What is a difficult mental health case? An empirical study of relationships among domain variables

A difficult case in psychotherapy can be defined in many ways. This study proposes a model for that definition, in which three domains (patient characteristics, case characteristics, and therapist characteristics) are considered to impact on that definition. A total of 264 professionals received a questionnaire to assess the relative importance of a series of variables within and across these domains. Wilcoxon Matched-Pairs Signed-Ranks tests indicated that patient characteristics were considered more important than therapist or case characteristics in defining a difficult case. Case characteristics were considered more important than therapist characteristics. Pearson correlations, however, suggested that the three domains in the model are related. Correlations (for years of experience) and Kruskal-Wallis one-way ANOVA for ranks (for professions) also indicated that participants were able to identify variables within domains as important in that definition regardless of years of experience or professions. Across domains, the most important variables included the motivation of the client (a patient characteristic), dropout/attrition and multiple diagnoses (case characteristics), and the degree of therapist-client racial similarity (a therapist characteristic).     

Ingroup Versus Outgroup Perceptions of the Characteristics of High-Risk Youth: Negative Stereotyping1

Adolescents tend to categorize themselves and their peers into discrete ingroups and outgroups. A comparison of ingroup versus outgroup perceptions of the characteristics of high-risk youth was investigated. Based on current stereotype research, we examined the perspective that outgroup members would hold a more extreme stereotype of high-risk youth compared to the perceptions of ingroup members. A total of 955 7th- and 10th-grade southern California adolescents completed a questionnaire regarding the characteristics of their own peer group and a high-risk group. Support was obtained for an extremity of judgement effect. Outgroup youth perceived that their high-risk peers engaged in fewer school and nonschool low-risk activities, more high-risk activities, and greater drug use than did ingroup members. Outgroup members also held perceptions of high-risk youth as less likely to hold a white-collar job than did the ingroup members. The perceptions that adolescents have of these groups may play major roles in their own social behavior. The implications of these results for future tobacco use prevention programs are considered.     

VALIDATING PREDICTED ACTIVITY PREFERENCES OF INDIVIDUALS WITH SEVERE DISABILITIES

We examined the accuracy of 24 staff members' predictions of activities preferred by 14 individuals with severe disabilities. For each of 144 activities, staff members assigned a client preference rating of “likes a lot,” “likes,” or “dislikes.” Two activities from each category were randomly selected for each individual with disabilities. Pairs of selected activities were presented to the individuals, who were prompted to choose an activity. Staff members' activity preference ratings correctly predicted the choices made by the individuals with disabilities for 78% of the trials. The more divergent the preference ratings of the paired activities, the more likely staff members were to predict correctly the activity selected by a participant.     

INCREASING CALORIE CONSUMPTION IN CHILDREN WITH CYSTIC FIBROSIS: REPLICATION WITH 2-YEAR FOLLOW-UP

Three mildly malnourished children with cystic fibrosis and their parents participated in a behavioral group-treatment program that focused on promoting and maintaining increased calorie consumption. Treatment included nutritional education, gradually increasing calorie goals, contingency management, and relaxation training, and was evaluated in a multiple baseline design across four meals. Children's calorie intake increased across meals, and total calorie intake was 32% to 60% above baseline at posttreatment. Increased calorie consumption was maintained at the 96-week follow-up (2 years posttreatment). The children's growth rates in weight and height were greater during the 2 years following treatment than the year prior to treatment. Increases in pace of eating and calories consumed per minute were also observed 1 year posttreatment. These findings replicated and extended earlier research supporting the efficacy of behavioral intervention in the treatment of malnutrition in children with cystic fibrosis.     

CHANGING PROTECTIVE AND RISKY BEHAVIORS TO PREVENT CHILD-TO-PARENT TRANSMISSION OF CYTOMEGALOVIRUS

Child-to-parent transmission of cytomegalovirus may be reduced by increasing protective behaviors (handwashing and glove use) and decreasing risky behaviors (intimate contact between child and parent). This study showed that an educational intervention resulted in increases in reported and objective measures of protective behaviors and decreases in reported risky behaviors. Further study must determine if changes in protective and risky behavior are maintained and prevent cytomegalovirus transmission.     

Testing a stochastic foraging model in an operant simulation: Agreement with qualitative but not quantitative predictions

An operant simulation of foraging through baited and empty patches was studied with 4 pigeons. On a three-key panel, side keys were designated as patches, and successive opportunities to complete 16 fixed-ratio 10 schedules on side keys were defined as encounters with feeders. In a random half of the patches in any session, some of the fixed-ratio 10 schedules yielded reinforcement (baited feeders) and the other schedules yielded nonreinforcement (empty feeders). In the other half of the patches, all feeders were empty. Pigeons could travel between patches at any time by completing a fixed-ratio schedule on the center key. An optimal foraging model was tested in Experiments 1 and 2 by varying center-key travel time and number of baited feeders in baited patches. The ordinal predictions that number of feeders visited in empty patches would increase with travel time and decrease as number of baited feeders increased were supported, but pigeons visited far more feeders in empty patches than the optimal number predicted by the model to maximize energy/time. In Experiment 3, evidence was found to suggest that the number of empty feeders encountered before the first baited feeder in baited patches is an important factor controlling leaving empty patches.     

Unit price as a useful metric in analyzing effects of reinforcer magnitude.

In this paper, we applied the behavioral-economic concept of unit price to the study of reinforcer magnitude in an attempt to provide a consistent account of the effects of reinforcer magnitude on behavior. Recent research in the experimental analysis of behavior and in behavioral pharmacology suggests that reinforcer magnitude interacts with the schedule of reinforcement to determine response rate and total consumption. The utility of the unit-price concept thus stems from its ability to quantify this interaction as a cost-benefit ratio (i.e., unit price = characteristics of the schedule of reinforcement divided by magnitude of reinforcement). Research employing the unit-price concept has shown that as unit price increases, a positively decelerating function exists for consumption (i.e., a function with an increasingly negative slope, when plotted on log coordinates) and a bitonic function exists for response rate. Based on these findings, the present analysis applied the unit-price concept to those studies of reinforcer magnitude and drug self-administration that examined the effects of reinforcer magnitude on response rate using simple schedules of reinforcement (e.g., fixed-ratio schedule). This resulted in three findings: (a) Reinforcer-magnitude manipulations and schedule manipulations interact in a manner that can be quantified in terms of unit price as benefit and cost factors, respectively; (b) different reinforcer-magnitude manipulations are functionally interchangeable as benefit factors in the unit-price ratio; and (c) these conclusions appear warranted despite the differences in reinforcers (food or drug), species (dogs, monkeys, or rats), and schedules (interval or ratio), and despite the fact that these studies were not designed for a unit-price analysis. In methodological terms, these results provide further evidence that employing the unit-price concept is a parsimonious method for examining the effects of reinforcer magnitude. In theoretical terms, these results suggest that a single process may underlie the effect of combined reinforcer-magnitude and schedule manipulations.