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Do therapists bias their ratings of patient functioning under peer review?
The present study was an attempt to examine the rating bias of therapists participating in an evaluation of an experimental quality assurance system at a community mental health center. The test program was intended to identify patients who demonstrated lack of progress or poor level of functioning after two months of treatment, and to employ a clinical assessment process by independent clinicians to evaluate problems in the quality of care. It was believed that the therapists knowledge that they might have their clinical work assessed would lead to biased ratings of more severe symptomatology in their patients. The results of this study partially supported the hypothesis. Patients in the peer review system were rated as more dysfunctional at admission on Psychological Functioning than patients in the control groups. No differences, however, were found on Basic Life Functioning, Anti-Social Behavior, or Mental Processes. The implications for these results relative to psychotherapy research, quality assurance, and program evaluation are discussed.
The psychological functions of preadolescent peer activities.
The psychological functions of preadolescent peer activities were assessed by examining activity-related prescriptions and prescriptions for peer behavior. 91 fifth- and sixth-grade children (48 girls) kept week-long diaries of important peer activities and liked and disliked behaviors performed by peers in the activities. 81 other fifth- and sixth-grade children (40 girls) rated the importance and prevalence of each activity and indicated which of several positive and negative behaviors they would most like or dislike to happen in 10 of the activities. Results indicate that collectively, the activities sampled serve 3 main functions based on their prescriptive and prescriptive behavioral profiles: (a) they provide a context for sociability, enhancement of relationships, and a sense of belonging; (b) they promote concern for achievements and integrity of the self; and (c) they provide opportunities for instruction and learning. Not all activities serve all functions, however, and children may require exposure to a variety of activities to accrue a full range of psychological experiences. The findings also illustrate the potential importance of activity-related information for discerning the meaning and evaluating the effectiveness of social behavior. The advantages of the methodology are discussed.
Selection of social partners as a function of peer contact during rearing.
Three groups of monkeys were raised with different degrees of contact with their peers. The first group was allowed no contact, the second only visual and auditory contact, and the third was allowed complete and normal contact with their peers. Animals of all three groups were allowed to interact socially; they were then tested for their preference for monkeys raised under the same conditions or for monkeys raised under different conditions. Monkeys raised under the same conditions preferred each other, even if the stimulus animals were completely strange to the test monkey.
The impact of a physically ill parent on adolescents: cross-sectional findings from a clinic population.
The degree to which the physical illness of a parent affects adolescents is unknown. This study examines this issue through a cross-sectional survey of patients referred consecutively to an adolescent outpatient psychiatry clinic. Demographic and clinical data concerning symptoms, diagnosis of major depression, peer isolation, and family functioning were collected on all subjects from both the adolescent and a parent (usually the mother). No significant differences were found between the groups on measures of family functioning, peer isolation and major depression. According to both youth and parent report, adolescents with physically ill parents had more somatic symptoms than controls. These findings are discussed in the light of the existing literature and the methodological shortcomings of the study.
Children's responses to retarded peers as a function of social behaviors, labeling, and age.
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Guidelines for accepting volunteers: consent, ethical implications and the function of a peer review.
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Conceptions and perceived influence of peer groups: interviews with preadolescents and adolescents.
72 fifth-, eighth-, and eleventh-grade boys and girls were interviewed to investigate developmental changes in perceptions of peer groups and group influence. Results indicated that preadolescents defined groups on the basis of common activities and social behavior and considered group influence to be greatest in these domains. Older adolescents were more likely to describe peer-group influence as global and far reaching, affecting one's appearance, illicit acts, attitudes, and values. Corresponding to increases in peer-group conceptions emphasizing group attitudes/norms and global influence were increases in the extent to which subjects felt that peer-group acceptance or rejection influenced self-evaluation. Developmental changes in the apparent reference-group functions of peer groups for adolescent identity formation are discussed.
Utilization and peer review. Medicine's privilege and responsibility.
