A theology of pastoral multiplicity

The contemporary moment is characterized by liquidity and difference. “Liquidity” means rapidly changing social structures, accelerations in consumption, and constantly changing personal and group identities. In this increasingly diverse context, encounters with difference are not only inevitable, they are essential—and can be transformative for our understandings of our multiple selves, for our pastoral encounters with others, and for our theological imagination, as well. Viewing the self, especially the pastor's self, as a collection of multiple selves, identities, and performances illumines pastoral leadership; pastors who claim their multiplicity more wholly meet “others” when encountering difference. The triune God reveals divine multiplicity, so pastors who claim their multiplicity as their identity thereby make a theological claim.     

Confirmatory Factor Analysis of the School Refusal Assessment Scale-Revised: Child and Parent Versions

The School Refusal Assessment Scale-Revised (SRAS-R) is an instrument designed to evaluate the relative strength of four functional conditions of school refusal behavior in youth. Although previous work has shown the scale's child and parent versions to show good reliability, verification of the SRAS-R factor structure remains necessary. The present study investigated administrations of the child and parent versions of the SRAS-R (SRAS-R-C and SRAS-R-P) using confirmatory factor analysis. For both measures, four-factor models were supported following the removal of two SRAS-R-C and three SRAS-R-P items. Three-factor and two-factor models for each SRAS-R version were not supported. Ramifications of these results for use of the SRAS-R are discussed.     

紧急救治规则研究

现行法律规定之下的紧急救治规则缺失调和患者生命权、健康权与知情同意权冲突的机制,对紧急情况的判定标准也不一,“不能取得患者近亲属意见”的解释依旧不明。此外,也没有相应机制保障紧急救治情形下的医疗欠费问题。为了完善紧急救治规则,有必要建立事先医疗指令制度,并以“不利因素比较说”为标准判定紧急情况,进一步再明确“不能取得患者近亲属意见”的具体内容。再者,为了有效解决紧急救治情形下的医疗欠费问题,提高医务人员因承担患者所欠医疗费用而降低的救治积极性,有必要建立征信机制和保险机制。     

THE COSTS OF EATING: A BEHAVIORAL ECONOMIC ANALYSIS OF FOOD REFUSAL

Behavioral economic concepts were applied to the analysis and treatment of pediatric feeding disorders in a clinical setting. In Experiment 1, children who chronically refused food were presented with varying amounts of food on a spoon (empty, dipped, quarter, half, and level). Each child exhibited a different but orderly demand function of response (acceptance, expulsion, and mouth clean) by cost (increasing spoon volume) for a constant pay-off of toys and social interaction. In Experiment 2, physical guidance or nonremoval of the spoon for food refusal was initiated at the smallest spoon volume with low levels of acceptance, and was subsequently introduced at the largest spoon volume with moderate levels of acceptance. Treatment was effective in increasing acceptance, and these effects generalized hierarchically across untargeted spoon volumes. The results of both studies provide preliminary support that increasing spoon volume can be equated conceptually with increasing response effort, and that the change from differential reinforcement to physical guidance or nonremoval of the spoon appears to have altered the elasticity of each child's demand function.     

USE OF TEXTURE FADING IN THE TREATMENT OF FOOD SELECTIVITY

Children with feeding disorders often display severe food selectivity. For many of these children, consuming highly textured foods may be aversive or potentially dangerous because of frequent gagging. The purpose of this study was to demonstrate the efficacy of texture fading in the treatment of food selectivity displayed by 4 children. Treatment involved the gradual addition of higher textures based on the results of periodic probes. In addition, food acceptance and swallowing were reinforced, while food refusal and food expulsion were placed on extinction. Results showed that all participants successfully advanced to consumption of age-appropriate texture and volume. The results suggest that texture fading with intermittent probes at higher textures may be an effective method for the treatment of food selectivity by texture.     

