Integrating Systems of Care in California for Youth with Severe Emotional Disturbance IV: Educational Attendance and Achievement

Empirical results are presented from school-based interventions in three California counties that are pioneering participants in a carefully evaluated effort to create an innovative system of care for youth with severe emotional disturbance. Data are presented about the educational attendance and achievement of youth enrolled in clinical and academic programs designed to provide collaborative mental health and education services. Attendance levels were uniformly high. The youth were below expected grade level as measured by standardized tests at program admission. Across programs, two counties demonstrated grade level increases of one year or more for one year in school on all subscales of established measures of educational achievement. The third county demonstrated increases of slightly less than one year on two of three subscales of the educational achievement measures. These results are the first from a multisite demonstration of integrated education and mental health programs embedded within a broader system of care for youth. The findings, combined with those from our prior studies, illustrate that is possible to reduce and control placements in restrictive levels of care while improving the academic performance of a vast majority of the youth enrolled in specialized programs within the care systems.     

Using videotape modeling to facilitate generalized purchasing skills

Six students with moderate and severe disabilities were taught generalized purchasing skills through the use of videotape modeling in one, two, or three stores and in vivo instruction within one store. Training was conducted within three orders of treatments: (a) in vivo instruction followed by videotape training, (b) videotape training followed by in vivo instruction, and (c) concurrent videotape and in vivo instruction. Generalization probes were conducted in stores that were the same as those modeled on videotape, untrained stores that were infrequently probed (and never modeled on tape or taught directly), and novel stores that were probed only once after training. Results indicated the production of generalized purchasing skills by the students who received concurrent training and by the students who received sequential training. Videotape and in vivo training in isolation did not lead to generalized shopping skills. The results are discussed in terms of investigating the possible role of verbalization during videotape training on generalized responding and the effects of multiple probe interventions on inadvertent learning of critical skills.deceased.     

Discrimination of picture requests for missing items among young children with developmental disabilities

Two experiments were conducted to assess discrimination of picture requests for missing items among young children with developmental disabilities. In Experiment 1, three children were first taught to request one object when it was missing from a set of two related leisure items. In Experiment 2, two children were taught to request one object belonging to a set of three leisure items. In both studies the requesting response consisted of pointing to a photograph of the missing item. After acquisition of the initial request, discrimination of picture requests was assessed when the second item (Experiment 1) and second or third item (Experiment 2) was missing. Requests for the untrained items emerged in the presence of natural maintaining contingencies and in the absence of instructional prompts for all but the third child in Experiment 1. This child required continued intervention on the initial request. The results suggest that for some children a sequence of intervention and the programming of natural maintaining contingencies may prove effective in promoting the discrimination of picture requests for missing items among young children with developmental disabilities.     

A View of the violence contained in chronic fatigue syndrome

In this paper I ask whether there might be any one particular psychopathology likely to be linked specifically with the physical illness known as chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), and whether CFS/ME aids and abets and 'fits' an original mental state. I think the question cannot yet be answered. However it is my hypothesis that in some personality structures the onset of CFS/ME following a physical illness exacerbates negativity and is an aspect of ordinary depression where there is a lowering of energy levels and a loss of zest for life, or it may reveal the pathological aspect of unresolved rage.
Depending on the degree of pathological disturbance, working with and through the rage may or may not result in a resolution of the symptoms of ME. In this paper I consider some of the problems in the transference and countertransference relationship, which make it extremely difficult to separate out reality from phantasy. There is then the further problem of the denial of the psyche by the patient as part of the violence inherent in the illness.
One case is presented, an example of ME in a borderline male patient in whom resolution could not be achieved.     

The Sense of Agency and the Search for a Narrative in Acute Psychosis

The search for a narrative in acute psychosis exists but the result of this search can be insufficient because the stories available do not sufficiently capture the pre-narrative quality of personal experience, and hence the sense of agency may be diminished. The context of reflexivity is lost when a subjugating story blocks an individual off from making a choice from among a multiplicity of stories. Psychosis can also be an escape in order to maintain a sense of agency. When the patient has trouble in creating meaning through narrative action, the aim of therapy and treatment is to open a channel through which the pre-narrative quality of life can become narrated, to create a multiplicity of stories, and so offer the possibility of choice in the construction of a narrative identity.     