Peer review affords a privilege for medicine to participate in the shaping of its future. As a corollary, however, medicine must accept the responsibility of stewardship which attends this privilege. Physicians must be willing to participate even more actively in peer review.Properly, utilization review of professional medical services can be performed only by physicians. They may be assisted by informed lay personnel and by computer-derived data. In no instances, however, should judgment of medical necessity be rendered by computer alone. Although an important function of peer review is the control of health care costs, even more important is the evaluation of the quality of care provided the consumers-our patients."Due process" must be an integral feature of peer review. Any provider must be given the opportunity to discuss his pattern of practice with his peers, and an appellate mechanism must be available.Prospective, rather than retrospective review is preferable, although both approaches are necessary.
Conceptual framework for drug usage review, medical audit and other patient care review procedures.
The following concepts are discussed: (1) quality assurance programs, (2) drug usage review, (3) utilization review, (4) peer review, (5) medical audit, (6) patient care audit and (7) medical care evaluation studies. A framework within which all types of hospital quality assurance mechanisms can be constructed is proposed and their interrelationships are described. The pharmacist's particpiation in the hospital's overall quality assurance program is stressed in two main areas-drug usage review, performed jointly with the medical staff, and quality assurance of pharmaceutical services, a peer review function of the pharmacy profession. These services are primarily drug distribution and control, drug information, clinical pharmacy, continuing education, and other pharmacy and pharmacist functions. Both functions may be viewed as parts of the pharmacy audit, one of several patient care audits within the facility. Pharmacists in skilled nursing facilities have quality assurance responsibilities similar to those of hospital-based pharmacists.
Critique of an earlier study of the Sacramento Medical Care Foundation's Certified Hospital Admission Program (CHAP).
The Certified Hospital Admission Program (CHAP), which was originated by the Medical Care Foundation of Sacramento, California, is regarded as a prototype of admission certification programs and the concurrent monitoring of inpatient care. These peer review functions have now been made key elements of provider utilization review requirements and of Professional Standards Review Organizations' program operations for Medicare and Medicaid. The present article questions, on methodological and interpretive grounds, earlier published findings and conclusions about CHAP's effectiveness. Significant deficiencies in evaluating its impact may mean that the success of CHAP has not yet been demonstrated and, hence, that an adequate basis for formulating certain national peer review policies may not exist.
Interaction of deaf and hearing preschool children.
Hearing and hearing-imparied children attending an integrated preschool were observed in a free-play situation. The principal objective was to discern how hearing and deaf children interacted and modified their communication skills as a function of hearing status. The data indicate that hearing children interact more frequently with other hearing children on several behavioral categories (approaches, vocalizations, social play, and physical contact). Although there was a tendency for deaf children to approach other deaf children more frequently than they approached hearing children, they showed no preferences for other interactions as a function of peers' hearing status. These findings are consistent with those of research on other exceptional children, such as the mentally retarded, in showing that, while hearing-impaired children showed no peer preference, they were least preferred by normal peers.
Social status and the comorbidity of child depression and conduct disorder.
This study examined the overlap between child depression and conduct disorder (D&CD) as a function of peer social status (i.e., popular, rejected, neglected, controversial, average) in a sample of 1,464 nonreferred 4th graders. Both D&CD were measured by self-report, peer nomination, and teacher ratings. Social status was assessed by peer nomination. A strong correlation (.73) was found between D&CD, even after accounting for shared method variance by confirmatory factor analysis. Furthermore, the number of Ss who scored high on both D&CD was greater than would be expected by chance alone. Multivariate tests revealed that rejected Ss scored higher than average Ss on measures of D&CD. Controversial boys also scored higher on measures of CD. However, analyses also revealed that the association between depression and rejected social status might be due to a subgroup of depressed children who also manifested symptoms of CD. Implications for assessment and treatment of child disorders are discussed.
Oral health status and dental needs of an autistic population of children and young adults.
