A review of behavioral procedures to teach motor skills to individuals with severe disabilities

Behavioral procedures are one approach to teaching or improving the fluency of motor skills of individuals with severe disabilities. This article provides a review of behavioral procedures by highlighting antecedents, consequences, and multifaceted techniques. Investigations are reviewed in each area according to (a) replicability of the intervention, (b) experimental control, (c) maintenance, (d) generalization, and (e) social validation. Practitioner implications address selection of reinforcers, reinforcement schedules, and teaching within meaningful routines. Future research recommendations highlight the need for documenting that stimuli are actually reinforcers. Additional research needs emphasize targeting maintenance, generalization, and social validation.     

The effects of confederate prompt delivery style in a standardized social simulation test

Role plays or social simulations are presently one of the most common methods for assessing social skills. Although social simulation techniques have become quite popular, little is known about the psychometric adequacy of many of the role-play instruments which have been developed. This investigation was an attempt to determine certain properties of one particular social skills assessment instrument: the Simulated Social Interaction Test. The effects of various confederate prompt delivery styles on the judged social competency level of subjects in the Simulated Social Interaction Test were examined. Two confederates, one male and one female, were trained to portray three confederate prompt delivery styles: (a) unreceptive, (b) neutral, and (c) receptive. In order to determine if judges would compensate for the different confederate prompt delivery styles, two sets of trained judges rated the levels of skill and anxiety generated by the 30 subjects tested. One set of judges was screened from the confererate delivery while observing the simulation; the other set of judges followed the more common rating procedure (i.e., they were not screened from the confederates' deliveries). Data analysis examined variation in subject performance under each condition and according to each set of judges for both overall social skills and anxiety ratings. Confederate prompt delivery style was found to affect subjects' rated performance. There was also suggestive evidence that judges were sometimes able to compensate for different confederate delivery styles. The practical and theoretical implications of the results are discussed.This study was funded in part by a research grant from the Veterans Administration.     

Psychological Predictors of Neurobehavioral Symptoms in a Polytrauma Veteran Sample

Given the high prevalence of comorbid conditions found in polytrauma settings, effective screening measures are needed. Several screening tools are commonly used in polytrauma clinics within the Department of Veterans Affairs (VA). This study examined the use of three screening measures—the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and PTSD Checklist–Civilian Version (PCL-C)—to predict scores on the Neurobehavioral Symptom Inventory (NSI). Research suggests that the presence of mental health conditions, such as PTSD, shares a significant amount of variance with postconcussive symptoms. The investigators hypothesized that the PCL-C would be the best predictor of scores on the NSI. All subjects were administered the screening measures as part of an evaluation in an outpatient Level III polytrauma clinic. Regression analysis was used to determine which instrument might serve as the best predictor of NSI total scores. Regression analysis revealed that BAI, BDI-II, and PCL-C total scores were good predictors of NSI total scores, with the BAI accounting for the majority of the variance. Mental health conditions can account for higher scores on the NSI, and screening of other mental health conditions should be taken into account when reviewing the NSI for individuals in polytrauma settings.     

Transition to the Clinical Doctorate: Attitudes of the Genetic Counseling Training Program Directors in North America

In North America, genetic counseling is an allied health profession where entry level practitioners currently must hold a master’s degree earned from a graduate program accredited by the American Board of Genetic Counseling. This is one of many health care professions that could transition to an entry level clinical doctorate degree. This study explored the attitudes of genetic counseling training program directors toward such a transition. Thirty-one North American program directors were invited to complete an online survey and a follow-up telephone interview. Twenty-one program directors completed the survey and ten directors also completed a follow up phone interview. There was disagreement among the respondents on the issue of transitioning to a clinical doctorate degree (nine in favor, six against and six undecided). Respondents disagreed about whether the transition would lead to higher salaries (six yes, eight no, and seven unsure) or increased professional recognition (eight yes, eight no, and four unsure). Approximately half (n = 10) of directors were not sure if the transition to a clinical doctorate would help or hurt minority recruitment; six thought it would help and four thought it would hurt. However, the majority (n = 13) thought a clinical doctorate would help genetic counselors to obtain faculty positions. If the field transitions to a clinical doctorate, 11 of the directors thought their program would convert, seven were unsure and one thought their program would shut down. Themes identified in interview data included 1) implications for the profession 2) institution-specific considerations and 3) perception of the unknown. Opinions are quite varied at this time regarding the possible transition to the clinical doctorate among genetic counseling training program directors.     

