Project Destiny

Abstract

Students with emotional and behavioral disorders present significant challenges to educators and community professionals in contemporary practice. At the same time, parents of middle school students experience parenting as a difficult time period that is laden with a variety of feelings. A central strategy for assisting both parents and professionals during this developmental period is to work collaboratively with one another. This sharing of ideas and strategies is helpful in attaining goals for students that are usually not met in the absence of cooperative team work. Furthermore, the recommended direction for service provision for these youth is to work through a coordinated, interagency approach across the community.

This paper presents the first year's methods and initial findings from Project Destiny, a three year study that is attempting to enhance the knowledge and strategies of professionals, parents and community teams for working with middle school students having emotional or behavioral disorders (EBD). Initial results from the project's work in three communities suggest that teachers at the middle schools have been interested and able in acquiring new knowledge and skills for working with the youth. These gains were evident in self-evaluations completed by the teachers. Additionally, 60% of parents of youth with EBD were recruited and participate regularly in parent support and advocacy groups. Efforts to integrate the project with local interagency teams have been somewhat less successful due to the current political and economic climate that has eliminated essential resource personnel on local teams. The Project Destiny model has merit for further replication and further analysis of student performance and will be completed in the final year of the project.     

INCREASING THE INDEPENDENT RESPONDING OF AUTISTIC CHILDREN WITH UNPREDICTABLE SUPERVISION

We investigated the role of predictable versus unpredictable supervision on the independent task responding of three autistic children. In a predictable supervision condition, the therapist was present in the setting for a regular period of time and then was absent for the remainder of the session. In an unpredictable supervision condition, the therapist's presence was scheduled on a random, intermittent, and unpredictable basis throughout the session. The multiple baseline analysis showed that the unpredictable supervision produced much higher levels of on-task responding during the therapist's absence for all three children. Analysis of work completed during the therapist's absence also favored the unpredictable supervision condition. The results are discussed in relation to the literature on generalization and educational practice.     

The use of multitreatment modalities in early intervention: A quantitative case study

A quantitative single case study is presented to illustrate how an early intervention program used two therapeutic modalities to treat a depressed mother and her 2-month-old son. Drawing upon an ecological, transactional model of development, the case study utilized a multimethod, longitudinal approach to assess the infant's developmental competence and attachment status, the mother's history and current psychosocial functioning, patterns of mother-infant interaction, and components of the family's social ecology. Measures were administered during a baseline period to assess pre-intervention functioning and were systematically repeated throughout the 2-year period of intervention. The treatment modalities included psychodynamically oriented individual therapy and Parent-Infant Relationship Treatment (PIRT) in which the dyad was also seen by a second therapist to foster more adaptive mother-infant transactional patterns. The findings indicated increased infant developmental competence and a shift from an insecure to a secure attachment classification, improved maternal psychosocial functioning, and a decline in the dyadic interactional pattern of maternal intrusiveness and infant withdrawal. The advantages of using two treatment modalities and a single case approach to evaluation are discussed.     

THE INSULAR MOTHER: HER PROBLEMS IN PARENT-CHILD TREATMENT

Eighteen mother-child dyads were referred for psychological help because of the children's oppositional behaviors and the mothers' aversive reactions to the children. All dyads were from low income families in which the mothers reported themselves to be relatively isolated from social contact in their communities. Following a baseline phase, the mothers were trained to modify their children's oppositional behaviors through time out and a point system. Fourteen of the dyads were observed in three phases of the study: baseline, parent training or treatment, and a 1-year follow-up period. In Phases one and two, child opposition and mother aversive reactions to the children were measured twice weekly by professional observers in the home settings. During Phase three (follow-up), these observations occurred twice per month. In addition, the mothers' self-reported contacts with people in their communities were obtained immediately after each observation. Results showed significant improvement in the mother-child problems during the parent training or treatment phase. However, the problems returned to baseline levels of occurrence during the follow-up phase. The self-report findings indicated that number of mother contacts with friends was an inverse predictor of these problems. On days marked by high proportions of friend contacts, mother-child problems were lower in frequency than on days marked by low proportions of friend contacts. These correlational findings were taken to suggest that a mother's extra-family social contacts may influence her child interaction patterns at home. This possibility was discussed as a factor in the long-term success of parent training as a treatment strategy.     

A Review of: “Kennedy-Moore,E., & Lowenthal,M. S. (2011). Smart Parenting for Smart Kids: Nurturing Your Child's True Potential.”

