New assessment systems for residential treatment,management, research,and evaluation: A symposium

An introduction and overview are presented to new observational assessment systems for ongoing assessment and monitoring of both staff and resident (client or patient) functioning in residential treatment programs for emotionally disturbed and mentally retarded adults.Preparation of articles and the research and development on which the articles are based was supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health, and by grants from the Joyce Foundation and the Illinois Department of Mental Health and Developmental Disabilities.A symposium presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979.     

Systems use to objectify program evaluation,clinical, and management decisions

The utility of the observational assessment systems at different levels — from local clinical to systemwide management — is outlined. An overview is provided of TSBC information applied to individualized problem identification and programming/monitoring, discharge and competency determinations, and both absolute and comparative program evaluation. The utility of SRIC information for prgoramming/monitoring and for staff training and evaluation is outlined in addition to the applied uses of the information of the assessment systems in combination. Once implemented, the continuous data from the systems allow for empirically based self-corrective improvements in the quality of mental health services while automatically providing a basis for legal documentation and accurate cost/effectiveness comparisons of mental health programs.Preparation of this article and the research and development on which the article is based were supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health, and by grants from The Joyce Foundation and the Illinois Department of Mental Health and Developmental Disabilities.Presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979, as part of a symposium on New assessment systems for residential treatment, management, research, and evaluation.     

SOCIAL-SKILLS TRAINING FOR UNASSERTIVE CHILDREN: A MULTIPLE-BASELINE ANALYSIS1

The effects of social-skills training consisting of instructions, feedback, behavior rehearsal, and modelling were examined in a multiple-baseline analysis in four unassertive children. The treatment was effective in that the behaviors selected for modification changed markedly. The effects of treatment generalized from trained to untrained items (interpersonal situations requiring assertive responding) and gains were maintained at the two- and four-week followup probe sessions. In addition, overall assertiveness in all subjects increased from baseline assessment to the conclusion of treatment and into followup.     

TEACHING COIN EQUIVALENCE TO THE MENTALLY RETARDED1

A program was designed to teach coin equivalence to mentally retarded adolescents. Coin equivalence was defined as choosing several different combinations of coins to equal specified target values. A pretest-posttest matched-groups design was employed with an experimental group receiving the monetary training, and a no-training control group. A multiple baseline across coin-counting responses was also incorporated in the experimental group. Training was divided into six stages, each teaching one specific method of combining coins to equal 10 target values from 5¢ through 50¢. A three-component response chain was used, requiring (a) naming, (b) selecting and counting, and (c) depositing target monetary values into a coin machine. Experimental subjects improved significantly in coin equivalence performance and maintained their skill on follow up tests; control subjects did not.     

TEACHING CONVERSATION-RELATED SKILLS TO PREDELINQUENT GIRLS1

The use of conversation-related skills by youthful offenders can influence social interactions with adults. These behaviors are also likely to be useful to adolescents after their release from a treatment program (Journal of Applied Behavior Analysis, 1972, 5 , 343–372). Four girls, aged 13 to 15 yr, residing at Achievement Place for Girls in Lawrence, Kansas, received training on conversation-related behaviors. A multiple-baseline design across youths and across behaviors was used. Youth answer-volunteering in response to questions and three youth nonverbal components (“hand on face”, “hand at rest”, and “facial orientation”) were measured during daily 10-min sessions with a simulated guest in the group home's living room. Answer-volunteering was scored each session as the per cent of 13 “secondary” questions that the simulated guest did not have to ask following 10 “primary” questions. The three nonverbal components were scored according to their occurrence during 10-sec intervals and the resultant scores were averaged per session for an overall appropriate nonverbal score. The girls individually earned points within the home's token economy for participating in each session and additional points were awarded after training if preselected behavioral criteria were achieved for each of the two behavior categories per girl. Some of the training sessions were led by a “teaching-parent” (specially trained houseparent) while others were led by individual girls. Point consequences were administered by both the teaching-parent and by the “peer-trainers”. The average observed rate of answer-volunteering by the girls during pretraining sessions was 30% for S₁, 30% for S₂, 23% for S₃, and 68% for S₄. The average rate of answer-volunteering during posttraining sessions was: S₁ = 92%, S₂ = 89%, S₃ = 90%, and S₄ = 98%. The average nonverbal score during pretraining sessions was 82% for S₁, 53% for S₂, 60% for S₃, and 82% for S₄. The average nonverbal score during posttraining sessions was: S₁ = 98%, S₂ = 98%, S₃ = 98%, and S₄ = 100%. Videotapes of the sessions were shown in a random sequence to four adults (probation officer, social worker, etc who represented “significant others” for the youths' future success in the community. The adults judged posttraining tapes on the average as more appropriate 100% of the time for S₁, 100% of the time for S₂, 90% of the time for S₃, and 70% of the time for S₄. The study demonstrated that training of conversation-related skills is feasible with predelinquent girls, that the girls can help train each other, and that social validation of the training results is possible.     

