Wraparound care in vermont: Program development,implementation, and evaluation of a statewide system of individualized services

Over the past decade, there has been a dramatic shift in the provision of mental health services to children, adolescents, and their families. This shift has been marked by a movement away from restrictive treatment options toward the development of comprehensive community-based systems of care designed to keep the most challenging children in their homes, schools, and communities. Based on a model of intensive case management referred to as Wraparound Care, Vermont's statewide approach emphasizes aggressive outreach, use of the least restrictive treatment options, and care that is flexible, unconditional, and child- and family-centered. We chart the development of Vermont's Wraparound Care Initiative and present residential, educational, and behavioral outcome data for a cohort of 40 youth receiving Wraparound Care over a 12-month period. The results showed that after 12-months, youth who had been previously removed from their homes or were at imminent risk of such removal, were residing in significantly less restrictive community-based living arrangements and exhibiting significantly fewer problem behaviors than at intake. These results are discussed in light of recent national studies and previous studies on similar cohorts of Vermont youth receiving Wraparound Care.     

Knowledge of Results for Motor Learning: Relationship Between Error Estimation and Knowledge of Results Frequency

The authors of the present study investigated the apparent contradiction between early and more recent views of knowledge of results (KR), the idea that how one is engaged before receiving KR may not be independent of how one uses that KR. In a 2 × 2 factorial design, participants (N = 64) practiced a simple force-production task and (a) were required, or not required, to estimate error about their previous response and (b) were provided KR either after every response (100%) or after every 5th response (20%) during acquisition. A no-KR retention test revealed an interaction between acquisition error estimation and KR frequencies. The group that received 100% KR and was required to error estimate during acquisition performed the best during retention. The 2 groups that received 20% KR performed less well. Finally, the group that received 100% KR and was not required to error estimate during acquisition performed the poorest during retention. One general interpretation of that pattern of results is that motor learning is an increasing function of the degree to which participants use KR to test response hypotheses (J. A. Adams, 1971; R. A. Schmidt, 1975). Practicing simple responses coupled with error estimation may embody response hypotheses that can be tested with KR, thus benefiting motor learning most under a 100% KR condition. Practicing simple responses without error estimation is less likely to embody response hypothesis, however, which may increase the probability that participants will use KR to guide upcoming responses, thus attenuating motor learning under a 100% KR condition. The authors conclude, therefore, that how one is engaged before receiving KR may not be independent of how one uses KR.     

The Neural Basis of Motor-Skill Learning

Recent work indicates that motor-skill learning is supported by four processes: a strategic process that selects new goals of what to change in the environment, a perceptual-motor integration process that adjusts to new relationships between environmental stimuli and the appropriate motor response, a sequencing process that learns sequences of motor acts, and a dynamic process that learns new patterns of muscle activations. These four processes can operate in one of two modes: an unconscious mode, in which one is aware only of the goal of the movement, or a conscious mode, in which one consciously controls detailed aspects of the movement. This article provides an overview of these four processes and two modes, and describes their neural bases.     

Adult urinary incontinence: Assessment,intervention, and the role of clinical health psychology in program development

Urinary incontinence (UI) is a disorder receiving little attention from clinical health psychologists. This paper establishes the importance of addressing the issue of UI within the clinical and research practices of clinical health psychologists. Over 10 million Americans suffer from loss of bladder control. Incontinence affects over half of older individuals in long-term care institutions, about one-third of hospitalized elderly, and up to 30% of Americans over the age of 60 living at home. Because of social stigma and misconceptions attached to urinary incontinence, it is estimated that less than half of those affected see a physician about their condition. Since UI is generally associated with medical, social, psychological, and economic consequences, a multidisciplinary perspective is important because these factors are integral in the selection of appropriate treatment. Definitions of UI, its incidence and costs, and brief reviews of treatment and management techniques are presented. Psychological sequelae and treatments are presented as a foundation for developing further treatment and research approaches. Guidelines for collaboration and consultation by clinical health psychologists with medical professionals in the area of UI are also discussed.     

A scale to assess the restrictiveness of educational settings

The placement of students into educational settings is perhaps one of the most debated issues in special education, particularly for students with emotional and behavioral disorders (EBD). A primary consideration in this decision is the restrictiveness of the setting, yet no scale to assess restrictiveness of educational settings exists. We undertook two surveys that asked respondents to rate the restrictiveness of 18 educational placements. The first survey was sent to a national panel of experts, the second survey was sent to supervisors of programs for students with EBD. The results of the surveys led to the development of theScale to Assess Restrictiveness of Educational Settings. This scale is designed to provide a measure of restrictiveness of educational settings that can provide data to evaluate student progress and program outcomes.     

