Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale

The Child and Adolescent Functional Assessment Scale (CAFAS) is a multidimensional measure of degree of impairment in functioning. Interrater reliability data are presented for lay raters, graduate students, and frontline staff. Reliability was high for the total score and behaviorally-oriented scales. Construct, concurrent, and discriminant validity were assessed with the sample of children and adolescents evaluated at the Fort Bragg Demonstration Evaluation Project. Youth and their caregivers were evaluated via interview and selfcompleted instruments at four time points. Significant correlations were found between the CAFAS and other related constructs. Concurrent validity was demonstrated by logistic regression analyses examining the relationship between CAFAS ratings and problematic behaviors endorsed on measures completed by parents, teachers, or the youth. Youth with higher CAFAS total scores were much more likely to have poor social relationships, difficulties in school, and problems with the law. Discriminant validity was assessed with a repeated measures analysis of variance with intensity of care at intake and time as factors. Youth who were inpatients or in residential treatment centers at intake had higher CAFAS scores than those who were outpatients. These findings provide strong evidence for the reliability and validity of the CAFAS.     

The Products of the Imagination: Psychoanalytic Theory and Postmodern Literary Criticism

This article considers some of the affinities between postmodern literary theory and the psychoanalytic theories concerned with intersubjective phenomena. Postmodern literary theory is described briefly, and it is argued that one of its major concerns is the nature of, and the political and cultural influences on, subjectivity and identity. Despite that, postmodernism generally, and literary postmodernism in particular, can be said to lack a theory of the psychological and interpersonal dimensions of the experience of self. This article contends that the more relational schools of psychoanalytic theory can provide an example of the construction of selfhood that is of importance to contemporary and postmodern literary criticism. The academy has, to a considerable extent identified psychoanalysis with the work of Jacques Lacan, but since the 1980s the work of such theorists as Jane Flax and Jessica Benjamin, building on the work of Nancy Chodorow, have increasingly opened up the possibilities of relational and object relations theory for literary studies. The relational psychoanalytic theories operate in the same epistemological universe as postmodern literary criticism, congruent with the postmodern idea of truth as constructed and relational, and selfhood as shifting, contingent, and always-in-process. Particular attention is paid to the work of Wilfred Bion, whose understanding of self provides an account both of the failure of meaning, and of the development of mind. Some examples of a relational approach to literary analysis are provided.     

Spontaneous Interentity Coordination in a Dissipative Structure

Humans and other creatures display remarkable interorganism coordination. For ecological theorists, interorganism coordination poses a challenge because it appears to be an especially “representation-hungry” phenomenon (Clark, 1999 Clark, A. (1999). An embodied cognitive science? Trends in Cognitive Sciences, 3, 345–351.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Ecological researchers have proposed that interorganism coordination arises from fundamental laws of pattern formation and synchronization. A key example in support of the ecological approach to coordination is the phase locking of 2 or more weakly coupled metronomes. Here we provide a complementary example of interentity coordination in a system that is more closely analogous to living systems. We show that two self-organizing dissipative structures, coupled in a single electrical field, spontaneously exhibit fairly complex motion coordination. Further, the degree of coordination predicts the rate of entropy production for the system as a whole. We suggest that the complex behavior of motion coordination fulfills a rudimentary end-directedness of the system: evolve to states that create higher rates of entropy production.     

Confidentiality, privacy, and the facilitating role of psychoanalytic organizations

Burgeoning external threats to confidentiality by claims to clinical information create unprecedented challenges for psychoanalysts. Internal threats arise from the use of clinical material for educational, scientific and historical purposes. Traditionally, confidentiality is considered a patient's right and an analyst's obligation; privacy is not usually stated as a professional requirement. Little consideration has been given to the impact of the confidentiality and privacy dilemmas that analysts encounter throughout their careers. There has been no systematic examination of the confidentiality policies of psychoanalytic organizations, nor has their role in facilitating maintenance of patient confidentiality and analysts' privacy been made explicit. The research reported here was undertaken to address these issues and to obtain baseline information about the current confidentiality policies and practices of psychoanalytic organizations in three English-speaking countries (Britain, Canada and the USA). The author discusses survey results in the light of the challenges which arise at each phase of the analytic career. She makes suggestions as to how psychoanalytic organizations can and should facilitate analysts' resolutions of contemporary confidentiality and privacy dilemmas.     

