Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.     

Semilattice-based dualities

The paper discusses regularisation of dualities. A given duality between (concrete) categories, e.g. a variety of algebras and a category of representation spaces, is lifted to a duality between the respective categories of semilattice representations in the category of algebras and the category of spaces. In particular, this gives duality for the regularisation of an irregular variety that has a duality. If the type of the variety includes constants, then the regularisation depends critically on the location or absence of constants within the defining identities. The role of schizophrenic objects is discussed, and a number of applications are given. Among these applications are different forms of regularisation of Priestley, Stone and Pontryagin dualities.     

Physical characteristics of residential psychiatric and substance abuse programs: Organizational determinants and patient outcomes

Described the Physical and Architectural Characteristics Inventory (PACI), which assesses the physical characteristics of hospital- and community-based psychiatric and substance abuse residential treatment programs for adults. Developed using data from 94 representative programs, the PACI has 7 dimensions that assess community accessibility, physical features that add convenience, aid recreation, and provide support for patients, and space for patient and staff functions. In comparison to community-based programs (n=63), hospital programs (n=31) had more social-recreational and prosthetic aids, safety features, staff facilities, and space. The PACI dimensions were also related to other organizational features, such as facility ownership and program size and staffing level. Programs with more physical amenities had patients who were more involved in self-initiated and community activities and were more likely to successfully complete the program and be discharged to independent living situations and paid jobs. Programs with more social-recreational and prosthetic aids, space, and access to community resources also had better patient outcomes. In addition, PACI dimensions were related to observers' ratings of facility attractiveness. Potential applications of the PACI and the full inventory of which it is a part are discussed.     

Characteristics and consequences of help-giving practices in contrasting human services programs

Relationships between human services program models and help-giving practices, and between both program models and help-giving practices and help-seeker control appraisals were examined in a study of 107 low socioeconomic background families. Three kinds of human services agencies were included in the study, each of which differed in terms of their implicit and explicit assumptions about the families they served and the roles professionals and families played as part of helping relationships. Results support the hypotheses that (a) a program philosophy that was family centered would be associated with more empowering help-giving practices compared to more professionally centered philosophies and (b) a family-centered program philosophy and empowering help-giving practices would be related to an enhanced sense of personal control over needed supports and resources from a target help-giver.     

Practice-based competencies for accreditation of and training in graduate programs in genetic counseling

In January 1996, the American Board of Genetic Counseling (ABGC) adopted 27 practice-based competencies as a standard for assessing the training of graduate students in genetic counseling. These competencies were identified and refined through a collective, narrative process that took place from January through November 1994, and included directors of graduate programs in genetic counseling, ABGC board members and expert consultants. These competencies now form the basis of the document Requirements for Graduate Programs in Genetic Counseling Seeking Accreditation by the American Board of Genetic Counseling (American Board of Genetic Counseling, 1996). The competencies are organized into four domains and are presented and discussed in this article.The Consortium includes Directors of established graduate programs in genetic counseling and members of the ABGC Board of Directors who participated in the Consensus Development Conference held in January, 1994: Diane Baker (University of Michigan/ABGC); Bonnie Baty (ABGC); Joan Burns (University of Wisconsin); Debra Collins (ABGC); Virginia Corson (ABGC); Beth Fine (Northwestern University/ABGC); Elizabeth Gettig (University of Pittsburgh); Verle Headings (Howard University); Jacqueline Hecht (University of Texas); Carl Huether (University of Cincinnati); Bonnie LeRoy (University of Minnesota); Joan Marks (Sarah Lawrence College); Anne Matthews (University of Colorado); Roberta Palmour (McGill University); Lorna Phelps (Medical College of Virginia); Kimberly Quaid (Indiana University); Joan Scott (ABGC); Ann Smith (ABGC); Helen Travers (ABGC); Judith Tsipis (Brandeis University); Ann Walker (University of California-Irvine/ABGC); Jon Weil (University of California-Berkeley); S. Robert Young (University of South Carolina); Randi Zinberg (Mount Sinai School of Medicine, New York).     