The Utility of Connectionism for Motor Learning: A Reinterpretation of Contextual Interference in Movement Schemas

Using the general framework of schema theory, and building on it, the present article takes a connectionist approach to motor learning and to contextual interference effects. These phenomena were simulated in an exploratory manner in neural networks. The outcome closely reflects previous research with humans. In a simulated ballistic movement task, networks performed worse during practice but showed better transfer when target movement distances were presented in a random rather than a blocked fashion. Connectionism provides a parsimonious account of the effect in terms of properties inherent in the parallel distributed network.     

Behavioral versus Behavioral and Pharmacological Treatment in ADHD Children Attending a Summer Treatment Program

As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD (MTA), children participated in an intensive summer treatment program (STP). This study examined the differences between 57 children in the combined treatment (Comb) group, who were medicated, and 60 children in the behavioral treatment (Beh) group, who were unmedicated throughout the STP. Comb children were significantly better than Beh on 5 measures: rule following, good sportsmanship, peer negative nominations, and STP teacher posttreatment ratings of inattention/overactivity. Groups did not differ on any of the other 30 measures, and responded similarly to the STP over time. Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures. The differences between these results and the main MTA results, in which Comb was always superior to Beh, are discussed in terms of the relative intensity of combined treatments. The implications for future studies of pharmacological and behavioral treatment for ADHD are discussed.     

The supplementary motor area in motor and perceptual time processing: fMRI studies

The neural bases of timing mechanisms in the second-to-minute range are currently investigated using multidisciplinary approaches. This paper documents the involvement of the supplementary motor area (SMA) in the encoding of target durations by reporting convergent fMRI data from motor and perceptual timing tasks. Event-related fMRI was used in two temporal procedures, involving (1) the production of an accurate interval as compared to an accurate force, and (2) a dual-task of time and colour discrimination with parametric manipulation of the level of attention attributed to each parameter. The first study revealed greater activation of the SMA proper in skilful control of time compared to force. The second showed that increasing attentional allocation to time increased activity in a cortico-striatal network including the pre-SMA (in contrast with the occipital cortex for increasing attention to colour). Further, the SMA proper was sensitive to the attentional modulation cued prior to the time processing period. Taken together, these data and related literature suggest that the SMA plays a key role in time processing as part of the striato-cortical pathway previously identified by animal studies, human neuropsychology and neuroimaging.     

Evaluation of two methods of prompting drivers to use specific exits on conflicts between vehicles at the critical exit

The Florida Department of Transportation used a series of changeable-message signs that functioned as freeway guide signs to divert traffic to Universal Theme Park via one of two eastbound exits based on traffic congestion at the first of the two exits. An examination of crashes along the entire route indicated a statistically significant increase in crashes at the first eastbound exit following the actuation of the system. Furthermore, all of the crashes occurred in close proximity to the exit gore (the crosshatched area at exits that drivers are not supposed to enter or traverse) at the first exit. In Experiment 1, behavioral data were collected using an alternating treatments design. These data revealed that reassigning the exit signs was effective in producing a change in the percentage of drivers using each of the two exits. These data also showed that the reassignment of the theme park exit was associated with an increase in the percentage of motor vehicle conflicts that consisted of vehicles cutting across the exit gore. An analysis revealed that the method used for switching the designated or active theme park exit on the series of changeable-message signs led to the presentation of conflicting messages to some motorists, thus resulting in erratic driving behavior (cutting across the exit gore). In Experiment 2, the treatment evaluated the use of a phased method of switching the designated theme park exit to eliminate the delivery of conflicting messages. The new method for switching the designated theme park exit was not associated with an increase in motorists cutting across the exit gore.     

Teacher rated problems and school ability tests in relation to preschool problems and parents'' health information at school start. A study of first-graders

The reliability of assessments at four and six years of age in identifying teacher rated problems in behaviour, concentration, motor skill and school achievement was investigated in a study of first-graders. Relationships between preschool data and school ability tests, and between parents' information at school start and teacher ratings were also studied. Problems noted in preschool and school were often present in more than one area. Multiple problems at four and six years were strong predictors of later school problems, but preschool assessments of separate areas could not in general predict problems in corresponding areas in school. However, cross situational concentration deficits at the age of six did reliably identify concentration problems in the first grade, at the age of seven.