavioral health had treatment advantages (e.g., therapeutic relationship, treatment engagement, group dynamics). Though survey results highlighted several implementation challenges in using the new virtual platform (e.g., technological connectivity, confidential space for engagement), no survey respondents reported that participation in this program resulted in harm to facilitators or participants. All facilitators and one participant agreed that the transition from in-person to virtual services was easy and reduced transportation barriers. Given the limited treatment engagement for this population (Lora et al., 2012) and the importance of early intervention to maximize clinical outcomes (Black et al., 2001; Bottlender et al., 2003), unanimous facilitator and participant report about improved patient attendance and participation in treatment after the transition to telebehavioral health was critically important. Though results of this case study are promising in suggesting telebehavioral health could be a viable modality for providing psychosocial treatment to people with schizophrenia spectrum and other psychotic disorders, more rigorous study is needed.     

INCREASING EXTENDED CARE FACILITY RESIDENTS' ATTENDANCE AT RECREATIONAL ACTIVITIES WITH CONVENIENT LOCATIONS AND PERSONAL INVITATIONS1

Residents of extended care facilities generally exhibit a low level of attendance at recreational and therapeutic activities. Spatial arrangement of rooms, prompting, snacks, and small prizes have been suggested as factors that affect attendance. The present study examined the effects of an extensive system of prompts and the location of activity areas on the attendance of residents at a variety of activities. Twenty-six subjects were randomly selected from the ambulatory population of the facility. The first time each subject entered the activity room during the first 6 min of an activity session their name was recorded. Reliability measures were taken at 10 sessions, with a 95% mean agreement between observers. The variables examined were the amount of individualization of subjects (experimental group I: names announced versus experimental group 2: names not announced), room location (central or peripheral), use of names in announcements (activity only versus activity and group I names), and mode of announcement (PA system only versus PA system and in-person). A counter-balanced group design with repeated measures was used, with a randomly determined order of application of experimental treatments. An analysis of variance split plot 2.222 (Kirk, R. E. Experimental Design: Procedures for the Behavioral Science. Belmont, Ca.: Brooks-Cole, 1968.) of the level of subject attendance yielded significant main effects for room location, F(1, 24) = 5.47, p < 0.05, and type of announcement, F(1, 24) = 9.10, p < 0.01, and significant interactions for Individualization × Use of Names in Announcements, F(1, 24) = 5.57, p < 0.05, and Room Location × Mode of Announcement, F(1, 24) = 7.90, p < 0.01. The results indicate that using a centrally located room and announcement of resident names increases attendance at a variety of activities. The increased social and environmental interaction generated by activity attendance has potential therapeutic benefits for the residents involved. Furthermore, the kind of information reported here and by others should be taken into consideration by planners of a variety of group living facilities, ranging from nursing homes to residential treatment cottages.     

A DBT Skills training group for family caregivers of persons with dementia

A Dialectical Behavior Therapy Skills training manual (DBT Skills) was adapted for use with caregivers of individuals with dementia. Implementation occurred in a community clinic with a heterogeneous caregiver group at risk for elder abuse. Sixteen caregivers completed the 9-week group. The results point to improved psychosocial adjustment, particularly increased problem-focused coping, enhanced emotional well-being, and less fatigue. Caregivers tended to utilize individual therapeutic services at a higher rate during the period of group attendance, indicative of appropriate help-seeking behavior in highly demanding situations. Six of the 16 caregivers repeated the training sequence in “booster” groups. Follow-up data from the booster groups suggest that high-risk caregivers may require continuing support to maintain treatment gains. In addition to demonstrating the feasibility of DBT Skills with caregivers, the results warrant a controlled outcome evaluation.     

Actions,Feelings, and Values: Foundations of Meaning and Personhood in Dementia

SUMMARY

Viktor Frankl's writings on the sources of meaning in human life are compared to emergent views on personhood in older individuals with dementing illnesses. An ethnomethodological study of a CBRF (community based residential facility) with two sections, each housing about 10 persons, revealed meaning in residents' actions, feelings, and expressions of values. These individuals showed it is possible to retain what Frankl called “tragic optimism” despite cognitive deterioration. Through active engagement with their environments and with one another, a wide range of expressed emotions including happiness and humor, and caring sensitivity toward others, these elders showed that given a supportive environment, dementia does not destroy meaning. These observations form the basis of suggestions for pastoral care and ministry with people with dementia.