Personality and preference for painting style

40 university students were asked to choose between the cubist or surrealist from among 15 pairs of slides of paintings according to their aesthetic preference. Their choices were correlated with scores on Rotter's internal vs external locus of control scale. The data support the hypothesis that there is a positive relationship between preference for cubism over surrealism and internal locus control and vice versa.     

The Kawa Model: Therapists' Experiences in Mental Health Practice

This pilot study sought to gather information related to the experience of occupational therapists, using the Kawa Model of practice in a mental health setting. Two therapists utilized the model with one client, each over a six-week period. Through qualitative inquiry, the participants (therapists) revealed that, although initially apprehensive about using a new model, they found that the Kawa Model increased client/therapist interaction and energy levels and challenged them to push the boundaries of therapeutic practice. This research suggests that exploration of new models of practice may be beneficial in terms of facilitating successful partnerships and outcomes with clients in mental health settings.     

Mothers’ Perspectives on Their Child’s Mental Illness as Compared to Other Complex Disorders in Their Family: Insights to Inform Genetic Counseling Practice

To facilitate the development of a therapeutic alliance in genetic counseling, it is important that the counselor understands how families might perceive the condition that constitutes the reason for the referral. Through training and professional practice, genetic counselors develop a thorough understanding of families' perceptions of the conditions that are common indications for genetic counseling. But, for referral indications that are less frequent, like serious mental illnesses, genetic counselors may feel less confident in their understanding of the family's experience, or in their ability to provide psychosocial support when serious mental illness is reported in a family history. This may impede the establishment of a therapeutic alliance. As research shows that most referrals for genetic counseling related to serious mental illness are for female first-degree family members of affected individuals, we sought to explore how this group perceives serious mental illness. To provide a frame of reference with which genetic counselors may be more familiar, we explored how women perceived serious mental illness compared to other common complex disorders in their family. We conducted semi-structured interviews with women who had a child with a serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder) and a first-degree relative with another common complex disorder (diabetes, heart disease, cancer). Interviews were transcribed and subjected to thematic analysis. Saturation was reached when nine women had participated. Serious mental illness was perceived as being more severe and as having a greater impact on the family than diabetes, heart disease, or cancer. Themes identified included guilt, stigma, and loss. Some of the most important issues that contribute to mothers' perceptions that serious mental illness is more severe than other common complex disorders could be effectively addressed in genetic counseling. Developing a heightened awareness of how family members experience a relative's mental illness may help genetic counselors to be better able to provide psychosocial support to this group, whether serious mental illness constitutes the primary reason for referral or appears in the family history during counseling for a different referral reason.     

Dimensionality of the Beck Anxiety Inventory in a Polytrauma Sample of OEF/OIF/OND Veterans: Findings From Exploratory and Confirmatory Factor Analysis

The Beck Anxiety Inventory (BAI) is commonly used as a screening instrument for symptoms of anxiety in clinical settings. The factor structure has been researched in a variety of different clinical settings with results ranging from a 2- to 5-factor structure. The purpose of this study was to explore the factor structure of this instrument in a polytrauma veteran sample. A sample of 304 veterans was used for this study. All subjects were administered the BAI screening measure as part of an evaluation in an outpatient polytrauma clinic. Exploratory factor analysis was conducted for half of the sample, followed by confirmatory factor analysis for the remaining sample to determine the best model. Factor analyses revealed that a 5-factor model provided a best fit. It is interesting to note that previously identified models of the BAI with other types of samples did not provide the best fit for this polytrauma sample. The BAI may provide additional information for clinicians when examining the 5-factor model with veterans in polytrauma settings. The factor structure of the BAI includes 1 factor (i.e., personal safety) that may be unique for veterans who have served in combat zones.