TEACHING PEDESTRIAN SKILLS TO RETARDED PERSONS: GENERALIZATION FROM THE CLASSROOM TO THE NATURAL ENVIRONMENT1

Little attention has been given to teaching adaptive community skills to retarded persons. In this study, five retarded male students were taught basic pedestrian skills in a classroom. Training was conducted on a model built to simulate city traffic conditions. Each subject was taught five specific skills involved in street crossing in sequence, viz. intersection recognition, pedestrian-light skills, traffic-light skills, and skills for two different stop-sign conditions. Before, during, and after training, subjects were tested on generalization probes on the model and under actual city traffic conditions. Results of a multiple-baseline design across both subjects and behaviors indicated that after receiving classroom training on the skills, each subject exhibited appropriate pedestrian skills under city traffic conditions. In addition, training in some skills appeared to facilitate performance in skills not yet trained.     

Excessive Object Attachment in Hoarding Disorder: Examining the Role of Interpersonal Functioning

Excessive attachment towards possessions can be maladaptive because it can lead individuals to excessively acquire and save objects. Little is known about how attachment to objects develops and changes over time; however, interpersonal factors have been theorized to play a role. The current study examined whether interpersonal factors, specifically interpersonal attachment style and empathy, moderate changes in object attachment over time. A total of 145 participants with excessive acquiring and discarding difficulties rated their level of attachment to a novel object just after receiving it, and 1 week later. Participants also completed measures of interpersonal anxious attachment and interpersonal functioning. We found that changes in object attachment over time were moderated by interpersonal anxious attachment. Also, our findings suggested that individuals with hoarding problems are likely not impaired in their ability to empathize with others, but rather have difficulty displaying empathy in tense social situations and also have more empathy for fictional characters. Further, greater discomfort in tense social situations and greater empathy for fictional characters interacted to predict greater object attachment. Taken together, these findings indicate that individuals with an interpersonal anxious attachment style may be those at risk of forming greater attachments to objects over time. A learning history that includes inconsistent support from caregivers may result in individuals experiencing more empathy for fictional characters and discomfort in tense social situations, which may produce a vulnerability for becoming excessively attached to objects. Our results are in line with theories of hoarding which propose that individuals use objects to compensate for unmet interpersonal needs and suggest that treatment may need to target interpersonal functioning to reduce hoarding symptoms.     

Prospective and Concurrent Affective Dynamics in Self-Injurious Thoughts and Behaviors: An Examination in Young Adult Women

Affective dynamics, assessed using ecological momentary assessment (EMA), provide a nuanced understanding of within-person fluctuations of negative affect (NA) and positive affect (PA) in daily life. NA and PA dynamics have been associated with psychopathology and response to psychological treatments. NA and PA dynamics have been rarely studied concurrently in association with self-injurious thoughts and behaviors (SITB), transdiagnostic difficulties encountered regularly in clinical and community settings. Here we present EMA data from a large, diverse sample of young adult women with high rates of SITB to examine NA and PA dynamics (mean intensity, variability, and inertia). Specifically, we considered the prospective associations between past-year suicidal thoughts and past-year nonsuicidal self-injury and affective dynamics, as well as the concurrent associations between affective dynamics, EMA-reported suicidal thoughts, and EMA-reported urges for nonsuicidal self-injury. Results demonstrate that elevated mean NA and NA variability are robustly associated with all types of SITB assessed prospectively or concurrently. Interestingly, these associations were weakest for past-year nonsuicidal self-injurious behaviors, relative to past-year and concurrent suicidal or nonsuicidal self-injurious thoughts. Past-year suicidal thoughts further predicted increased NA inertia. Decreased PA inertia was associated with past-year nonsuicidal self-injury behavior, as well as concurrent EMA suicidal thoughts. We found no associations (prospective or concurrent) between SITB and mean PA intensity or PA variability. These results highlight the importance of understanding affective processes to develop real-world interventions to prevent nonsuicidal self-injury and suicidal behavior in daily life.     

Skill Acquisition During Transdiagnostic Treatment With the Unified Protocol

The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is an emotion-focused, cognitive-behavioral intervention developed to address the full range of anxiety, depressive, and related disorders. The UP consists of core therapeutic skills that, though unique in focus, are each designed to promote an approach-oriented stance toward emotional experiences. The goal of the present investigation was to characterize changes in these skills for patients that received a course of treatment with the UP, as well as to examine associations between skills and symptoms changes. Patients with principal anxiety disorders, assigned to receive treatment with the UP (N = 88) as part of a randomized controlled trial, were included in this study. They completed validated self-report measures of UP skills (Understanding Emotions, Mindful Emotion Awareness, Cognitive Flexibility, Countering Emotional Behaviors, and Interoceptive Awareness and Tolerance), as well as clinician-rated measures of psychological symptoms. Skill measures improved significantly over the course of 12 to 16 UP treatment sessions and changes in these skills measures were associated with improvements in anxiety symptoms. Determining whether improvement on all the skills learned during a course of treatment with UP is associated with symptom remission is critical to establishing the most streamlined and efficient interventions that may ultimately be best suited to widespread dissemination.     

青少年早期抑郁和自伤的联合发展轨迹：人际因素的作用

通过对859名初中生历时3年的3次追踪测量, 考察了抑郁和自伤的独立与联合发展轨迹, 并对3种重要人际关系(亲子关系、同伴关系、师生关系)在二者联合发展中的作用进行检验。结果发现, 青少年早期抑郁和自伤分别呈现4条和3条异质性发展轨迹; 二者的联合发展轨迹包含“低抑郁-低自伤-稳定”、“低抑郁-低自伤-增长”、“中抑郁-中自伤-降低”三类; 父母心理控制和同伴接纳分别为青少年早期抑郁和自伤的风险与保护性因素。