Implementing Effective Educational Practices at Scales of Social Importance

Implementing evidence-based practices is becoming both a goal and standard across medicine, psychology, and education. Initial successes, however, are now leading to questions about how successful demonstrations may be expanded to scales of social importance. In this paper, we review lessons learned about scaling up evidence-based practices gleaned from our experience implementing school-wide positive behavioral interventions and supports (PBIS) across more than 23,000 schools in the USA. We draw heavily from the work of Flay et al. (Prev Sci 6:151–175, 2005. doi: 10.1007/s11121-005-5553-y) related to defining evidence-based practices, the significant contributions from the emerging “implementation science” movement (Fixsen et al. in Implementation research: a synthesis of the literature, University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231), Tampa 2005), and guidance we have received from teachers, family members, students, and administrators who have adopted PBIS.     

Cognitive behavioral therapy in practice: treatment delivered by trainees at an outpatient clinic is clinically effective

Cognitive–behavioral therapy (CBT) is known to be effective for a number of disorders, and can be delivered effectively by trainees in controlled settings. However, the effectiveness of trainee therapists in general practice compared to that of more experienced therapists is unknown. In this study, the authors used a benchmarking strategy to compare the outcomes of naturalistic CBT delivered by trainee therapists to those of efficacy and effectiveness studies using primarily professional therapists. Patients (N = 249) with mood and anxiety disorders were treated by trainees (primarily by interns and postdocs) using nonstandardized nonmanualized CBT at an outpatient clinic in an urban academic medical center. Changes in anxiety and depression were assessed using effect sizes, reliable and clinically significant change, and benchmarked to efficacy and effectiveness studies. Symptoms of anxiety and depression significantly improved from start to end of treatment. Rates of improvement and recovery compared favorably to those achieved in other studies, with the exception of recovery rates in severe depression. Effect sizes were in the medium to large range, but generally lower than those achieved in other studies. Results suggest that CBT can be delivered effectively by trainees in an outpatient setting.     

Extended pausing by humans on multiple fixed-ratio schedules with varied reinforcer magnitude and response requirements

We conducted three experiments to reproduce and extend Perone and Courtney's (1992) study of pausing at the beginning of fixed-ratio schedules. In a multiple schedule with unequal amounts of food across two components, they found that pigeons paused longest in the component associated with the smaller amount of food (the lean component), but only when it was preceded by the rich component. In our studies, adults with mild intellectual disabilities responded on a touch-sensitive computer monitor to produce money. In Experiment 1, the multiple-schedule components differed in both response requirement and reinforcer magnitude (i.e., the rich component required fewer responses and produced more money than the lean component). Effects shown with pigeons were reproduced in all 7 participants. In Experiment 2, we removed the stimuli that signaled the two schedule components, and participants' extended pausing was eliminated. In Experiment 3, to assess sensitivity to reinforcer magnitude versus fixed-ratio size, we presented conditions with equal ratio sizes but disparate magnitudes and conditions with equal magnitudes but disparate ratio sizes. Sensitivity to these manipulations was idiosyncratic. The present experiments obtained schedule control in verbally competent human participants and, despite procedural differences, we reproduced findings with animal participants. We showed that pausing is jointly determined by past conditions of reinforcement and stimuli correlated with upcoming conditions.     

A direct link between gaze perception and social attention

How information is exchanged between the cognitive mechanisms responsible for gaze perception and social attention is unclear. These systems could be independent; the "gaze cueing" effect could emerge from the activation of a general-purpose attentional mechanism that is ignorant of the social nature of the gaze cue. Alternatively, orienting to social gaze direction might be directly determined by the operation of cognitive mechanisms specifically dedicated to gaze perception. This second notion is the dominant assumption in the literature, but there is little direct support for this account. Here, we systematically manipulated observers' perception of gaze direction by implementing a gaze adaptation paradigm. Gaze cueing was reduced only in conditions where perception of specific averted gaze stimuli was impaired (Experiment 1). Adaptation to a pointing stimulus failed to impact gaze cueing (Experiment 2). Overall, these data suggest a direct link between the specific operation of gaze perception mechanisms and the consequential orienting of attention.     

Friendship Dissolution Within Social Networks Modeled Through Multilevel Event History Analysis

A social network perspective can bring important insight into the processes that shape human behavior. Longitudinal social network data, measuring relations between individuals over time, has become increasingly common—as have the methods available to analyze such data. A friendship duration model utilizing discrete-time multilevel survival analysis with a multiple membership random effect structure is developed and applied here to study the processes leading to undirected friendship dissolution within a larger social network. While the modeling framework is introduced in terms of understanding friendship dissolution, it can be used to understand microlevel dynamics of a social network more generally. These models can be fit with standard generalized linear mixed-model software, after transforming the data to a pair-period data set. An empirical example highlights how the model can be applied to understand the processes leading to friendship dissolution between high school students, and a simulation study is used to test the use of the modeling framework under representative conditions that would be found in social network data. Advantages of the modeling framework are highlighted, and potential limitations and future directions are discussed.     

Specificity in practice benefits learning in novice models and variability in demonstration benefits observational practice

Considerable research has shown that both demonstration and verbal instruction can facilitate learning of a motor task in inexperienced individuals. In the current study, verbal instructions were used as a means to reduce the discovery learning process and control the amount of trial-to-trial variability in demonstrations. The task required models to learn to trace a pair of circles with a 90°-relative phase pattern between the arms. Verbal instructions directed one group of models toward a single strategy, and this group improved at a faster rate and performed better in a 24-h retention test compared to a group of models in a discovery learning context. The discovery models utilized multiple strategies throughout the practice. Each model was watched for 2 days by an observer, who was instructed that they would have to produce the 90°-relative phase pattern on day 3. Observers, who watched the discovery models, performed better than those who watched the single strategy models. The results support two primary conclusions. First, trial-to-trial variability associated with strategy selection processes in a model benefits an observer by facilitating perceptual discrimination processes that may play a key role in action generation. Second, verbal instructions that reduce discovery learning during physical practice benefit acquisition and retention performance when the task has multiple strategies wherein no one strategy guarantees the best performance outcome.     

"Broken covenant": healthcare aides' "experience of the ethical" in caring for dying seniors in a personal care home

Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.     

Relational Theory and Intergenerational Connectedness: A Qualitative Study

Relational theory encourages women to be connected in relationships. The authors used qualitative methodology to explore the interactions of a nonfamilial intergenerational group of 7 female adolescents (13–15 years) and 5 older women (62–80 years) in a structured retreat. Findings indicated that the participants experienced increased connectivity and feminine identity.     

Subtypes of obsessive-compulsive disorder: Implications for specialized cognitive behavior therapy

Although obsessive-compulsive disorder (OCD) is a heterogeneous condition, OCD subtypes have received limited attention in trials of cognitive behavior therapy (CBT). Because many patients with OCD do not respond optimally to CBT, it is important for clinicians to consider whether variability in treatment response is related to symptom presentation. Treatment modifications for patients without overt compulsions or with hoarding symptoms show promise. In this article we discuss the available research addressing the treatment of OCD subtypes, review the clinical characteristics and treatment recommendations for prominent OCD subtypes, raise the prospect of using dysfunctional beliefs as a potentially helpful conceptual approach to subtyping OCD and matching treatment to subtypes, and consider future directions in the treatment of OCD subtypes.