The Future of Psychology in Medicaid's Health Delivery System for People with Disabilities

State Medicaid programs are rapidly converting fee-for-service health delivery systems to managed care for people with disabilities. In theory, managed care models of health delivery will substantially improve the quality of care for people with disabilities, but in reality, few successful models exist. This period of transition holds both opportunities and challenges for psychologists in medical settings. Because Medicaid reforms for people with disabilities may herald similar reforms for both the public and the private sectors, psychology's response will determine its role in the future of health care delivery for this population. Changes in training and increased attention to outcomes research, innovations in practice, and advocacy will be the keys to success.     

A Comparison of Active Student Response and On-Task Instruction on the Acquisition and Maintenance of Health Facts by Fourth Grade Special Education Students

An alternating treatments design was used to compare the effects of active student response (ASR) and on-task (OT) instruction on the acquisition and maintenance of health facts during small-group lessons. Five students with learning difficulties (4 students identified as developmentally handicapped and 1 student identified as learning disabled) participated in daily instruction on weekly sets of 20 unknown health facts (10 facts assigned to the ASR condition and 10 to the OT condition). During ASR instruction, the teacher modeled the correct response to a health question that was presented visually on a health fact card, and the students immediately repeated the correct response in unison three times. During OT instruction, students attended visually to the health fact card as the teacher modeled the correct response. All 5 students made more correct responses on end-of-day tests on health facts taught with ASR instruction than they did on health facts taught with OT instruction. ASR instruction also produced consistently superior results on maintenance tests administered 2 weeks after instruction.     

8─11个月婴儿迂回行为发展特点与学习能力的研究

采用程序标准化的婴儿迂回行为测验,探讨了２４４名８－１１个月婴儿的迂回行为发展特点及学习能力。结果表明：（１）８－１１个月婴儿的迂回行为水平表现出随婴儿月龄的增长而提高的趋势。（２）８－１１个月的婴儿具有从反复尝试中学会迂回行为的可能性,其中９、１０个月的婴儿的学习可能性较大,而８个月婴儿的学习可能性较小。（３）８－１１个月婴儿的学习速度随月龄增大而提高。     

Internal Objects - A Theoretical Analysis of Jungian and Kleinian Models

In this paper I discuss the ways in which experimental and objective research from cognitive science and developmental psychology can help analysts evaluate the theoretical models of mental objects which we use; I indicate the ways in which such evidence tends to support models of internal objects as mental representations or developmental capacities rather than as wish-fulfilling expressions of instinctual drives. This land of empirical evidence is not just of academic interest but also has direct clinical relevance, particularly with borderline patients; such patients' sense of identity is totally dependent on the analyst's understanding of their internal world and for this to be misunderstood by the analyst can be catastrophic. An accurate theoretical model of mental objects can therefore help analysts to contain their patients more effectively.     

BEHAVIORAL CUSPS: A DEVELOPMENTAL AND PRAGMATIC CONCEPT FOR BEHAVIOR ANALYSIS

Most concepts of development explain certain behavior changes as products or markers of the invariable succession of emerging periods, stages, refinements, or achievements that define and order much of an individual's life. A different but comparable concept can be derived from the most basic mechanisms of behavior analysis, which are its environmental contingencies, and from its most basic strategy, which is to study behavior as its subject matter. From a behavior-analytic perspective, the most fundamental developmental questions are (a) whether these contingencies vary in any systematic way across the life span, and thus make behavior change in a correspondingly systematic way; and (b) whether some of these contingencies and their changes have more far-reaching consequences than others, in terms of the importance to the organism and others, of the behavior classes they change. Certain behavior changes open the door to especially broad or especially important further behavior change, leading to the concept of the behavioral cusp. A behavioral cusp, then, is any behavior change that brings the organism's behavior into contact with new contingencies that have even more far-reaching consequences. Of all the environmental contingencies that change or maintain behavior, those that accomplish cusps are developmental. Behavior change remains the fundamental phenomenon of development for a behavior-analytic view; a cusp is a special instance of behavior change, a change crucial to what can come next.     

