New directions for the education of clinical psychologists: The primary care setting,the VA's PRIME program,and the in-depth generalist model

As part of this special issue on psychology in primary care settings, we describe the Department of Veterans Affairs' (VA's) new approach to education for practice in the primary care setting and we concurrently address some general issues related to the education of clinical psychologists for practice in this setting. In this article we argue that the primary care psychologist, in parallel with the generalist in medicine, must have a strong generic background in clinical psychology in order to gain the broad range of clinical skills necessary to function effectively as an in-depth generalist (IDG) who is capable of addressing the variety of psychological issues that emerge in the primary care setting. The IDG model of professional practice, which we believe is best suited for primary care/managed care settings, requires extensive training in generic clinical skills and increased time devoted to its implementation at both the predoctoral and the postdoctoral levels.     

Matching adolescents with foster mothers and fathers: An evaluation of the role of temperament

We tested the notion that better foster care adjustment would be observed when the temperaments of mothers and fathers were matched with those of adolescent foster children. We hypothesized that families in which foster parents and foster children had high (easy) scores on subscales of the Revised Dimensions of Temperament Scale (DOTS-R) would also report higher family functioning and higher foster care adjustment than parents and children from families in which one or both family members had low (difficult) scores on these scales. The hypotheses were supported when the mothers and fathers family assessments were used but rejected when the observations of the case managers and adolescents were tested. Methodological and substantive explanations for the findings are discussed and recommendation for foster care practice and continuing research are provided.     

Selective attention by children and adults to pictures specified by color

Four conditions were used to investigate developmental trends in the ability to establish and use a color set to direct the selective processing of pictures. In three conditions, 6-year-old, 9-year-old, and adult subjects viewed a series of pairs of pictures, with one red and one black line drawing in each pair. Subjects were asked to look either at the red pictures only, the black pictures only, or both pictures. In a fourth condition, subjects viewed a series of singly presented red and black pictures. Pictures of both colors were included in a subsequent recognition memory test. At all ages recognition memory was comparable for pictures of each color in the both and single conditions but was higher for pictures of the specified color in the selective red and selective black conditions. There was no evidence at any age that memory for pictures of the specified color was decreased by the presence of the second picture. These results, showing roughly comparable selectivity at all ages, were discussed in relation to findings of developmental trends in selective attention on more “traditional” central-incidental learning tasks.     

Do medical decision analyses' largest gains grow from the smallest trees?

Some decision analysts recommend reserving their models for careful, complete study of complex problems. Others believe simple problem analyses provide the greatest gains. To clarify these issues, I tested: (1) whether simple published analyses compared to complex ones, produced results as non-intuitive; and (2) whether non-intuitiveness represented analytic gain (or equivalently, intuitive loss). Very limited data also examined (3) the gain from adding model intricacy for a given problem vs. selecting more complex problems for analysis. To assess two non-intuitiveness measures, 75 subjects (33 physicians and 42) non-physicians stated their intuitive preferences in 40 (22 published and 18 unpublished) medical dilemmas. For both physicians and non-physicians, simpler models (those with lees than 30 terminal branches in the decision tree) had about one third the non-intuitiveness of more complex ones. Three tests also supported the premise that analyses outperform intuition, therefore that on average the formers' non-intuitiveness reflects less analytic gain. In addition, for different models of the same problem, tree complexity did not correlate with gain. Thus, simpler trees may not generally gain less because they inadequately describe problems. Instead, simpler analyses may represent simpler problems, with more similar intuitive and formal solutions. If so, these findings may help us avoid some costly but unnecessary simple analyses.     

INCREASING EXTENDED CARE FACILITY RESIDENTS' ATTENDANCE AT RECREATIONAL ACTIVITIES WITH CONVENIENT LOCATIONS AND PERSONAL INVITATIONS1

