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.     

Family Secrets: The Case of the Patient Kept in the Dark

The author examines the position of a child from whom important matters in his or her own life or key events in the family have been kept secret, outlines criteria by which the decision whether or not to unveil the secret should be made, and urges colleagues to gather more data and examine further family secrets.     

BALANCING SOCIAL ACCEPTABILITY WITH TREATMENT EFFECTIVENESS OF AN INTRUSIVE PROCEDURE: A CASE REPORT

The debate over social acceptability of intrusive procedures has led some school districts to adopt policies allowing punishment for only the most extreme forms of destructive behavior. We investigated the effectiveness of selectively implementing punishment for only the most severe topographies of aggression and property destruction, while less extreme behaviors were ignored. Results indicated that severe behaviors were reduced to near-zero levels only when both severe and less severe behaviors were similarly punished.     

Preventing antisocial behavior in the schools

Multiple correlates and determinants of antisocial behavior within the home, community, and school are reviewed. Due to the school's pivotal role in our society, an emphasis is placed on how our schools contribute to antisocial behavior, and what educators can do to prevent anti-social behavior and related attendance problems. A variety of contextual factors and setting events within our schools appear to be major contributors to antisocial behavior, and some of the same factors identified within the schools also have been identified within the home. These setting events, rather than quick restrictive fixes, must be given more attention if we are to provide safe school environments-environments that durably prevent antisocial behavior and related attendance problems.     

INCREASING COMPLEX SOCIAL BEHAVIORS IN CHILDREN WITH AUTISM: EFFECTS OF PEER-IMPLEMENTED PIVOTAL RESPONSE TRAINING

Two children with autism were taught to engage in a variety of complex social behaviors using peer-implemented pivotal response training (PRT), a set of procedures designed to increase motivation and promote generalization. Typical peers were taught to implement PRT strategies by modeling, role playing, and didactic instruction. After training, peers implemented the procedures in the absence of direct supervision in a classroom environment. After the intervention, both children with autism maintained prolonged interactions with the peer, initiated play and conversations, and increased engagement in language and joint attention behaviors. In addition, teachers reported positive changes in social behavior, with the largest increases in peer-preferred social behavior. Further, these effects showed generality and maintenance. Implications of these findings are discussed.     

Resistance and adherence to the norms of genetic counseling

Genetic counseling for women of advanced maternal age who are considering prenatal testing continues to be based on a principle of nondirectiveness. We interviewed 11 genetic counseling students and four counselors about how they experience and manage, in practice, the tensions between the ideology of nondirectiveness and the acknowledged reality that one can never be truly nondirective. We found that our respondents creatively resolve this tension—simultaneously resisting and adhering to the values of nondirectiveness and information-giving—in individual and situation-specific ways. This resolution is facilitated by the extent to which information given to counselees is fluid, mobile and context-dependent, but these very features of information also have critical implications for both the norms and the practice of genetic counseling.     

小学儿童奖赏公平性的认知发展

采用信息加工研究途径并假设故事情境探索小学儿童对奖赏公平性的社会认知发展,并将儿童的发展与成人作对比。研究结果表明,７,９岁儿童容易将＂均等＂与＂公平＂混淆,还没形成一个稳定的分配模式,而１２岁儿童已能运用＂努力＂、＂成果＂、＂能力＂等规则较为稳定地作出公平奖赏决定或评价,但还没达到对更高层次的社会准则的理解和掌握。儿童这一发展制约于他们的信息加工能力以及获得有关社会价值观的社会化过程。