Behavioral procedures aimed at decreasing disruptiveness through increasing self-evaluative skills and programming generalization in a class of disruptive retarded children were examined. Phases of the study included: (a) baseline; (b) systematic feedback; (c) a token economy; (d) matching of teacher's ratings by students; (e) four fading phases during which progressively fewer students were required to match the teacher; (f) self-evaluation during which each student received the amount of points self-allotted regardless of teacher's ratings; (g) doubling of point costs of back-up reinforcers ("Inflation"); (h) complete removal of back-up reinforcers ("Points Only"); and (i) return to baseline conditions. The class was observed 5 days per week dueing a morning experimental period and several times per week in the afternoon as a measure of generalization. Additional measures of generalization included days when the token program was not in effect ("Off Days") and when the class was taught by a substitute teacher. Behavior was recorded according to an interval sampling observational code. The results showed that systematic feedback was effective in significantly reducing disruptiveness with even greater reductions resulting from the token program and the subsequent matching and fading phases. Decreased levels of disruptiveness were maintained throughout self-evaluation and the phases which followed. Decreased levels of disruption also generalized to afternoon sessions, to days when the experimental procedures were not in effect, and to self-evaluate, the class initially matched the teacher's ratings with about 50% accuracy. This gradually increased to consistently above 90% during the latter phases. The study demonstrated that retarded children can learn to accurately observe and veridically evaluate their own behavior, and that this has beneficial effects in terms of decreased disruptiveness.     

Participating in social enquiry and action

This paper describes the collaborative endeavours of residents and a wide range of professional workers in a particular area of Nottingham, with reference to a community psychology approach to addressing sources of psychological distress. The activities include a survey of people's views about living in the area and the factors they identify as affecting their health; and initiatives in community participation and action. One hundred and twenty three people were interviewed by members of the Sneinton and Bakersfield Community Forum. Harmful influences upon health and causes of stress were revealed as litter, dog dirt, air and traffic pollution, feeling unsafe to go out at night and lifestyle-related issues such as smoking and diet. Public meetings, the local press and short written reports were used to publicize these results and encourage further involvement. Many local residents and professionals are now active in a network of groups which address social and environmental concerns.     

Waiting for the next Shoe to Drop: The Experience of Parents of Children with Fanconi Anemia

Fanconi Anemia (FA) is a rare genetic disease that generally affects children and results in bone marrow failure requiring blood or marrow transplantation for survival. A unique feature of the condition is the long, often many years, waiting period between genetic diagnosis and treatment. This qualitative study looked at the lived experience of parents confronting their child’s diagnosis of FA. We aimed to describe factors which parents found helpful or detrimental during the waiting time period and to recommend strategies to support families who will have these experiences in the future. Categories that emerged were: parents’ emotional responses, thoughts about FA (which occurred daily for most parents), sources of stress, mechanisms of coping, family dynamics and responses that were supportive and non-supportive. We found that most parents experience stress, uncertainty, and active surveillance throughout the course of the illness. Healthcare professionals, and especially physicians, were agents of both the most and least supportive experiences of parents. Parents described family centered team care as helpful throughout the illness and health professional education as a priority need.     

BIOFEEDBACK,AUTOGENIC TRAINING,AND PROGRESSIVE RELAXATION IN THE TREATMENT OF RAYNAUD'S DISEASE: A COMPARATIVE STUDY

Twenty-one female patients suffering from diagnosed idiopathic Raynaud's Disease were trained to raise digital skin temperature using either autogenic training, progressive muscle relaxation, or a combination of autogenic training and skin temperature feedback. Patients were instructed in the treatment procedures in three one-hour group sessions spaced one week apart. All patients were instructed to practice what they had learned twice a day at home. Patients kept records of the frequency of vasospastic attacks occurring over a four-week baseline period, and during the first four weeks and the ninth week of training. In addition, patients underwent four laboratory cold stress tests during which they were instructed to maintain digital temperature as the ambient temperature was slowly dropped from 26° to 17°C. Cold stress tests were given during week 1 of baseline and during weeks 1, 3, and 5 of training. Results indicated that all patients improved during the first four weeks of training. No significant differences between the three behavioral treatment procedures were obtained. In addition, the ability of patients to maintain digital temperature during the cold stress challenge showed significant improvement from the first to the last tests. Symptomatic improvement was maintained by all patients nine weeks after the start of the training. The implications of these findings for the behavioral treatment of Raynaud's Disease are discussed.     

Individual,Housing, and Neighborhood Predictors of Psychological Integration Among Vulnerably Housed and Homeless Individuals

The current longitudinal study evaluated the individual, housing, and neighborhood characteristics predictive of feeling psychologically integrated within one's neighborhood among a population of homeless and vulnerably housed individuals. Participants were recruited at homeless shelters, meal programs, and rooming houses in Ottawa, Canada and participated in three in‐person interviews, each approximately 1 year apart. Prospective and cross‐sectional predictors of psychological integration at Follow‐up 1 and Follow‐up 2 were examined. There were 397 participants at baseline, 341 at Follow‐up 1 and 320 at Follow‐up 2. A hierarchical multiple regression uncovered several significant predictors of psychological integration. The most salient and common predictors were being older, having greater social support, living in high quality housing, and residing in a neighborhood with a positive impact. Implications for service provision and policy advancements are discussed.     

