Patterns of Change in Families Following Severe Head Injuries in Children

After severe head injuries, children can display behavioural problems for many years. Factors related to the individual have been discussed in other articles, and authors have also suggested that resulting behaviour problems may affect the family. This paper assesses the direct effect of the injury and events around it on the family. The reaction of the family may contribute to the persistence of the behavioural change, rather than just be a result of it. This paper describes the effect of the accident on family relationships and discusses the behaviour of the identified victim in terms of the stage of the family life cycle. The family as a whole, and not just the child, is a victim of the event, and therefore the use of family therapy is an important and appropriate part of treatment. A comparison of family and individual therapy is made, and the problem of assessing whether behavioural changes are related to organic brain injury is addressed.     

SOLUTION-FOCUSED THERAPY: TOWARD THE IDENTIFICATION OF THERAPEUTIC TASKS*

Brief therapy has often been regarded as “problem solving therapy.” This article discusses the development of a solution-focused approach to clinical practice. Solution-focused therapeutic tasks and interventions are described.     

An evaluation of the fidelity of implementation of a school-based drug abuse prevention program: project toward no drug abuse (TND)

This article provides an implementation fidelity evaluation of the fourth experimental trial of Project Towards No Drug Abuse (TND). Two theoretical content components of the curriculum were examined to increase our understanding of the active ingredients of successful drug abuse prevention programs. A total of 18 senior high schools were randomly assigned by block to receive one of three conditions: cognitive perception information curriculum, cognitive perception information + behavioral skills curriculum, or standard care (control). These curricula were delivered to both regular and continuation high schools students (n=2331) by trained project health educators and regular classroom teachers. Across all program schools, the two different curricula were implemented as intended, were received favorably by students, and showed significant improvements in knowledge specific to the theoretical content being delivered. This pattern of results suggests that the experimental manipulations worked as intended, and thus, permit the attribution of future behavioral outcome differences between conditions to differences in content of Project TND material provided rather than to differences in the fidelity of delivery. Further, our findings indicate that Project TND can be implemented effectively with low and high risk youth in a general environment as well as with high risk youth in a more specialized environment.     

Brief Family Therapy: A Metaphorical Task

This article presents a therapeutic procedure designed to prescribe, in metaphorical form, the family's troublesome behavior pattern. Particular attention is paid to using a compliment to precede delivering a task assignment as a method of increasing the likelihood that the family will perform the task, and thus change will be promoted. A case example is used to illustrate the use of this procedure to help make change less painful.     

The Social Work Assessment Tool (SWAT)

This paper reports on the last of three National Hospice and Palliative Care Organization initiatives to move hospice and palliative care social workers into the patient/family outcomes arena: the development of the Social Work Assessment Tool. The experience of a team of practitioners and researchers is described, including results of two pilot studies and subsequent SWAT revisions. The major focus is on the current model performance improvement project, in which 19 social workers from 14 hospice and palliative care programs used the SWAT with 101 patients and 81 primary caregivers for a median of 44 days. Quantitative analysis indicated significant improvement in SWAT scores for patients from the first to the second social work visit (t = -2.60, df = 47, p .01). Qualitative interviewing of the social workers indicated some lack of readiness in the field to conduct quantitative outcomes measurement. Additional measures are needed in addition to the SWAT, including qualitative measures, and measures of mezzo and macro practice. Participants indicated that the SWAT was appropriate for use with economically and culturally diverse clients.     

A stepwise algorithm for selecting category boundaries for the chi-squared goodness-of-fit test

A stepwise algorithm for selecting categories for the chisquared goodness-of-fit test with completely specified continuous null and alternative distributions is described in this paper. The procedure's starting point is an initial partitioning of the sample space into a large number of categories. A second partition with one fewer category is constructed by combining two categories of the original partition. The procedure continues until there are only two categories; the partition in the sequence with the highest estimated power is the one chosen. For illustartive purposes, the performance of the algorithm is evaluated for several hypothesis tests of the from H₀: normal distribution vs. H₁: a specific mixed normal distribution. For each test considered, the partition identified by the algorithm was compared to several equiprobable partitions, including the equiprobable partition with the highest estimated power. In all cases but one, the algorithm identified a parttion with higher estimated power than the best equiprobable partition. Applciations of the procedure are discussed.