EVALUATION OF COMPONENTS OF RESIDENTIAL TREATMENT BY MEDICAID ICF-MR SURVEYS: A VALIDITY ASSESSMENT

We evaluated the proficiency of the federal Medicaid program's survey process for evaluating intermediate care facilities for the mentally retarded. In Study 1, an observational analysis of active treatment during leisure times in living units suggested that these surveys did not discriminate between certified and noncertified units. In Study 2, a reactivity analysis of a survey indicated that direct-care staff performed differently during the survey by increasing interactions with clients and decreasing nonwork behavior. Similarly, results of Study 3 showed increases in client access to leisure materials during a survey. In Study 4, questionnaire results indicated considerable variability among service providers' opinions on the consistency, accuracy, and objectivity with which survey teams determine agency standard compliance. Results are discussed regarding effects of the questionable proficiency of survey processes and the potential utility of behavioral assessment methodologies to improve such processes.     

Reducing stress by counterattitudinal advocacy

In one condition, subjects were made apprehensive by being threatened with shock and then were induced to publicly argue that they were not apprehensive about the situation. It was hypothesized that the subjects who were induced to advocate a position contrary to their feelings about the situation would experience dissonance. To reduce dissonance, these subjects were expected to redefine the situation as less threatening and thereby experience less apprehension regarding the situation than subjects in a control threat condition. Results of physiological measures and a postexperimental questionnaire supported the expectations. Implications of the study for psychotherapy were mentioned.     

Women as authority figures: The use and nonuse of authority

This paper reports the results of two experiments designed to investigate the effect of sex-role stereotypes on evaluations of authority figures. Female and male subjects read short accounts of various situations in which an authority figure confronted a subordinate who had transgressed in some way and then evaluated the authority figure on a variety of dimensions. Sex of the authority figure and of the subordinate were varied factorially. In Experiment 1, where the authority figure took a hard line with the transgressing subordinate, it was found that a female authority figure being firm with a male subordinate was evaluated most negatively. In Experiment 2, where the authority figure was lenient with the subordinate, it was found that a female authority figure being lenient with a female subordinate was evaluated most negatively. Implications of the results are discussed.     

Gender and sex-role appropriateness: Bias in the judgment of disturbed behavior

Male and female undergraduate raters made attributions of mental disorder, personality traits, and diagnostic and treatment judgments for four case studies in which sex of client and sex-role appropriateness of client behavior were manipulated. Significant interactions of sex-role appropriateness with both client sex and rater sex highlighted the significance of sex-role stereotypes in the attribution of mental disorder by nonprofessionals. The data indicated that these cultural sex-role definitions had the strongest negative effect for females and the female sex role. Implications of these findings for the clinical judgment process and female self-perception are discussed.The order of authorship was determined by random selection.     

Attributed reasons for support of the feminist movement as a function of attractiveness

Male and female subjects were shown photographs of attractive and unattractive women. They were asked to indicate, for each photograph, the main reason why they thought the woman in the photograph was a feminist. Subjects attributed more positive, flattering reasons to the attractive women than to the unattractive women. In addition, it was found that subjects who did this task after having done a filler task made a greater distinction between the attractive and unattractive women than did subjects who did this task first. Interpretations and limitations of the results are discussed.     

A nonsexist look at the shift to risk

This paper reports the results of a study in which male and female subjects are exposed to standard shift-to-risk dilemmas in which the central character is either male or female, rather than just male as in previous research. It was found that, while subjects shift to risk on dilemmas with male characters, they generally do not show such shifts on dilemmas with female characters. Results are discussed in terms of major theories of the shift to risk and sex bias on the part of researchers in this area.     

Suicide Attempt Self-Injury Interview (SASII): development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury

The authors describe the development of the Suicide Attempt Self-Injury Interview (SASII), an instrument designed to assess the factors involved in nonfatal suicide attempts and intentional self-injury. Using 4 cohorts of participants, authors generated SASII items and evaluated them with factor and content analyses and internal consistency statistics. The final measure was assessed for reliability and validity with collateral measures. The SASII assesses variables related to method, lethality and impulsivity of the act, likelihood of rescue, suicide intent or ambivalence and other motivations, consequences, and habitual self-injury. The SASII was found to have very good interrater reliability and adequate validity.     

Risky assessments: participant suicidality and distress associated with research assessments in a treatment study of suicidal behavior

The purpose of this study was to examine patterns of self-reported suicidality and distress during research assessments in a sample of 63 women meeting criteria for borderline personality disorder and current and chronic suicidality. The risk management protocol we used during the two-year study period (University of Washington Risk Assessment Protocol; UWRAP) is described. Results indicated that changes in suicidality following assessments were small and relatively infrequent, and were just as likely to reflect decreases in suicidality as increases (17.5% versus 16.4% of sessions, respectively). Further, longitudinal analyses indicated that changes in suicidality became increasingly rare over the course of the 2-year study. Ratings of distress were more changeable than suicidality, underscoring the need for separate measurement of these constructs when assessing risk. With the aid of the UWRAP, our assessors judged 15 participants as high-risk status in 28 assessment sessions (3.7% of all sessions). In comparison to the rest of the sample, these individuals were of significantly greater clinical severity as measured by the HRSD 17-item, GAF scores, number and severity of previous suicide attempts, and number of previous psychiatric hospitalizations. Low-intensity risk intervention strategies (e.g., validating participant's feelings) were typically sufficient to reduce risk in these participants. Overall, our findings indicate that research with highly suicidal individuals can be done safely with the use of well-trained assessors and an appropriate crisis management protocol.