A PARTICIPATIVE MANAGEMENT APPROACH FOR IMPROVING DIRECT-CARE STAFF PERFORMANCE IN AN INSTITUTIONAL SETTING

The present study evaluated a participative management approach for increasing the frequency of interactions between institutional staff and severely/profoundly retarded residents. The participative management approach involved teaching staff how to use self-monitoring, standard setting, self-evaluation, and self-reinforcement procedures. These procedures were then used by staff with minimal involvement of supervisory personnel. Although supervisors provided feedback and praise to staff for using these self-management behaviors, feedback and praise were never dispensed contingent on staff interactions with residents. Results indicated that during the participative management program there was an increase in staff interactions that were contingent on appropriate resident behavior. The increase in this type of staff interaction was accompanied by an increase in appropriate resident behavior. Follow-up data on both staff and resident behaviors, although showing moderating trends, suggested generally good maintenance of the initial behavior changes. Acceptability data suggested that staff were quite receptive to the program. The advantages of participative management procedures for improving staff performance in residential settings are discussed.     

Two logit models for external analysis of preferences

A logit vector model and a logit ideal point model are presented for external analysis of paired comparison preference judgments aggregated over a homogeneous group. The logit vector model is hierarchically nested within the logit ideal point model so that statistical tests are available to distinguish between these two models. Generalized least squares estimation procedures are developed to account for heteroscedastic sampling error variances and specification error variances. Two numerical illustrations deal with judgments concerning employee compensation plans and preferences for salt and sugar in the brine of canned green beans.     

Combined group and individual treatment for the borderline patient

This article discusses the attenuating mechanisms of group psychotherapy that support and enhance analytic work with borderline patients in combined group and individual psychotherapy. A group case study is presented which addresses the manifestations and management of transference and countertransference in a combined treatment approach. Combined treatment was observed to respond effectively to both the intrapsychic and interpersonal difficulties of borderline patients. A multidimensional model for treating these patients in a community mental health setting is proposed.     

Recent developments in psychiatric malpractice

Common issues of mental health liability are examined in relationship to recent legislative and case law. Matters of practical importance to practitioners including the applicability insurance coverage to punitive damage awards of arising from malpractice are addressed. Specific legal doctrines involving proof of liability, proximate cause and the standard of care are explored as they relate to mental health malpractice cases.     

The use of family myths as an aid to strategic therapy

The concept of family myth can be used by the therapist to help organize the wealth of information provided by a family in therapy. Rituals, symbols and metaphors can be viewed as structurally related components within the family myth system which enable the therapist to interpret non-literal, analogic communications as a coherent yet primarily symbolic, narrative about the family's shared perceptions of its functioning. The concept of myth is explored in relation to mythology, the family therapy literature, and a case study. Several strategic intervention strategies are proposed which utilize the family's own metaphors, symbols and rituals to re-edit the family myth. Re-editing the myth on a symbolic level should be associated with improved system functioning, including more concrete areas of the family's life.     

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.     

FUNCTIONAL ASSESSMENT,CURRICULAR REVISION,AND SEVERE BEHAVIOR PROBLEMS

An adolescent female with multiple handicaps and a long history of severely disruptive behavior participated in a functional assessment linked directly to specific revisions in her school curriculum. During Phase 1, reversal designs were used to test hypotheses pertaining to antecedent and auricular influences on problem behavior. During Phase 2, a multiple baseline across afternoon and morning time periods demonstrated that the auricular revisions were effective in eliminating severely disruptive behavior and increasing on-task responding. Data also showed that inappropriate “psychotic” speech was reduced and appropriate social interactions were increased. Follow-up results showed that the changes were maintained throughout the school year. Questionnaire data provided social validation of the procedures and outcomes. The findings are discussed in relation to their implications for functional assessment, individualized curricula, and positive programming for students with disabilities and serious behavior problems.     

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.