Child- versus teacher-administered token programs in a psychiatric hospital school

The purpose of this study was to: (a) compare student-administered token programs with similar programs administered by professional teachers, (b) investigate the contribution of feedback to the success of token systems, (c) compare the effectiveness of peer and teacher feedback, and (d) test a sequence of withdrawal from token programs designed to increase generalization. Results indicated that (a) peers could do just as well as teachers in reducing disruptive behavior through a token program, (b) feedback is not solely responsible for the effectiveness of token reinforcement, (c) peer feedback may be more effective than teacher feedback, and (d) withdrawal from token reinforcement to feedback may be a successful method of retarding the increases in disruptive behavior usually found when backup reinforcers are eliminated.The project was supported by Grant OEG 0-71-2872 (607) from the U.S. Department of Education and Department of Health, Education, and Welfare. The opinions expressed herein, however, do not necessarily reflect the position or policy of the U.S. Office of Education, and no official endorsement by that Office should be inferred. The author would like to thank Drs. L. Krasner, A. O. Ross, and K. Feldman for their assistance throughout the study, and Dr. K. D. O'Leary for his invaluable help. Also gratefully acknowledged is the help of R. Spitalnik, R. Kent, M. Hageman. S. Ransom, W. Kaler, S. Golembeski and E. Howard.     

The effectiveness of drug treatment programs in reducing criminal behavior: a meta-analysis

The main aim of this paper is to assess the effectiveness of drug treatment programs in reducing criminal behavior. The research is based on a systematic review and meta-analysis of evaluations of drug treatment programs. The research investigated various drug treatment programs including methadone treatment, therapeutic communities, post-release supervision for drug-misusing offenders, and drug courts, and focused on drug treatment programs that were primarily concerned with heroin, crack and cocaine misuse. The main outcome variable analyzed was reoffending following treatment as measured by self-reports or official records. The study was based on a meta-analysis of 28 evaluations of drug treatment programs. The meta-analysis involved calculating individual effect sizes for each study and weighted mean effect sizes for groups of studies. The mean odds of offending following treatment were significantly lower among clients of the drug treatment programs than among the comparison groups. However, the results varied by type of program, type of evaluation methods used, and characteristics of clients.     

Crisis prevention and intervention training for psychiatric hospital staff

A 5-day course designed to train psychiatric hospital staff verbal and physical methods of preventing violence and injury when dealing with upset patients was taught to 89 staff from maximum and less secure wards. Compared to no-treatment controls, experimental subjects improved significantly on four tests of crisis-related tests and knowledge. Questionnaire and self-report measures from staff and patients on the training wards also indicated positive course effects. Assault frequencies decreased immediately after the course and staff injuries on experimental wards were reduced after the course relative to control wards.     

A randomized trial of a brief primary-care-based intervention for reducing at-risk drinking practices.

This randomized trial evaluated an intervention for reducing at-risk drinking practices in a sample of 307 patients. Eligible drinking patterns included chronic drinking (> or = 2 drinks per day in the past month), binge drinking (> or = 5 drinks per occasion at least twice in the past month), and drinking and driving (driving after > 2 drinks in the past month). Members of the intervention group received a message from their physician during their regularly scheduled visit, a self-help manual, written personalized feedback, and up to 3 telephone counseling calls. Dropout was significantly higher in the intervention than control group.     

Quality monitoring for early hearing detection and intervention programs to optimize performance

The purpose of this chapter is to review the principles of quality monitoring for newborn screening programs at both a hospital and a public health level. The focus is on quality assurance in Early Hearing Detection and Intervention (EHDI). The chapter addresses the need for a systems approach to quality, beginning with the birth screening, moving to follow-up re-screening and on to confirmatory evaluations and life-long intervention and management for the infants identified with permanent hearing loss. Benchmarks are identified to assist those involved in establishing programs or in improving program performance. As the use of electronic information systems in EHDI becomes widespread, the importance of strict computer-based logic rules to assure patient privacy is addressed.     

Personal responsibility,empowerment and medical utilization: a theoretical framework for considering counselling and offset costs

The problem of effectively managing patients with functional somatic symptoms remains huge in both primary and hospital care, although the potential benefits of mental health interventions such as counselling or psychotherapy are still not widely accepted. Unfortunately, the cost-effective evaluation of counselling has been beset by methodological problems, which stem from attempting to make comparisons between counsellors with different types of training, therapeutic approach and case mix. Since these real-world variations in counselling practice are likely to remain, it is proposed that a different approach to the evaluation of cost-effectiveness should be adopted in the hope of accelerating acceptance of the value of psychological interventions for the army of patients who are currently labelled as ‘difficult’ or ‘heartsink’ and who do not receive the treatment they deserve from the health-care services. It is proposed that, since the common aim of almost all mental health interventions is to engender or enhance a sense of ‘personal responsibility’ in patients/clients, this core objective should form an agreed ‘yardstick’ against which to evaluate the impact of various mental health interventions. Furthermore, since personal responsibility and future health-care utilization (and associated costs) can be assumed to be directly causally related, it is proposed that offset costs should form the basis for future cost-effectiveness evaluations.     

