Quality control and the practice of clinical psychology

Because of current health care reforms, quality control, accountability, and cost-effectiveness have become important issues in the practice of clinical psychology. It is imperative that practicing clinicians begin to evaluate their services to assess whether they demonstrate high quality and cost-effectiveness, as well as a continued commitment to qualify improvement. Deming's (1986) approach to quality control is discussed as a useful strategy for improving effectiveness in the practice of clinical psychology. This approach emphasizes the process of identification of the client population, improvements through incremental processes, and evaluation of outcomes. Organizational Behavior Management (OBM) techniques are also reviewed as useful ways in which to supplement and improve on Deming's approach to quality control. Science and quality control are discussed as being inherently coherent. The scientist—practitioner model dictates that services provided to clients should be rigorously evaluated. Various procedures for evaluating the quality of services provided in clinical practice are discussed.     

Does the Good Behavior Game evoke negative peer pressure? Analyses in primary and secondary classrooms

The Good Behavior Game (GBG) is a classroom management system that employs an interdependent group contingency, whereby students work as a team to win the game. Although previous anecdotal data have suggested that this arrangement may promote prosocial behavior, teachers may have concerns about its fairness and potential to evoke negative peer interactions (especially toward students who break the rules). We evaluated disruptive behaviors and social interactions during the GBG in a secondary classroom for students with emotional and behavioral disorders, as well as in a primary classroom for students with mild developmental disabilities. Results indicate that the GBG reduced disruptive behaviors; further, negative peer interactions decreased and positive interactions increased when the game was being played. Social validity results indicate that the majority of students thought the interdependent group contingency was fair.     

Concordance of teacher-rated and performance-based measures of executive functioning in preschoolers

The most common method used to evaluate child behavior and functioning is rating scales completed by parents and/or teachers. Given that executive functioning (EF) plays a fundamental role in the developing child’s cognitive, behavioral, and social-emotional development, it would be ideal if ratings of EF and performance-based EF measures assess the same construct. However, most studies report a small to negligible association between performance-based measures and ratings of EF. There are few studies investigating this association for preschoolers, and most only include parent ratings. Teachers may be more reliable reporters of EF behaviors due to the higher demand for EF skills in the preschool setting than at home and because teachers may have a better sense of what behaviors are normative. In this study, we reviewed the associations between three EF rating scales completed by teachers on 243 preschool children. Results showed small to moderate correlations with EF measures of inhibition and cognitive flexibility/switching for all three scales, with the strongest associations observed between Child Behavior Rating Scale (CBRS) Behavioral Regulation subscale and child EF measures. Exploratory multivariate path analyses showed that, after controlling for age, sex, and socioeconomic status (SES), Behavioral Regulation significantly predicted performance-based measures of EF and accounted for incrementally more variance in the models. We conclude that in ideal situations, it is best to measure EF using both rating scales and performance-based measures of EF. The CBRS seems to be a sensitive measure of EF in preschoolers and may be a helpful brief screening tool for use with teachers.     

Education for all: The Good Inclusion Game

The term “education for all” in the context of inclusive schooling describes the aim that children with identified special/additional needs are fully included in education together with their typically developing peers. However, this is easier said than done as there are few easy‐to‐use methods that teachers can use while at the same time teaching the approbate curriculum to children with a full range of different abilities. The Good Inclusion Game (GIG) is a group contingency‐based tool to create inclusive classrooms that utilizes principles of the applied branch of the science of behavior analysis (applied behavior analysis) and can be used across settings and academic subjects. The GIG was evaluated across nine classrooms including 93 boys and girls aged between 9 and 15 years of age, including 20 children with identified special educational needs. Findings show that the GIG reliably led to a significant increase of inclusive curriculum‐focused activities with the collateral effect of decreasing disruptive behaviors for all children. Findings are discussed in the context of inclusive schooling and evidence‐based education.     

Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.     

Therapeutic response to Cognitive Processing Therapy in White and Black female veterans with military sexual trauma-related PTSD

Cognitive Processing Therapy (CPT) is an evidence-based treatment (EBT) for posttraumatic stress disorder (PTSD) which has been validated for female veterans with military-related PTSD. Existing trials have enrolled predominantly White veterans with some studies documenting higher rates of early termination from EBTs among Black females when compared to White females. Data from a previously published randomized clinical trial were used to evaluate the effectiveness of CPT for Black female veterans with military sexual trauma (MST)-related PTSD. Reductions in PTSD symptom severity, number of sessions attended, and early termination rates were compared between Black (n = 20) and White (n = 16) female veterans. A hierarchical linear modeling approach was used, with PTSD symptom severity over the course of treatment and follow-up entered as a level-1 variable and race (Black or White) entered as a level-2 predictor. Piecewise growth curves analyses revealed that both Black and White female veterans experienced significant reductions in PTSD symptom severity over the course of treatment and gains were maintained up to 6 months post-treatment. Race was not found to be a significant predictor of change in the slope of PTSD symptom severity over the course of CPT treatment. Additionally, number of sessions attended and rates of early termination did not significantly differ based on race. Results suggest that CPT was a well-tolerated and effective psychotherapeutic treatment for this sample regardless of racial self-identification.     

伦理型领导影响员工建言的多重中介效应比较研究

采用问卷调查法,对244名企业员工进行调查,构建了伦理型领导对员工建言行为的多重中介模型,比较建言效能感、心理安全感与上下级关系的个别中介效应。结果显示:伦理型领导通过建言效能感、心理安全感与上下级关系的并行多重中介作用对员工建言行为产生影响;建言效能感与心理安全感的个别中介效应均显著大于上下级关系,建言效能感与心理安全感的中介效应无显著差异。     

父母婚姻冲突、不良同伴交往对初中生攻击行为的影响:一个有调节的中介模型

采用问卷法对1406名初一学生进行调查,考察了不良同伴交往在父母婚姻冲突与初中生攻击行为关系间的中介效应,以及冲动性对这一中介过程的调节效应。结果发现:(1)在控制了性别、年龄、家庭人均月收入和父母受教育水平之后,婚姻冲突显著正向预测青少年攻击行为;(2)不良同伴交往在婚姻冲突与攻击行为关系间起着显著的部分中介作用;(3)冲动性对中介路径"婚姻冲突→不良同伴交往→攻击行为"具有显著的调节效应。