Issues related to the diagnosis and treatment of autism spectrum disorders

This paper explores issues and implications for diagnosis and treatment, stemming from the growing number of children identified with autism spectrum disorders (ASDs). Recent developments and innovations in special education and Medicaid programs are emphasized. Eligibility determination policies, innovations in diagnostic practices, the cost and financing of assessment, variability among programs in diagnostic criteria, and racial/ethnic disparities in the timing of diagnosis all influence the capacity of service systems to provide diagnoses in a timely, coordinated, accurate, economical, and equitable manner. There are several barriers to the more widespread provision of intensive intervention for children with ASDs, including lack of strong evidence of effectiveness in scaled-up public programs, uncertainty about the extent of obligations to provide services under the Individuals with Disabilities Education Act, high cost of intervention, and variability among states in their willingness to fund intensive intervention via Medicaid. Innovative policy experiments with respect to financing intensive intervention through schools and Medicaid are being conducted in a number of states.     

Facilitators and barriers to the implementation of motivational interviewing for bullying perpetration in school settings

Bullying is a perplexing and persistent problem with negative consequences for all involved. Schools are assigned considerable responsibility for the management of bullying because of its prevalence amongst youth. Despite considerable efforts over decades to curtail bullying through the use of anti-bullying policies and other school-based interventions, the rates of young people who frequently bully has not decreased significantly. Motivational Interviewing (MI) is a relational and affirming conversational method that strengthens an individual's motivation and commitment to change, overcoming ambivalence toward the problem. The aim of the current study was to provide preliminary insight into the feasibility of incorporating MI into student service repertoires for addressing bullying. Ten staff participants from six secondary schools, who had roles in bullying intervention within their respective schools, were offered training in MI and invited to use and monitor this method in their practice as an intervention for students who perpetrate bullying. Results indicated a number factors which influenced the uptake of MI in schools. Facilitators enabling the use of MI included practitioner's professional background, administrative support, training and implementation of MI. Barriers to the use of MI included time pressure and administrative expectations, school roles and system limitations, and preconceptions and the stigma of bullying.     

心理贫困：概念、表现及其干预

长期物质贫困产生特殊的心理后果——心理贫困。心理贫困指的是不利于贫困阶层摆脱贫困的心理与行为模式,主要表现为 “志向失灵”与“行为失灵”,即抱负与志向缺位,理念和意识扭曲,能力与行为方式错位,还易于做出不利于脱贫的决策行为;长此以往,就陷入“贫穷—特定心理与行为模式—继续贫穷”的恶性循环。对此,研究者们先后开发了有条件现金转移项目、减少认知资源损耗项目、“转移和坚持”心理干预策略、社会阶层流动信念干预策略、公平感提升策略等干预方案。该领域研究及其相关成果对“精准”扶贫,促进社会公平、增加人类福祉具有重要意义。未来研究应在整合的干预方案和本土化的干预方案等方面予以加强。     

心理贫困：概念、表现及其干预

长期物质贫困产生特殊的心理后果——心理贫困。心理贫困指的是不利于贫困阶层摆脱贫困的心理与行为模式,主要表现为 “志向失灵”与“行为失灵”,即抱负与志向缺位,理念和意识扭曲,能力与行为方式错位,还易于做出不利于脱贫的决策行为;长此以往,就陷入“贫穷—特定心理与行为模式—继续贫穷”的恶性循环。对此,研究者们先后开发了有条件现金转移项目、减少认知资源损耗项目、“转移和坚持”心理干预策略、社会阶层流动信念干预策略、公平感提升策略等干预方案。该领域研究及其相关成果对“精准”扶贫,促进社会公平、增加人类福祉具有重要意义。未来研究应在整合的干预方案和本土化的干预方案等方面予以加强。     

Combining whole-school and targeted programs for the reduction of bullying victimization: A randomized,effectiveness trial

Despite the extensive evaluation of school-based interventions for bullying, victimization remains a significant problem in schools. Bullying victimization is significantly predicted by contextual (school-related) factors. As a consequence whole-school programs have been commonly used to prevent and reduce bullying victimization. Evidence also points to individual risk factors (such as emotional distress) in predicting victimization, yet programs to prevent bullying victimization by changing these individual risks are far less developed. Few studies have approximated “real-world” implementation conditions in their trials. The current effectiveness trial evaluated the combination of a whole-school program designed to prevent bullying perpetration and victimization together with a targeted intervention for at-risk students, teaching them individual and dyadic strategies to reduce their anxiety and manage victimization, allowing schools some latitude to implement programs as they typically would. Students from Grades 3 and 4 (N = 8,732) across 135 schools were randomly assigned to one of four conditions: combined intervention; whole-school intervention only; individual intervention only; and care as usual. Victimization decreased significantly and similarly across all four conditions at 12 and 24 months following baseline. Similar reductions and failure to discriminate conditions were found on other key constructs: anxiety; bullying perpetration; and depression. Possible reasons for the failure to demonstrate victimization prevention differences and lessons learned from this large, effectiveness trial are considered.     

