Group CBT for Externalizing Disorders in Urban Schools: Effect of Training Strategy on Treatment Fidelity and Child Outcomes

Public schools are an ideal setting for the delivery of mental health services to children. Unfortunately, services provided in schools, and more so in urban schools, have been found to lead to little or no significant clinical improvements. Studies with urban school children seldom report on the effects of clinician training on treatment fidelity and child outcomes. This study examines the differential effects of two levels of school-based counselor training: training workshop with basic consultation (C) vs. training workshop plus enhanced consultation (C +) on treatment fidelity and child outcomes. Fourteen school staff members (counselors) were randomly assigned to C or C +. Counselors implemented a group cognitive behavioral therapy protocol (Coping Power Program, CPP) for children with or at risk for externalizing behavior disorders. Independent coders coded each CPP session for content and process fidelity. Changes in outcomes from pre to post were assessed via a parent psychiatric interview and interviewer-rated severity of illness and global impairment. Counselors in C + delivered CPP with significantly higher levels of content and process fidelity compared to counselors in C. Both C and C + resulted in significant improvement in interviewer-rated impairment; the conditions did not differ from each other with regard to impairment. Groups did not differ with regard to pre- to- posttreatment changes in diagnostic severity level. School-based behavioral health staff in urban schools are able to implement interventions with fidelity and clinical effectiveness when provided with ongoing consultation. Enhanced consultation resulted in higher fidelity. Enhanced consultation did not result in better student outcomes compared to basic consultation. Implications for resource allocation decisions with staff training in EBP are discussed.     

Treating liquid expulsion in children with feeding disorders

In the current investigation, we compared and evaluated the effects of two intervention procedures, a modified chin prompt and reclined seating, on the liquid expulsion of 2 children with feeding disorders. For both participants, expulsion decreased to clinically meaningful levels when we added the modified chin prompt or reclined seating to a treatment package consisting of differential reinforcement of acceptance, nonremoval of the cup, and re‐presentation. We discuss possible mechanisms underlying the effects of the 2 interventions and areas for future research.     

Response to Critics

In this “Response to Critics,” Cathleen Kaveny continues the conversation in the JRE symposium centered on her recent book, Prophecy without Contempt: Religious Discourse in the Public Square. The book's central argument is that adequate discussion of contention in the contemporary public square requires attending to matters of rhetoric, particularly the rhetoric of prophetic indictment. Kaveny engages the comments of four interlocutors: Alda Balthrop‐Lewis, James Childress, William Hart, and Martin Kavka. The first section, “Overarching Goals,” summarizes the objectives of the book. The second section, “Methodology,” engages critics regarding methodological issues, highlighting Kaveny's commitment to a version of MacIntyre's tradition theory and her indebtedness to her legal training. The third section, “Structure,” responds to particular questions her interlocutors raise about the four parts of the book. The fourth section, “Larger Questions,” ponders the next stages of the academic and political discussion about contention in the public square.     

Training Pediatric Psychologists for Perinatal Behavioral Health Services in a Pediatric Hospital

Although pediatric hospitals specialize in providing care to children and adolescents, at The Children’s Hospital of Philadelphia (CHOP), our team has been providing behavioral health services for two unique parent populations—parents with a child in the Newborn Infant Intensive Care Unit and pregnant women carrying fetuses with specific birth defects and receiving prenatal care in the Center for Fetal Diagnosis and Treatment. A new training program was developed to expand the scope of pediatric psychologists’ practice to include perinatal behavioral health services, specifically for these two unique parent populations served at CHOP. The program includes direct service provision for adult mental health concerns, as well as education and support to help families cope with the existing medical conditions. This article describes the training program and its implementation as a model of training for other pediatric hospitals. The roles of psychologists embedded in these units and hospital privileges are discussed.     