饮酒期望、饮酒拒绝自我效能与青少年的饮酒行为:有中介的调节效应分析

以544名初一、初二、高一和高二的学生为研究对象,考察在控制了相关人口学变量后,消极饮酒期望对积极饮酒期望与青少年饮酒行为关系的调节作用,以及饮酒拒绝自我效能对消极、积极饮酒期望及两者交互作用与饮酒行为关系的中介作用。结果发现:(1)28.31%的中学生在过去一个月中曾饮酒,其中13.60%在过去一个月中曾大量饮酒,8.27%曾醉酒;(2)积极饮酒期望能正向预测青少年的饮酒行为,消极饮酒期望在积极饮酒期望与青少年饮酒行为关系中发挥调节作用;(3)饮酒拒绝自我效能在消极饮酒期望与饮酒行为关系中起部分中介作用,在积极饮酒期望与饮酒行为的关系以及消极饮酒期望的调节作用中发挥了完全中介作用;(4)调节效应的中介机制表明,低消极期望组中,随着积极期望的提高,饮酒拒绝自我效能呈直线下降的趋势;而在高消极期望组中,无论积极期望高或者低,饮酒拒绝自我效能均较高。研究结果对青少年饮酒行为的干预有重要的指导意义。     

INDUCTION AND MAINTENANCE OF SWALLOWING RESPONSES IN INFANTS WITH DYSPHAGIA

A treatment package was used to induce and maintain swallowing with three infants who did not swallow food or liquid. Prior to treatment, they received all nutrition and hydration via gastrostomy tube feedings. The treatment package consisted of least-to-most intrusive physical prompts, an eliciting stimulus, contingent social reinforcement, and repeated trials to induce and maintain swallowing. The design combined elements of reversal and changing criterion designs for all three infants. The package was applied across feeding devices (nipple, cup, spoon), situations (liquid, pureed foods), and persons (trainer, primary nurses, mothers). The number of swallows or ounces per feeding (from 0 to 8 ounces) and the number of feeding sessions per day (from one to five) were progressively increased. In each case, the infant received baseline conditions alternated with the treatment package. Follow-up probes were done at 15 months, 21 months, or 24 months, respectively, after the last phase for the three patients. The package was successful in that the gastrostomy tube was no longer needed for Patients 1 and 3. Patient 2 maintained functional swallowing responses but received supplemental gastrostomy feedings because of unrelated medical problems. Results are discussed in terms of the need to isolate components of the package. The package can be used in cases in which the preexisting treatments (reinforcement with preferred foods, force-feeding) are not feasible because of age, physical fragility, or the lack of a swallowing response following the presentation of food.     

TREATING TOTAL LIQUID REFUSAL WITH BACKWARD CHAINING AND FADING

In this study, we report on a 12-year-old boy with autism, mental retardation, and a history of severe gastrointestinal problems who presented with total liquid and food refusal. Backward chaining was used to shape drinking from a cup, and a fading procedure was used to increase the quantity of water he was required to drink.     

FUNCTIONAL ANALYSIS AND TREATMENT OF MULTIPLY CONTROLLED INAPPROPRIATE MEALTIME BEHAVIOR

Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function‐based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast, escape extinction alone resulted in a decrease in inappropriate mealtime behavior and an increase in acceptance. However, inappropriate mealtime behavior did not decrease to clinically acceptable levels. A combined extinction technique (i.e., escape and attention extinction) resulted in a decrease in inappropriate mealtime behavior to clinically acceptable levels and high and stable acceptance.     

Identifying the Function of School Refusal Behavior: A Revision of the School Refusal Assessment Scale

A revision of the School Refusal Assessment Scale (SRAS-R), a measure designed to help clinicians identify the primary function of a child's school refusal behavior, was examined. Changes in the original version of the scale were made to improve psychometric quality and align the measure in accordance with evolutions in the functional model. Two samples of youth with school refusal behavior, in addition to parents and teachers, were evaluated to determine the test-retest and interrater reliability and construct and concurrent validity of the SRAS-R. The scale was found to have good psychometric strength. Implications of these findings for clinicians who address this population are discussed.