PROMOTING PARENT-PROVIDER INTERACTION DURING YOUNG CHILDREN'S HEALTH-SUPERVISION VISITS

We prompted parents to increase their interactions with health-care providers during their children's health-supervision visits. Before scheduled appointments we asked parents of 32 infants and young children if they had specific child health questions or concerns. Sixteen parents randomly assigned to the prompted group were then prompted to initiate discussions of their concerns. Sixteen control parents discussed unrelated topics before their appointments. Prompted parents initiated significantly more interactions with health-care providers and more health and behavioral topics were discussed during their appointments. Both parent groups reported satisfaction with health-care services. Further research is needed to determine the clinical significance of outcomes associated with enhanced parent-provider interaction during children's health-supervision visits. These visits are ideal settings for behavioral research on improving health care for children and their families.     

EMPIRICALLY DERIVED INJURY PREVENTION RULES

This study describes a set of empirically derived safety rules that if followed, would have prevented the occurrence of minor injuries. Epidemiologists have criticized behavioral interventions as increasing “safe” behavior but failing to demonstrate a decrease in injury. The present study documents retrospectively the link between safe behavior and injury. It demonstrates that these empirically derived rules are very similar to rules for the prevention of serious injury. The study also shows that these rules are not widely accepted and implemented by parents. Suggestions for future research in this area are advanced.     

MODIFICATION OF ACTIVITY LEVEL THROUGH BIOFEEDBACK AND OPERANT CONDITIONING1

The biomotometer, an electronic device that simultaneously measures activity and provides auditory feedback to the subject, was used in combination with material reinforcers in two experiments attempting to modify activity level in children. In the first study the activity level of an 11-year-old highly active boy was decreased below mean baseline during conditioning in a classroom setting. His level of activity returned to baseline when feedback was withdrawn. In the second study, activity level of a 10-year-old hypoactive boy was increased over mean baseline level during conditioning in a free-play setting, and returned to slightly below baseline during five extinction trials. Results of these studies indicate that the biomotometer is a useful instrument for modification of activity level.     

ECOBEHAVIORAL CHARACTERISTICS OF A PEDIATRIC BURN INJURY UNIT

Behavioral observations were conducted on 40 children admitted consecutively to an inpatient pediatric burn care unit (PBCU) over a 6-month period. Children's responses to the PBCU environment as well as adult responses to patients were assessed. Data indicated that children most frequently (a) were oriented and alert, (b) emitted vocalizations or verbalizations, (c) were environmentally engaged, (d) and demonstrated positive or neutral affective responding. Adult-child interactions occurred during the majority of observations. Age was found to be significantly related to the type of distress response exhibited. Positive responses indicative of patient well-being were found to be associated with environmental engagement and the presence of other patients. In general, little evidence emerged to support the notion of a PBCU response pattern which resembles that observed in pediatric intensive care units (i.e., ICU syndrome). The use of observational methods for studying the behavioral adaptation of children in medical settings and the implications of the data for the design of interventions on PBCUs are discussed.     

A BRIEF COMPONENT ANALYSIS OF POTENTIAL TREATMENT PACKAGES IN AN OUTPATIENT CLINIC SETTING WITH YOUNG CHILDREN

The purpose of this study was to develop outpatient clinic assessments that allowed us to assess multiple treatment variables, produce relatively quick effects, and isolate active treatment components. Assessment began by evaluating a treatment package consisting of antecedent and consequence variables followed by a component analysis to determine the separate effects of the treatment variables. Three examples of the findings are presented.     

BEHAVIORAL ASSESSMENT FOR PEDIATRIC INTENSIVE CARE UNITS1

Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.     

Classroom-based functional and adjunctive assessments: proactive approaches to intervention selection for adolescents with attention deficit hyperactivity disorder.

The present investigation evaluated the utility of classroom-based functional and adjunctive assessments of problem behaviors for 2 adolescents who met diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD). For children with ADHD-ODD, environmental classroom variables, when systematically manipulated by teachers, were related to the occurrence and nonoccurrence of problem behaviors. Classroom interventions derived from information that was obtained during functional and adjunctive assessments and from subsequent analyses resulted in substantial reductions in problem behaviors. Teacher and student consumer satisfaction ratings indicated that the interventions were effective and feasible in the classroom setting.     

CHANGING PROTECTIVE AND RISKY BEHAVIORS TO PREVENT CHILD-TO-PARENT TRANSMISSION OF CYTOMEGALOVIRUS

Child-to-parent transmission of cytomegalovirus may be reduced by increasing protective behaviors (handwashing and glove use) and decreasing risky behaviors (intimate contact between child and parent). This study showed that an educational intervention resulted in increases in reported and objective measures of protective behaviors and decreases in reported risky behaviors. Further study must determine if changes in protective and risky behavior are maintained and prevent cytomegalovirus transmission.     

EFFECTS OF PROBLEM-BASED SCHEDULING ON PATIENT WAITING AND STAFF UTILIZATION OF TIME IN A PEDIATRIC CLINIC

The patient scheduling system in a pediatric outpatient clinic was changed from time-based to problem-based in an A-B-A-B reversal design. During baseline, time-based scheduling was in effect with patients being scheduled in 15-min periods regardless of presenting problem. During intervention, a receptionist matched client problems with time slots so that a more extensive treatment was allocated more time. Problem-based scheduling resulted in a substantial decrease in mean number of minutes spent in clinic across all presenting problems. Waiting time increased to baseline levels when problem-based scheduling was removed and decreased again on reintroduction of the program. A follow-up check conducted 1 month after the end of the second intervention phase revealed that the effects were maintained. The problem-based schedule also resulted in an increase in the proportion of extra time that medical staff had available and produced a positive consumer response.     