Imitation of Goal Engagement and Disengagement Processes in Romantic Relationships

Individual differences in goal engagement and goal disengagement processes have been demonstrated to be related to goal attainment, health, and emotional well-being. However, there is a dearth of studies on the developmental conditions of individual differences in these processes. Social learning processes contribute to the formation of individual dispositions even in adulthood. As one pathway of learning, we investigated observational learning of goal regulation processes in romantic relationships in two experimental studies. Study 1 (N = 67 couples, M = 32.65 years) replicated a previous finding that observing partners imitated their partner's goal regulation processes in the same task and extended it by showing transfer effects to another task. Study 2 (N = 60 couples, M = 25.9 years) demonstrated that—given a lack of praise of the modelled actions—partners still imitated goal regulation processes but to a smaller extent. These findings lend support for observational learning as a pathway to individual differences in the application of goal regulation processes. © 2020 The Authors. European Journal of Personality published by John Wiley & Sons Ltd on behalf of European Association of Personality Psychology     

Assessing ADHD and comorbid disorders in children: the Child Behavior Checklist and the Devereux Scales of Mental Disorders

Evaluated discriminant validity and clinical utility of selected subscales of the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) and the Child Behavior Checklist (CBCL; Achenbach, 1991a) in 228 children referred to a clinic for the evaluation and treatment of attention deficit hyperactivity disorder (ADHD). The DSMD is a multiaxial behavior rating scale that measures symptomatology for a broad range of child psychopathology as described in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-R-III] and 4th ed. [DSM-IV]; American Psychiatric Association, 1987, 1994). Discriminant function analyses as well as sensitivity, specificity, and predictive power analyses were computed to evaluate the discriminant validity and clinical utility of selected DSMD and CBCL subscales for assessing ADHD, oppositional defiant disorder (ODD), and anxiety disorders. Results indicated that the DSMD compared very favorably with the CBCL in the ability to discriminate between children with ADHD and those without ADHD and between children with comorbid ODD and anxiety disorders and children who did not meet criteria for these disorders. The DSMD Attention subscale may be somewhat better at ruling in ADHD combined subtype (ADHD-C) and ADHD inattentive subtype (ADHD-I) than the CBCL Attention Problems subscale, but the CBCL Attention Problems subscale may have slightly better utility than the DSMD Attention subscale in ruling out these subtypes. Both the CBCL and DSMD were more useful for ruling out than for ruling in ODD and anxiety disorders.     

Stress-buffering effects of social support: A longitudinal study

The purpose of the present study was to investigate the effects of stress and social support in a longitudinal design. A sample of mature female students took part in a study that measured stress, social support, and psychiatric symptoms at two points 6 months apart. The results showed that the Time 1 measure of social support was a significant predictor of Time 2 symptoms when Time 1 symptoms were controlled for. Furthermore, a stress-buffering effect was obtained for Emotional support, but not for Practical support in conjunction with life events that occurred in the follow-up phase. Some of the conditions under which stress-buffering effects should be obtained are briefly considered.     

A COMPARISON OF TWO APPROACHES FOR IDENTIFYING REINFORCERS FOR PERSONS WITH SEVERE AND PROFOUND DISABILITIES

The development of effective training programs for persons with profound mental retardation remains one of the greatest challenges for behavior analysts working in the field of developmental disabilities. One significant advancement for this population has been the reinforcer assessment procedure developed by Pace, Ivancic, Edwards, Iwata, and Page (1985), which involves repeatedly presenting a variety of stimuli to the client and then measuring approach behaviors to differentiate preferred from nonpreferred stimuli. One potential limitation of this procedure is that some clients consistently approach most or all of the stimuli on each presentation, making it difficult to differentiate among these stimuli. In this study, we used a concurrent operants paradigm to compare the Pace et al. (1985) procedure with a modified procedure wherein clients were presented with two stimuli simultaneously and were given access only to the first stimulus approached. The results revealed that this forced-choice stimulus preference assessment resulted in greater differentiation among stimuli and better predicted which stimuli would result in higher levels of responding when presented contingently in a concurrent operants paradigm.     

Does negative priming imply preselective identification of irrelevant stimuli?

Responses to recently ignored stimuli are often slower than responses to new stimuli (negative priming). This slowing is thought to imply that the irrelevant stimuli were identified before the relevant stimuli were selected. The slowing may, however, reflect processing that occurred after the selection process had already begun. In two experiments, the opportunity for preselective identification of irrelevant stimuli was eliminated by presenting the irrelevant stimuli late within the trial. Negative priming failed to occur under these conditions.