Unravelling socioeconomic school composition effects on higher education enrollment: the role of students’ individual and shared feelings of futility and self-efficacy

Despite the massification of higher education, social inequality in higher education outcomes still persists. It is known that secondary schools’ socioeconomic composition is at least partly responsible for this social inequality. Nevertheless, the mechanisms by which socioeconomic composition affects higher education enrollment are still poorly understood. Based on the attribution theory, this study expects students’ feelings of academic self-efficacy and sense of futility to act as underlying mechanisms. Additionally, given that individual self-efficacy beliefs and individual sense of futility are shared among students within schools — that is, schools have different self-efficacy and futility cultures — we investigate whether these cultures are consequential for higher education enrollment and program choice. Results of binomial logistic multilevel analyses on the data of the International Study of City Youth (www.iscy.org) in Ghent, consisting of 1214 Flemish students across 29 schools, indicated that students in low socioeconomic composition schools are less likely to enroll in higher education because these schools are characterized by high futility cultures. In contrast, high self-efficacy and self-efficacy cultures are positively associated with the choice for academic bachelor programs, but they did not explain socioeconomic composition effects. We conclude that educational policies should aim at increasing a sense of control over academic outcomes in order to improve social equality in higher education outcomes.

     

Psychosocial safety climate as a precursor to conducive work environments,psychological health problems,and employee engagement

We constructed a model of workplace psychosocial safety climate (PSC) to explain the origins of job demands and resources, worker psychological health, and employee engagement. PSC refers to policies, practices, and procedures for the protection of worker psychological health and safety. Using the job demands–resources framework, we hypothesized that PSC as an upstream organizational resource influenced largely by senior management, would precede the work context (i.e., job demands and resources) and would in turn predict psychological health and work engagement via mediation and moderation pathways. We operationalized PSC at the school level and tested meso‐mediational models using two‐level (longitudinal) hierarchical linear modelling in a sample of Australian education workers (N = 209–288). Data were repeated measures separated by 12 months, nested within 18 schools. PSC predicted change in individual psychological health problems (psychological distress, emotional exhaustion) through its relationship with individual job demands (work pressure and emotional demands). PSC moderated the relationship between emotional demands and emotional exhaustion. PSC predicted change in employee engagement, through its relationship with skill discretion. The results show that the PSC construct is a key upstream component of work stress theory and a logical intervention site for work stress intervention.     

Striving to do Good Things: Teaching Humanities in Canadian Medical Schools

We provide the results of a systematic key-informant review of medical humanities curricula at fourteen of Canada's seventeen medical schools. This survey was the first of its kind. We found a wide diversity of views among medical educators as to what constitutes the medical humanities, and a lack of consensus on how best to train medical students in the field. In fact, it is not clear that consensus has been attempted - or is even desirable - given that Canadian medical humanities programs are largely shaped by individual educators' interests, experience and passions. This anarchic approach to teaching the medical humanities contrasts sharply with teaching in the clinical sciences where national accreditation processes attempt to ensure that doctors graduating from different schools have roughly the same knowledge (or at least have passed the same exams). We argue that medical humanities are marginalized in Canadian curricula because they are considered to be at odds philosophically with the current dominant culture of evidence-based medicine (EBM). In such a culture where adhering to a consensual standard is a measure of worth, the medical humanities - which defy easy metrical appraisal - are vulnerable. We close with a plea for medical education to become more comfortable in the borderlands between EBM and humanities approaches.     

ABA-Based Programs for Children Diagnosed With Autism Spectrum Disorder: Parental and Professional Experiences at School and at Home

Having a child diagnosed with Autism Spectrum Disorder (ASD) poses a range of challenges to families, many of which can be addressed through appropriate intervention. A study of parental (n = 95) and professional (n = 67) experiences was carried out in relation to two settings: (a) schools that provided intensive interventions based on the science of Applied Behavior Analysis (ABA), and (b) non-intensive ABA-based home programs. Results show that parents whose children attend ABA-based schools were generally more satisfied with their child's educational provision, monitoring procedures, and level of staff training, than parents who were not offered ABA-based education in schools.     

