DISTRACTION: ITS UTILIZATION AND EFFICACY WITH CHILDREN UNDERGOING DENTAL TREATMENT

We investigated the utilization and efficacy of distraction in reducing the anxious and disruptive behavior of 4 children undergoing dental treatment. During the distraction procedure, the children were shown a poster and told a story about it during dental treatment. They earned a prize if they attended to the poster and story and could correctly answer questions about them following each intervention visit. The children's disruptive behavior was assessed via direct observation, and results were analyzed within a multiple baseline design. The children exhibited high levels of anxious and disruptive behavior across baseline visits, regardless of the length of time in treatment or number of visits. Anxious and disruptive behavior decreased upon introduction of the intervention for all children. This was accompanied by the children meeting the criterion for correct answers on the distraction quiz. However, 2 of the children demonstrated an increase in their anxious and disruptive behavior across intervention visits. Results are discussed in terms of the need to evaluate treatment strategies that promote maintenance as well as initial changes.     

USE OF ESCAPE AND REWARD IN THE MANAGEMENT OF YOUNG CHILDREN DURING DENTAL TREATMENT

A reinforced practice procedure was used to facilitate cooperative behavior in five children, aged 3 to 6 years, during dental treatment. In a multiple baseline design across subjects, the children were rewarded with escape, inexpensive stickers, and praise for cooperative behavior in the presence of the sights, sounds, and some sensations of the dental instruments prior to actual dental treatment. Direct observations of disruptive behavior via a 15-s interval recording system indicated baseline levels as high as 90% were reduced to less than 15% by the final treatment visit. In addition, the procedure was effective in reducing overall heart rate and blood pressure reactivity to dental treatment. All children were rated by the involved dental professionals as more cooperative and relaxed following exposure to reinforced practice.     

VISITING THE DENTIST: A BEHAVIORAL COMMUNITY ANALYSIS OF PARTICIPATION IN A DENTAL HEALTH SCREENING AND REFERRAL PROGRAM

One-hundred and twenty-five families in the Medicaid Early Periodic Screening, Diagnosis and Treatment Program were assigned to one of five treatments to encourage parents to obtain health care service following the dental screening of their children: (a) a control procedure, in which parents were given a dentist's name; (b) a multiple contact procedure, in which parents received a postcard and two telephone call reminders; (c) a problem-solve procedure, in which a social worker aide conducted a brief session with the parent; (d) an incentive procedure, in which parents selected among four gifts that were contingent on seeking care; (e) an incentive + problem-solve procedure, in which the latter two treatments were combined. The multiple contact, incentive, and incentive + problem-solve techniques were significantly more effective in initiating dental visits than the control procedures. Families assigned to the intensive strategies were most likely to complete treatment. A cost-efficiency analysis showed the multiple contact technique to be a low-cost and highly effective procedure.     

Computer‐based training to teach observers to accurately score problem behavior using fast forwarding at 5x normal speed

The current study evaluated whether a computer‐based training program could improve observers' accuracy in scoring discrete instances of problem behavior at 5x normal speed using a multiple‐baseline design across subjects. During pretraining and posttraining, observers attempted to score multiple examples of problem behavior at 5.0x without feedback. During training, participants scored multiple examples of problem behavior at 5.0x with automated feedback. Researchers measured omission (missing problem behavior) and commission (scoring other behavior as problem behavior) errors and the total duration of scoring time to determine the observers' accuracy and efficiency, respectively. After training, all participants scored instances of problem behavior with less than 11% error using 5.0x. The time required to score the videos across 90‐min observations was reduced by 66%. Results extend previous evaluations of fast forwarding by demonstrating that the training program could be used to teach observers to accurately score problem behavior using a speed faster than 3.5x.     

Love and space in the nursing home

Nursing homes and other institutionsdesigned for persons with impairments are not,in fact, designed for persons with impairments.They are typically designed for theimpairments, not the persons, and therebybecome a part of the problem by reinforcingphysical and cultural manifestations of theimpairments. In the essay that follows, Idescribe an architectural design project inwhich students were asked to make changes to anexisting nursing home for the persons who livedthere. This requires not only becoming familiarwith the spaces, but with the personsthemselves and designing space to helparticulate their voices and being. This revised version was published online in June 2006 with corrections to the Cover Date.     

A Social Version of Gerotranscendence: Case Study

This article reexamines the concept of gerotranscendence in the light of anthropological findings. Particular social patterns in a nursing home reveal a unique reality communal to its tenants. The author assumes that the tenants' spontaneous patterns of social gathering construct a collective death consciousness which is spiritual in its nature. Tornstam's term another paradigm seems suitable not only for a developmental shift in old age but also for the situational shift in the daily life of the subjects. Anthropological concepts, as well as contextual and inter-subjective parameters, join to indicate that some gerotranscendence dimensions are experienced in what the author terms as sitting and giving episodes.     

Fix and sample with rats in the dynamics of choice

The generality of the molar view of behavior was extended to the study of choice with rats, showing the usefulness of studying order at various levels of extendedness. Rats' presses on two levers produced food according to concurrent variable-interval variable-interval schedules. Seven different reinforcer ratios were arranged within each session, without cues identifying them, and separated by blackouts. To alternate between levers, rats pressed on a third changeover lever. Choice changed rapidly with changes in component reinforcer ratio, and more presses occurred on the lever with the higher reinforcer rate. With continuing reinforcers, choice shifted progressively in the direction of the reinforced lever, but shifted more slowly with each new reinforcer. Sensitivity to reinforcer ratio, as estimated by the generalized matching law, reached an average of 0.9 and exceeded that documented in previous studies with pigeons. Visits to the more-reinforced lever preceded by a reinforcer from that lever increased in duration, while all visits to the less-reinforced lever decreased in duration. Thus, the rats' performances moved faster toward fix and sample than did pigeons' performances in previous studies. Analysis of the effects of sequences of reinforcer sources indicated that sequences of five to seven reinforcers might have sufficed for studying local effects of reinforcers with rats. This study supports the idea that reinforcer sequences control choice between reinforcers, pulses in preference, and visits following reinforcers.     

Chapter 7. Workfare

SUMMARY

In this chapter, I present the participants' experiences in the work setting from their own perspective.