A case-based approach to the development of practice-based competencies for accreditation of and training in graduate programs in genetic counseling

The American Board of Genetic Counseling (ABGC) sponsored a consensus development conference with participation from directors of graduate programs in genetic counseling, board members, and expert consultants. Using a collective, narrative, and case-based approach, 27 competencies were identified as embedded in the practice of genetic counseling. These competencies were organized into four domains of skills: Communication; Critical Thinking; Interpersonal, Counseling, and Psychosocial Assessment; and Professional Ethics and Values. The adoption of a competency framework for accreditation has a variety of implications for curriculum design and implementation. We report here the process by which a set of practice-based genetic counseling competencies have been derived; and in an accompanying article, the competencies themselves are provided. We also discuss the application of the competencies to graduate program accreditation as well as some of the implications competency-based standards may have for education and the genetic counseling profession. These guidelines may also serve as a basis for the continuing education of practicing genetic counselors and a performance evaluation tool in the workplace.The Consortium includes Directors of established graduate programs in genetic counseling and members of the ABGC Board of Directors who participated in the Consensus Development Conference held in January 1994: Diane Baker (University of Michigan/ABGC); Bonnie Baty (ABGC); Joan Burns (University of Wisconsin); Debra Collins (ABGC); Virginia Corson (ABGC); Beth Fine (Northwestern University/ABGC); Elizabeth Gettig (University of Pittsburgh); Verle Headings (Howard University); Jacqueline Hecht (University of Texas); Carl Huether (University of Cincinnati); Bonnie LeRoy (University of Minnesota); Joan Marks (Sarah Lawrence College); Anne Matthews (University of Colorado); Roberta Palmour (McGill University); Lorna Phelps (Medical College of Virginia); Kimberly Quaid (Indiana University); Joan Scott (ABGC); Ann Smith (ABGC); Helen Travers (ABGC); Judith Tsipis (Brandeis University); Ann Walker (University of California-Irvine/ABGC); Jon Weil (University of California-Berkeley); S. Robert Young (University of South Carolina); Randi Zinberg (Mount Sinai School of Medicine, New York).     

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.     

SEVERE CLASSROOM BEHAVIOR PROBLEMS: TEACHERS OR COUNSELLORS

This experiment was designed to determine the relative effectiveness of teacher and counselling approaches in the reduction of disruptive or inappropriate classroom behavior. Inappropriate classroom behavior frequencies of 12 academically low achieving, seventh-grade, black male students, with a reported high rate of inappropriate classroom behavior, were recorded. Three groups, with nearly equal mean inappropriate behaviors, were randomly assigned to one of three treatment conditions: behavioral counselling, client-centered counselling, or no counselling. Each counselling group received fifteen 30-minute counselling sessions, at a rate of two to three times a week. In addition to counselling, all students subsequently received teacher approval within the classroom. Results indicated that the teacher was able to reduce inappropriate behavior more than any counselling group. There were also indications that behavioral counselling, but not client-centered counselling, was moderately helpful in reducing inappropriate classroom behavior.     

Effects of a pairing contingency on behavior in a three-person programmed environment

Four groups of three subjects resided for 10 days within a continuously programmed environment. Subjects followed a behavioral program of contingently scheduled activities that determined individual and social behaviors. A triadic condition was in effect when all three subjects were required to select simultaneous access to a group area before it became available for a social episode. A dyadic condition was in effect when access to a group area was permitted to any combination of two, and only two, subjects. The effects of these two conditions on individual and social behaviors were studied in reversal designs with several successive days devoted to each condition. Results showed that durations of social activities and synchronization of individual activities were greater during triadic conditions than during dyadic conditions. Under both conditions, wake-sleep cycles departed from a typical day-night rhythm for most subjects. Instances when subjects did not respond to each others' attempts to initiate conversations using the intercom were generally more frequent during dyadic than triadic conditions. Physical distance during triadic social episodes was found to be related to sociability levels during dyadic conditions.     

On various causes of improper solutions in maximum likelihood factor analysis

In the applications of maximum likelihood factor analysis the occurrence of boundary minima instead of proper minima is no exception at all. In the past the causes of such improper solutions could not be detected. This was impossible because the matrices containing the parameters of the factor analysis model were kept positive definite. By dropping these constraints, it becomes possible to distinguish between the different causes of improper solutions. In this paper some of the most important causes are discussed and illustrated by means of artificial and empirical data.The author is indebted to H. J. Prins for stimulating and encouraging discussions.     

The effect of sex differences on sociometric data generated by a roster-rating scale instrument

Sociometric data generated by roster-rating scale instruments are being used for assessment and evaluation purposes. Little information exists, however, on the influence of peer gender on this particular type of sociometric data. In a sample of 441 male and 455 female fourth, fifth, and sixth grade children, this study found same-sex ratings to be significantly higher than opposite-sex ratings. Opposite-sex ratings, while significantly lower, were slightly correlated with the higher same-sex ratings. Differing methods for interpreting roster-rating scale data are discussed in light of the above results.The author is Assistant Professor at the School of Social Welfare, State University of New York at Albany currently on leave at the Baerwald School of Social Work, Hebrew University, Jerusalem, Israel. This project was completed under the auspices of the Interpersonal Skill Training and Research Project of the School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin.     

NORMAL CHILDREN AS TUTORS TO TEACH SOCIAL RESPONSES TO WITHDRAWN MENTALLY RETARDED SCHOOLMATES: TRAINING,MAINTENANCE, AND GENERALIZATION

The findings of the three experiments reported herein indicate that normal children can successfully teach social responses (i.e., delayed imitation, cooperative play, and verbalization of positive comments) to withdrawn mentally retarded peers. The effects of the intervention generalized across stimulus and response conditions, while the trained and generalized levels of responding were maintained after the end of the intervention. Moreover, the subjects developed social responding within their classrooms and play areas parallel to the intervention and continued to increase such responding after the interruption of the intervention. Direct edible reinforcement appeared to be necessary at least during the initial period of the intervention. Vicarious edible reinforcement seemed useful to prompt the appearance of responding. Vicarious social reinforcement was ineffective at the beginning of the intervention, but apparently acquired prompting power at a later stage of training. Generalization results indicated that the similarity between the response occasions used for training and those used for testing generalization played an important role. Yet, the extensiveness of training and the development of responding within the classrooms and play areas may also have had a relevant effect. The development of social responding within the classrooms and play areas appeared to be mainly the effect of new learning. This was perhaps due to vicarious and direct social reinforcement.     

Standardized classroom management program: Social validation and replication studies in Utah and Oregon

A comprehensive validation study was conducted of the Program for Academic Survival Skills (PASS), a consultant-based, teacher-mediated program for student classroom behavior. The study addressed questions related to: (a) brief consultant training, (b) subsequent teacher training by consultants using PASS manuals, (c) contrasts between PASS experimental teachers and students and equivalent controls on measures of teacher management skills, student classroom behavior, teacher ratings of student problem behaviors, and academic achievement, (d) reported satisfaction of participants, and (e) replication of effects across two separate school sites. Results indicated that in both sites significant effects were noted in favor of the PASS experimental group for (a) teacher approval, (b) student appropriate classroom behavior, and (c) four categories of student inappropriate behavior. Program satisfaction ratings of students, teachers, and consultants were uniformly positive, and continued use of the program was reported a year later. Discussion focused upon issues of cost-effectiveness, differential site effects, and the relationship between appropriate classroom behavior and academic achievement.     

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.