Implementing a Comprehensive Program for the Prevention of Conduct Problems in Rural Communities: The Fast Track Experience

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.     

Are there fundamental differences in the peripheral mechanisms of visceral and somatic pain?

There are some conspicuous differences between the sensibilities of cutaneous and visceral tissues: (1) Direct trauma, which readily produces pain when applied to the skin, is mostly without effect in healthy visceral tissue. (2) Pain that arises from visceral tissues is initially often poorly localised and diffuse. (3) With time, visceral pains are often referred to more superficial structures. (4) The site of referred pain may also show hyperalgesia. (5) In disease states, the afflicted viscera may also become hyperalgesic. In this target article, I consider to what extent differences in the physiology, anatomy, and chemistry of peripheral processing systems explain these different sensibilities. In almost every aspect, there are subtle differences in the properties of the processing mechanisms for cutaneous and visceral information. These may arise because of distinct developmental cues operating in the two domains. Many of the differences between visceral and cutaneous afferents are quantitative rather than qualitative. The quantitative differences, for example in the density of afferent innervation, can be large. The quantitative differences in the numbers of afferents alone may be a sufficient explanation for some aspects of the differential sensibility, for example, the poor localisation of sensation and the apparent insensitivity to focal yet tissue-damaging stimuli. In addition, the few clear qualitative differences apparent in the innervations of the two tissue types may be of special importance. That the encoding of visceral nociceptive events may occur by an intensity mechanism rather than a specificity mechanism could be the key difference in viscerosensory and somatosensory processing.     

Education as a moderator of goal setting effectiveness

The majority of empirical support for Locke's (1968) goal setting theory is based on a series of well designed and rigorous laboratory experiments with educated college students performing rather simple arithmetic and memorization tasks. There is little known about what role educational attainment plays in responsiveness to goal setting in a field setting. A sample of 128 skilled technicians working under an assigned goal setting program were studied in order to learn about the moderating impact of education on the relationship between performance and six goal setting properties. Speculation is advanced as to why education is an important moderator variable for specific types of goal setting properties.     

Confidentiality in psychological practice: a decrepit concept?

Although the principle of confidentiality in the relationship between psychologists and client has been vaunted, and is emphasised in the Australian Psychological Society's Code of Professional Conduct (the APS code; 1994), the confidentiality of this relationship is circumscribed by the absence of legal protections, the ethical beliefs of psychologists, institutional practices, and the provisions of the APS code itself. Lack of privilege in judicial proceedings, and statutory obligations to report certain types of behaviour, mandate breaches of confidentiality in some circumstances. Ethical beliefs of psychologists may support disclosure, especially where it is believed that there is danger of serious physical harm to the client or others. Multidisciplinary teams and institutional settings require the exchange of information for optimal delivery of services. Recent amendments to the APS code may require disclosure without the client's consent when a client is believed to be suicidal. Such developments, when considered at all, are typically regarded as exceptions to a general obligation of confidentiality. However, discussion of exceptions presupposes agreement on fundamental principle: the significance of, and rationale for, confidentiality in the psychologist-client relationship. It is argued in this paper that the obligation of confidentiality has been assumed rather than vigorously analysed and empirically explored. A critical examination of this obligation is the most appropriate starting point for the rehabilitation of contemporary principles of confidentiality in the psychologist-client relationship.     

Expectations and preferences regarding confidentiality in the psychologist-client relationship

Two hundred and fifty-six members of the Australian public were surveyed regarding situations in which a psychologist might breach confidentiality and third parties to whom information might be disclosed. There was strong agreement between respondents' expectations about the way in which psychologists would act, and their preferences regarding how psychologists should act. While respondents supported confidentiality within the psychotherapeutic relationship, they clearly distinguished situations in which, and third parties to whom, disclosure could appropriately occur. Disclosure was expected and preferred when a client revealed a murder (planned or confessed), suicide plans, child abuse, or treason, and where the recipients of the information were colleagues of the psychologist or parents of a client younger than 13 years. Compared to nonparents, parents more strongly supported disclosure regarding illegal drug use and child abuse, and believed that parents should have access to a child's records. In general, respondents' view of the way in which psychologists should treat confidentiality issues were consistent with the guidelines prescribed by the Australian Psychological Society in the Code of Professional Conduct (1986).     