Political Psychology as a Lens for Viewing Traumatic Events

A burgeoning area of scientific inquiry uses psychological perspectives to understand traumatic events. This research has led to the identification of psychological symptoms and disorders frequently experienced in response to traumatic events. Many of the events having traumatic effects on large numbers of persons are of interest to political psychologists. Such events include the Holocaust, war, terrorism, captivity, torture, political migration, living as a political refugee, and assassination. Some interpersonal forms of trauma, such as rape and incest, also may be viewed with a political perspective. Although a number of studies have examined psychological consequences of political events, this area of inquiry is rarely explicitly considered within the domain of political psychology. Adopting an explicitly political psychology perspective on traumatic events may enrich our interdisciplinary understanding of these events and inform the design and evaluation of intervention programs to reduce psychological distress resulting from these events.     

Motivational effects of smoked marijuana: behavioral contingencies and low-probability activities.

Six adult male research volunteers, in two groups of 3 subjects each, lived in a residential laboratory for 15 days. All contact with the experimenters was through a networked computer system, and subjects' behavior was monitored continuously and recorded. During the first part of each day, they were allowed to socialize. Two cigarettes containing active marijuana (2.7% delta 9-THC) or placebo were smoked during the private work period and the period of access to social activities. Three-day contingency conditions requiring subjects to engage in a low-probability work activity (instrumental activity) in order to earn time that could be spent engaging in a high-probability work activity (contingent activity) were programmed during periods of placebo and active-marijuana smoking. During placebo administration, the contingency requirement reliably increased the amount of time that subjects spent engaged in the low-probability instrumental activity and decreased the time spent engaged in the high-probability activity. During active-marijuana administration, however, the increases in instrumental activity were consistently larger than observed under placebo conditions. The decreases in contingent activity were similar to those seen under placebo conditions. Smoking active marijuana was thus observed to produce increments in instrumental activity under motivational conditions involving contingencies for "work activities."     

EFFECT OF SUPPORTED EMPLOYMENT ON THE VOCATIONAL OUTCOMES OF PERSONS WITH TRAUMATIC BRAIN INJURY

This paper reports the job placement of 5 males with severe traumatic brain injury. An individual placement model of supported employment was used. All individuals were placed in competitive employment and received staggered intervention over time by trained employment specialists. A multiple baseline design across persons was used to evaluate results. All individuals had been unable to work consistently or at all in competitive work environments. The range of wages was $4.25 to $5.00 per hour with an average of 339 hours of employment specialist intervention time required per case. The major problems experienced by employment specialists were insubordinate and disruptive behaviors as well as other inappropriate social behaviors displayed at the job site.     

BENEFITS AND COSTS OF SUPPORTED EMPLOYMENT: AN ANALYSIS OF THE ILLINOIS SUPPORTED EMPLOYMENT PROJECT

This investigation presents a cost-benefit analysis completed for one of 27 states implementing supported employment as a result of federal funding. Based upon the benefits and costs detailed, society realized a $0.75 return for every $1.00 invested in supported employment in Illinois. Supported employees realized a 37% increase in their earnings over a comparable period. The results of this study are discussed and recommendations are made for similar analyses across states.     

The cognitive profile of Sotos syndrome

Sotos syndrome is a congenital overgrowth disorder, associated with intellectual disability. Previous research suggests that Sotos syndrome may be associated with relative strength in verbal ability and relative weakness in non-verbal reasoning ability but this has not been explicitly assessed. To date, the cognitive profile of Sotos syndrome is unknown. Cognitive abilities of a large and representative sample of individuals with Sotos syndrome (N = 52) were assessed using the British Ability Scales (BAS3). The majority of participants had intellectual disability or borderline intellectual functioning. The cluster score profile analysis revealed a consistent verbal ability > non-verbal reasoning ability profile. Four specific criteria were proposed as the Sotos syndrome cognitive profile (SSCP): verbal ability > non-verbal reasoning ability; quantitative reasoning T-score or matrices T-score <20th percentile; quantitative reasoning T-score < mean T-score; recognition of designs T-score or recognition of pictures T-score > mean T-score. Of the 35 participants included in the profile analysis, 28 met all four SSCP criteria, yielding a sensitivity of 0.8. The sensitivity of each of the SSCP criteria was >0.9. Individuals with Sotos syndrome display a clear and consistent cognitive profile, characterized by relative strength in verbal ability and visuospatial memory but relative weakness in non-verbal reasoning ability and quantitative reasoning. This has important implications for the education of individuals with Sotos syndrome.