The sound of spiritual care: music interventions in a palliative care setting

The article describes how music has been integrated into spiritual and supportive care for palliative care patients at Brantford General Hospital (Ontario). Numerous case examples illustrate how a song or piece of music can play a vital role in the spiritual dimension of end of life care. The article expands the concept of the "living human document" by positing that a life story has an accompanying soundtrack: a musical memory and sensorial attunement that can be energized when music is offered at the bedside. The writers suggest that music provides an alternate spiritual language for patients whether or not they have a religious affiliation.     

Pausing phenomena: Influence on the quality of instruction

This report summarizes work of 7 years on the influence of a variable called “wait-time” on the development of language and logic of children taking part in elementary science programs. Analysis of over 300 classroom tape recordings showed mean pauses to be on the order of 1 sec; that is, after a teacher asked a question, students had to begin a response within an average time of 1 sec. If they did not, the teacher typically repeated, rephrased or asked a different question, or called on others. A second wait-time is involved: when a student makes a response, the teacher normally reacts or asks another question within an average time of 0.9 sec. This study investigates the consequences of manipulating both species of wait-time. When mean wait-time of 3–5 sec is achieved through training, analysis of more than 900 tapes shows changed values on eight student variables: (1) the length of response (number of words) increases, (2) the number of unsolicited but appropriate responses increases, (3) failures to respond decrease, (4) incidence of speculative responses increases, (5) incidence of student-student comparisons of data increases, (6) incidence of evidence-inference statements increases, (7) frequency of student-initiated questions increases, and (8) the variety in type of verbal moves made by students increases. Servochart plots of recordings show that students discussing science phenomena tend to speak in bursts, with intervals of as much as 3–5 sec between bursts being fairly common provided they are not interrupted. The average post-student-response wait-time of 0.9 sec apparently intervenes between bursts to prevent completion of a thought. The classroom is conceptualized as a two-player game in which the quality of inquiry will tend to improve when there is a better equity in the distribution of moves between the players. The teacher is treated as one player and the collection of students as the second player. Changes in wait-time shift the game toward a more equitable state. Over time, a classroom or instructional group on the prolonged wait-time schedule undergoes certain spontaneous changes. Two teacher variables change: (1) response flexibility scores increase, and (2) teacher questioning patterns becomes more variable. There is some indication that teacher expectations for performance of students rated as relatively slow improves.     

Establishing Treatment Fidelity in Evidence-Based Parent Training Programs for Externalizing Disorders in Children and Adolescents

The current review evaluates the use of treatment fidelity strategies in evidence-based parent training programs for treating externalizing disorders. We used a broad framework for evaluating treatment fidelity developed by the National Institutes of Health Treatment Fidelity Workgroup that includes the aspects of treatment design, treatment delivery, training providers, and assessment of participant receipt of treatment and enactment of treatment skills. Sixty-five articles reporting outcome trials of evidence-based parent training programs met inclusion criteria and were coded for treatment fidelity strategies. The mean adherence to fidelity strategies was .73, which was higher than two previous review studies employing this framework in the health literature. Strategies related to treatment design showed the highest mean adherence (.83), whereas training of providers and enactment of treatment skills had the lowest (.58). In light of an increasing emphasis on effectiveness and dissemination trials, the broader treatment fidelity framework as applied in this review focuses needed attention on areas often overlooked in fidelity practices, such as training providers and generalization of treatment skills. We discuss the strengths and limitations of fidelity practices in parent training studies, implications of these findings, and areas for future research.