Mathematical modeling of movement between residential placements: A systems analytic approach to understanding systems of care

Although the concept of a system of care for children and adolescents with a severe emotional disturbance has become core to treatment philosophy, very little research has focused on systems of care as systems. This article attempts to contribute to the development of a systems research paradigm in children's mental health as well as to add to the substantive knowledge of utilization of and movement between residential options in a statewide multiagency service delivery system. Information on residential placement gathered at six month intervals over a three year period is used to develop a mathematical model of the system of care. This model can help administrators to predict future needs for residential care, and to project probable outcomes of alternative strategies for meeting the needs of these children and adolescents.     

Clinical psychology in medical settings: Psychology's role in health care

The number of clinical psychologists working in medical settings has grown along with the range of services provided by psychologists to patients with a multitude of medical problems across the lifespan. Medical care cost savings brought about by these psychological interventions is highlighted along with issues of public policy and specialization of training. The opportunity for ongoing development of clinical psychology in medical settings is described as unlimited and the mission of the newJournal of Clinical Psychology in Medical Settings is presented as supporting that growth.     

BEHAVIORAL COMMUNITY PSYCHOLOGY: ENCOURAGING LOW-INCOME PARENTS TO SEEK DENTAL CARE FOR THEIR CHILDREN1

The present study examined the effectiveness and cost efficiency of three different techniques to encourage low-income rural parents to seek dental care for their children. The families of 51 children who needed immediate dental care (determined by dental screening at a local school) were placed into three matched groups and randomly assigned to the treatment conditions: One Prompt (Note Only), Three Prompt (Note, Telephone Contact, Home Visit), and One Prompt plus $5 Incentive. The Three Prompt and One Prompt plus $5 Incentive were significantly more effective in initiating dental visits than the Note-Only procedure. Not only was the One Prompt plus $5 Incentive technique effective in producing a slightly larger percentage of initial dental visits compared to the Three-Prompt technique, it also produced a significantly larger number of followup visits. Furthermore, the cost-effectiveness analysis showed the Incentive condition to be less costly than the Three-Prompt condition in encouraging initial dental visits.     

EVALUATION OF A SOCIAL INTERACTION COACHING PROGRAM IN AN INTEGRATED DAY-CARE SETTING

We used a multiple baseline design across teachers (with a reversal phase for 1 teacher) to evaluate the direct and indirect effects of a structured coaching procedure on the teaching behaviors of 3 day-care teachers. Structured coaching preceding daily caregiver routines resulted in (a) substantial increases in adult delivery of behavioral support of social interaction during group activities with 2- and 4-year-old children and (b) marked collateral increases in positive interactions of socially withdrawn children. Long-term maintenance effects were demonstrated by both the teachers and target children, and social validity measures indicated that the teachers rated coaching very positively on several dimensions. The results are discussed in relation to in-service training of day-care staff, the concept of coaching as a setting event, and the dissemination of teaching technology related to social interaction of young children.     

VIDEO-BASED TRAINING OF RESPITE CARE PROVIDERS: AN INTERACTIONAL ANALYSIS OF PRESENTATION FORMAT

We conducted two studies to evaluate a video-based instructional package for training respite care providers and the role of presentation format (viewing the videotapes alone, with a partner, and with structured group training) as a contextual variable. In Study 1, the results of a within-subjects Latin square design nested within a multiple baseline showed that performance during simulated (role-played) respite care situations improved in five of the six skill areas for the 12 trainees following presentation of the videotape, with no differences between presentation formats. Correct responding generalized to respite care situations involving a developmentally disabled child, and in most cases, acquired skills were maintained for up to 6 months. In Study 2, we conducted a clinical replication of Study 1 under conditions more closely approximating those in which the training program would be implemented by respite care agencies. Results of the between-groups analysis were consistent with the findings of Study 1.     

Effects of day care and maternal teaching on child educability

Two groups of matched mother-child pairs, a day care sample (N = 38) and a home reared sample (N = 38) participated in a study testing mothers for degree of decentred teaching and children for degree of decentred educability. The children were seven years old. Mother and child were tested in separate settings, thus preventing interdependency among scores. The study used a matched-pair design with control of five background variables; age of the child, mother's educational level, mother's occupational status, family SES level, and type of family. The results showed strong positive effects of both day care experience and maternal teaching on child educability. Day care experience improved the educability of children independent of the mother's teaching strategy and gender of the child.     

TEACHING MENSTRUAL CARE TO MENTALLY RETARDED WOMEN: ACQUISITION,GENERALIZATION, AND MAINTENANCE

We evaluated a training package designed to teach menstrual care skills to five mild to severely mentally retarded women. Three specific skill areas (changing stained underwear; sanitary napkin; and both stained underwear and sanitary napkin) were task analyzed and taught in a sequential manner. Results of a multiple-baseline design across women indicated that the training package was successful in teaching these skills; the women continued to perform the skills during naturally occurring menses up to 5 months following termination of the study.     

Language lateralization as measured by dichotic VRT and recognition tasks

A dichotic color-naming VRT task and a dichotic digits recognition task were administered. The first required the naming of five colors paired with their backward pronunciation; the second of five nonsimilar digits. Forty-eight right-handed male and female subjects were used, controlling for the factors of sex, handedness, and familial sinistrality. A highly significant left-ear advantage was obtained, suggesting that previous results of dichotic studies may only pertain to a limited class of phenomic stimuli. Results implicate different cerebral processes in the analysis of familiar and novel auditory and phenomic stimuli.     

When is enough enough? We are only beginning

Sheridan (1995) presents the problem of the psychologist consulting to a medical residency program as an example of the difficulty one experiences in attempting to challenge, even from a data-based perspective, the calcification inherent in health systems and medical education in particular. This paper responds to her challenging questions, “How much should we get involved in changing health care and medical education, and at what level (local, national) should psychology intervene (if at all)?” It is suggested that psychologists pick up the challenge to bring about change, whenever possible, with the admonition—we are only beginning.     

Mental Health Problems of Children in Foster Care

We compared the rates of mental health problems in children in foster care across three counties in California. A total of 267 children, ages 0 to 17, were assessed two to four months after entry into foster care using a behavioral screening checklist, a measure of self-concept and, in one county, an adaptive behavior survey. Results confirmed previous research and indicated consistently high rates of mental health problems across the three counties. Behavior problems in the clinical or borderline range of the CBCL were observed at two and a half times the rate expected in a community population. Fewer children fell within the clinical range on the self-concept measure. No significant differences in rates between the three county foster care cohorts were observed, despite the different demographic characteristics of the counties. On the adaptive behavior scale, the mean scores for children in foster care were more than one standard deviation below the norm. Our findings suggest that the most important mental health screening issue with children in foster care is to identify what specific mental health problems need to be addressed so that the most effective treatment services can be provided.