Preparing direct service staff to teach people with severe disabilities: A comprehensive evalution of an effective and acceptable training program

In light of the continuing need for residential, direct service staff to be able to teach people with severe disabilities, we comprehensively evaluated a program to train staff in behavioral teaching strategies. The program was developed and evaluated with attention given to recent concerns in the staff management literature regarding shortcomings with staff training research. The training program, involving a maximum of four, 2-hr classroom instruction sessions and three in vivo observation and feedback sessions, was evaluated in four studies. In Study 1, the program was shown to improve verbal skills of 13 direct service staff regarding behavioral teaching principles and terminology. In Study 2, the program was demonstrated to improve performance based teaching skills of nine staff and four staff supervisors. In Study 3, the program was shown to result in improvements in adaptive skills of three clients with severe disabilities when direct care staff used their newly acquired teaching skills with the clients. In Study 4, the training program was shown to be well received among 17 staff trainees, although the trainees were more accepting of some program components than others. Results of the studies are discussed in regard to the importance of agencies providing effective and acceptable staff training programs. Future research areas also are noted, focusing on the need to determine, and minimize where possible, the amount of time required to conduct successful staff training.     

EVALUATION OF REINFORCER PREFERENCES FOR PROFOUNDLY HANDICAPPED STUDENTS

Five students classified as profoundly/multiply handicapped were trained to use microswitches to indicate reinforcer preferences. The students were trained to emit a designated motoric response (raise arm or raise head) which in turn activated a microswitch. The microswitches were connected to battery-operated toys and devices, and served to provide immediate, contingent consequences tothe students for their motoric responding. The results of the investigation were evaluated within a multiple baseline (across students) with alternating treatments (potential reinforcers) design. During baseline, the students were provided withthe switches and devices, butthe switches were not connected tothe devices. Duringthe training conditions, the switches activatedthe devices. Evaluation of the devices was conducted by recordingthe cumulative frequency and duration of the students' responses. Whenthe microswitches activatedthe devices during training, a substantial increase inthe duration of motoric responding occurred for all students. In addition, some students performed differentially across devices, suggesting that they had reinforcer preferences.     

Co-leader termination in an outpatient alcohol treatment group

The termination of a co-leader from a long-term therapy group for alcoholic outpatients is described over a seven-week period from the initial termination announcement to the first week following the co-leader's departure. The authors highlight salient themes and defensive maneuvers that appear as the group struggles with the difficult task of termination. Attempting initially to flee from the impending loss, the group defends with pseudomature responses and veiled hostility. These are followed by themes of abandonment and loss. The group leaders' initial collusion with the group's denial of loss is described, along with leader tactics to facilitate the group's termination work. Finally, the meaning of a group farewell gift is discussed in terms of both its implicit communications and as a form of resistance.     

Treatment contracts in long-term groups with alcoholic outpatients: A group case study

This paper describes the process of treatment contracting in a long-term group with alcoholic outpatients — relating the contracting process to the dynamics of the group and to the total treatment context. The material presented highlights the ways in which the contracting process (in particular, grappling with the issue of who should set the terms of the contract) may serve as a model for helping group members better understand and cope with problems in assertiueness and limit setting.     

The Peter Pan Syndrome: Inpatient treatment of adolescent anorexia nervosa

Specific strategies designed for intervening in family, hospital, community, and school systems are discussed as crucial components in the treatment of adolescent anorexia nervosa. It is suggested that all these systems inadvertently collude in the “Peter Pan Syndrome”: maintaining the adolescent-identified patient in a latency age role in order to protect mother from depression and the family in its entirety from an “empty nest” developmental crisis. When strategic and structural alterations occurred within the above mentioned systems while the child was hospitalized and after discharge, the anorectic symptom was alleviated.     

Treating PTSD in suicidal and self-injuring women with borderline personality disorder: development and preliminary evaluation of a Dialectical Behavior Therapy Prolonged Exposure Protocol

This study focused on the development and pilot testing of a protocol based on Prolonged Exposure (PE) that can be added to Dialectical Behavior Therapy (DBT) to treat PTSD in suicidal and self-injuring individuals with borderline personality disorder (BPD). Women with BPD, PTSD, and recent and/or imminent serious intentional self-injury (n = 13) received one year of DBT with the DBT PE Protocol, plus three months of follow-up assessment. The treatment was associated with significant reductions in PTSD, with the majority of patients no longer meeting criteria for PTSD at post-treatment (71.4% of DBT PE Protocol completers, 60.0% of the intent-to-treat sample). A minority of patients (27.3%) engaged in intentional self-injury during the study. Improvements were also found for suicidal ideation, dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and social adjustment. There was no evidence that the DBT PE Protocol led to exacerbations of intentional self-injury urges or behaviors, PTSD, treatment dropout, or crisis service use. Overall, the results indicate that this integrated BPD and PTSD treatment is feasible to implement within one year of treatment, highly acceptable to patients and therapists, safe to administer, and shows promise as an effective intervention for PTSD in this complex and high-risk patient population.     

Maternal Psychological Absence and Toddlers' Social‐Emotional Development: Interpretations From the Perspective of Boundary Ambiguity Theory

The current study tests a novel latent construct reflecting psychological absence and examines its relations with maternal depression, mother–toddler interactions, and toddlers' social‐emotional outcomes in a low‐income sample (N = 2,632). Structural equation modeling confirmed a psychological absence construct and revealed that psychological absence, measured at the child's 36‐month birthday‐related assessment, is a significant predictor of children's social‐emotional development at 36 months, mediated by mother–child interaction. Results are interpreted within a boundary ambiguity framework.     

An Investigation of the Relationships among Negative Affect, Difficulties in Emotion Regulation, and Features of Borderline Personality Disorder

This study investigated the indirect effects of problematic emotion regulation on features of Borderline Personality Disorder (BPD) when accounting for negative affect in 456 participants from two distinct geographic regions. Participants completed the Affect Intensity Measure (AIM), Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), and the Borderline Symptom List (BSL). Results from this study supported a model in which there were significant indirect effects of both a lack of emotional clarity and limited access to emotion regulation strategies on features of BPD when accounting for negative affective intensity. Results also supported a second model in which there were significant indirect effects of both limited access to emotion regulation strategies and difficulties engaging in goal-directed behavior on features of BPD when accounting for negative affective reactivity. The results highlight important inter-relationships among features of BPD, difficulties regulating emotions, and negative affective intensity and reactivity.     

Are we documenting performance validity testing in pediatric neuropsychological assessments? A brief report

A 2016 survey of pediatric neuropsychologists found that 92% of clinicians reported use of “at least one” performance validity test (PVT) in each assessment. The present investigation sought to verify documented PVT use among clinicians by review of actual reports. A convenience sample of pediatric neuropsychological reports of children ages 6–17 were reviewed over an 24-month period (January 2015–January 2017); reports were those seen as part of our routine practice, including reports on children we were reevaluating, cases that we consulted on, or cases evaluated elsewhere presenting to our centers that required record review for clinical decision making (e.g., presurgical epilepsy evaluations). A total of 131 reports, from 102 unique neuropsychologists were reviewed. PVT usage was documented in only six reports, from six unique clinicians, representing only 4.58% of the reports (or 5.88% of clinicians), far below expectations recent survey results. Though sampling differences and documentation factors may account for some of this disparity, a “social desirability bias” on surveys is likely a major factor in explaining these discordant findings.