The behavioral impact of an advertising campaign to promote safety belt use.

Safety belt use was observed at one restaurant during McDonald''s "Make It Click" promotional campaign. Following baseline, the program was monitored without intervention. During the final 2 weeks of the campaign an incentive strategy was added providing a large soft drink contingent on safety belt use. Safety belt use did not change from baseline levels before the incentive phase. The rate of belt use increased under contingent reward and declined during follow-up. The effects of a verbal prompt could not be assessed because of the almost nonexistent use of the "Make It Click" stickers throughout the study.     

Experiences of Prenatal Diagnosis of Spina Bifida or Hydrocephalus in Parents Who Decide to Continue with Their Pregnancy

The current study aimed to gain an understanding of the perspectives of those parents provided with a prenatal diagnosis of spina bifida or hydrocephalus and who decided to continue with their pregnancy. Qualitative interviews were conducted with 15 parents who learned of their unborn child’s spina bifida and/or hydrocephalus in the prenatal period. The interviewer asked parents about their experiences of receiving a prenatal diagnosis and their experience of coping throughout the remainder of the antenatal period. Parents’ reactions and experiences fell into five domains: response to diagnosis, experience of medical systems, information gathering, decision-making regarding continuation of the pregnancy following diagnosis and responses of significant others. Each of these domains is explicated. The findings derived from the current study have implications for professionals who provide support to parents during the prenatal period. Future research needs to further explore the common and unique issues for parents living in both urban and rural areas.     

TEACHING THE HANDICAPPED TO EAT IN PUBLIC PLACES: ACQUISITION,GENERALIZATION AND MAINTENANCE OF RESTAURANT SKILLS

This study examined classroom-based instruction in restauranting skills for handicapped persons. Three male students were taught each of four skill components in sequential order: locating, ordering, paying, and eating and exiting. Training was implemented in a multiple baseline design across subjects and consisted of modeling and role playing in conjunction with photo slide sequences and a simulated ordering counter. The use of a menu containing general item classes and a finger matching procedure for identifying errors in the delivery of change greatly reduced the reading and math skills necessary to enter and complete the program. Periodic probes were conducted in a McDonald's restaurant prior to, during, and up to one-year following the termination of training. In addition, two probes (overt and covert observation) were conducted in a Burger King restaurant to assess further generalization to a location different from the one depicted throughout training. Results showed that students' performance on restaurant probes improved as a result of training, generalized to novel settings, maintained over an extended period of time, and was comparable to that of a normative sample of nonretarded persons.     

Perceived partner support and psychosexual adjustment to breast cancer

Support from a partner can play a key role in a woman's emotional adjustment to breast cancer. However, little is known about the influence of partner behaviours on a woman's sexual adjustment. This study examined the prospective relationship between baseline levels of several types of perceived partner support (instrumental, informational, emotional and negative) and psychosexual adjustment (sexual functioning and relationship satisfaction) over the course of 12 months post-surgery in a sample of 130 women with breast cancer. Results indicated that perceptions of greater emotional and informational support from the partner at baseline were associated with less sexual difficulties among breast cancer patients concurrently and 6 months post-surgery. Baseline perceptions of greater emotional and instrumental support from a partner were associated with greater relationship satisfaction at all time points. Perceptions of informational support at baseline were related to greater concurrent relationship satisfaction. Baseline perceptions of negative partner support were related to less relationship satisfaction, but only concurrently. These findings suggest that the perception of a partner's provision of emotional, instrumental and informational support may each play a role in facilitating sexual adjustment and relationship satisfaction.     

PROTECTIVE EQUIPMENT AS TREATMENT FOR STEREOTYPIC HAND MOUTHING: SENSORY EXTINCTION OR PUNISHMENT EFFECTS?

We examined the effects of noncontingent and contingent protective equipment as treatment for self-injurious hand mouthing exhibited by 2 individuals with profound mental retardation. Results of a functional analysis assessment revealed that neither subject's self-injury was maintained by social reinforcement: One subject's self-injury was cyclical in nature; the other's occurred during all assessment conditions but most frequently when left alone. In the noncontingent-equipment condition, oven mitts were placed on the individual's hands at the beginning of a session and remained on throughout. In the contingent-equipment condition, the mitts were briefly placed on the individual's hands following occurrences of hand mouthing. For 1 subject, noncontingent mitts produced a large decrease in the rate of hand mouthing and contingent mitts produced similar results following a return to baseline. Hand mouthing was also reduced in the 2nd subject, but this individual was exposed only to the contingent-equipment condition (i.e., there was no prior history with the noncontingent-equipment condition). These results suggest either a punishment or a time-out interpretation rather than an extinction interpretation to account for the behavior-reducing effects of contingent protective equipment on self-injury.     

