The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital

The widespread use of seclusion and restraint in child psychiatric hospitals to manage aggression and noncompliance is based on the assumption that coercive consequences reduce the frequency of undesirable behaviors exhibited by the patients. We report a study of the use of seclusion and restraint in a public child psychiatric hospital during a 3-year period. Twenty-eight percent of the patients had been secluded or restrained a total of 1670 times. About 25% of these patients had been secluded more than five times during their hospitalization, and 32% had been placed in restraints more than once. Behaviors that typically resulted in repeated seclusion included physical aggression toward staff, verbal aggression toward peers, non-compliant or oppositional behavior, and self-harm. Variables that predicted patients most at risk for repeated seclusion included age, gender, and psychiatric diagnosis. The predictor variables for those most at risk for repeated restraint included age, property destruction, and self-harm. The high rates of use of seclusion and restraint suggest that these methods for controlling the behavior of children and adolescents in this child psychiatric hospital may not have been therapeutic. We suggest that staff in such hospitals engage in a pattern of behavior characterized by an aggression-coercion cycle, in which increasingly aggressive and coercive behaviors are exhibited by both patients and staff.     

The effects of a response cost treatment tactic on hyperactive children

In a pilot study, a multielement design was used to assess the effectiveness of a response cost procedure on a 7-year-old child's hyperactive behavior and academic performance across days. The procedure was effective in reducing off-task behavior and in increasing academic assignment completion. In Experiment 2, three strategies were compared to a no-treatment baseline in treating an 8-year-old hyperactive child: drug (Ritalin) alone, response cost alone, and drug plus response cost. The cost program alone and the cost program combined with medication were effective in reducing off-task behavior and in increasing academic performance. In both studies, the procedure was viewed by the teachers as practical and effective for use in a classroom setting. The subjects liked the cost system and believed that they completed more academic work when it was operative.     

Reconciliation and the Great (whole) Commission

The label “Great Commission,” attributed to Matthew 28:16-20, has been for evangelicals the inspiration for the evangelization of the world for over a century. But there is more to the commissioning words of Jesus than the ministry of evangelism. This article contends that a missiology of reconciliation, applied to “the Great Commission,” uncovers the broader, holistic nature of the mission of the church. In addition to evangelism, reconciliation as mission also includes peacemaking and stewardship.     

Developing and validating a new multi-dimensional scale for anti-social behavior in a higher education setting

The purpose of this research is to construct and validate a multi-dimensional scale of Anti-social Behavior (hereafter ASB) in a Western higher education context (i.e., USA). To achieve this, four studies, each with a different sample, were performed. Study 1 (n = 150) followed an exploratory design to generate a pool of potential items measuring ASB. Study 2 (n = 254) explored the dimensionality of the items produced in Study 1 using exploratory factor analysis (EFA) and reliability measures. Study 3 (n = 654) confirmed the factorial structure from Study 2 and assessed the measurement model invariance using structural equation modeling (SEM). Finally, Study 4 (n = 287) assessed the predictive validity of the ASB measure through testing a hypothetical path model linking ASB to narcissism and Machiavellianism via an SEM procedure. In total, our research findings conclude that the ASB measurement model is a two-factor multi-dimensional structure comprising: Interpersonal Antagonistic Behavior (six items) as well as Indirect Distractive Behavior (four items). The research and practical implications for universities are thereafter discussed.     

Imagined contact and mental illness stigma in an Asian context: Bolstering the effect and examining the impact of factual information

Imagined contact can be effective at reducing social stigma. However, the effect may depend on the strength of the stigma held. We tested the robustness of imagined contact in an Asian setting where stigmatization of mental illness is stronger than in Western countries. In Experiment 1 (n = 167) with five conditions, only an enhanced version of positive imagined contact was able to decrease stigma towards people with schizophrenia through decreasing intergroup anxiety. Given the potential discrepancy between imaginations and reality about experiences with stigmatized groups, in Experiment 2 (n = 121), we tested the hypothesis that after presenting participants with factual information about a mental illness group, imagined contact might backfire, resulting in more negative perceptions. However, enhanced imagined contact alongside factual message about schizophrenia did not increase stigma. The backfiring hypothesis was therefore not supported. Nevertheless, providing realistic information did negate the positive effects of enhanced imagined contact on stigma reduction. In both experiments, we also showed that intergroup anxiety mediated the effect of enhanced imagined contact on various measures of stigma.     

Lateralization of narrow-band noise by blind and sighted listeners

The effects of varying interaural time delay (ITD) and interaural intensity difference (IID) were measured in normal-hearing sighted and congenitally blind subjects as a function of eleven frequencies and at sound pressure levels of 70 and 90 dB, and at a sensation level of 25 dB (sensation level refers to the pressure level of the sound above its threshold for the individual subject). Using an 'acoustic' pointing paradigm, the subject varied the IID of a 500 Hz narrow-band (100 Hz) noise (the 'pointer') to coincide with the apparent lateral position of a 'target' ITD stimulus. ITDs of 0, +/-200, and +/-400 micros were obtained through total waveform delays of narrow-band noise, including envelope and fine structure. For both groups, the results of this experiment confirm the traditional view of binaural hearing for like stimuli: non-zero ITDs produce little perceived lateral displacement away from 0 IID at frequencies above 1250 Hz. To the extent that greater magnitude of lateralization for a given ITD, presentation level, and center frequency can be equated with superior localization abilities, blind listeners appear at least comparable and even somewhat better than sighted subjects, especially when attending to signals in the periphery. The present findings suggest that blind listeners are fully able to utilize the cues for spatial hearing, and that vision is not a mandatory prerequisite for the calibration of human spatial hearing.     

Intentional and unintentional nonadherence in patients prescribed HAART treatment regimens

The objective was to investigate intentional and unintentional nonadherence to anti-HIV treatment regimens from a decision-making perspective. The participants (n?=?117) being treated with anti-HIV medication completed a questionnaire asking about nonadherence; reasons for and against taking the medication; and medical consultation style. Thirty-three participants (29%) reported intentionally missing or altering doses of medication at least 5% of the time; 59 participants (50%) reported forgetting to take medication at least 5% of the time. Intentional nonadherence was associated with the balance of the perceived benefits and losses of taking medication, and extent to which participants were 'prepared for the effects of the medication'. Unintentional nonadherence was associated with demographic and clinical variables. The research highlights the importance of (i) treating intentional and unintentional nonadherence as separate entities; (ii) assessing individuals' idiosyncratic beliefs and internal logic when considering intentional nonadherence; and (iii) ensuring that individuals feel prepared for the effects of their medications.     

Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.