Effects of positive youth development programs on school, family, and community systems

A review of efforts at social system change in 526 universal competence-promotion outcome studies indicated that 64% of the interventions attempted some type of microsystemic or mesosystemic change involving schools, families, or community-based organizations in an attempt to foster developmental competencies in children and adolescents. Only 24% of the reports provided quantitative data on the change that occurred in targeted systems. However, studies containing the necessary information produced several mean effect sizes that were statistically significant, and ranged from modest to large in magnitude. These data indicate that attempts to change social systems affecting children and adolescents can be successful. Future work should measure more thoroughly the extent to which the systemic changes that are targeted through intervention are achieved, and investigate how such changes contribute to the development and sustainability of the outcomes that might be demonstrated by participants of competence-promotion programs. The authors wish to thank David Wilson for supplying the macros used to calculate study level effect sizes and Mark Lipsey for supplying the SPSS macros used to weight effect sizes and calculate mean effects across studies. This study was supported in part by a grant from the William T. Grant Foundation (#2212) awarded to the first and last authors.     

Evidence for a Comprehensive Sexuality Education Intervention that Enhances Chinese Adolescents’ Sexual Knowledge and Gender Awareness and Empowers Young Women

While Chinese adolescents become more sexually active, their sexual attitudes are profoundly influenced by traditional gender and sexual norms. The tensions between the rapid transition in youth sexuality and lags in sex education call for a paradigm shift of sexuality education in China. The present study examined the effectiveness of a school-based empowerment comprehensive sexuality education (CSE) intervention in changing adolescents’ sexual knowledge, gender and sexual attitudes, and sexual self-efficacy. We used data from a quasi-experimental intervention study with self-administered pretest and posttest surveys conducted among 1131 10th grade high school students in Lanzhou, northwest China. Whereas 583 participants in two intervention schools attended 12 45-min CSE sessions focusing on gender, rights, and critical thinking skills across 4–7 months, 548 participants in two comparison schools received no or limited conventional sex education. After controlling for differences in sociodemographics and in the influence of family, peers, and internet use between the two groups, female and male adolescents exhibited significantly more accurate sexual knowledge, stronger endorsement of nontraditional gender roles, and greater rejection of sexual double standards immediately after the intervention. Additionally, young women reported significantly higher sexual self-efficacy following the intervention. The findings suggest that the school-based empowerment CSE intervention is helpful in creating an environment in which both young men and young women benefit in sexual knowledge and gender awareness and young women increase their sexual decision-making skills, thereby lending support to the theory and practice of an empowerment CSE approach.

     

Students with Disabilities Use of Various Options to Access Alternative Schools and Area Learning Centers

Alternative schools that were developed to encourage students experiencing difficulties in conventional schools to graduate from high school have been in existence since the 1970s. Alternative schools represent a form of school choice available to parents and students. This investigation focused on the extent to which students with disabilities are accessing Alternative Schools and Area Learning Centers (ALC) in Minnesota. More specifically, attention centered on (a) the option used by both students with and without disabilities to enroll in the school, (b) the extent to which students crossed district boundaries to attend the school, and (c) differential participation by category of disability. Results indicate that students with disabilities are accessing Alternative SchooVALC programs in ways similar to non-disabled students. Moreover, students with emotionalhehavioral disorders are heavily represented in these schools. It also was discovered that when students enter these programs, special education labels are often dropped and services discontinued. Implications for students with emotional and behavioral disorders are discussed.     

From ��Water Boiling in a Peruvian Town�� to ��Letting them Die��: Culture, Community Intervention, and the Metabolic Balance Between Patience and Zeal

While the concept of culture has long been central to community psychology research and intervention, it has most frequently referred to the communities in which such work occurs. The purpose of this paper is to reframe this discussion by viewing community interventions as instances of intercultural contact between the culture of science, reflected in community intervention research, and the culture of the communities in which those interventions occur. Following a brief discussion of the complexities of culture as a concept, two illustrative stories of failed community interventions are provided to highlight the centrality of cultural and contextual understanding as prelude to community intervention. These stories, set 50 years apart, reflect the depth and pervasive influence of both the culture of science and the culture of communities. Next, a series of propositions about the culture of social science as a partial reflection of the broader culture of the United States are offered, and their implications for the conduct of community interventions drawn. The paper concludes with a series of recommendations which, together, provide an ecological mind-set for taking culture seriously in community interventions. Central to this mind set are the importance of focusing on communities rather than programs and emphasizing the intervention goal of choice over change.     

Personal knowledge,belief systems,and educational innovators

The role of early socialization is examined to determine the relationship of this prior experience to teachers' belief systems. A brief analysis of belief systems is undertaken, followed by a narrative drawn from the life history of one reform-minded teacher from an innovative school. A constructivist position represented by George Kelly and Jerome Bruner is used to explicate the analysis. Implications are drawn for the importance of considering the early experience of teachers in developing teacher education programs. In particular, the recent reform literature in teacher education is critiqued and faulted for ignoring the important role of teacher belief systems, which in turn are argued to be strongly influenced by early socialization.     