INCREASING THE IMMUNIZATION OF PRESCHOOL CHILDREN; AN EVALUATION OF APPLIED COMMUNITY INTERVENTIONS

We evaluated the relative impact of four procedures designed to encourage parents to obtain immunizations for their children. In a public health setting, the families of 1,133 immunization-deficient preschool children were randomly assigned to six conditions: (a) a general prompt; (b) a more client-specific prompt; (c) a specific prompt and increased public health clinic access; (d) a specific prompt and monetary incentives; (e) contact control; and (f) no contact control. All interventions, except the general prompt, produced some evidence of improvement when compared with the control groups. The monetary incentive group revealed the largest effect, followed by the increased access group, specific prompt group, and general prompt group, respectively. The data suggest that relatively powerful and immediate effects on preschoolers' clinic attendance for immunization may be produced by monetary incentives in conjunction with client-specific prompts. However, client-specific prompts alone appear to be the most cost-effective of the interventions.     

Teachers' and mothers' assessment of children's behaviors from kindergarten to grade two: Stability and change within and across informants

Consistency between teachers' and parents' ratings of 229 children's prosocial and problem behaviors was investigated from kindergarten through grade two. Intrarater stability was also analyzed. Results indicated moderate but decreasing interrater agreement from kindergarten to grade two for boys on externalizing behaviors. Interrater agreement for the same behavior dimension for girls was moderate and stable, whereas it was low on internalizing behavior problems and prosocial behaviors, for both genders throughout the 3-year period. Moreover, difference between teachers' and parents' ratings of externalizing behaviors increased from kindergarten to grade two. Decreasing level of agreement through time appeared to be related to a reduction of teacher-rated externalizing behaviors not paralleled by a reduction in parent ratings. Analyses were also performed at the item level of the externalization scale to identify which specific behaviors were responsible for the increasing divergence in interrater agreement from kindergarten through grade two. Alternative interpretations were considered in order to account for present and past results. Implications for screening and assessment purposes were discussed.This research was supported by grants from the Social Sciences and Humanities Research Council of Canada and from Québec's Health Research Fund (FRSQ). We wish to thank the authorities and directors of the schools from the Val d'Or School Board as well as the kindergarten, first and second grade teachers, children, and parents for their collaboration. We also thank Lyse Desmarais-Gervais, Daniel Corriveau, Jean Desrosiers and Hélène Boileau for their participation in the data collection or analysis.     

Reinforcement of compliance with respiratory treatment in a child with cystic fibrosis.

An 8-year-old boy with cystic fibrosis (CF), mental retardation, and autism exhibited noncompliance with respiratory treatments that were essential for the management of his CF. A treatment involving shaping cooperation while still allowing escape for aggression and avoidance behavior resulted in increases compliance with respiratory treatments and decreases in problem behavior. Treatment gains were maintained over 3 months.     

Alternative factor structures of health-related psychological tendencies and their relationship to self-reported health seeking behaviors

Abstract

The MHQ-Multidimensional Health Questionnaire (Snell and Johnson, 1997) and a checklist of twenty Health Promoting Behaviors were administered to 1,011 Italian subjects aged 21 to 80 years. The MHQ measures twenty health related psychological tendencies (e.g, Health Efficacy, Locus of Control, Optimistic Expectations). A Principal Components Analysis was carried out on the twenty scales to study their internal structure. Both a four- and a two-factor solution are discussed, presenting different perspectives on the data. The former solution yielded a larger motivational factor, which we labeled Aspiration for Health, and three smaller factors, which we labeled Optimistic Expectations, Internal Control and Lack of Control. All factors, particularly the first one, discriminated self-reported health seeking behaviors. The latter solution yielded a Health Management factor and a Negative Thinking one, both discriminating health behaviors. Moreover, the two factors provide a useful model for distinguishing efficacy, optimism and internal control in terms of their cognitive and affective components.     

AN APPOINTMENT-KEEPING IMPROVEMENT PACKAGE FOR OUTPATIENT PEDIATRICS: SYSTEMATIC REPLICATION AND COMPONENT ANALYSIS

Child health-care appointments that are not kept are an important pediatric problem. Previous research has shown that reducing effort (with a parking pass) and reminding patients (with mailed and telephone reminders) significantly improved appointment keeping for first-time and patient-scheduled appointments. This study, using a posttest-only group design, evaluated the effects of various combinations of that intervention applied to clinic-scheduled follow-up appointments. All combinations of the intervention significantly increased cancellations, but none increased appointments kept or decreased appointments not kept significantly. Log linear analyses showed that the lag time between scheduling and the appointment significantly influenced appointment keeping. The results suggest that if clinics want to increase cancellations, a mailed reminder and effort reduction are sufficient. To increase appointment keeping, other interventions, such as reduced lag time, may be necessary.     

Learning to stand tall: Idiopathic scoliosis,behavioral electronics,and technologically-assisted patient participation in treatment,c. 1969–1992

Drawing on the archives of American learning psychologist Neal E. Miller, this article investigates the role of instrumentation in the expansion and diversification of the behavior therapy domain from the late 1960s to the early 1990s. Through the case of Miller's research on the use of biofeedback to treat idiopathic scoliosis, it argues that the post-World War II adoption of electronic technology by behavioral psychologists contributed to extending their subject matter to include physiological processes and somatic conditions. It also enabled a technologically-instrumented move outside the laboratory through the development of portable ambulatory treatment devices. Using the example of the Posture-Training Device that Miller and his collaborators invented for the behavioral treatment of idiopathic scoliosis, this paper considers how electromechanical psychological instrumentation illustrated a larger and ambiguous strategic shift in behavior therapy from an orientation toward external control to one of self-control.