DIRECT AND COLLATERAL EFFECTS OF RESTRAINTS AND RESTRAINT FADING

Mechanical restraints are commonly used to reduce the risks associated with severe self-injurious behavior (SIB), but may result in movement restriction and adverse side effects (e.g., bone demineralization). Restraint fading may provide a method for decreasing SIB while increasing movement and reducing these side effects. In the current investigation, rigid arm sleeves and restraint fading (gradually reducing the rigidity of the sleeves) were used with 3 clients who engaged in hand-to-head SIB. Restraints and fading reduced the hand-to-head SIB of all clients. However, for 1 client, the addition of a water mist procedure further reduced SIB to near-zero levels. For a 2nd client, another form of SIB developed that was not prevented by the rigid sleeves. For a 3rd client, a topography of SIB that was not physically prevented by the rigid sleeves was also reduced when restraints and fading were introduced.     

HYPOTHESIS-BASED INTERVENTIONS FOR TANTRUM BEHAVIORS OF PERSONS WITH DEVELOPMENTAL DISABILITIES IN SCHOOL SETTINGS

We conducted a functional assessment of problem behaviors of 2 students with developmental disabilities in their classroom environments. Results of the assessments showed that although there were more tantrums in demand than in no-demand conditions, the function of the behavior was to gain attention (positive reinforcement) rather than to avoid or escape demands (negative reinforcement); demand conditions apparently served a discriminative function for the availability of attention. Therefore, intervention was based on the positive reinforcement hypothesis, resulting in a substantial reduction of tantrums for both subjects.     

INCREASING REQUESTS BY ADULTS WITH DEVELOPMENTAL DISABILITIES USING INCIDENTAL TEACHING BY PEERS

A peer-delivered incidental-teaching procedure was used to instruct appropriate requesting in adults with moderate to severe mental retardation or autism. Three pairs of group-home residents participated in an incidental-teaching procedure to increase appropriate requesting, prompting, and responding of residents during lunch-preparation sessions. An increase in the number of incidental-teaching episodes during dinner was obtained, and remained high when lunch-making training sessions were withdrawn. In addition, during the incidental-teaching phase, an increase in appropriate requests and overall verbalizations occurred for the peer learners. Changes in appropriate requesting and overall verbalizations also remained higher than baseline when training was withdrawn.     

A PRELIMINARY PROCEDURE FOR PREDICTING THE POSITIVE AND NEGATIVE EFFECTS OF REINFORCEMENT-BASED PROCEDURES

In the current investigation, a modification was made to the preference assessment described by Pace, Ivancic, Edwards, Iwata, and Page (1985) to predict the effects of stimuli when used in a differential-reinforcement-of-other-behavior (DRO) schedule for 2 clients with severe self-injurious behavior (SIB) and profound mental retardation. Based on the results of the preference assessment, three types of stimuli were identified: (a) high-preference stimuli associated with high rates of SIB (HP/HS), (b) high-preference stimuli associated with relatively lower rates of SIB (HP/LS), and (c) low-preference stimuli associated with low rates of SIB (LP/LS). Consistent with the results of the preference assessment, the DRO schedule with HP/HS stimuli resulted in increased SIB, and the DRO schedule with LP/LS stimuli resulted in no changes in SIB. HP/LS stimuli were demonstrated reinforcers but did not result in a change in SIB when used in a DRO schedule. Thus, the stimulus preference assessment may be useful clinically in some situations for predicting both the beneficial and the negative side effects of stimuli in DRO procedures.     

Predictors of Developmental Task Attainment for Young Adults from Divorced Families

To determine which variables impact developmental task attainment for young adults from divorced families, respondents completed demographic questions, the young adult version of the Personal Authority in the Family System Questionnaire, and the three family relationship subscales of the Family Environment Scale. Of the factors assessed, results suggest that the quality of post-divorce family functioning is the most salient predictor of development for young adults from divorced families. Additionally, although conflict and cohesion have unique effects on task attainment for young adults, expressiveness appears to be the dimension of post divorce family functioning most related to young adult development.