Family-centered intensive case management: A step toward understanding individualized care

New York State's initial attempt at individualizing services occurred within the context of an experiment. We randomly assigned children 5–12 years old who were referred for out-of-home placement in treatment foster care to either treatment foster care, Family-Based Treatment (n=15), or to Family-Centered Intensive Case Management (FCICM) (n=27). FCICM used teams of case managers and parent advocates to provide in-home services. Flexible service dollars, respite care, and behavior management skills training were available to assist teams in individualizing care. Preliminary outcomes indicate that children in FCICM are doing as well or better than children assigned to FBT in their functioning and symptom reduction. Parents of children in FCICM have made gains, although not at a statistically significant level, in behavior management skills and family strengths that allow them to provide care for their children at home.     

Matching adolescents with foster mothers and fathers: An evaluation of the role of temperament

We tested the notion that better foster care adjustment would be observed when the temperaments of mothers and fathers were matched with those of adolescent foster children. We hypothesized that families in which foster parents and foster children had high (easy) scores on subscales of the Revised Dimensions of Temperament Scale (DOTS-R) would also report higher family functioning and higher foster care adjustment than parents and children from families in which one or both family members had low (difficult) scores on these scales. The hypotheses were supported when the mothers and fathers family assessments were used but rejected when the observations of the case managers and adolescents were tested. Methodological and substantive explanations for the findings are discussed and recommendation for foster care practice and continuing research are provided.     

A biopsychosocial therapeutic approach in a private outpatient clinic in Portugal

Patients with chronic stress and ambiguous symptoms are likely to be more frequent in primary care. Somatizers represent 75.8% of the patients in this study and executives 56% of the sample. Job stressors were present in 78.3% of executive men. This scenario suggests that the primary care physician has to be academically better prepared to fully understand and deal with stress problems in daily clinical practice. The physician must have skills to deal with stress at a curative and preventive level, extending those skills to the workplace.     

Realism,instrumentalism, and the intentional stance

One of Dennett's principal arguments for an instrumentalistic construal of intentional attributions (e.g., attributions of belief, etc.) is that such attributions are environment relative. I argue that one can and should adopt a realist perspective toward such attributions, but accommodate their environmental relativity by treating intentional properties as relational properties. By doing so one acquires a useful perspective on experimental cognitive psychology; in particular, one can overcome the temptation to treat ecological accounts and information processing accounts as incompatible alternatives and come to see them as mutually supportive. Treating intentional properties as relational may be counter-intuitive, but I provide examples of how other sciences have had to treat what seem to be intrinsic properties as relational.     

The effects of situational performance constraints on intrinsic motivation and satisfaction: The role of perceived competence and self-determination

Situational performance constraints, task interest, and pay contingencies were manipulated in a laboratory study in order to investigate the cognitive mechanisms associated with the previously observed detrimental effects of constraints on affective task reactions. It was hypothesized that feelings of task competence and self-determination would account for both the direct and the interactive effects of constraints on motivation and satisfaction. The results of the study indicated that despite the fact that participants' performance was being constrained and they were aware of these constraints, the mere presence of the constraints alone failed to result in lower levels of satisfaction or motivation on a proofreading task. Post hoc analyses suggested that the constraints, in fact, led to negative affective task reactions when they also reduced participants' feelings of competence and self-determination. Interestingly, participants' generalized locus of control was associated with such effects. Internals tended to maintain stronger feelings of competence and self-determination than externals in the presence of constraints, thereby also maintaining greater motivation and satisfaction.     

The effects of feedback consistency and feedback favorability on self-perceived task competence and perceived feedback accuracy

The present study, employing a 2 × 2 true-experimental design and regression analyses assessed the main and interactive effects of feedback consistency (consistent vs inconsistent), and feedback favorability (acceptable vs superior), for feedback given at two time periods on measures of perceived feedback accuracy and self-perceived task competence. Among the study's findings were that (a) the perceived accuracy of feedback at the second period was a function of the favorability of feedback received at the first time period, (b) the self-perceived task competence levels of subjects were jointly determined by the favorability of feedback received at both time periods, and (c) the perceived accuracy of feedback was a function of its consistency. Organizational implications of the study's results are offered.     

Individualized behavior therapy for alcoholics: a third year independent double-blind follow-up.

An independently conducted double-blind study providing third year follow-up data for 53 of 70 male alcoholics who served as subjects in an experiment evaluating “Individualized Behavior Therapy (IBT)” techniques is reported. In the original study, subjects were initially assigned to either a controlled drinking or non-drinking (abstinence) treatment goal, and were then randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment oriented towards abstinence. Previously reported results showed that IBT subjects functioned significantly better than control subjects throughout the first year of follow-up. Second year follow-up results found that IBT subjects treated with a controlled drinking goal functioned significantly better than their respective control subjects on a variety of measures, including drinking behavior. Differences between IBT subjects treated with a non-drinking goal and their control subjects did not retain statistical significance during the second year of follow-up. The independently determined follow-up data showed that during the third post-treatment year, subjects in the experimental groups generally functioned better than their respective control subjects. Comparison of the controlled drinking experimental group with its control group showed the significantly better functioning of subjects in the experimental condition on a number of drinking and other life functioning measures. Comparison of the non-drinking groups indicated only one possible difference on the drinking related measures involving a trend for subjects in the experimental condition to abstain more than those in the non-drinker control group. On other life functioning measures, however, subjects in the non-drinking experimental condition showed consistent improvement over their respective control subjects. Both of the controlled drinking groups reported more controlled drinking days than the non-drinking groups throughout the third year follow-up period.     

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.