Left–right ideological differences in system justification following exposure to complementary versus noncomplementary stereotype exemplars

The capacity for victim‐derogating stereotypes and attributions to justify social inequality and maintain the status quo is well known among social scientists and other observers. Research conducted from the perspective of system justification theory suggests that an alternative to derogation is to justify inequality through the use of complementary stereotypes that ascribe compensating benefits and burdens to disadvantaged and advantaged groups, respectively. In two experimental studies conducted in Poland we investigated the hypothesis that preferences for these two routes to system justification would depend upon one's political orientation. That is, we predicted that the system‐justifying potential of complementary versus noncomplementary stereotype exemplars would be moderated by individual differences in left–right ideology, such that left‐wingers would exhibit stronger support for the societal status quo following exposure to complementary (e.g., “poor but happy,” “rich but miserable”) representations, whereas right‐wingers would exhibit stronger support for the status quo following exposure to noncomplementary (e.g., “poor and dishonest,” “rich and honest”) representations. Results were supportive of these predictions. Implications for theory and practice concerning stereotyping, ideology, and system justification are discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

Questioning the social intelligence hypothesis

The social intelligence hypothesis posits that complex cognition and enlarged "executive brains" evolved in response to challenges that are associated with social complexity. This hypothesis has been well supported, but some recent data are inconsistent with its predictions. It is becoming increasingly clear that multiple selective agents, and non-selective constraints, must have acted to shape cognitive abilities in humans and other animals. The task now is to develop a larger theoretical framework that takes into account both inter-specific differences and similarities in cognition. This new framework should facilitate consideration of how selection pressures that are associated with sociality interact with those that are imposed by non-social forms of environmental complexity, and how both types of functional demands interact with phylogenetic and developmental constraints.     

Games for health conference 2004: issues, trends, and needs unique to games for health.

The first-ever Games for Health Conference (Madison, WI, September 16-17, 2004) identified issues, trends, and needs unique to games for healthcare. More than 130 doctors, educators, therapists, and game makers gathered to share experiences particular to the health industry, health practitioners, and patient treatment. Co-sponsored by Games for Health, Project of the Serious Games Initiative, the Academic ADL Co-Lab, and the Federation of American Scientists, the conference highlighted applications for direct patient care and therapy, as well as health education, policy, and management ideas. This paper presents key concepts from the conference's panel discussions and summarizes successful projects demonstrated at the conference that can serve as models for the field.     

Can I Make a Difference? Efficacy,Employment, and Disability

Political efficacy is a widely studied phenomenon and an important predictor of political participation, but little is known about the political efficacy of the millions of people with disabilities in the United States. This paper reports the results of a nationally representative telephone survey of 1,240 people—stratified to include 700 people with disabilities—following the November 1998 elections. Several measures of efficacy that help predict political activity were found to be significantly lower among people with disabilities than among otherwise similar people without disabilities. Although lower levels of internal efficacy and civic skills could largely be explained by educational and employment gaps, lower levels of other variables (external efficacy, perceived influence of people with disabilities, and perceived treatment of people with disabilities) remained after applying a wide range of controls, indicating that people with disabilities are less likely to see the political system as responsive to them. This perception is concentrated among non–employed people with disabilities. The lower efficacy levels linked to "disability gaps" in employment, income, education, and group attendance appear to account for as much as half of the disability political participation gap; hence, policies intended to increase employment and educational opportunities for people with disabilities have potentially important political effects.     

Use of the CAFAS to Evaluate Outcome for Youths with Severe Emotional Disturbance Served by Public Mental Health

Outcomes are reported for youths with serious emotional disturbance receiving customary services from community mental health service providers who receive state mental health funds. Various outcome indicators for the Child and Adolescent Functional Assessment Scale (CAFAS) are described, as well as a procedure for categorizing youths into client types based on the CAFAS subscale scores. The youth's intake assessment was compared to the last CAFAS evaluation that the youth received. A statistically significant reduction in mean CAFAS total score was observed for the entire sample and for each client type. In addition, the mean number of subscales on which the youth was rated as severely impaired significantly decreased for the total sample and for each client type. The proportion of youths who experienced a clinically meaningful improvement in functioning was 58.6%. For the subset of youths who were rated as severely impaired on one or more subscales at intake, 53.1% left services without any severe impairments. The pattern of outcome results differed for subgroups based on type and extent of impairment. Implications of these findings and suggestions for using outcome monitoring to improve services in the public mental health sector are discussed.