Evaluating pediatric psychology consultation services in a medical setting: An example

We examined the nature of referrals to a health center-based pediatric psychology service from 1990 to 1993 and assessed the satisfaction of health professionals with these services. Archival evaluation of 1467 records showed that over half of the consultation requests came from general pediatrics, pediatric neurology, and surgical services and that 70% of the psychological services were delivered on an outpatient basis. The most frequent referrals were for cognitive/neuropsychological evaluation and externalizing behavior problems. Pediatric psychology trainees were involved in 94% of the consultations. Survey of health professionals (n = 143) indicated very high overall satisfaction with the quality of services delivered. Presenting problems yielding the greatest likelihood for future consultation requests were behavior problems, child abuse, coping with illness, and depression/suicide. Results are discussed in the context of previous evaluations of pediatric psychology services and recommendations for future evaluation research.     

The detection and management of mental health disorders in pediatric primary care

We reviewed the literature on the detection and management of mental health disorders within the context of pediatric primary care. Pediatricians have displayed a low sensitivity and high specificity in research investigating the detection of mental health impairment in children. Active management efforts characterize approaches to identified cases with more recently trained primary care pediatricians displaying a wider range of skills in managing mental health disorders. Few efforts have been made by pediatric psychologists to develop strategies for enhancing detection rates and management or to empirically evaluate the integration of pediatric psychology services into the primary care context. A conceptual model of factors influencing detection rates and ongoing management of mental health disorders within pediatric primary care is presented. Recommendations are made for more direct involvement of pediatric psychologists within the primary care context.     

Children’s reading skills: A comparison of traditional and computerized assessment

Student’s ability to read computer text was investigated by comparing reading performance on decoding and phonetics tests of the Woodcock-Johnson (Revised) Tests of Achievement, Forms A and B. Fifty-one students completed one form of the reading tests through the traditional administration method and a second form using computer administration. Initial form and administration order were counterbalanced. Coefficients of equivalence of .91 and .86 were obtained for traditional and computer administration methods of the two tests. The results are interpreted as indicating that computer-administered reading tests can assess the same domains as traditional measures, and that they may become increasingly important in the complete assessment of functional reading skills.     

Social reinforcement of operant behavior in rats: a methodological note.

An apparatus was developed to study social reinforcement in the rat. Four Long-Evans female rats were trained to press a lever via shaping, with the reinforcer being access to a castrated male rat. Responding under a fixed-ratio schedule and in extinction was also observed. Social access was found to be an effective reinforcer. When social reinforcement was compared with food reinforcement under similar conditions of deprivation and reinforcer duration, no significant differences were observed.     

Driving assessment with computer-video scenarios: More is sometimes better

Several factors are critical in designing effective simulator systems for driving research and driver assessment. First, there is cost, in terms of which, less is better. Costly systems are sometimes fine for specific research purposes, but they are impractical for most other purposes. Second, there is realism; in this case, more may be better, but we don’t know how much realism is really necessary for good prediction of actual driving behaviors. Recent evidence suggests that real-world clutter may enhance prediction, but it also makes interpreting research more difficult. More realism may increase cost, but this is not necessarily the case. Third, there is user-friendliness, in terms of which, again, more is better. Systems that are easier to operate require less-highly trained personnel; hence, increasing user-friendliness also decreases cost, especially for assessment. We demonstrated a highly user-friendly, low-cost, moderately realistic, and partly interactive computer-video driving research and assessment system. In recent research, we obtained multipleR values ofA7 for older drivers with only three to four scenarios predicting a real-world crash index.     

The Influence of Outcome Expectancy and Self-Efficacy on the Behavioral Intentions of Novice Exercisers

The present study was based upon self-efficacy (SE) theory (Bandura, 1986). Its purpose was to examine whether incentives, defined as the product of outcome expectancy and outcome value, would help to predict the behavioral intentions of novice exercisers when coupled with SE expectations for a specific form of exercise. Fifty- three volunteers who were novices at weight training for exercise, participated in a 2-day learn-to-weight-train clinic offered at a university. They completed pre- and postclinic measures of SE for weight training, expectancy-value ratings of outcomes primary and secondary to 1 month's weight-training participation, and a strength- of-intention measure of multiple actions consequent to clinic participation. Results indicated that primary physical health outcomes expected of postclinic participation independently predicted the variability in pre- and postclinic future intentions beyond the variance predicted by SE. Further, incentives and SE clearly discriminated between individuals extreme in the strength of their intentions at pre- and postclinic. Discussion concerns the inclusion of measures of incentive in studies using self-efficacy theory in order to examine individuals who begin exercise and then move through various decision stages about exercise adoption and maintenance. Rather than merely assuming the influence of incentives necessary and sufficient to encourage a cognitive or behavioral impact of efficacy, arguments are made for actively examining incentive as manifested through outcome expectations.     

CHOICE-MAKING TREATMENT OF YOUNG CHILDREN'S SEVERE BEHAVIOR PROBLEMS

The choice-making behavior of 5 young children with developmental disabilities who engaged in aberrant behavior was studied within a concurrent operants framework. Experimental analyses were conducted to identify reinforcers that maintained aberrant behavior, and functional communication training packages were implemented to teach the participants to gain reinforcement using mands. Next, a choice-making analysis, in which the participants chose one of two responses (either a mand or an alternative neutral response) to obtain different durations and qualities of reinforcement, was conducted. Finally, treatment packages involving choice making via manding were implemented to decrease inappropriate behavior and to increase mands. The results extended previous applications of choice making to severe behavior disorders and across behaviors maintained by positive and negative reinforcement.     

Dispositionai Optimism as a Protective Factor in Resisting HIV Exposure in Sexually Active Inner-City Minority Adolescents1

Recent investigations have explored dispositional optimism as a determinant of various health-related behaviors, though such research has been infrequently conducted in populations where pessimism would be expected to be prevalent. The present study examines optimism and unsafe sexual behavior in 230 sexually active inner-city minority adolescents. Findings suggest that dispositional optimism is a protective factor regarding adolescents' intentions to avoid engaging in unsafe sex. Further, the benefits of optimism appear to be explained by those who are more optimistic having higher levels of perceived condom use self-efficacy and stronger negative expectancies toward unsafe sex. Future interventions may need to address optimism in concert with behavioral-specific determinants to increase the probability of reducing unsafe sexual behavior in high-risk populations.     

Family-centered intensive case management: A step toward understanding individualized care

New York State's initial attempt at individualizing services occurred within the context of an experiment. We randomly assigned children 5–12 years old who were referred for out-of-home placement in treatment foster care to either treatment foster care, Family-Based Treatment (n=15), or to Family-Centered Intensive Case Management (FCICM) (n=27). FCICM used teams of case managers and parent advocates to provide in-home services. Flexible service dollars, respite care, and behavior management skills training were available to assist teams in individualizing care. Preliminary outcomes indicate that children in FCICM are doing as well or better than children assigned to FBT in their functioning and symptom reduction. Parents of children in FCICM have made gains, although not at a statistically significant level, in behavior management skills and family strengths that allow them to provide care for their children at home.