Do substance abuse and mental health clients prefer automated assessments?

In both psychiatric and substance-abuse services, clinicians have been concerned with the introduction of automated assessments and with their clients’ reactions toward those assessments. The positive reactions of psychiatric clients have been well documented, but little has been known about substance-abusing clients’ impressions of automated assessments. The impact of automated assessment on clients seeking substance-abuse services was evaluated and compared with a previously analyzed sample of clients seeking mental health services. On the whole, both groups responded similarly and positively to automated assessments. Factor analyses revealed three underlying dimensions in client attitudes toward automated assessment,Completeness and satisfaction,Ease of use and enjoyment, andNegative attitudes. In addition, statistically, though not clinically, significant differences in attitudes were found between various demographic groups. Overall, the results support the use of automated assessments with individuals seeking either substance-abuse or mental-health services.     

Clinical pragmatism: a method of moral problem solving

This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in moral problem solving are discussed.     

Some correlates of health locus of control among multicultural individuals

The relationship of locus of control to depression, anxiety, hostility, and physical health was assessed in a sample of multicultural college students (N = 162). Powerful Others Health Locus of Control was correlated with depression, anxiety, hostility, and recent physical symptoms while Chance Health Locus of Control (CHLC) was correlated with all of the above as well as chronic physical symptoms and major health problems. When controlling for a variety of health risk factors (viz., age, sex, body mass, exercise, smoking, salt, alcohol, and caffeine), only CHLC remained significant in the physical health models. Results support the cognitive model of mental health which emphasize the importance of adaptive beliefs. Specifically, they suggest that issues about control are related to negative affect and indicate that the often-cited relationship of an external locus of control to depression and anxiety also holds for hostility. The findings do not, however, support the view that anxiety and depression are associated with different types of external locus of control but rather suggest a unified set of locus of control beliefs underlying the three types of negative affect. In addition, evidence is provided for the external validity of the Multidimensional Health Locus of Control (MHLC) Scales with respect to mental health. Further, the results indicate that belief about one’s health may play a significant role in one’s physical health and that the health behavior model of the relationship between locus of control and physical health is insufficient to explain the relationship. As the Chance and Powerful Others MHLC scales were not related to health habits in this sample but were related to mental health (viz., depression, anxiety, and hostility), locus of control beliefs may be related to physical health via their relationship with mental health.     

EFFECTS OF HIGH-PROBABILITY REQUESTS ON THE SOCIAL INTERACTIONS OF YOUNG CHILDREN WITH SEVERE DISABILITIES

High-probability requests were used to increase social interactions in 3 young boys with severe disabilities who had been identified as severely socially withdrawn. A multiple baseline design across participants was used to evaluate the effects of high-probability request intervention on (a) social initiations, (b) social responses, (c) continued interactions, and (d) performance of high- and low-probability requests. The students were observed in a second setting to examine generalization effects across peers who did not participate in the training sequence and settings. The results demonstrated that the high-probability requests increased the students' responsiveness to low-probability requests to initiate social behavior. Increases were also found in (a) unprompted initiations and extended interactions to the training peers, (b) unprompted initiations and extended interactions to peers who were not involved in the training procedure, and (c) generalized unprompted initiations and interactions in a second nontraining setting. The students maintained increased levels of initiations and interactions after all prompts were removed from both the training and nontraining settings.     

Antecedents and Consequences of Victimization of Lesbian, Gay, and Bisexual Young People: A Structural Model Comparing Rural University and Urban Samples

Research indicates that antigay victimization is widespread and that lesbian, gay, and bisexual young people may be very vulnerable to such victimization. The current study builds upon previous work by Hershberger and D'Augelli (1995), who studied the consequences of sexual orientation-based victimization in 194 urban lesbian, gay, and bisexual youths. Using structural equation modeling, the present study models both antecedents and consequences (including psychological distress, self-esteem, and suicidality) of victimization via a secondary analysis of their data set. In addition, a second sample of 54 lesbian, gay, and bisexual youths from a rural university setting was examined to cross-validate and generalize the relationships found in urban settings. Results indicated that a revised model of victimization exhibited sufficient fit to the urban sample data and provided preliminary support for the generalizability of the model beyond the initial sample. Additional similarities were found between the urban and rural university community samples, including a high prevalence of reported suicide attempts: 42% of the urban sample and 32% of the rural university sample had attempted suicide at least once. Results indicated that victimization based on sexual orientation has similar correlates for young people in different community settings.     

The symbolic distance effect for alphabetic order judgements: A subjective report and reaction time analysis

The time needed to decide whether a pair of letters is in the correct alphabetic order varies inversely with alphabetic separation. This is an example of a phenomenon generally found with the comparison of ordered symbols or concepts, called the symbolic distance effect (Moyer and Bayer, 1976). It is argued that when letters are compared, an important determinant of this effect is the degree to which subjects subvocally run-through parts of the alphabet to determine the correctness of the order of a stimulus pair. A trial-by-trial introspection procedure coupled with reaction time measurements is used in the present experiment, in which letter order judgements were made over a range of separations. RTs increased with increasing number of letters in the reported run-through. At small letter separations, run-through occurred more frequently, and this was found to be the basis of the symbolic distance effect. For trials on which no run-through was reported the symbolic distance effect was absent. The data are summarized as a model in which comparisons are made from directly available order information from memory, or with an additional run-through process. The details of the run-through process suggest that groupings learned in childhood are probably involved in the selection of the starting letter for run-through.     

TRAINING PARENTS IN BEHAVIORAL SELF-MANAGEMENT: AN ANALYSIS OF GENERALIZATION AND MAINTENANCE

This study examined the generalization and maintenance effects of three phases of parent training (Instructions plus Feedback and two Self-management Training phases) on levels of disruptive child behavior and the accuracy with which parents implemented programs. Data were collected from five families in three main settings: the initial training setting (the home), a variety of generalization settings in the community, and the family breakfast. A multiple baseline across subjects design was used. Instructions plus Feedback comprised instructing parents to use a range of behavior management procedures and provided home-based differential feedback concerning accuracy of program implementation. Self-management Training phases involved training parents in goal setting, self-monitoring, and planning skills, specific to their performance of appropriate parenting skills in generalization settings. Results indicated that the Instructions plus Feedback phase was sufficient to produce reduced levels of problem behavior at home and high levels of accurate implementation, but generalization effects out of home were equivocal. Self-management maintained reduced levels of problem behavior at home but, in addition, resulted in generalization effects in community settings for both children and parents. Maintenance probes 3 months following the program revealed the effects had been maintained.     

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.