Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Context-processing deficits in schizophrenia: converging evidence from three theoretically motivated cognitive tasks

To test the hypothesis that the ability to actively represent and maintain context information in a central function of working memory and that a disturbance in this function contributes to cognitive deficits in schizophrenia, the authors modified 3 tasks--the AX version of the Continuous Performance Test, Stroop, and a lexical disambiguation task--and administered them to patients with schizophrenia as well as to depressed and healthy controls. The results suggest an accentuation of deficits in patients with schizophrenia in context-sensitive conditions and cross-task correlations of performance in these conditions. However, the results do not definitively eliminate the possibility of a generalized deficit. The significance of these findings is discussed with regard to the specificity of deficits in schizophrenia and the hypothesis concerning the neural and cognitive mechanisms that underlie these deficits.     

Perceived family environment as a moderator of young adolescents' life stress adjustment

A longitudinal design was employed to test the main and stress-moderating effects of young adolescents' perceived family environment (Family Environment Scales; FES; Moos & Moos, 1981) on their depression, anxiety, and self-esteem. This study was part of a larger longitudinal project (L. Cohen, Burt, & Bjorck, 1987) that demonstrated the significant cross-sectional effects of the young adolescents' controllable and uncontrollable negative events, and the significant longitudinal effects of the former. The present cross-sectional analyses demonstrated the hypothesized main effects of the FES scores; families perceived as cohesive, organized, and expressive were related to positive psychological functioning, whereas families perceived as conflict-ridden and controlling were related to negative functioning. However, in general these effects were nonsignificant in the longitudinal analyses. Although there were a number of significant Negative Events x FES interactions, in no instance did the pattern support the hypothesized stress-buffering role of positive family climate.     

The problem of serial order in behavior: Lashley's legacy

In a prescient paper Karl Lashley (1951) rejected reflex chaining accounts of the sequencing of behavior and argued instead for a more cognitive account in which behavioral sequences are typically controlled with central plans. An important feature of such plans, according to Lashley, is that they are hierarchical. Lashley offered several sources of evidence for the hierarchical organization for behavioral plans, and others afterward provided more evidence for this hypothesis. We briefly review that evidence here and then shift from a focus on the structure of plans (Lashley's point of concentration) to the processes by which plans are formed in real time. Two principles emerge from the studies we review. One is that plans are not formed from scratch for each successive movement sequence but instead are formed by making whatever changes are needed to distinguish the movement sequence to be performed next from the movement sequence that has just been performed. This plan-modification view is supported by two phenomena discovered in our laboratory: the parameter remapping effect, and the handpath priming effect. The other principle we review is that even single movements appear to be controlled with hierarchically organized plans. At the top level are the starting and goal postures. At the lower level are the intermediate states comprising the transition from the starting posture to the goal posture. The latter principle is supported by another phenomenon discovered in our lab, the end-state comfort effect, and by a computational model of motor planning which accounts for a large number of motor phenomena. Interestingly, the computational model hearkens back to a classical method of generating cartoon animations that relies on the production of keyframes first and the production of interframes (intermediate frames) second.     

Dysfunctional attitudes and episodes of major depression: Predictive validity and temporal stability in never-depressed, depressed, and recovered women

In a large, community-based sample of women (N = 750), the authors examined the nature of associations between dysfunctional attitudes and depression. Dysfunctional attitudes were evaluated both as a vulnerability factor for depression and as a consequence of depression. A link was found between past depression and baseline elevations in dysfunctional attitudes that was independent of current subsyndromal symptoms, but intensification of dysfunctional attitudes following prospectively evaluated episodes of depression (depressive "scarring") was not observed. Although baseline dysfunctional attitudes predicted an episode of major depression over 3 years of prospective study, this prediction, considered alone or in interaction with negative life events, was redundant with that offered by history of past depression. Further, no significant prediction was evident for the Dysfunctional Attitude Scale (A. N. Weissman & A. T. Beck, 1978) when the formerly depressed and never-depressed cohorts were considered separately. Implications for cognitive theories are discussed.     

Common items and reliability in personality measurement

Most psychological tests and inventories, particularly in personality and attitude measurement, contain common items, that is, various subscales of the test or inventory may share one or more items in common. Surprisingly, the role of common items in such a fundamental personality test attribute as reliability is not known. The present report specifically considered common-item contributions to test internal consistency reliability using extant data from the California Psychological Inventory. No negative contribution of item overlap was found. To the contrary, it was concluded that the use of common items is an economical technique for increasing the total number of items in the scales, thus increasing scale internal reliabilities without increasing the overall number of items in the inventory.