Behavior of patients with autistic syndrome makes delivery of oral hygiene and dental treatment a problem. In this study, the oral health and needs of two groups of patients with autism were evaluated: noninstitutionalized children with a mean age of 11 and institutionalized adults with a mean age of 22. The latter group had severe periodontal problems; almost half required periodontal surgery. Many of the children also needed periodontal treatment. Adults were found to have lower decayed, missing, and filled teeth (DMFT) scores than functionally independent Israeli persons of the same age. This finding was surprising because institutionalized adults are predisposed to development of dental caries; they frequently consume sweets, have poor oral hygiene, and do not use fluoride. Noninstitutionalized children with autism had caries rates that were similar to rates of functionally independent peers.
Investigating stress levels of residents: a pilot study.
A pilot study of the levels of stress among residents was conducted in three departments in a university hospital prior to initiating a programme in stress management for residents. The Beck Depression Inventory, which is a brief, standardized self-report measure of depression, was given to residents in anaesthesiology, paediatrics and psychiatry. Six additional questions were asked about the functioning of peers and services residents would like to have available. Of the 113 residents surveyed, 16% were experiencing a mild mood disturbance. The researchers feel this is probably under-reported. Residents felt that about 15% of their colleagues were emotionally impaired; 10% may have a drug and/or alcohol problem; 12% were having marital problems. Eighty per cent of all residents studied said that they would attend support groups if they existed. Approximately 60% thought coping skills/stress management seminars would be useful, and 30% of the paediatric and anaesthesiology residents (60% of the psychiatry residents) said they would use confidential individual psychotherapy if it were available.
The simulated tutorial. Method for assessing medical school applicants.
The simulated tutorial is a method for selecting medical students by their performance in a small problem-solving group, currently being tested at McMaster University. Four hundred and thirty-two applicants were randomly allocated to groups consisting of 5 or 6 members, assigned a group leader, and asked to work through two unstructured problem situations in a 50-minute session. Assessors, seated behind a one-way mirror, evaluated applicants according to their abilities to relate to their peers, to function in the group, and to define issues in the problem situations. Feedback from the assessors and applicants suggests that the simulated tutorial is potentially useful as a selection tool. All assessors thought they were able to evaluate the 5 or 6 applicants in the group in the time provided. Nearly 80% of the applicants who anonymously returned questionnaires felt they were able to express themselves during their simulated tutorial. The data also suggest that applicants with experience in small groups and applicants previously rated as having outstanding 'personal qualities' are given higher ratings than other applicants. A validation study of the simulated tutorial, comparing individual's scores with evaluations of performance in tutorial groups in the undergraduate M.D. programme, is currently in progress.
Identification and characterization of a B cell activation factor (BCAF) produced by a human T cell line.
A human T cell line, Peer, that expresses the T cell helper phenotype produces discrete activation and growth factors for tonsillar B cells. The B cell activation factor produced by Peer is biochemically and physiologically distinct from other lymphokines known to enhance B cell proliferation, namely, interleukin 1, interleukin 2, interferon, and previously characterized B cell growth factors (BCGF). The BCGF produced by Peer is functionally similar to previously described BCGF but has a m.w. of approximately 30,000 daltons. The identification and characterization of a T cell-derived activation factor that can induce apparently resting (Go phase) B cells to enter S phase in the absence of an exogenous first signal has important implications in the additional dissection of the complex steps in the human B cell cycle.
A comparison of the verbal social behavior of adolescents with behavioral disorders and regular class peers.
Improved social functioning of adolescents with behavioral disorders (BD) is of critical importance for the successful integration of these students in school, domestic, vocational, and community settings. Three comparisons were addressed in the study; overall verbal responding of BD adolescents was compared to verbal responding of their regular class peers, verbal responding of the same BD adolescents was compared across their self-contained and mainstreamed settings, and responding of the BD adolescents when in mainstreamed settings was compared to responding of regular class peers. Portable microcomputers were used to collect data across 10 categories of verbal responding for 14 BD adolescents and 14 regular class peers. Results supported several general conclusions: (a) Adolescents with behavioral disorders engaged in more negative verbal responding than their regular class peers; (b) BD adolescents exhibited less inappropriate verbal behavior when in the mainstream than when self-contained; and (c) when in the mainstream, the verbal behavior of BD students was similar to that of their regular class peers. Implications of the general and specific differences that emerged from the comparisons were presented and discussed.