Medicaid: A potential source of revenue for special education

Currently, over 4.3 million children are receiving special services within the nation's schools because of physical, developmental, and educational disabilities. It is estimated that twice this number would benefit from special education services. Public Law 94–142, the Education for the Handicapped Act, offered the first real opportunity for many children with disabilities to receive special health and educational services. Public schools have become a primary setting for provision of services to these children, however, many states have encountered difficulty in procuring funding. One federally mandated source of revenue is the Medicaid program. In the fall of 1991, all state Medicaid and special education programs were asked to provide information concerning current or planned use of Medicaid funds for special education services. Responses were received from 36 states. Only 19 states reported using Medicaid funding in any capacity, and of these, only four required schools to bill Medicaid for services rendered. The majority of these programs are in the pilot stages of development. Special education services covered by Medicaid vary widely, as do reimbursement mechanisms. All 19 states allow Medicaid coverage for speech, physical, and occupational therapy. Only about half of those states provide allowances for diagnostic evaluation and assessment, while coverage for psychological services is provided by three-fourths of those states, and EPSDT screens by half of the states. Only two programs had been evaluated formally at the state and/or federal level. Medicaid remains a largely untapped source of revenue that could be used to help fund services for disabled children.     

Enhancing young people's social competence and health behavior: An important challenge for educators, scientists, policymakers, and funders

Large numbers of America's young people engage in multiple high-risk behaviors that may jeopardize their health and social development. Given the gravity of this situation, many federal agencies and national organizations have called for the implementation of school-based K-12 social competence and health promotion programs. Unfortunately, there is a gap between the comprehensive programs that policymakers are asking educators to implement and the limited scope, duration, and intensity of state-of-the-art health promotion programs that scientists have developed and evaluated. As a result, most schools currently adopt well-marketed programs that lack documented effectiveness. Although current research indicates that brief, well-designed, theory-driven competence promotion and health education programs produce short-term benefits, there have been no controlled, longitudinal field studies to evaluate the long-term effects of K-12 efforts. This paper proposes that policymakers and funding agencies support long-term collaborations among educators and scientists to develop and evaluate K-12 comprehensive social competence and health education programs and identifies critical issues that funded projects should address.     

Implementing school psychological service programs: Description and application of the durable approach

Implementing school psychological service programs is a challenging and complex endeavor facing school psychologists. In order to assure that their programs occur as planned, practitioners may benefit from organizational management strategies. This paper presents the DURABLE approach as a strategy that can be employed by school psychologists to facilitate implementation of counseling and other intervention programs. In the paper, the seven phases of DURABLE are described. Then results are reported of an investigation in which the approach was applied by school psychologists to facilitate implementation of group counseling programs in urban high schools. Discussion occurs within a context of the need for school psychologists to incorporate organizational management strategies into their practice.     

The Behavior Education Support and Treatment (BEST) school intervention program: pilot project data examining schoolwide, targeted-school, and targeted-home approaches

As part of a pilot project, four elementary schools were randomly assigned to receive one of four interventions: (a) a schoolwide intervention that incorporated universal and targeted treatment, (b) a targeted-school intervention delivered to individual students in regular and special education classrooms, (c) a targeted-home intervention delivered in home and regular classroom settings, and (d) a control condition that did not receive a designated intervention. Results showed that the behavior of disruptive children in all schools improved during the course of the year, with some evidence that interventions provided complementary effects. These findings support the continued use of behavioral interventions in elementary schools and argue for interventions that combine different methods of delivering interventions.     

Have Mental Health Education Programs Influenced the Mental Health Literacy of Those with Major Depression and Suicidal Ideation? A Comparison between 1998 and 2008 in South Australia

Mental health literacy is the knowledge and beliefs about mental disorders that aid their recognition, management, or prevention and is considered to be an important determinant of help‐seeking. This has relevance in suicide prevention, as depression, the clinical condition most frequently associated with suicidality, has been the target of community and professional education programs designed to enhance mental health literacy. In this study, whether such programs have influenced help‐seeking attitudes and behavior in those who are depressed and suicidal was considered. The results indicate that despite intensive community education programs over the last two decades, there has been little change in those who are depressed and suicidal in terms of their attitudes toward treatment seeking and, more importantly, their treatment‐seeking behavior. These results draw into question the value of current community education programs for those most vulnerable to suicidal behavior.     

Another View of School Reform: Values and Ethics Restored

The article discusses a need for action in teaching values and morality in the public schools to gain control of the social problems that hinder school learning. Moral and ethical education are necessary to support parents and the community in teaching appropriate civic and moral values. Problems affecting school learning were substantiated by data collected from a national sample of public school principals reporting an alarming number of serious problems in the schools related to the home and society. Through teacher education programs, teachers must be prepared to provide moral education. Suggestions are offered to address the moral education of children and youth.