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.     

Effects of Different Telephone Intervention Styles with Suicidal Callers at Two Suicide Prevention Centers: An Empirical Investigation

To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of Rogerian nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.     

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.     

Coping, competence, and aggression prevention: Part 2. Universal school-based prevention

Coping—competence theory yields a structural model of the development of persistent aggression in which current challenge encounters determine future life outcomes and competence. Driven by this model, universal, school-based prevention programs would aim in multiple ways to promote prosocial coping among high-risk, resilient, and advantaged youth from kindergarten through high school. Expected benefits of prosocial coping would include: less aggressive behavior, fewer adverse life outcomes (e.g., school dropout, police arrest, teen pregnancy, conduct, mood, and substance-use disorders), and a more competent self-definition and social reputation. Five stages are described that may prove useful in creating prosocial schools and neighborhoods supportive of youth in transition away from antisocial coping and deviant peers.     

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.     

A preventive,psychoeducational approach to increase perceived social support

Investigated the effects of a 13-week preventive, psychoeducational intervention program to improve perceived social support. Fifty-one, low-perceived support, community residents were randomly assigned to an intervention or wait-list control condition. Intervention subjects received training in social skills and cognitive reframing regarding the self and social relations. The intervention led to increased perceived social support from family, but not from friends. As hypothesized by social cognition models, increases in perceived support appeared to be mediated by changes in self-esteem and frequency of self-reinforcement. Further, such changes in cognition about the self were larger than the changes observed for perceived support, suggesting that it may be easier to change cognition about the self than perceptions of support.     

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。     

Developing the matrix representation grid (MRG): A method for observing group processes. Findings from time-limited group psychotherapy for alcohol-dependent patients

The MRG was published 1988 in order to support developments in group psychotherapy methods as one of the all too few process observation research methods for studying group-as-a-whole. After 9 years of what pilot studies have labeled successful clinical trials, this study aims at validating the MRG against the established SAVI: Structural Analysis of Verbal Interaction (Agazarian & Simon 1989). Videotaped group sessions from short-term groups for alcohol dependent patients conducted along two therapy methods, one behaviorally oriented and the other group analytic, are used as material. The MRG is validated in the study, confirmed to be clinically valuable, and some interesting comparisons between the two treatment modalities are also made.