COMMUNICATION SKILLS TRAINING FOR PARENTS: EXPERIMENTAL AND SOCIAL VALIDATION

Coordination of professional services on behalf of children often hinges on the involvement of informed parents. The purposes of this study were to identify and experimentally and socially validate skills required of parents for effective communication with professionals. Target skills were identified on the basis of judges' social validation ratings of (a) sample interactions between parents and professionals and (b) the behaviors comprising a resultant task analysis. Eight parents were then trained in these skills via an instructional package. Results of a multiple baseline design across subjects and grouped skill domains showed that each parent acquired the targeted skills during simulated conferences and that correct responding usually generalized to actual conferences. Independent judges validated training outcomes, and participating parents indicated satisfaction with the curriculum.     

Efficacy of a Brief Relaxation Training Intervention for Pediatric Recurrent Abdominal Pain

This study is a preliminary investigation of the efficacy of a brief intervention for recurrent abdominal pain (RAP) via a multiple baseline across subjects design. The intervention consisted of a single 1-hour session including psychoeducation and coaching of breathing retraining; the length, duration, and content of the intervention were designed with a goal of maximum portability to primary-care settings. Five children with recurrent abdominal pain participated in this study, 1 of whom served as a pilot participant. Children received the intervention at 1-week intervals. Parent and child reports of each child's abdominal pain, general somatic complaints, functional disability, and anxiety were collected throughout the study. All children participated in a 3-month follow-up session. Results indicated that this brief intervention was successful in lessening abdominal pain, as demonstrated by decreased Abdominal Pain Index (API) scores in two children and decreased abdominal pain following breathing retraining practice in all children. The intervention was also successful in decreasing some children's general somatic symptoms. Functional disability and anxiety symptoms remained consistent for all children throughout the study, which may be due to low levels of these symptoms pretreatment. Limitations and directions for future research are discussed.     

A naturalistic longitudinal evaluation of counselling in primary care

This study evaluated the effectiveness of generic counselling in a primary healthcare setting during three months of counselling and followed up the patients' progress after counselling had finished for the next twenty-one months. Questionnaires were completed by patients within the Dorset Primary Care counselling service on referral to counselling and at set points afterwards. A naturally occurring waiting-list group was compared with patients receiving counselling at baseline and three months. Measurements were taken of patients' psychiatric symptomatology, quality of life (QOL) and self-esteem. Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.     

ARTIFACTUAL EFFECTS OF SENSORY-INTEGRATIVE THERAPY ON SELF-INJURIOUS BEHAVIOR

Three individuals who exhibited self-injurious behavior (SIB) were exposed to sensory-integrative therapy. Prior to treatment, a functional analysis baseline was conducted to identify the motivational features of their SIB. One subject's SIB appeared to be an attention-getting response (maintained by positive reinforcement), which varied subsequently as a function of attention being either withheld or provided noncontingently during sensory-integration sessions. The 2nd subject displayed a pattern of responding suggestive of stereotypic SIB (maintained by automatic reinforcement), which paradoxically increased during sensory-integration sessions. The 3rd subject's SIB appeared to function as an escape response (maintained by negative reinforcement), and his behavior during sensory-integration sessions was similar to that observed during baseline sessions in which demands were not present. The SIB of all 3 subjects later was reduced when behavioral interventions were applied. The data presented raise questions about the active components of sensory-integrative therapy and the functional types of SIB for which it might be appropriate.     

Mother–child disputes as arenas for fostering negotiation skills

Valsiner's concepts of the zone of free movement (ZFM) and the zone of promoted actions (ZPA) were applied to mother-child disputes to study how mothers discharge their role as experts in negotiation. Twenty mothers of 3-5-year-olds each reported 20 disputes, 10 in which the mother was making a request and 10 in which she was refusing her child's request. The disputes were analysed sequentially using four models, preservation, copycat, reward/punishment, and provision of a rationale. The results showed that perseveration and copycat models were more likely to apply when there was negative affect. Mother's re-requests fitted the reward/punishment model whereas mother's refusals better fitted the provision of a rationale model. Information from follow-up interviews supported the notion that requests and refusals are being socialized differently. The results imply that, whereas children's requests and refusals are within the ZFM, only their requests are within the ZPA.