A decade of research and services for homeless mentally ill persons. Where do we stand?

Over the past decade, researchers have documented the range of needs and devised new methods for increasing our understanding of the homeless severely mentally ill population. Clinicians have developed an appreciation of the difficulty and complexity of effectively treating this population, and policymakers have become increasingly aware of the barriers to developing services and housing. In this article, the progress-to-date in research, the evolution of new service approaches, and the development of federal, state, and local policies to meet the needs of homeless mentally ill individuals are assessed. The many challenges that remain are also considered.     

Multifactorial assessment of bulimia nervosa

We investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. Two hundred forty-five bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing undimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients.     

A COMPREHENSIVE EVALUATION OF REINFORCER IDENTIFICATION PROCESSES FOR PERSONS WITH PROFOUND MULTIPLE HANDICAPS

We evaluated comprehensively a preference assessment for identifying reinforcers for persons with profound multiple handicaps. Four experiments were conducted involving 18 individuals. Results of Experiment 1 replicated previous findings in that the assessment identified student preferences for respective stimuli, and caregiver opinion of preferences did not coincide with the systematic assessment. Results of Experiment 2 indicated highly preferred stimuli were likely to function as reinforcers in training programs, whereas stimuli not highly preferred did not function as reinforcers. Results of Experiment 3 suggested the 12 stimuli used in the assessment represented a comprehensive stimulus set for identifying preferences, although the utility of the set sometimes could be enhanced by caregiver opinion. Results of Experiment 4 indicated the assessment identified preferences likely to be maintained over time. Overall, results are discussed in terms of identifying limits and alternatives to a behavioral teaching technology when applied to persons with profound multiple handicaps.     

The Measurement of Self-Esteem, Stress-Related Life Events, and Locus of Control Among Unemployed and Employed Blue-Collar Workers

The purpose of this study was to measure the self-esteem, stress of life events, and locus of control among unemployed and employed blue-collar workers. It was hypothesized that (a) being unemployed decreases an individual's self-esteem, (b) being unemployed increases an individual's stress level by experiencing significant life changes, and (c) being unemployed increases an individual's external locus of control orientation. The study was conducted in a production/manufacturing organization, utilizing a systematic random sampling procedure that yielded 562 subjects. The results from the collected data did not support Hypothesis A or C. A significant change with stress in conjunction with life events was found but was mediated by several factors, including age and a nonsignificant correlation between time laid-off and stress levels. The study suggests that an individual's reaction to unemployment does not appreciably affect their self-esteem and locus of control when compared to the employed.     

The development of therapeutic consultations in child-focused family work

This paper outlines the theoretical influences that have led to our use of a consultation approach to work with children and families. Winnicott's notion of therapeutic consultation, the narrative approach in family therapy, the use of letters in therapeutic work and the two-plus-one model of therapeutic contact are discussed. A model of the consultation interview and process is presented together with examples of consultation letters responding to typical client expectations of the process.     

Making choice a routine part of mealtimes for persons with profound mental retardation

Despite increased recognition of the importance of providing routine choice opportunities for persons with severe handicaps, this population continues to experience a typical lack of such opportunities. We evaluated a program for increasing the amount of choices made during routine mealtimes by persons with profound mental retardation and minimal communication skills. The choice provision program, involving systematic presentation of alternative food and drink items in a step-wise fashion during the course of the meal, was implemented with three persons in a residential facility. Results indicated that after implementation of the choice program, all three participants made consistently more choices concerning the foods and beverages they consumed relative to baseline. The choice provision program was conducted without extending the amount of time typically allotted to mealtime within the residential setting. Results are discussed in regard to additional research needed to continue developing means of assisting persons with profound mental retardation to exert control over meaningful events in their lives.     

Attentional scanning and space errors

Using the method of paired comparisons, pairs of simultaneous horizontal or vertical lines, with one line above and one below or one on the left and one on the right of a fixation point, respectively, were presented tachistoscopically for length comparison. Space errors were found to have a pattern similar to that of time errors. The tendency to guess the comparative response from the absolute magnitude of stimuli is proposed as a basis for time and space errors. Manipulation of attentional scanning, which implies a more frequent usage of this guessing strategy for one of the two lines in a pair, was shown to affect space errors.