Effectiveness of a brief intervention using mental simulations in reducing alcohol consumption in corporate employees

A theory-based intervention aimed at reducing corporate employees' alcohol consumption in excess of guideline limits is presented. The intervention adopted an outcome mental simulation technique and was administered to a sample of corporate employees from three companies. A single-arm randomized-controlled design was adopted. All participants completed baseline psychological measures and self-reported number of alcohol units consumed and binge-drinking occasions. Participants allocated to the intervention condition were presented with a mental simulation exercise. One month later, participants completed follow-up measures of the psychological variables and alcohol consumption. Results revealed a significant effect of the mental simulation intervention on number of units of alcohol consumed at follow-up. There was no effect of the intervention on frequency of binge-drinking occasions. There was no evidence for the mediation of the effect of mental simulations on alcohol consumption by the perceived behavioural control and motivation variables. Results support the efficacy of the mental simulation intervention in reducing alcohol consumption but not in reducing binge drinking or alcohol consumption in excess of guideline limits, among corporate employees. Results are discussed with respect to the importance of the mental simulation intervention to inform practice and the proposed processes by which mental simulations affect alcohol consumption.     

Working with high-risk youth in prevention and early intervention programs: toward a comprehensive wellness model

Societal problems resulting from school dropouts, teenage pregnancy, drug abuse, suicide and other health-damaging behavior are increasing, along with the financial costs. This paper presents a theory of youth development and learning, and an integrated, interactive and reciprocal model for the prevention of health-damaging behavior.     

Teaching medical staff psychological concepts via a hospital newsletter

Despite the increased recognition of the critical role of social and psychological factors in health and illness, the teaching of psychology is rarely integrated in medical education. Staff generally have minimal formal training in psychological concepts. Patients on the inpatient rehabilitation unit frequently present with unexpected reactions in response to acute trauma and resulting changes in identity and capabilities. Rehabilitation goals therefore, must be based on psychological, as well as physical, capacities. A one-page, user-friendly newsletter was designed to illustrate basic psychological principles via case vignettes. The topics of fear, countertransference, and resistance were selected as critical issues staff frequently encounter in their work with patients. The newsletters provided the staff with basic conceptual tools for effectively treating patients, and the work of psychologists was demystified. The newsletter format is proposed as a creative adjunct to didactic teaching.Copies of the newsletter Insight can be obtained by request from Dr. Gold.     

Stress management training for law students: Cognitive-behavioral intervention

The practice of law has created chronic and, at times, severe psychological stress both in law school and subsequent practice. In the current study, students volunteered to participate in a six-session seminar on personal stress management skills including self-relaxation training, schedule planning, priority-setting, leisure time planning, and cognitive modification techniques. Subjects showed pre- to posttreatment improvement on a variety of measures that included their knowledge about stress, personal ratings of stressful situations, and their daily activity schedules. In contrast, a control group showed no improvement and worsened in reported levels of personal stress. The importance of providing law students with personal stress management skills is discussed.     

The efficacy of postdivorce intervention programs for children: A meta-analytical review

Preventive postdivorce interventions aim to help children cope with divorce and promote their adjustment. Nevertheless, questions remain regarding the concrete outcomes of these interventions and the intervention characteristics that influence them. This meta-analysis of 30 studies analyzes the efficacy of postdivorce interventions on children's symptomatology, personal resources, and adaptation to divorce. Likewise, it explores whether the intervention impacts the putative mediators from the family context and whether the characteristics of the studies themselves also influence the results. Using a data set of N = 4344 individuals, 258 effect sizes were calculated. Random effects analyses evidenced the impact of the interventions on specific variables instead of on children's global adjustment. There were no significant effects on children's mental health outcomes, and none of these effects were qualified by the moderators that were examined. Preventive postdivorce interventions had significant effects, specifically on children's divorce adjustment and self-esteem. The study of the moderators found that the interventions were generally homogeneous, and only one of the 20 moderators examined had a significant effect. Based on children's age, the interventions had an impact on family functioning only when they involved younger children, but this result should be interpreted with caution due to the small sample of studies. This meta-analysis provides evidence of the relevance of postdivorce interventions to critical variables as well as information about the role of the intervention characteristics in the effects and makes suggestions for future research on divorce interventions that encompass both practical and empirical developments.     

Preventing and curing mental retardation by behavioral intervention: An evaluation of some claims

Statements are being made that by the judicious application of known behavioral and cognitive techniques we now have the means to raise intelligence and prevent or cure most mental retardation. As one example, it has been claimed that this goal can be achieved by combining infant, preschool, and elementary school intervention programs that have already proven effective. However, examination of the cited programs fails to reveal any evidence that they are effective. In view of the cycle of optimism and disillusionment that pervades the history of this field, caution and restraint are recommended.