Systems use to objectify program evaluation,clinical, and management decisions

The utility of the observational assessment systems at different levels — from local clinical to systemwide management — is outlined. An overview is provided of TSBC information applied to individualized problem identification and programming/monitoring, discharge and competency determinations, and both absolute and comparative program evaluation. The utility of SRIC information for prgoramming/monitoring and for staff training and evaluation is outlined in addition to the applied uses of the information of the assessment systems in combination. Once implemented, the continuous data from the systems allow for empirically based self-corrective improvements in the quality of mental health services while automatically providing a basis for legal documentation and accurate cost/effectiveness comparisons of mental health programs.Preparation of this article and the research and development on which the article is based were supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health, and by grants from The Joyce Foundation and the Illinois Department of Mental Health and Developmental Disabilities.Presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979, as part of a symposium on New assessment systems for residential treatment, management, research, and evaluation.     

COMPARING TREATMENT TACTICS WITH A HYPERACTIVE PRESCHOOL CHILD: STIMULANT MEDICATION AND PROGRAMMED TEACHER INTERVENTION1

Two treatment tactics, food and praise contingent on appropriate play and varying doses of methylphenidate (Ritalin), were evaluated for their effects on a preschool child's activity changes. In addition, other social, verbal, and academic behaviors were monitored to examine possible side effects of the two treatment tactics. Fewer free-play activity changes occurred during contingent reinforcement phases while medication had variable effects: increasing attention to tasks but, at higher doses, decreasing intelligibility of speech and responsiveness to mands. The study outlines a replicable model for comparing medication with alternative behavioral strategies to control hyperactivity and enhance skill development.     

BEHAVIOR ANALYSIS APPLIED TO ENVIRONMENTAL/ECOLOGICAL PROBLEMS; A REVIEW1

Recent applications of operant technology, including the manipulation of environmental conditions and response consequences, have been directed toward the improvement of man-environment relations. This document summarizes the research designs, procedures, results, and conclusions of these recent behavioral interventions for ecological rebalance. Each of the 32 studies reviewed was undertaken since 1970; all studies were relatively successful in changing the probability of an ecology-related response; all studies incorporated basic methodologies applicable for large-scale, community programs; most of the investigations were conducted in field settings (e.g., college campuses, grocery stores, mobile-trailer parks, homes, movie theaters, public campgrounds, and a football stadium). Several of the studies are as yet unpublished. Sources for receiving documentation of the unpublished research are provided in this document. About 50% of the investigations reviewed were designed to influence behaviors related to environmental litter; the others were of behavior-modification programs that substantially increased bus-ridership, decreased lawn-trampling, promoted the purchase of drinks in returnable rather than throwaway containers, initiated a recycling process, or reduced energy consumption. Essentially, the interventions were either preventive in nature (i.e., designed to discourage environment-destructive behaviors before they occur), or remedial (i.e., designed to encourage behaviors that correct an existing environmental problem). Usually, the preventive measures emphasized responses priming (or prompting), while the corrective measures applied some form of positive reinforcement. Response priming was accomplished with modelling techniques, or with written and/or verbal prompts presented either publicly or on a personal, one-to-one basis. Among the positive reinforcement procedures were field applications of token economies, lottery systems, feedback programming, and intergroup contests, as well as individual contingency contracting. Some experimental designs provided for comparisons between the behavioral effects of response priming and positive reinforcement.     

The effects of instructions, incentive, and feedback on a community problem: dormitory noise

A reinforcement system utilizing instructions, modelling, feedback, and group reinforcement was employed in an attempt to reduce disruptive noise on three university residence halls. A fourth hall received the same treatment program without the reinforcement component. Noise scores were determined by recording the number of discrete noise occurrences over a criterion decibel level. On all four residential floors, noise scores during treatment conditions were lower than initial and final baseline levels. Additionally, periods of noise reduction corresponded to the changing criterion multiple-baseline and reversal designs utilized. Pre- and posttreatment questionnaire responses from the three reinforcement floors paralleled changes in objective noise data. At posttreatment, residents reported less noise disturbance of study and sleep and more control over the noise situation and floor problems in general. These results indicated that a comprehensive behavior-modification treatment package was effective in reducing disruptive noise in university residence halls. Difficulties in data collection and anomalies in the data are discussed. Future directions for field-based behavior-modification research are outlined.     

