Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.     

医学伦理学概念之探究

医学伦理学的概念看起来很简单,一般情况下人们便习以为常地接受了作为应用规范伦理学的一个分支的科学地位,而忽视了医学对医学伦理学所起的作用。本文认为：医学伦理学的具体内容是医学科技与伦理道德两因素相互作用的产物,对其相互作用的形式和产物的具体分析和总结便可构成这门学科的理论体系。     

Epistemic Normativity, Argumentation, and Fallacies

In Biro and Siegel (1992) we argued that a theory of argumentation mustfully engage the normativity of judgments about arguments, and we developedsuch a theory. In this paper we further develop and defend our theory.     

THE TREATMENT OF COVERT SELF-INJURY THROUGH CONTINGENCIES ON RESPONSE PRODUCTS

Assessment and treatment of covert self-injurious behavior are complicated because it is difficult to quantify and apply differential consequences to covert responses. In this study, both tangible and social reinforcers were identified using reinforcer assessment methods. These reinforcers were then provided contingent upon the absence of tissue damage identified during physical examinations, resulting in near 100% success in physical assessment checks that was maintained over 10 months.     

Sensitizing Medical Residents to Fantasies and Alignments in the Family: Mastering Psychosocial Skills in the Medical Encounter

In this paper, it is proposed that a) psychosocial medicine is best taught in a setting that provides technical and emotional support, while seizing for teaching only those moments when the learner is most receptive; and b) that the setting should avoid the development of a separate psychosocial skills curriculum, but should take the student where he or she is and integrate the psychosocial skills into his or her everyday biomedical practice. The paper gives specific case examples in which family based psychosocial issues were preeminent in the clinical problem-solving medical residents faced.     

THE BEHAVIOR OBSERVATION INSTRUMENT: A METHOD OF DIRECT OBSERVATION FOR PROGRAM EVALUATION1

The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.     

Some values guiding community research and action

The dual purposes of applied research-contributing to understanding and improvement-are only partially served by method systems that encourage studying (with increasing precision) a narrow range of questions of modest societal importance. To optimize contributions to challenging societal problems, a field's cherished standards should be adapted to support more adventuresome forms of community research and action. This paper outlines 10 values for community research and action, based on insights from the fields of behavioral and community psychology. These values-reflect the goals and challenges of establishing collaborative relationships with research participants, determining research goals and methods, designing and disseminating interventions, communicating research findings, and advocating for community change. Critical challenges are outlined, and implications for the field and its clients are discussed.     

MULTIVARIATE ASSESSMENT OF CONFLICT IN DISTRESSED AND NONDISTRESSED MOTHER-ADOLESCENT DYADS

A battery of measures was used to assess conflict between mothers and young adolescents (females and males, 11 to 15 years of age). Two groups of families, one composed of a distressed clinical sample (N = 38), the other a nondistressed normative sample (N = 40), participated. The assessment battery included retrospective judgments, frequency estimates, self-monitored home recording, and tape-recorded discussion of a home problem. Content of assessment measures tapped aspects of parental control, decisionmaking, self-reported interaction behavior, arguments, interaction behavior rated by independent “blind” observers, frequency and anger-intensity of specific problematic issues, and perceptions of positive and negative behaviors of the other family member. Based on univariate analyses, 21 of the 26 defined variables discriminated significantly in the predicted direction. Maternal and adolescent reports of behavior and independent ratings of tape-recorded interaction emerged as strong and consistent discriminators. Stepwise multivariate discriminant analysis provided successful classification of 100% of the families based on the inclusion of nine variables. In a cross-validation sample, 84% of the families were correctly classified. Implications for systematic outcome research as well as clinical application are discussed.