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.     

INCREASING HABILITATIVE SERVICES FOR PERSONS WITH PROFOUND HANDICAPS: AN APPLICATION OF STRUCTURAL ANALYSIS TO STAFF MANAGEMENT

We evaluated a structural analysis methodology for enhancing the utility of a staff management program. In Experiment 1, a structural analysis of direct-care staff behavior in a mental retardation facility revealed differences in work patterns over time. Specific times were identified when few basic care duties were necessary and staff engaged in nonwork activity. In Experiment 2, a management program was implemented to increase staff members' training activities during periods identified through the structural analysis. The program was accompanied by increases in training activities and decreases in nonwork behavior. The improvements were maintained during a 43-week period while the most labor-intensive component of the program was withdrawn. Staff acceptability measures indicated a positive response to the management intervention, although responses varied across components within the multifaceted program. The increased training was accompanied by beneficial changes among clients with profound handicaps. Results are discussed regarding practical considerations for improving staff performance and for adopting innovations resulting from applied research.     

Mediational screening as a model for prevention research

Examined here is Pillow, Sandler, Braver, Wolchik, and Gersten's (this issue) strategy for screening prevention trial participants. The reviewer concludes that their selection strategy should increase the statistical power of prevention outcome studies, increase intervention cost effectiveness, and help to prevent their possible iatrogenic effects. Also, their model points up inadequacies in the longitudinal data on which most prevention strategies are based, and their model could well serve as a template for future research.     

Individuation and reference in memory: Proper names and definite descriptions

A theory is presented which assumes that individuals are represented by unique nodes in memory. To test the theory, simple facts were predicated of an individual person. Some facts referred to him by proper name, and other facts by his profession. In a before condition, subjects learned that the profession and name referred to the same individual before learning the facts, while in an after condition, they learned the identity after learning the facts. Subsequent to learning the facts and identities, subjects verified sentences based on what they had learned. Verification latencies indicated that in the before condition, one memory node was created to represent the individual, but two nodes were set up in the after condition. Assymmetries between proper names and professions indicate that the two types of referring expressions are treated differently in long-term memory.     

Sound-induced seizure: asymmetries exhibited are related to the latency of seizure onset

Audiogenic seizures of SJL/J mice sensitized before 3 weeks of age were found to be of two distinct types. Seizures with short latencies to onset were without clear asymmetries of either run or fall direction, whereas seizures occurring after a longer latency were characterized by asymmetries of both of these behaviors.     

Group instruction with profoundly retarded persons: acquisition, generalization, and maintenance of a remunerative work skill.

We evaluated a group instruction program for teaching a vocational skill to profoundly retarded adults. The program involved designated trainer roles and both individual student-directed and total group-directed procedures. Results indicated that, following the program, participants acquired the skill of stamping addresses on envelopes, the skill generalized across an untrained type of envelope, and the skill maintained over time. The group activity was incorporated into the regular classroom without increased disruption and the participants earned a wage for their productivity. Implications for the development of a group instruction technology for severely handicapped persons are discussed.     

The effects of memory strategy instruction in the short-term motor memory of the mentally retarded

The present study investigated the effectiveness of teaching mnemonic strategies aimed at overcoming difficulties of mentally retarded students in retaining the motor short-term memory information of a preselected movement. The memory strategy employed was a combination of the "feel" of the movement and the spatial location of the hand relative to the body. The design of the study was a 2 x 2 (Instructional Treatment x Retention Condition) factorial. The instructional treatment factor included teaching the subjects a memory strategy versus no memory-strategy instruction. The retention condition factor included immediate recall and a 15-sec retention interval. There were five trials per subject. The data were interpreted as supporting the effectiveness of the memory-strategy instruction.     

Discriminative functions of schedule stimuli and memory: a combination of schedule and choice procedures

Pigeons responded under a combination brief-stimulus schedule and choice procedure. Normally, a fixed-interval schedule was in effect, where completion randomly produced either a brief stimulus or food. Intermittently, this schedule was interrupted by a choice arrangement. Two choice keys were lit, either a short or a long time since a prior event (food or stimulus). One choice response produced food if the time had been short, and the alternate response produced food if the time had been long. Across conditions, the duration of the fixed-interval schedule was varied, the stimuli that comprised the brief-stimulus operation were changed, and the stimuli were presented as paired and nonpaired with food. The focus of the study was the control of both schedule performance and choice responding across conditions. The results showed that choice accuracy was correlated with the degree of fixed-interval curvature, the response pattern of a pause followed by a gradually accelerated rate. As fixed-interval schedule duration was increased, both the degree of fixed-interval curvature and choice accuracy decreased. The particular brief stimulus used affected schedule and choice performance, with a more salient stimulus producing a greater degree of curvature and higher accuracy. Pairing and nonpairing operations produced striking differences in performance with the less salient brief stimulus, but not with the more salient stimulus. The results suggest that brief-stimulus schedule performance may be conceptualized in the context of memory research.