Analysis of clustered data in community psychology: With an example from a worksite smoking cessation project

Although it is common in community psychology research to have data at both the community, or cluster, and individual level, the analysis of such clustered data often presents difficulties for many researchers. Since the individuals within the cluster cannot be assumed to be independent, the use of many traditional statistical techniques that assumes independence of observations is problematic. Further, there is often interest in assessing the degree of dependence in the data resulting from the clustering of individuals within communities. In this paper, a random-effects regression model is described for analysis of clustered data. Unlike ordinary regression analysis of clustered data, random-effects regression models do not assume that each observation is independent, but do assume data within clusters are dependent to some degree. The degree of this dependency is estimated along with estimates of the usual model parameters, thus adjusting these effects for the dependency resulting from the clustering of the data. Models are described for both continuous and dichotomous outcome variables, and available statistical software for these models is discussed. An analysis of a data set where individuals are clustered within firms is used to illustrate fetatures of random-effects regression analysis, relative to both individual-level analysis which ignores the clustering of the data, and cluster-level analysis which aggregates the individual data. Preparation of this article was supported by National Heart, Lung, and Blood Institute Grant R18 HL42987-01A1, National Institutes of Mental Health Grant MH44826-01A2, and University of Illinois at Chicago Prevention Research Center Developmental Project CDC Grant R48/CCR505025.     

A systematic review of physical guidance procedures as an open‐mouth prompt to increase acceptance for children with pediatric feeding disorders

This article reviews behavioral treatments of pediatric feeding disorders using physical guidance procedures as an open‐mouth prompt (i.e., jaw prompt, finger prompt, Nuk prompt, side deposit) to increase food acceptance. We identified 9 articles containing 35 systematic evaluations. We coded participant and study characteristics and assessed the experimental rigor, quality, and outcomes of each evaluation. Of the high‐quality research present, the finger prompt variation and side deposit reliably increased acceptance. We found mixed results on the efficacy of the jaw prompt, although it was the most widely researched procedure. Further, authors reported interobserver agreement for 100% of the participants, procedural integrity for 60%, social validity for 80%, fading for 5%, and follow‐up for 55%. Based on the invasive nature of physical guidance, we provide recommendations for researchers and clinicians to increase the quality of their treatment evaluations. We discuss limitations, implications for practice, and future research.     

Childhood Conduct Problems Trajectories are Associated with Distinct Antisocial Process Screening Device Dimensions

Journal of Psychopathology and Behavioral Assessment - There is ongoing debate regarding whether psychopathy dimensions (i.e., narcissism, callous-unemotional [CU] traits, and impulsivity) can be...     

Teaching oddity and insertion to Head Start children: An economical cognitive intervention

Two interventions were offered to Head Start preschoolers. Half of the children played numerous learning set games designed to teach the children (1) the oddity principle and (2) how to insert objects into a series. Mastery of these concepts is theoretically an important aspect of school readiness. The other half of the children engaged in the I Can Problem Solve (ICPS) exercises, a program designed to increase the children's competency in recognizing and responding to other people's feelings. The children who played the learning set games became superior at oddity and insertions with manipulable objects, and generalized these games to workbook-like formats resembling those encountered in kindergarten. They also scored higher on the numeracy and memory scales of the McCarthy Scales of Children's Abilities, indicating that mastery of oddity and insertions may have served as foundations for further cognitive growth. The children who participated in the ICPS exercises became superior at creating solutions to interpersonal problems, as measured by the Preschoolers Interpersonal Problem Solving Scale. The differences in the outcomes indicate that both interventions were successful in their own domains. The advantage the cognitive intervention produced on the McCarthy Scales suggests that oddity and insertion abilities may be a foundation in fact as well as in theory for general cognitive growth at this age.