THE GOOD TOOTHBRUSHING GAME: A SCHOOL-BASED DENTAL HYGIENE PROGRAM FOR INCREASING THE TOOTHBRUSHING EFFECTIVENESS OF CHILDREN

There has been a serious lack of experimentally verified, effective dental hygiene programs in the schools. In and of themselves, the instruction-alone programs which comprise children's dental education do not produce proper toothbrushing skills. In the present study, a school-based contingency dental hygiene program designed to increase the effectiveness of children's toothbrushing skills at home was implemented with grade one and two classes. Each class was divided into teams and participated in the “Good Toothbrushing Game.” Each day four children from each team had the cleanliness of their teeth assessed according to the Simplified Oral Hygiene Index (Greene & Vermillion, 1964). The team with the lowest mean oral hygiene score was declared the daily winner. Winning teams received stickers and had their names posted. A multiple baseline across classrooms single-subject group design (Hersen & Barlow, 1976, pp. 228–229) established that the good toothbrushing game greatly increased the effectiveness of children's oral hygiene skills. The treatment terminal level for the grade one scores was 2.0 as compared to a baseline terminal level of 5.0, and for the grade two's was 2.3 compared to 5.7 at the end of baseline. A 9-mo follow-up indicated that these results were maintained. The data strongly suggest that proper implementation of behavioral principles is essential to the success of oral hygiene programs.     

EVALUATING STRATEGIES TO IMPROVE CAREPROVIDER PERFORMANCE ON HEALTH AND DEVELOPMENTAL TASKS IN AN INFANT CARE FACILITY

Responding to administrative staff and parental concerns, using modified reversal and withdrawal designs, two experiments evaluated a staff-managed feedback system to improve the hygiene and developmental skills of children in an infant/toddler center. Experiment 1 examined feedback designed to increase staff performance in checking and changing diapers, and recording those changes. A chart plus supervisory feedback produced increases in and maintenance of staff performance. Experiment 2 compared an existing staff management system with a “playchart” plus feedback in increasing careprovider-infant stimulation. The data (with follow-up on a new staff) supported the use of the new feedback system. Questionnaire data further supported the utility of the playchart system.     

MANAGEMENT OF GERIATRIC INCONTINENCE IN NURSING HOMES

A behavioral management system designed to reduce urinary incontinence was evaluated in two nursing homes with a pretest-posttest control group design with repeated measures. The primary components of the system were prompting and contingent social approval/disapproval which required approximately 2.5 minutes per patient per hour to administer. The frequency of correct toileting for experimental subjects increased by approximately 45%. The experimental groups were significantly different from the control groups on both incontinence and correct toileting measures. The results are discussed in view of the management issues inherent in nursing home settings.     

Emerging quality improvement measures in genetic counseling

The need to establish guidelines for total quality management in genetic counseling is now recognized as new genetic technologies are being introduced into genetics services and primary care. Genetic counselors have an important role in developing methods for assuring quality in the genetic counseling process. Emerging quality improvement measures as well as selected examples from the Quality Assurance Program in the Genetics Services Division at the Foundation for Blood Research are presented as examples of direct genetic counselor involvement. Suggestions for future directions of quality improvement activities for genetic counselors are discussed.     

Managing occupational stress: A national and international perspective

Theoretical models of occupational stress are important because they suggest a focus for intervention, and inform practice. The gap between research and practice was exposed most recently by Burke (1993) claiming little awareness of research findings by practitioners (managers, consultants, clinicians), little intervention activity being undertaken at the organizational level, little research being undertaken to determine the effectiveness of individual level interventions, and only modest use of work research findings for intervention and policy development (p. 85). This paper discusses the issue of intervention, and examines values, assumptions and the politics of applied research. A critical review of the evaluation studies of individual vs. organizational level interventions is undertaken and finally the problem of occupational stress as a national and international issue is considered.     

The technical and democratic approaches to risk situations: Their appeal,limitations, and rhetorical alternative

Because of the increasing number of man-made hazards in contemporary life, as well as the growing number of disastrous industrial accidents, interest in risk communication has burgeoned. Consequently, scholars and practitioners need to understand two of the more common responses to risk situations, the technical and democratic. This paper describes these two responses, identifies types of individuals likely to prefer each, and explains why, historically and sociologically, they are so intuitively compelling for many people. Arguing that both responses to risk situations are ultimately unconducive to rational discourse, the paper identifies problematic assumptions about communication that underlie both. The paper then sketches an alternative model of risk communication that recognizes the distinct features of communication in risk-ridden situations, describes ways in which communicators can identify characteristic tensions and goals in these situations, and specifies how to use research-supported heuristics for diagnosing the principal obstacles to their communicative goals and selecting the best strategies to address these obstacles.     

TRAINING RESIDENTIAL SUPERVISORS TO PROVIDE FEEDBACK FOR MAINTAINING STAFF TEACHING SKILLS WITH PEOPLE WHO HAVE SEVERE DISABILITIES

We evaluated procedures for training supervisors in a residential setting to provide feedback for maintaining direct-service staff members' teaching skills with people who have severe disabilities. Using classroom-based instruction and on-the-job observation and feedback, 10 supervisors were initially trained to implement teaching programs themselves. The training improved supervisors' teaching skills but was insufficient to improve the quality of feedback they provided to direct-service staff regarding the staff members' teaching skills. Subsequently, classroom-based instruction and on-the-job observation and feedback that targeted supervisors' feedback skills were provided. Following training in provision of feedback, all supervisors met criterion for providing feedback to their staff. Results also indicated that maintenance of teaching skills was greater for direct-service staff whose supervisors had received training in providing feedback relative to staff whose supervisors had not received such training. The need for analysis of other variables that affect maintenance of staff performance, as well as variables that affect other important areas of supervisor performance, is discussed.     

Validity and Application of Computer-simulated Scenarios in Personnel Assessment

In Germany computer-simulated scenarios have been applied in personnel management for several years. Their goals are either to assess how potential managers cope with complex and connected problem states (job aptitude testing aspect) or to provide feedback on manager strengths and weaknesses in dealing with complexity, and how to modify these when necessary (training aspect). This paper presents and evaluates those scenarios that have been subjected to validity studies.     

Characteristics of seriously emotionally disturbed youth with and without substance abuse in intensive case management

Youth with emotional disturbance who have substance abuse problems are of particular concern to child-serving agencies. Approximately 22% of the youth served in New York State's Intensive Case Management Program for Children and Youth (CYICM) have identified substance abuse problems. We compared youths enrolled in CYICM who abuse substances with those who do not abuse substances. Adolescents with substance abuse problems differed from non-abusing adolescents. The abusing cohort was most likely to be emancipated minors, not enrolled in school, less likely to be members of a minority group, and more likely to have private health care coverage. They also evidenced a different constellation of symptoms than the non-abusing cohort, with abusers tending to display suicidal symptoms and behaviors and sexual acting out. Abusers were also more likely to have been admitted to private psychiatric hospitals and to have had crisis contacts in emergency rooms. Similar to non-abusers, however, abusers spent significantly fewer days as inpatients in state hospitals, and had fewer admissions to these hospitals following their enrollment in CYICM.