DIRECT AND COLLATERAL EFFECTS OF RESTRAINTS AND RESTRAINT FADING

Mechanical restraints are commonly used to reduce the risks associated with severe self-injurious behavior (SIB), but may result in movement restriction and adverse side effects (e.g., bone demineralization). Restraint fading may provide a method for decreasing SIB while increasing movement and reducing these side effects. In the current investigation, rigid arm sleeves and restraint fading (gradually reducing the rigidity of the sleeves) were used with 3 clients who engaged in hand-to-head SIB. Restraints and fading reduced the hand-to-head SIB of all clients. However, for 1 client, the addition of a water mist procedure further reduced SIB to near-zero levels. For a 2nd client, another form of SIB developed that was not prevented by the rigid sleeves. For a 3rd client, a topography of SIB that was not physically prevented by the rigid sleeves was also reduced when restraints and fading were introduced.     

Extracting the coherent core of human probability judgement: a research program for cognitive psychology

Human intuition is a rich and useful guide to uncertain events in the environment but suffers from probabilistic incoherence in the technical sense. Developing methods for extracting a coherent body of judgement that is maximally consistent with a person's intuition is a challenging task for cognitive psychology, and also relevant to the construction of artificial expert systems. The present article motivates this problem, and outlines one approach to it.     

BALANCING SOCIAL ACCEPTABILITY WITH TREATMENT EFFECTIVENESS OF AN INTRUSIVE PROCEDURE: A CASE REPORT

The debate over social acceptability of intrusive procedures has led some school districts to adopt policies allowing punishment for only the most extreme forms of destructive behavior. We investigated the effectiveness of selectively implementing punishment for only the most severe topographies of aggression and property destruction, while less extreme behaviors were ignored. Results indicated that severe behaviors were reduced to near-zero levels only when both severe and less severe behaviors were similarly punished.     

Burnout in Spurned Medical Caregivers and the Impact of Job Expectancy Training

This study represents an extrapolation to the practical realm of a theoretical model that has been supported thus far only by laboratory studies. The model regards the rejection of help by people in need as being stressful for caregivers partly because it violates their expectations of acceptance and threatens their self-image as competent caregivers. It was hypothesized that high levels of perceived rejection by patients and others at work would contribute to burnout in medical caregivers. It was also predicted that high levels of stress preparation in caregivers' training with regard to job expectancies and patient (non)compliance would lessen burnout and buffer the effects of spurning. Responses to a questionnaire by a sample of physicians and hospital nurses revealed a direct association of perceived spurning, as well as an inverse association of stress preparation with burnout, and gave some indication of buffering, as hypothesized. Expressions of violated expectancies and of job disillusionment were directly associated with burnout and inversely associated with stress preparation. Informal job expectancy shaped by coworkers was found to be directly associated with burnout in physicians, but it was inversely associated with burn out in nurses. The implications of these findings are considered     

Loomingness and the Fear of AIDS: Perceptions of Motion and Menace

The authors examined the role of "perceived loomingness" in fear of HIV. Perceived loomingness refers to perceptions of rapid forward movement and instantaneous changes in the distance and danger of a potential threat (Riskind, 1992). One hundred and twenty undergraduates rated vignettes of two public encounters with an HIV-positive stranger. High-HIV fear subjects perceived greater loomingness and danger in these vignettes than did low-HIV fear subjects. Regression analyses that tested for a mediated model confirmed that the perceptions of loomingness may spark threat cognitions (such as the probability and imminence of harm), which, in turn, lead to fear. As predicted by the harm-looming model, loomingness also had some effects on fear that were not mediated by such standard threat cognitions.     

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.     

THE THEOLOGICAL ANTHROPOLOGY OF RALPH WENDELL BURHOE

Abstract. A central aim of Ralph Wendell Burhoe's scientific theology is to define and interpret the meaning of human existence in relation to “ultimate reality.” As such, it can be understood as an exercise in theological anthropology. For Burhoe, this ultimate reality is “nature,” understood as the total reality system which is studied by the sciences and which the sciences are showing to be the sole determiner of the way things are. This article discusses various aspects of Burhoe's theological anthropology, as well as its value and credibility, and raises questions concerning his understanding of the value of the individual and the problems of evil and human sinfulness.     

Assessing mental capacity and susceptibility to undue influence

Clinicians are commonly asked to participate in the determination of an individual's mental capacity and susceptibility to undue influence. Vague statutory definitions and lack of operational criteria for both determinations have contributed to inconsistency in the quality and usefulness of expert input to these determinations. Questionnaire responses of 119 probate judges from the U.S. indicate that this input is quite influential despite the problems mentioned above. This paper presents and discusses the judges' views on selected procedural and conceptual aspects of expert evaluation and testimony.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.