Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Psychological Distress and Symptoms of Posttraumatic Stress Disorder in Jewish Adolescents Following a Brief Exposure to Concentration Camps

We investigated the psychological impact of an organized visit to Polish concentration camps on Jewish-American adolescents. Eighty-seven adolescents who participated in a B'nai B'rith memorial visit to concentration camps in Poland completed measures of general psychological adjustment and posttraumatic stress disorder (PTSD) at four time-points: pretest, posttest, 6-month follow-up and 12-month follow-up. Measures included the SCL-90-R, the Mississippi Scale for PTSD, and the Impact of Events Scale (IES) for PTSD. On the SCL-90-R, changes in somatization, interpersonal sensitivity, obsessive-compulsive tendencies, depression, anxiety, and phobic anxiety were observed over time, with peak symptom scores at posttest and 6-month follow-up. Scores on the Mississippi Scale for PTSD and the IES Intrusion subscale also increased at 6-months. Predictors of PTSD symptoms on the Mississippi Scale included previous psychiatric treatment and SCL-90-R symptoms of paranoia, depression, and psychosis. Elevated psychotic symptoms on the SCL-90-R predicted PTSD symptoms on the IES. Jewish adolescents with preexisting symptoms of generalized distress or psychoticism appeared at increased risk for PTSD symptoms following exposure to Holocaust stimuli. This study contributes a prospective, multi-measure assessment of trauma reactions in adolescents.     

The impact on pastoral care of structural, organisational and statutory changes in schooling: Some empirical evidence and a discussion

Against the historical background of institutionalised pastoral care in schools, the results are reported of a questionnaire survey of 159 members of the National Association for Pastoral Care in Education (NAPCE) with regard to the impact of post-1988 changes on pastoral care and personal and social education (PSE). Five hypotheses are generated concerning the likely effects of the 1988 Education Reform Act, the National Curriculum and associated developments in educational policy and management. The data reveal that, for the sample surveyed, the importance, time and resources given to pastoral care and PSE are considered not to have declined in the way predicted. Respondents were also more positive than expected about the impact of a range of related changes, including school-centred initial teacher training, teacher mentoring, the introduction of statutory training days, National Curriculum cross-curricular elements, and SCAA and OFSTED guidance. However, there were some developments which were considered to have had a negative effect. These included the National Curriculum programmes of study and key-stage assessments, published league tables and collective acts of worship. Respondents were divided as to the impact of other developments, including the advent of local financial management (LMS), grant-maintained status and OFSTED inspections. There was little visible effect on the role structures in schools, with traditional 'horizontal' arrangements of years and schools-within-schools predominating. In sum, the picture as regards the impact on pastoral care and PSE of a decade of educational policy change is more optimistic than might have been supposed.     

Exergaming immediately enhances children's executive function

The current study examined an important aspect of experience--physical activity--that may contribute to children's executive function. The design attempted to tease apart 2 important aspects of children's exercise by examining the separate and combined effects of acute physical activity and cognitive engagement on an aspect of children's executive functioning. In a 2 × 2 within-subject experimental design, children (N = 33, 6 to 10 years old) completed activities that varied systematically in both physical activity (physically active video games versus sedentary video activities) and cognitive engagement (challenging and interactive video games versus repetitive video activities). Cognitive functioning, including executive function, was assessed after each activity by a modified flanker task (Rueda et al., 2004). Whereas cognitive engagement had no effect on any aspect of task performance, physical activity (i.e., exergaming) enhanced children's speed to resolve interference from conflicting visuospatial stimuli. Age comparisons indicated improvements with age in the accuracy of resolving interference and in overall response time. The results extend past research by showing more precisely how physical activity influences executive function and how this effect differs from the improvements that occur with development.     

