Delivering Parent Management Training in an Integrated Primary Care Setting: Description and Preliminary Outcome Data

This paper describes how behavioral health consultants (BHCs) in an integrated primary care setting use evidence-based principles that underlie parent management training (PMT) to assist caregivers of youth with externalizing behavior problems. Illustrated is the decision-making process that BHCs utilize from the moment they receive a patient referral from a primary care provider to how interventions are selected and delivered. When delivering PMT in integrated care, operant-based learning principles underlying PMT are often selected based on a combination of factors, including match with presenting problem, caregiver efficacy, caregiver beliefs about the causes and maintaining factors, and feasibility of implementation. We further present preliminary outcome data on the effectiveness of BHCs’ efforts to use PMT principles in a primary care setting. Participants were 21 caregivers and their children (M_age = 7.76 years, 38.1% female; 66.7% Hispanic) seen for an average of 2.38 visits. Pre-post data provided by caregivers (for youth 11 years or younger) and adolescents (self-report of patients 12–17 years of age) taken at the time of first and last sessions revealed significant reductions in global distress scores and high levels of satisfaction with services received. Findings support the viability of providing brief, focused PMT interventions for pediatric populations seen in primary care.     

Family Therapy Training: Program and Outcome

A family therapy training program has been conducted for staff of mental health agencies located throughout Pennsylvania. This paper is a report on the content and results of the four-year-old training program. Three hundred practitioners have been trained in family therapy. The program has also led to the development of a core group of 64 family therapy trainers. There has been an associated delivery of more family-oriented mental health services throughout the Commonwealth.     

Direct Observation of Family Management: Validity and Reliability as a Function of Coder Ethnicity and Training

This study examines the influence of coder ethnicity on the validity and reliability of direct observations of family management. Eight coders, 4 European American (EA) and 4 African American (AA), were randomly assigned to conduct behavior ratings of videotaped family interactions of European American and African American families, under two conditions: untrained and trained. Results indicated statistical differences between EA and AA coder ratings of family management practices across both untrained and trained conditions, suggesting the presence of ethnocentric perceptions of coders. Specifically, EA coders tended to rate AA families as exhibiting poorer family management skills compared with those of EA families. AA coder ratings for EA and for AA families showed no statistical differences. Although not statistically significant, posttraining coding results indicated a trend toward decreased differences among coder perceptions, especially in improving the validity and reliability of EA coder ratings of AA families. These findings are discussed with respect to recommendations for cross-cultural research as well as general theories of ethnic socialization.     

Maternal Depression and Parent Management Training Outcomes

This study examines the impact of maternal depression on reductions in children’s behavior problems severity following implementation of the Brief Behavioral Intervention—a brief, manualized parent management training treatment. The parents of 87 children aged 2–6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated.     

Evidence-Based Practice in Psychology: An Ethical Framework for Graduate Education,Clinical Training,and Maintaining Professional Competence

Evidence-based practice is often acknowledged as the future state of psychology, yet those graduate students who will soon be applying such practices tend to hold several misconceptions about the major components within this framework. This review highlights implications for graduate education, clinical training, and professional competence in light of the movement toward evidence-based practice in psychology. These implications are discussed in relation to the close parallel between the major components of the evidence-based framework and the current Ethical Principles of Psychologists and Code of Conduct. The evidence-based framework is discussed as an ideology that promotes lifelong learning and best prepares graduate students for ethical clinical practice throughout their careers as psychologists.     

Full Preservation of a Response-Outcome Association through Training with a Second Outcome

In two experiments rats were trained to make instrumental responses, with each response earning first one and then a second outcome. Subsequent devaluation of either the first or the second earned outcome had a depressive effect on responding. The magnitude of the effect was similar, whichever outcome was devalued. This result suggests that initially trained response-outcome associations are fully preserved despite the same response being trained with a second outcome.     

Predicting Outcome of Military Basic Training for Individuals Referred for Psychological Evaluation

We examined outcome data for 632 U.S. Air Force personnel who were referred for psychological evaluation during Basic Military Training (BMT) but who were subsequently returned to BMT to determine what proportion graduated. We analyzed motivational, biographical, and psychological testing variables, using logistic regression to develop a model predictive of training outcome. The results demonstrated that a relatively small number of variables could predict outcome with close to 70% accuracy. Level of optimism regarding training, history of physical abuse, and frequency of visits to the trainee health clinic were major contributors to the model. MMPI-2 (Hathaway & McKinley, 1989) Scales D and Sc also remained in the model but added little to its power. The findings are generally consistent with prior research on normal military populations, except that some factors previously linked to adjustment, such as sex and ethnicity, were found to be unrelated to training outcome in this population.     

