A case-based approach to the development of practice-based competencies for accreditation of and training in graduate programs in genetic counseling

The American Board of Genetic Counseling (ABGC) sponsored a consensus development conference with participation from directors of graduate programs in genetic counseling, board members, and expert consultants. Using a collective, narrative, and case-based approach, 27 competencies were identified as embedded in the practice of genetic counseling. These competencies were organized into four domains of skills: Communication; Critical Thinking; Interpersonal, Counseling, and Psychosocial Assessment; and Professional Ethics and Values. The adoption of a competency framework for accreditation has a variety of implications for curriculum design and implementation. We report here the process by which a set of practice-based genetic counseling competencies have been derived; and in an accompanying article, the competencies themselves are provided. We also discuss the application of the competencies to graduate program accreditation as well as some of the implications competency-based standards may have for education and the genetic counseling profession. These guidelines may also serve as a basis for the continuing education of practicing genetic counselors and a performance evaluation tool in the workplace.The Consortium includes Directors of established graduate programs in genetic counseling and members of the ABGC Board of Directors who participated in the Consensus Development Conference held in January 1994: Diane Baker (University of Michigan/ABGC); Bonnie Baty (ABGC); Joan Burns (University of Wisconsin); Debra Collins (ABGC); Virginia Corson (ABGC); Beth Fine (Northwestern University/ABGC); Elizabeth Gettig (University of Pittsburgh); Verle Headings (Howard University); Jacqueline Hecht (University of Texas); Carl Huether (University of Cincinnati); Bonnie LeRoy (University of Minnesota); Joan Marks (Sarah Lawrence College); Anne Matthews (University of Colorado); Roberta Palmour (McGill University); Lorna Phelps (Medical College of Virginia); Kimberly Quaid (Indiana University); Joan Scott (ABGC); Ann Smith (ABGC); Helen Travers (ABGC); Judith Tsipis (Brandeis University); Ann Walker (University of California-Irvine/ABGC); Jon Weil (University of California-Berkeley); S. Robert Young (University of South Carolina); Randi Zinberg (Mount Sinai School of Medicine, New York).     

A voice-operated method for administering the MMPI

Paper/pencil psychological tests such as the Minnesota Multiphasic Personality Inventory (MMPI) are difficult to complete independently by patients with limited hand function. This paper describes a voice recognition system developed to allow patients with no hand function to take the MMPI independently. Profiles generated by this system are not statistically different from those generated by standard MMPI booklet format. Limitations and possible extensions of the system as it currently exists are discussed.     

Field-dependence,extraversion, Eysenck and autarky

The research literature was examined with regard to relationships between Field-dependence and Extraversion. Eysenck's contention that the two variables are significantly related to an extent justifying the use of causal hypotheses based on extraversion theory to account for field-dependent behavior was not supported.     

Factors affecting entrapment in escalating conflicts: The importance of timing

Entrapping conflicts are those in which individuals continue to invest their resources—even in seemingly losing propositions-in large part to justify previous unfilled expenditures. It has been demonstrated that individuals define their motivation for investing very differently at the various stages of an entrapping conflict. One implication of this motivational dynamic is that various factors may differentially affect degree of entrapment (i.e., amount invested), depending upon the point in time at which they are introduced. The present studies were designed to test this notion. All subjects were given an initial monetary stake and had the opportunity to win more by taking part in an entrapping investment situation. In Experiment 1, half the subjects were provided with a payoff chart that made salient the costs associated with investing (Highcost salience condition) whereas half were not (Low-cost salience condition). Moreover, for half of the subjects the payoff chart was introduced before they were asked to invest (Early condition) whereas for the other half it was introduced after they had invested a considerable portion of their resources (Late condition). Entrapment was lower in the High salience-Early than in the Low salience-Early condition. However, there was no difference between groups in the Late condition. In Experiment 2, the perceived presence of an audience interacted with personality variables related to face-saving to effect entrapment. When the audience was described as “experts in decision making,” subjects high in public self-consciousness (or social anxiety) became less entrapped than those low on these dimensions. When the audience consisted of individuals who “wished simply to observe the experimental procedure,” however, high public self-consciousness (or social anxiety) individuals were significantly more entrapped than lows. Moreover, these interaction effects occurred when the audience was introduced late, but not early, into the entrapment situation. Taken together, these (and other) findings suggest that economic factors are more influential determinants of behavior in the earlier stages of an entrapping conflict, whereas face-saving variables are more potent in the later phases. Alternative explanations are discussed.     

Semantics for the Logic of Essence

This paper provides a possible worlds semantics for the system of the author's previous paper The Logic of Essence. The basic idea behind the semantics is that a statement should be taken to be true in virtue of the nature of certain objects just in case it is true in any possible world compatible with the nature of those objects. It is shown that a slight variant of the original system is sound and complete under the proposed semantics.     

Effects of Stimulant Medication Treatment on Mothers' and Children's Attributions for the Behavior of Children with Attention Deficit Hyperactivity Disorder

Participants were 55 children with attention deficit hyperactivity disorder (ADHD) who were receiving ongoing treatment with stimulant medications and their mothers, and 31 children with ADHD who were beginning stimulant medication and their mothers. Mothers and children offered attributions for child behaviors that occurred when the child was medicated and not medicated. Mothers rated child compliance and prosocial behavior as more global and stable when the child was medicated and rated noncompliance, ADHD symptoms, and oppositional behavior as more externally caused, less global and stable, but more controllable by the child when the child was medicated. Children rated both their compliance and noncompliance as more controllable in the medicated condition. On a forced-choice measure, both mothers and children selected ability, effort, and task attributions for compliance more in the not-medicated condition, and pill-taking attributions more in the medicated condition. This was reversed for noncompliance, which was attributed more to effort, task, or ability in the medicated condition and more to not taking a pill in the not-medicated condition. The potential risks and benefits for parent–child interactions and children's self-perceptions of these medication-related differences in attributions are discussed.     

Ego atrophy in substance abuse: addiction from a socio-cultural perspective

The use of intoxicants is indexed in American history adopting a social perspective of the role of alcoholism in traditional American society. Appealing to societal patterns, the elaboration of substance abuse as a disease is explored with a diagnostic focus on intervention as it relates to pathogenesis. Using clinical vignettes, the ego is proposed as the focus of pathology in the addiction process, featuring a regression to the defenses of projection and denial. Following the model proposed in Zinberg's seminal paper on addiction and ego function, various deficits are annotated that typify such regression. The ultimate clinical picture is one of ego atrophy, where basic interests and object relations are usurped by the all-consuming preoccupation with the substance of abuse.     

Emotion knowledge as a predictor of social behavior and academic competence in children at risk

Following leads from differential emotions theory and empirical research, we evaluated an index of emotion knowledge as a long-term predictor of positive and negative social behavior and academic competence in a sample of children from economically disadvantaged families ( N = 72). The index of emotion knowledge represents the child's ability to recognize and label emotion expressions. We administered control and predictor measures when the children were 5 years old and obtained criterion data at age 9. After controlling for verbal ability and temperament, our index of emotion knowledge predicted aggregate indices of positive and negative social behavior and academic competence. Path analysis showed that emotion knowledge mediated the effect of verbal ability on academic competence. We argue that the ability to detect and label emotion cues facilitates positive social interactions and that a deficit in this ability contributes to behavioral and learning problems. Our findings have implications for primary prevention.