Residents of extended care facilities generally exhibit a low level of attendance at recreational and therapeutic activities. Spatial arrangement of rooms, prompting, snacks, and small prizes have been suggested as factors that affect attendance. The present study examined the effects of an extensive system of prompts and the location of activity areas on the attendance of residents at a variety of activities. Twenty-six subjects were randomly selected from the ambulatory population of the facility. The first time each subject entered the activity room during the first 6 min of an activity session their name was recorded. Reliability measures were taken at 10 sessions, with a 95% mean agreement between observers. The variables examined were the amount of individualization of subjects (experimental group I: names announced versus experimental group 2: names not announced), room location (central or peripheral), use of names in announcements (activity only versus activity and group I names), and mode of announcement (PA system only versus PA system and in-person). A counter-balanced group design with repeated measures was used, with a randomly determined order of application of experimental treatments. An analysis of variance split plot 2.222 (Kirk, R. E. Experimental Design: Procedures for the Behavioral Science. Belmont, Ca.: Brooks-Cole, 1968.) of the level of subject attendance yielded significant main effects for room location, F(1, 24) = 5.47, p < 0.05, and type of announcement, F(1, 24) = 9.10, p < 0.01, and significant interactions for Individualization × Use of Names in Announcements, F(1, 24) = 5.57, p < 0.05, and Room Location × Mode of Announcement, F(1, 24) = 7.90, p < 0.01. The results indicate that using a centrally located room and announcement of resident names increases attendance at a variety of activities. The increased social and environmental interaction generated by activity attendance has potential therapeutic benefits for the residents involved. Furthermore, the kind of information reported here and by others should be taken into consideration by planners of a variety of group living facilities, ranging from nursing homes to residential treatment cottages.     

呼吸危重症临床决策中的若干问题

在临床实践中,呼吸危重症的诊断和治疗存在着一些不同的观点。就其中某些热点问题,如慢性阻塞性肺疾病合并哮喘的诊断和机械通气的指征、肺栓塞的诊断、急性呼吸窘迫综合征的治疗、呼吸重症监护病房的建设和呼吸危重症的伦理学问题进行阐述,以期提高对呼吸危重症的认识。     

我国大学生在关爱价值观者特征上的公众观

在开放式预调查基础上,对452名大学各专业学生进行调查研究。结果表明:我国大学生认为善良、真诚、有爱心、不歧视残障者、宽容、设身处地、尊重7项是关爱价值观者最应该具有的特征;个人修养、利他助人、处事交往、外表印象、内在气质、尊重宽容、奉献与责任是关爱价值观者的7个品质因素,其中个人修养的品质因素最为突出;对这些品质因素,男女大学生看法没有明显差异,对某些品质因素城乡大学生、不同专业大学生有明显不同的看法。     

Motivational Predictors of Change in Oral Health: An Experimental Test of Self-Determination Theory

We tested the hypothesis that a psychosocial dental intervention formulated in terms of self-determination theory would increase patients’ perceived competence and autonomous motivation for dental care and would decrease their plaque and gingivitis over a seven month period, compared to standard dental treatment. We also tested a process model in which the intervention was expected to increase perceived dental competence and autonomous motivation, that they would be positively associated with oral health behaviors (i.e., brushing and flossing), which was expected to decrease plaque and, in turn, decrease gingivitis. We also examined whether: changes in perceived competence and autonomous motivation would mediate the effect of the intervention on dental-health behaviors; dental-health behaviors would mediate the links from changes in perceived competence and autonomous motivation to change in plaque; and change in plaque would mediate the relation of dental health behaviors to change in gingivitis. Finally, we examined the fit of the overall model with structural equation modelling. Results supported all predictions.

From a Distance: Pastoral Care and Theological Education

Abstract. This article is a presentation and discussion of a seminary course on the Corinthian Correspondence. The pedagogical model for this course was structured to parallel the pattern of Paul's pastoral care from a distance as he relates to the Corinthian congregation by personal visits, delegations from and to the congregation, letters from and to the congregation, and unofficial grapevine types of communication. The course was designed for dispersed students to interact with the Corinthian letters, with each other, and with myself as instructor in ways that 1) simulate a first‐century exchange between congregation and apostle and 2) facilitate careful interpretive work on the message of these letters, including their contemporary relevance.     

Predicting Resource Utilization by Children with Serious Emotional Disturbance and Their Families

Our study represents a rural case management agency's use of its data to aid in its transition from being funded by federal grant funds to self-sustainment. We wanted to learn if some characteristics of those children served could predict the resources needed to serve them. We analyzed data on 90 children and adolescents living in a rural community. Using multiple regression analysis we found that CAFAS total and CBCL total problem scores predicted Medicaid reimbursements but not flexible funds spending or case management hours. History of psychiatric hospitalization, however, predicted flexible funds spending and case management hours. Using one-way ANOVA and post hoc analysis we found that the staff members' assessments of each child and family's level of service needs were reflected in differences in mean CAFAS total scores, Medicaid reimbursements and case management hours, but not CBCL total problem scores or flexible funds spending.