Political and interpersonal aspects of ethics consultation

Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff seem important, especially where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record.     

Behavioral case consultation with parents and teachers: An example using differential reinforcement to treat psychogenic cough

This study presents a demonstration of successful behavioral case consultation combined with case study methodology in the treatment of a 13-year-old female who presented with a brief history of psychogenic cough. Psychogenic cough is diagnosed when there is no organic or physiologic basis for the repeated, harsh coughing. We first present a brief review of treatments for psychogenic cough and then describe how we used differential reinforcement of low rate responding (DRL) and differential reinforcement of zero responding (DRO) within an A-B-C design. The DRL schedule produced significant decreases in coughing but plateaued at about one-third the baseline rate. Thereafter, a DRO schedule was employed which resulted in complete and lasting elimination of coughing. Discussion focuses on the limitations of case study methodology as well as its usefulness for conducting service related research in the schools, implications of some of the findings for practitioners, and other issues related to treatment.     

Effectiveness of a consultation intervention to promote tobacco control policies in Northwest Indian tribes: Integrating experimental evaluation and service delivery

A quasi-experimental replication of an intervention for promoting tobacco control policies in Northwest Indian tribes is described and the process of intervention including issues of collaboration among research institutions and Indian organizations is discussed. The policy intervention was evaluated using a pretest-posttest design wherein 20 tribes that had served as wait-list controls now received the intervention. The intervention comprised a tribal representative attending a kickoff orientation; follow-up visits to the tribes; distribution of tobacco policy workbooks; and phone call consultations. Policy status and stringency were assessed by means of telephone interviews with two key contacts per tribe, and by a count of enacted policies. There were significant pre-post changes in the primary outcome measure, a composite summary score of tobacco policy stringency, and changes were also reflected in enacted policies. The intervention effects observed were similar to those found in the prior randomized trial and suggest a robust, disseminable intervention. Much of the success achieved was attributed to the role of an Indian organization in planning the project and implementing the intervention and evaluation protocols.     

IMPLICATIONS OF BEHAVIORAL PHARMACOLOGY RESEARCH FOR APPLIED BEHAVIOR ANALYSES: JEAB'S SPECIAL ISSUE CELEBRATING THE CONTRIBUTIONS OF JOSEPH V. BRADY (MARCH 1994)

We review four articles from JEAB's March 1994 issue celebrating the contributions of Joseph V. Brady. These articles have implications for studying private events and for studying multiple operants. We suggest that regularly including self-reports about private events in behavioral pharmacological research has resulted in an accumulated knowledge that has facilitated examination of interesting relations among self-reports, environmental factors, and other observable behaviors. Methodological lessons that behavioral pharmacologists have learned regarding the study of multiple operants are also relayed. We provide examples of how these lessons could be useful to applied behavior analysts studying nonpharmacological issues.     

Ecosystemic consultation in the kibbutz: social process and narrative in two cases of community “epidemic”

This paper emphasizes working with the social component of the biopsychosocial model. A dual approach for renarrating dysfunctional community narratives and for changing the social process is described. This approach was applied to two cases of epidemics allegedly cased by mysterious environmental agents that occured on kibbutzim. The collective adoption of irrational beliefs is analyzed by using concepts from sociology and crowd psychology. The suggestive effects of the emotional contagion and of the preoccupation with a persistent belief are examined by applying the concept of monoideism. The epidemics were resolved by working in collaboration with the community. The intervention programs mobilized inner resources by helping the kibbutzim to adopt a more unified approach to their presenting problems, and by challenged them to face previously avoided more fundamental dilemmas.     

Eliminating nail-biting by the habit reversal procedure

Fingernail-biting is prevalent among children and adults alike. About 43% of children bite their nails during the puberty ages (Wechsler, 1931); 25% of college students are nail-biters (Coleman and McCalley, 1948), and 10% of adults bite their nails (Pennington, 1945).A variety of treatments including negative practice, operant procedures and psychotherapy have been used in treating nail-biting but no single treatment has been generally effective in eliminating nail-biting. Smith (1957) using negative practice reported that 21 of 57 (39%) of his nail-biting clients were cured. 9 improved and 27 (47%) were unimproved. Bucher (1968) reported that 13 of 20 (65%) college students stopped nail-biting by using a self-administered operant shock procedure. However, he reported many relapses after the withdrawal of shock for nail-biting. No evaluation of psychoanalytic treatment for nail-biting appears to have been made.