Audit and family systems consultation: evaluation of practice at a child and family centre

This audit of practice at a child and family centre included a 16-month case note review covering 319 cases, a postal survey of 45 families and an interview survey of ten GPs who typically referred cases to the centre. The audit furnished information from three different perspectives on the referral process, the consultation process, and outcome for clients attending the centre. The referral rate was about one new case per day and peak referral times were the beginning of the autumn and winter school terms. Almost half the referrals came from GPs; the remainder were largely from Paediatrics, Education and Social Services. Most clients were seen within two months. Half of the families referred had serious psychosocial difficulties including multiple problem members, multi-problem children, multi-agency involvement, psycho-educational difficulties, child protection problems or child placement difficulties. The majority of cases received six hours of consultation. Families where child abuse had occurred or families containing a multi-problem adolescent received a more intensive service. Between a half and three-quarters of cases had positive outcomes as rated by staff and parents. The service was viewed by GPs to be highly satisfactory. On the negative side, many parents felt ill-prepared for the consultation process and most children did not enjoy the experience.     

Psychology and mind-body segregation: Are we part of the problem?

Despite advances in behavioral medicine and health psychology, the health care system and medical education continue to show resistance to a truly biopsychosocial model of medical practice. Psychologists in medical settings have generally been identified as challenging the concept of mind-body duality and the segregation of biologic and psychosocial sciences in medicine. However, examples are presented of how psychologists contribute to and perpetuate mind-body segregation via exclusive theoretical conceptualizations, arbitrary definitions of professional behavior, and dogmatic constraints on the limits of psychology's field of knowledge.     

Biasing the development of response topography with nonspecific positive and negative evocative verbal stimuli

Conditioned response (CR) rate and development of CR latency, rise time, and airpuff attenuation were examined for V- and C-form responders using two nonspecific command words, do and don't, as conditioned stimuli (CSs) in single-cue, double-cue, and differential eyelid conditioning. In both single-cue and differential conditioning, regardless of the command word used to signal the unconditioned stimulus (UCS), the Vs produced a higher response rate and learned a better UCS-attenuating response topography than the Cs. However, in a double-cue conditioning paradigm in which both command words were presented alone on different trials and reinforced, response latency was longer and puff attenuation poorer among Vs than when the UCS was signaled by a unique cue. In contrast, adding a second reinforced cue actually enhanced the development of puff-avoidant CR topographies among Cs compared to single-cue conditioning. These results and others indicate that response topography development is to some extent a labile process that can be biased toward either good or poor puff-avoidant properties and that the factors responsible for influencing CR topography differ for Vs and Cs.     

FUNCTIONAL COMMUNICATION TRAINING TO REDUCE CHALLENGING BEHAVIOR: MAINTENANCE AND APPLICATION IN NEW SETTINGS

We evaluated the initial effectiveness, maintenance, and transferability of the results of functional communication training as an intervention for the challenging behaviors exhibited by 3 students. Assessment indicated that escape from academic demands was involved in the maintenance of the challenging behaviors. Social attention was also implicated as controlling the behavior of 1 student. The intervention involved teaching alternative assistance-seeking and attention-getting phrases to the students in an effort to replace challenging behavior with these verbal equivalents. Multiple baseline data collected across the 3 students indicated that not only did the intervention substantially reduce challenging behavior but also that these results transferred across new tasks, environments, and teachers, and were generally maintained from 18 to 24 months following the introduction of functional communication training. These results are discussed in light of recent efforts to develop effective interventions for severe challenging behavior and to understand the processes underlying transfer and maintenance of intervention effects.     

Orthography and familiarity effects in word processing

Both orthographic regularity and visual familiarity have been implicated as contributors to the efficiency of processing visually presented words. Our studies sought to determine which of the internal codes representing words in the nervous system are facilitated by these two variables. To do this, sets of letter strings in which orthography and familiarity were factorially combined were used as the basis for physical, phonetic, semantic, and lexical judgments. The data indicated consistent effects of orthography on the activation of all codes. These effects were seen in same-different matching and in judgments of stimulus orientation, which are based on visual codes; in judgments of pronounceability based on phonetic codes; in judgments of meaningfulness based on semantic codes; and in lexical decisions, which are based on phonetic and semantic codes together. Familiarity, on the other hand, had a clear influence on the activation of semantic codes and to a lesser extent affected phonetic codes. Despite previous positive results found in matching letter strings, however, no influence of familiarity occurred in judgments based on visual codes once evidence for criterion shifting was eliminated. Our negative results included direct tests of facilitation in matching acronyms (e.g., FBI) and in matching both regular and irregular strings familiarized by specific training. It now appears that earlier findings of visual familiarity effects may be attributed to response biases resulting from the activation of higher level codes sensitive to familiarity, and to the use of small sets of training stimuli that allowed subjects to induce orthographic-like rules. The results obtained so far with our methods seem to reconcile an inconsistent literature by showing that speeded decisions based on visual codes are most strongly influenced by rule-governed processing mechanisms sensitive to orthographic structure, whereas decisions based on phonetic and semantic codes are affected about equally by rule-governed mechanisms and by stimulus-specific mechanisms sensitive to familiarity. This conclusion may lead to changes in notions of how effective various kinds of visual training are likely to be at different stages in the acquisition of reading skill.