Psychiatric malpractice in the military

Available data indicates that the incidence of malpractice in military psychiatry, involving both civilian and active duty beneficiaries, is the lowest of all specialties and may be lower than in the civilian sector. Recovery for malpractice damages by means of claim versus suit is restricted to civilian patients; active duty service members recover through a special disability system. The federal government provides military psychiatrists with considerable protection from personal financial loss when involved in malpractice, but there may be limits to that protection. There have been recent efforts to criminally prosecute military physicians in some instances. A registry review of military psychiatry malpractice cases from 1978 to 1987provides a profile of the malpractice situation and suggests areas of practice that need vigilance. The Department of Defense has established a broad-based, comprehensive program of quality assurance and risk management in the interest of maximizing the benefit of medical care and minimizing substandard practice.     

How and when to correct for juror hindsight bias in mental health malpractice litigation: Some preliminary observations

This article examines the hindsight bias in the context of mental health malpractice litigation, analyzes various legal mechanisms for dealing with the bias, and discusses whether the law should strive for debiasing in all mental health malpractice cases.     

Automation of learning-set testing: The video-task paradigm

Researchers interested in studying discrimination learning in primates have typically utilized variations in the Wisconsin General Test Apparatus (WGTA). In the present experiment, a new testing apparatus for the study of primate learning is proposed. In the video-task paradigm, rhesus monkeys (Macaca mulatta) respond to computer-generated stimuli by manipulating a joystick. Using this apparatus, discrimination learning-set data for 2 monkeys were obtained. Performance on Trial 2 exceeded 80% within 200 discrimination learning problems. These data illustrate the utility of the video-task paradigm in comparative research. Additionally, the efficient learning and rich data that were characteristic of this study suggest several advantages of the present testing paradigm over traditional WGTA testing.     

Effects of uncertainty on melodic

In three experiments, musically trained and untrained adults listened to three repetitions of a 5-note melodic sequence followed by a final melody with either the same tune as those preceding it or differing in one position by one semitone. In Experiment 1, ability to recognize the final sequence was examined as a function of redundancy at the levels of musical structurein a sequence, contour complexity of transpositions in a trial, and trial context in a session. Within a sequence, tones were related as the major or augmented triad; within a trial, the four sequences began on successively higher notes (simple macrocontour) or on randomly selected notes (complex macrocontour); and within a session, trials were either blocked (all major or all augmented) or mixed (major and augmented randomly selected). Performance was superior for major melodies, for systematic transpositions within a trial (simple macrocontours), for blocked trials, and for musically trained listeners. In Experiment 2, we examined further the effect of macrocontour. Performance on simple macrocontours exceeded that on complex, and excluded the possibility that repetition of the 20-note sequences provided the entire benefit of systematic transposition in Experiment 1. The effect of musical structure (major/augmented) was also replicated. In Experiment 3, listeners provided structure ratings of ascending 20-note sequences fromExperiment 2. Ratings onsame trials were higher than those on correspondingdifferent trials, in contrast to performance scores for augmentedsame anddifferent trials in previous experiments. The concept of functional uncertainty was proposed to account for recognition difficulties on augmented same trials. The significant effects of redundancy on all the levels examined confirm the utility of the information-processing framework for thestudy of melodic sequence perception.     

A TEST OF SHAVELSON'S HIERARCHICAL MULTIFACETED SELF-CONCEPT MODEL IN A FILIPINO COLLEGE SAMPLE

Shavelson's hierarchical, multifaceted self-concept model (HMFM) has proven useful to educational and psychological researchers. The reliability and factorial validity of a well-known HMFM instrument - the Fleming-Courtney Self-Rating Scales (SRS) - were examined for a sample of 198 Filipino college students. Confirmatory factor analysis compared six structural models. A six-factor, oblique model that included two social factors (Social Acceptance and Social Anxiety) fit the data best, and a second-order factor analysis supported the hierarchical structure of the SRS. The men were significantly higher than the women on three self-concept scales, but the only large effect was for Physical Abilities, consistent with findings in a U.S. college sample. Results provided some support for the utility of both the SRS and HMFM for Filipinos.     

Violent Men In Intimate Relationships: An Analysis of Risk Markers1

In the family violence literature, a number of risk markers associated with men's use of violence against women have been identified. Using the 1975 National Family Violence Survey, a multivariate analysis was performed to examine which risk markers best differentiated among nonviolent men, verbally aggressive men, men who exhibit minor physical violence, and severely physically violent men. High levels of marital conflict, lower socioeconomic status, and greater exposure to violent role models in the home of origin emerged as primary correlates of levels of violence between intimates. Theoretical and research implications are discussed.     

THE USE OF BEHAVIORAL ASSESSMENT TO PRESCRIBE AND EVALUATE TREATMENTS FOR SEVERELY HANDICAPPED CHILDREN

Behavioral assessment procedures were used to prescribe and evaluate treatments of maladaptive behavior for 2 children with severe multiple handicaps. In Experiment 1, the results of an assessment of reinforcer preference were used in conjunction with a functional analysis of the conditions maintaining self-injurious behavior to prescribe a treatment for a child with severe disabilities. The treatment procedure involved the use of a pressure-sensitive microswitch to activate reinforcing stimuli during two solitary conditions, during which self-injurious behavior had occurred at high rates. The results were evaluated with a multiple baseline across settings design and indicated that self-injury decreased with concomitant increases in microswitch activation. Results were maintained at 6 weeks, 8 weeks, and 6 months. In Experiment 2, the results of behavioral assessments of reinforcer preference and self-injurious behavior were combined to develop a treatment for a second severely handicapped child, who exhibited high rates of self-injury in demand situations. This treatment was evaluated with a multiple baseline across tasks design and resulted in the elimination of self-injury for up to 15 months.     

DISTRACTION: ITS UTILIZATION AND EFFICACY WITH CHILDREN UNDERGOING DENTAL TREATMENT

We investigated the utilization and efficacy of distraction in reducing the anxious and disruptive behavior of 4 children undergoing dental treatment. During the distraction procedure, the children were shown a poster and told a story about it during dental treatment. They earned a prize if they attended to the poster and story and could correctly answer questions about them following each intervention visit. The children's disruptive behavior was assessed via direct observation, and results were analyzed within a multiple baseline design. The children exhibited high levels of anxious and disruptive behavior across baseline visits, regardless of the length of time in treatment or number of visits. Anxious and disruptive behavior decreased upon introduction of the intervention for all children. This was accompanied by the children meeting the criterion for correct answers on the distraction quiz. However, 2 of the children demonstrated an increase in their anxious and disruptive behavior across intervention visits. Results are discussed in terms of the need to evaluate treatment strategies that promote maintenance as well as initial changes.     

EVALUATION OF TACTILE PROMPTS WITH A STUDENT WHO IS DEAF,BLIND, AND MENTALLY RETARDED

We provided tactile cues to a student who was deaf, blind, and mentally retarded to guide her performance on a variety of packaging tasks. The student had previously received extensive training on multiple packaging and sequencing tasks through her vocational education program. Although she was able to complete these tasks, each change in materials necessitated that similar levels of retraining be conducted in order for her to perform revised tasks. Tactile cues were introduced and evaluated through a multiple baseline with sequential withdrawal design for two envelope-stuffing tasks and one bagging task. Results indicated that the tactile prompts were effective in guiding her performance on the training task and in promoting generalization to novel tasks and cues. Continued use of the cues was necessary to maintain the student's performance. Our findings suggest that tactile prompts function similarly to picture prompts and may be an effective alternative external prompting system for persons for whom picture prompts would not be appropriate.