Encoding and Maintaining Reference in Oral Discourse

This study deals with information management and reference encoding modes in oral discourse production. Three potentially influential factors were the distance between the first occurrence of an item and its later occurrences, a topic change that takes the focus off that item, and the span of the conceptual information available for verbalization. French-speaking adult subjects were asked to tell stories from comic strips to a listener who was unfamiliar with them. The frames in each strip were presented simultaneously or in succession. Four versions were generated for each comic strip: a given version was either short (three frames) or long (eight frames), and either did or did not have a topic change. The results showed that the target character was usually marked as a given, regardless of the version. This was more often true, however, when the topic did not change. When the character was treated as a given, referent accessibility marking was dependent on (1) topic change alone when the frames were presented simultaneously, and (2) topic change and comic strip length when the frames were presented in succession. The discussion analyzes the results in terms of the allocation of cognitive resources to maintaining coreference and to assisting addressees in their processing.     

Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.     

伦理委员会继续培训项目和质量管理

伦理委员会的继续培训是伦理委员会能力建设的重要任务.通过对WHO/TD华山伦理培训中心培训项目的介绍,从建立标准化培训模块和课程、注重培训前准备和培训后的评估过程、师资队伍建设等方面来探讨如何在培训过程中进行质量管理,使得伦理委员会通过高质量的培训来提高对伦理原则的理解和在实践中运用的能力.     

管理培训背景下适应性绩效的结构分析

本研究以适应性绩效理论为基础,在上海、北京、广州、浙江、江苏、重庆等地用问卷调查了十多个企业的管理培训实施情况,得到了334个有效样本。对数据进行探索性因素分析和验证性因素分析后,得到了管理培训背景下的四因素适应性绩效结构模型,四个因素分别被命名为:压力和应急处理、创新解决问题、岗位持续学习以及人际和文化适应。该适应性绩效结构为管理培训评估研究中效标的确定提供了新思路。最后讨论了今后研究需要进一步注意的问题。     

Implementing Parent Management Training in the Context of Poverty

Parent management training (PMT) is a well-investigated, effective, and preferred treatment for children's externalizing behaviors and related disorders. Unfortunately, PMT is not as effective for children living in poor families, who disproportionately exhibit the behaviors that PMT is designed to correct. We suggest that PMT is less successful for poor children because (1) the same factors that explain the relation between economic hardship and children's externalizing behaviors also are related to unsuccessful PMT outcomes; and (2) PMT interventions are less acceptable to poor parents, and therefore less likely to be adopted. Clinical implications are drawn from the analysis.

     

Selling and Sales Management in Action: Sales Training: Status and Needs

Initial training, continuing education and management development activities continue to receive attention in the industrial sector (Honeycutt and Ford 1991). For example, recent reports indicate that organizations spend upwards of $30 billion annually for training programs involving 15 billion work hours (Huber 1985), with the objective being to improve the profitability of the firms.     

A Teacher-Consultation Approach to Social Skills Training for Pre-Kindergarten Children: Treatment Model and Short-Term Outcome Effects

This study evaluated the post-treatment outcome effects of a classroom-based social skills program for pre-kindergarten children, using a teacher-consultation model. The pre-K RECAP (Reaching Educators, Children, and Parents) program is a semi-structured, cognitive-behavioral skills training program that provides teachers with in-classroom consultation on program implementation and classroom-wide behavior management. Data on children's social skills and behavior problems were collected from parents and teachers at pre- and post-treatment, for 149 children aged 4–5 years (of whom 56% were girls). Significant treatment effects were found for teacher but not parent reports, with treatment group children improving significantly more than comparison group children in their teacher-rated social skills and internalizing and externalizing problems. These results provide some preliminary support for the efficacy of the program on children's social skills and behavior problems, and for a teacher-consultation model for training teachers to implement school-based mental health programs.     

Synthesis and Outcome

Leading experts on the nature and treatment of posttraumatic stress disorder (PTSD) were invited to comment on the assessment, case conceptualization, and treatment of a case of PTSD arising from a road traffic collision. Common themes and salient differences among the commentators are discussed. The treatment that the patient actually received is described, and the outcome is presented. Treatment outcome is discussed in light of the commentators’ remarks, and future directions for improving treatment outcome are considered.     

Depression Management Training: A Structured Group Approach

This article describes a structured group program called Depression Management Training (DMT), the focus of which is to increase participants' awareness of the multidimentional sources of depression and to enhance their coping strategies.