社区卫生服务的“管理模式”与“治理模式”比较

依据社区卫生服务的提供方与消费方之间的权力关系,社区卫生服务模式可以划分为管理模式和治理模式。在管理模式中,社区卫生服务提供方与消费方之间是建立在行政和技术权威基础上的管理与被管理关系。在治理模式中,社区卫生服务的提供方与消费方则是建立在沟通基础上的合作关系。我国社区卫生服务模式的发展趋势是从管理向治理的转变。     

Contingency Management for Attendance to Group Substance Abuse Treatment Administered by Clinicians in Community Clinics

Contingency management (CM) is effective in enhancing retention in therapy. After an 8-week baseline, four community-based substance abuse treatment clinics were exposed in random order to 16 weeks of standard care with CM followed by 16 weeks of standard care without CM or vice versa. In total, 75 outpatients participated. Patients who were enrolled in the clinics when the CM treatment phase was in effect attended a significantly greater percentage of therapy sessions than patients who were enrolled in treatment when CM was not in effect. This study is one of the first to investigate CM in community settings implemented entirely by community clinicians, and results suggest that CM is effective in improving therapy attendance.     

Minorities and the Philosophical Marketplace

This article argues for two theses. The first is that many of the sociological factors endemic in the philosophical community function as barriers to the recruitment of members of minority groups in the profession and to their functioning as public intellectuals. The division into familial groups, the fights for security and success, and the weakness of the federal organization of the American Philosophical Association all contribute to these barriers. The second is that sociology has a place in philosophy, even though it should not be confused with it. This means that philosophers need to consider social phenomena.     

The Role for Occupational Therapists in Community Mobility Training for People With Autism Spectrum Disorders

Symptoms and behaviors of Autism Spectrum Disorders can challenge community mobility, thus hindering independence and participation in occupation. Community mobility, also called travel training, helps people make journeys safely using public transportation, enabling engagement in activities/services otherwise unavailable. Yet, few articles have been written about this topic for people with Autism Spectrum Disorders. The purpose of the authors in this article is to: (1) explain the need for travel training with people diagnosed with Autism Spectrum Disorders; (2) describe specific travel training assessments; (3) review literature on travel training programs; and (4) define a role for occupational therapy in travel training with individuals diagnosed with Autism Spectrum Disorders.     

TEACHING FUNCTIONAL COMMUNITY SKILLS TO AUTISTIC CHILDREN USING NONHANDICAPPED PEER TUTORS

In this study, two autistic children were paired with normal peers who, after pretraining sessions, taught community skills to the autistic children. Data were collected during three conditions: baseline, modeling, and peer tutoring. Results demonstrated that no identified skills were acquired during the baseline and modeling conditions. However, direct instruction of each child by a peer tutor resulted in the learning and maintenance of functional community skills.     

TRAINING APARTMENT UPKEEP SKILLS TO REHABILITATION CLIENTS: A COMPARISON OF TASK ANALYTIC STRATEGIES

The research was designed to validate procedures to teach apartment upkeep skills to severely handicapped clients with various categorical disabilities. Methodological features of this research included performance comparisons between general and specific task analyses, effect of an impasse correction baseline procedure, social validation of training goals, natural environment assessments and contingencies, as well as long-term follow-up. Subjects were taught to perform upkeep responses on their air conditioner-heating unit, electric range, refrigerator, and electrical appliances within the context of a multiple-probe across subjects experimental design. The results showed acquisition, long-term maintenance, and generalization of the upkeep skills to a nontraining apartment. General task analyses were recommended for assessment and specific task analyses for training. The impasse correction procedure generally did not produce acquisition.     

A PERSONALIZED SYSTEM OF INSTRUCTION FOR TEACHING CHECKING ACCOUNT SKILLS TO ADULTS WITH MILD DISABILITIES

This study evaluated the efficacy of a personalized system of instruction to teach checking account skills to persons with mild disabilities. Using a self-paced manual, 8 participants in two groups were taught to write checks, complete deposit slips, and reconcile monthly bank statements. Four participants were assessed for generalization from the classroom to community sites and demonstrated nearly perfect performance. A multiple probe design showed that acquisition occurred sequentially for each skill only after training using the self-paced manual. Follow-up sessions demonstrated that participants maintained the checking account skills. The results provide evidence of the effectiveness and adaptability of a personalized system of instruction for teaching complex monetary skills to persons with mild disabilities.     

AN ANALYSIS OF AND INTERVENTION IN THE SEXUAL TRANSMISSION OF DISEASE

Sexually transmitted diseases are a serious threat to the public health. Indeed, when an individual seeks medical treatment for a sexually transmitted disease, health authorities frequently attempt to identify, procure, and treat that individual's sexual contact(s). We conducted a comparative analysis of three alternative approaches to tracing the sexual partners of individuals diagnosed as having a sexually transmitted disease. The first approach involved counseling individuals (n = 27) infected with either gonorrhea or nongonococcal urethritis and exhorting them to procure their sexual partners for treatment. In addition to counseling, the second and third approaches involved distributing “occasion cards” for patients to use when informing sexual contacts of the need for treatment. Moreover, in the second approach, the counselor (a nurse or physician) informed infected patients (n = 19) that they and their partners could waive the $3 clinic fee contingent upon the partners seeking treatment within 1 week. In the third approach, the counselor asked infected persons (n = 19) to accept a follow-up telephone contact if their sexual partners failed to seek treatment within 1 week. The third approach was most effective. Ninety percent of the partners identified through this approach sought treatment, versus only about 60% of the partners in the other two conditions. The third approach was also the least expensive, costing about $2.95 to procure each partner for treatment.     

Training self-advocacy skills to adults with mild handicaps.

We developed and empirically evaluated an instructional program to teach self-advocacy skills to eight young adults with mild handicaps. Participants were taught to discriminate whether or not possible violations of legal rights occurred in socially validated scenarios and, if so, to role-play how to redress rights violations. Experimental control was demonstrated with a multiple probe design across four general legal rights categories for the discrimination component of training, and a multiple probe across groups of subjects for the redressing legal rights component of training. Participants'' behavior was probed in simulations and deceptions of legal rights violations in natural settings. There were marked increases in dependent measures after instruction. Difficulties in assessing generalization and maintenance of low-rate behaviors and suggestions for future research are presented.     

Theft reduction in a grocery store through product identification and graphing of losses for employees

Shoplifting and employee theft constitute a major problem for retailers. Previous research has described techniques for effectively reducing either type of theft but has not addressed the problem of thefts of unspecified origin. In a grocery store we evaluated the effect of identifying for employees frequently stolen products from three groups of items and graphing, twice weekly in the lunchroom, losses for the separate groups. After the products were identified and losses graphed, thefts from the three groups dropped from eight per day to two per day.