A case-based approach to the development of practice-based competencies for accreditation of and training in graduate programs in genetic counseling

The American Board of Genetic Counseling (ABGC) sponsored a consensus development conference with participation from directors of graduate programs in genetic counseling, board members, and expert consultants. Using a collective, narrative, and case-based approach, 27 competencies were identified as embedded in the practice of genetic counseling. These competencies were organized into four domains of skills: Communication; Critical Thinking; Interpersonal, Counseling, and Psychosocial Assessment; and Professional Ethics and Values. The adoption of a competency framework for accreditation has a variety of implications for curriculum design and implementation. We report here the process by which a set of practice-based genetic counseling competencies have been derived; and in an accompanying article, the competencies themselves are provided. We also discuss the application of the competencies to graduate program accreditation as well as some of the implications competency-based standards may have for education and the genetic counseling profession. These guidelines may also serve as a basis for the continuing education of practicing genetic counselors and a performance evaluation tool in the workplace.The Consortium includes Directors of established graduate programs in genetic counseling and members of the ABGC Board of Directors who participated in the Consensus Development Conference held in January 1994: Diane Baker (University of Michigan/ABGC); Bonnie Baty (ABGC); Joan Burns (University of Wisconsin); Debra Collins (ABGC); Virginia Corson (ABGC); Beth Fine (Northwestern University/ABGC); Elizabeth Gettig (University of Pittsburgh); Verle Headings (Howard University); Jacqueline Hecht (University of Texas); Carl Huether (University of Cincinnati); Bonnie LeRoy (University of Minnesota); Joan Marks (Sarah Lawrence College); Anne Matthews (University of Colorado); Roberta Palmour (McGill University); Lorna Phelps (Medical College of Virginia); Kimberly Quaid (Indiana University); Joan Scott (ABGC); Ann Smith (ABGC); Helen Travers (ABGC); Judith Tsipis (Brandeis University); Ann Walker (University of California-Irvine/ABGC); Jon Weil (University of California-Berkeley); S. Robert Young (University of South Carolina); Randi Zinberg (Mount Sinai School of Medicine, New York).     

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.     

SEVERE CLASSROOM BEHAVIOR PROBLEMS: TEACHERS OR COUNSELLORS

This experiment was designed to determine the relative effectiveness of teacher and counselling approaches in the reduction of disruptive or inappropriate classroom behavior. Inappropriate classroom behavior frequencies of 12 academically low achieving, seventh-grade, black male students, with a reported high rate of inappropriate classroom behavior, were recorded. Three groups, with nearly equal mean inappropriate behaviors, were randomly assigned to one of three treatment conditions: behavioral counselling, client-centered counselling, or no counselling. Each counselling group received fifteen 30-minute counselling sessions, at a rate of two to three times a week. In addition to counselling, all students subsequently received teacher approval within the classroom. Results indicated that the teacher was able to reduce inappropriate behavior more than any counselling group. There were also indications that behavioral counselling, but not client-centered counselling, was moderately helpful in reducing inappropriate classroom behavior.     

Effects of a pairing contingency on behavior in a three-person programmed environment

Four groups of three subjects resided for 10 days within a continuously programmed environment. Subjects followed a behavioral program of contingently scheduled activities that determined individual and social behaviors. A triadic condition was in effect when all three subjects were required to select simultaneous access to a group area before it became available for a social episode. A dyadic condition was in effect when access to a group area was permitted to any combination of two, and only two, subjects. The effects of these two conditions on individual and social behaviors were studied in reversal designs with several successive days devoted to each condition. Results showed that durations of social activities and synchronization of individual activities were greater during triadic conditions than during dyadic conditions. Under both conditions, wake-sleep cycles departed from a typical day-night rhythm for most subjects. Instances when subjects did not respond to each others' attempts to initiate conversations using the intercom were generally more frequent during dyadic than triadic conditions. Physical distance during triadic social episodes was found to be related to sociability levels during dyadic conditions.     

On various causes of improper solutions in maximum likelihood factor analysis

In the applications of maximum likelihood factor analysis the occurrence of boundary minima instead of proper minima is no exception at all. In the past the causes of such improper solutions could not be detected. This was impossible because the matrices containing the parameters of the factor analysis model were kept positive definite. By dropping these constraints, it becomes possible to distinguish between the different causes of improper solutions. In this paper some of the most important causes are discussed and illustrated by means of artificial and empirical data.The author is indebted to H. J. Prins for stimulating and encouraging discussions.