Facilitating paper recycling: effects of prompts, raffles, and contests

The effects of prompts and reinforcement to promote paper recycling were compared in six university dormitories. For a Prompt condition, residents were urged to recycle paper for ecological reasons via flyers distributed to each room. For a Raffle contingency, residents were given one raffle ticket for every pound of paper brought to a collection center. For a Contest contingency, two dorms were paired and the dorm whose residents delivered the most paper won $15 for its treasury. Contingency awareness was strengthened via a flyer placed under the door of each resident's room. Flyers alone had little effect in increasing paper-recycling behaviors, but the raffle (substantially) and the contest (somewhat) increased the amount of paper brought to a dorm's recycling center. Students whose rooms were closest to the collection center showed the greatest participation. Removal of the reinforcement contingencies resulted in a return to baseline levels.     

Evaluating the method of levels

An investigation of the method of levels (MOL) was undertaken. Based on the principles of perceptual control theory (PCT), MOL is a way of helping people to reduce psychological distress. MOL assumes that psychological distress results when people are unable to control experiences that are important to them. The approach was implemented over six months in a large urban GP practice. Patients attended for between one and six sessions. Patients who attended for more than one session demonstrated significant reductions in scores of symptomatology on a standardized questionnaire. Effect sizes of these differences were relatively large. There appeared to be no relationship between the number of sessions a patient attended and the amount of reduction in symptomatology that was recorded. Similarly, there was no relationship between the number of sessions a patient attended and their recorded level of symptomatology at their first appointment. Although the study has important limitations we suggest that these findings might offer new directions for future research and might provide a way of unifying the specific and common factors as well as understanding the Dodo Bird effect.     

医生健康素养认知调查及内涵探析

调查医生对健康素养概念及内涵、健康教育方式、存在问题等方面的认知情况。调查显示,一半以上的医生对健康素养了解程度一般,96.3%的医生认为病人的健康素养一般或差,96.7%的医生认为其有责任对病人进行健康教育,同时86.2%的医生认为医生健康素养与病人有区别。基于调查,提出医生健康素养应该具有双重属性,第一重属性为医生作为个体应该具备维持和促进自身健康的知识和能力;第二重属性为作为医生应该具备的本科室常见病相关健康教育知识、运用健康知识,针对病人健康问题进行有效沟通,提高病人健康素养水平的能力。

     

患者的诊治期望值与医患矛盾的关系研究

从患者视角来探索医患矛盾发生的原因,寻找一种有效的医患沟通方法。研究认为医患矛盾的核心问题是患者对诊治期望值的不满意,通过构建以患者诊治期望值为主体的医患沟通方法,发现医生和患者之间对诊治期望值存在明显差异。医生通过对医患之间存在的差异性诊治期望值进行充分沟通,形成医患诊治期望值差异下的共识,建立互信合作的关系,最终实现医患互惠共赢。以患者诊治期望值为主体的医患沟通方法,为避免医患矛盾发生,促进和谐医患关系提供一种新的思路。

     

公立医院“医疗联合体”改革探析

公立医院“医疗联合体”改革模式为解决“看病难”问题提供了新思路, 其目的是促使优质医疗资源通过医疗联合体纵向下沉, 从而达到医疗资源最大化利用和居民就诊的合理分流。为了推进我国“医疗联合体”改革模式的发展, 首先分析了医疗联合体的作用和面临的障碍, 然后介绍我国上海、北京、湖北、重庆的“医疗联合体”改革实践模式, 在此基础上对我国“医疗联合体”改革发展提出相关建议, 期望对我国这种改革模式的实施推进提供一定的参考价值。