BEHAVIORAL ASSESSMENT FOR PEDIATRIC INTENSIVE CARE UNITS1

Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.     

THE FUNCTIONS OF ASSESSMENT: IMPLICATIONS FOR SELECTION AND DEVELOPMENT OF DEVICES FOR ASSESSING REPERTOIRES IN CLINICAL,EDUCATIONAL, AND OTHER SETTINGS

An attempt is made to identify the many different functions that assessment of an individual's repertoire can serve. Implications of these functions for the character of and evidence about assessment devices are suggested. The functions fall into two general groups, those which influence decisions regarding an individual learner, and those which influence policy, program development, and scientific knowledge. The first group of functions is presented in a rough chronological sequence such that they form a “behavioral assessment funnel,” beginning with functions involving broad-band assessment to identify likely persons and skill areas, and narrowing to the precise pinpointing, monitoring, and follow-up functions. The contribution of behavior analysis and behavior therapy to assessment methodology in this sequence is identified as well as the areas where more traditionally conceived methods are still useful. The second group of functions and behavioral contributions to it are then discussed.     

Effects of self-monitoring and feedback on residential electricity consumption

Prior research has indicated that frequent feedback could reduce residential electricity consumption by 10% to 15%. However, because feedback was primarily given in written form, this procedure might not be practical. The present study evaluated a potentially more practical feedback procedure during peak-use periods with high electricity consuming households. The study was conducted during the winter in an upper-middle class neighborhood of almost identical, all-electric townhouses (N = 71) that averaged about 170 KWH per day per household for a monthly bill of over $200. Twelve households received daily written feedback. Sixteen households (self-monitoring) were taught to read their outdoor electricity meter and to record KWH used every day. A comparison group was composed of 14 households that had volunteered to participate and 29 others that had only given permission to have their meters read. During a 1-month period that the procedures were in effect, the feedback group reduced consumption by 13% and the self-monitoring group by about 7%. These reductions, relative to the comparison group, were maintained during an early spring 1-month follow-up period and, to a lesser extent, during a 6-week warm spring period. Self-monitoring participants were highly reliable and persistent meter readers. Reductions in electricity use were reported by households to be largely attributable to lowering of the heat thermostat, and large monetary and KWH savings were found. Techniques to make self-monitoring cost-effective important components of the self-monitoring procedure, methods to apply self-monitoring more broadly, and plans to combine behavioral procedures with physical technology are discussed.     

Reducing residential electrical energy use: payments, information, and feedback

Monetary payments, energy information, and daily feedback on consumption were employed to reduce electricity use in four units of a university student housing complex. A combined multiple-baseline and withdrawal design permitted both within- and between-unit comparisons. Payments produced immediate and substantial reductions in consumption in all units, even when the magnitude of the payments was reduced considerably. Feedback also produced reductions, but information about ways to conserve and about the cost of using various appliances did not. It was also found that, in general, payments combined with either information or feedback produced no greater effect than payments alone.     

Community applications of instructional technology: teaching writers of instructional packages

A community education program, to develop a variety of performance competencies in large numbers of neighborhood residents, requires a technology for preparing learning units administerable by community members themselves. The effects of a writing manual, designed to teach nonprofessionals to prepare such instructional packages, were analyzed in two experiments. Experiment I employed a multiple-baseline design across three university student trainees. The results showed that appropriate program writing increased by 75% after completion of the manual. The results of Experiment II, with two low-income neighborhood residents serving as trainees, showed that packages produced by trained writers resulted in a greater increase in skill activities than sets of training stimuli produced by untrained writers.     

ISSUES AND IMPLICATIONS OF ESTABLISHING GUIDELINES FOR THE USE OF BEHAVIORAL TECHNIQUES

Several guidelines surrounding the use of behavioral procedures have recently appeared, the best of which is that of the National Association of Retarded Citizens (NARC). Some issues and implications of the establishment of guidelines are briefly reviewed in the context of the NARC guidelines. Issues include the factual versus opinion bases for guidelines and the need to continue the development of explicit behavioral criteria for assessing staff competence. Implications for programs include the impact of guidelines on professional boundaries, administrative decision-making, and budgeting, together with the dangers of expanding the regulatory bureaucracy. Several miscellaneous impacts are noted, including a potential for curbing innovative behavioral technology.     

THE ROLE OF FEEDBACK IN VOLUNTARY CONTROL OF BLOOD PRESSURE IN INSTRUCTED SUBJECTS1

Forty normal male volunteers were randomly assigned to one of four experimental conditions and instructed to raise and lower their systolic blood pressure. Subjects received either beat-to-beat feedback contingent on pressure changes, noncontingent beat-to-beat feedback, noncontingent feedback presented randomly with respect to the occurrence of each heart beat, or instructions alone. The order of increase and decrease trial blocks was counterbalanced across groups. Subjects receiving contingent feedback were monetarily rewarded for appropriate pressure changes. Subjects receiving noncontingent feedback received rewards and feedback equal to the mean received by the contingent group. Subjects in the instructions-only condition were also paid this bonus but were informed of their earnings only at the conclusion of the experiment. Results indicated that in the presence of instructions, feedback, whether contingent or noncontingent, added little to subjects' ability to control pressure during a single session. Theoretical and clinical implications are discussed.     

Demand for food on fixed-ratio schedules as a function of the quality of concurrently available reinforcement

Six rats lever pressed for food on concurrent fixed-ratio schedules, in a two-compartment chamber. In one compartment, mixed diet pellets were delivered on fixed-ratio schedules of 1, 6, 11, and 16; in the other, either no food was delivered, or sucrose or mixed diet pellets were delivered on fixed-ratio 8. The number of pellets obtained in the first compartment declined as a function of fixed-ratio size in that compartment in all three conditions, but the decline was greatest overall with mixed diet pellets concurrently available in the other compartment, and least with no food concurrently available. The result is discussed in terms of economic demand theory, and is consistent with the prediction that elasticity of demand for a commodity (defined in operant terms as the ratio of the proportionate change in number of reinforcements per session to the proportionate change in fixed-ratio size) is greater the more substitutable for that commodity are any concurrently available commodities.     

A comparison of frequency, interval, and time-sampling methods of data collection

Data representing high, medium, and low response rates in constant and nonconstant patterns were generated by electromechanical equipment to determine whether the same data collected by time-sampling, interval recording, and frequency recording would be represented similarly by each method. Results indicated: (1) that time-sampling provided an extremely inaccurate estimate of responding, and (2) that interval recording accurately represented responding of low and medium rates, but grossly underestimated high-rate responding.     

The design and evaluation of a worksharing system for experimental group living

Failure to share household chores equitably may be a major cause of the high failure rate of experimental group-living arrangements. A behavioral approach to worksharing based on a point system was implemented in one experimental group and its most important components experimentally evaluated. Experiment I showed that awarding credits produced more work than not awarding credits. Experiment II showed that making credits contingent on the outcome of a detailed inspection produced more work than awarding credits noncontingently. Experiment III demonstrated that awarding rent reductions contingent on credit earnings produced more work than awarding rent reductions noncontingently. Other evaluative data suggest that the resulting living arrangement is cheaper, more effective, and more satisfactory to the residents when compared to the most popular alternative living arrangements.