Multiple trials may yield exaggerated effect size estimates

Published psychological research attempting to support the existence of small and medium effect sizes may not have enough participants to do so accurately, and thus, repeated trials or the use of multiple items may be used in an attempt to obtain significance. Through a series of Monte-Carlo simulations, this article describes the results of multiple trials or items on effect size estimates when the averages and aggregates of a dependent measure are analyzed. The simulations revealed a large increase in observed effect size estimates when the numbers of trials or items in an experiment were increased. Overestimation effects are mitigated by correlations between trials or items, but remain substantial in some cases. Some concepts, such as a P300 wave or a test score, are best defined as a composite of measures. Troubles may arise in more exploratory research where the interrelations among trials or items may not be well described.     

Do procedures for verbal reporting of thinking have to be reactive? A meta-analysis and recommendations for best reporting methods

Since its establishment, psychology has struggled to find valid methods for studying thoughts and subjective experiences. Thirty years ago, Ericsson and Simon (1980) proposed that participants can give concurrent verbal expression to their thoughts (think aloud) while completing tasks without changing objectively measurable performance (accuracy). In contrast, directed requests for concurrent verbal reports, such as explanations or directions to describe particular kinds of information, were predicted to change thought processes as a consequence of the need to generate this information, thus altering performance. By comparing performance of concurrent verbal reporting conditions with their matching silent control condition, Ericsson and Simon found several studies demonstrating that directed verbalization was associated with changes in performance. In contrast, the lack of effects of thinking aloud was merely suggested by a handful of experimental studies. In this article, Ericsson and Simon's model is tested by a meta-analysis of 94 studies comparing performance while giving concurrent verbalizations to a matching condition without verbalization. Findings based on nearly 3,500 participants show that the "think-aloud" effect size is indistinguishable from zero (r = -.03) and that this procedure remains nonreactive even after statistically controlling additional factors such as task type (primarily visual or nonvisual). In contrast, procedures that entail describing or explaining thoughts and actions are significantly reactive, leading to higher performance than silent control conditions. All verbal reporting procedures tend to increase times to complete tasks. These results suggest that think-aloud should be distinguished from other methods in future studies. Theoretical and practical implications are discussed.     

THE FATHER,THE FATHER FUNCTION,THE FATHER PRINCIPLE: SOME CONTEMPORARY PSYCHOANALYTIC DEVELOPMENTS

The author discusses Freud's thinking on the role of the father, as well as that of later French theoreticians. To illustrate his remarks, he draws on the poetry of Carlos Drummond de Andrade (1912–1987), a Brazilian poet whose work often dealt with themes of the father, the family, and his own paternal relationship. The author also discusses the psychic formation of the father principle and how this may be evident in the clinical analytic setting, even when the analyst's approach privileges field theory, intersubjectivity, or other concepts emphasizing the relationship between analyst and patient.     

The Role of Context on Strategic Actions in Mastermind

When inexperienced solvers play consecutive Mastermind games, they begin to use a strategy in which specific hypothetical types are offered in response to specific feedback types, a strategy known as the modal hypothesis strategy. When participants who had learned that strategy were shifted onto Mastermind games whose code format was different from, and easier than, that they had experienced, their use of the strategy was degraded despite their familiarity and experience in dealing with the specific feedback types occurring in the new code. The results suggest that the use of a domain-specific strategy is at least somewhat influenced by the match between the context in which the strategy has been acquired and the context in which it is being put to use.     

A Review of “Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds”

Abstract

Psychiatry in General Medical Practice, edited by Gene Usdin, M.D. and Jerry M. Lewis, M.D. New York: McGraw-Hill, 1979, 771 pages, $19.95.

Private Practice: A Handbook for the Independent Mental Health Practitioner, by Robert M. Pressman. New York: Gardner Press, 1979, 256 pages, $18.95.

Marital Therapy: Strategies Based upon Social Learning and Behavior Exchange Principles, by Neil S. Jacobson and Gayla Margolin. New York: Brunner/Mazel, 1979, 415 pages, $17.50.