Linking outcomes analysis to critical clinical pathways.

Expert decision-support soft-ware systems, when integrated with outcomes analyses, provide the opportunity to develop behavioral healthcare delivery systems in which providers are equipped to act decisively in a socially responsible manner. Key benefits of such systems include: enhancing the consistency and quality of clinical decision making across providers with varying professional backgrounds; providing a mechanism to ensure the rapid dissemination and implementation of new clinical research findings; performing severity-adjusted profiling of providers and programs based on the outcomes their services produce; and linking the prospective focus of clinical pathways with the retrospective rigor of outcomes analysis to accelerate advances in behavioral health. Integrating expert systems with outcomes analyses has the potential to rectify the historical failure by the behavioral healthcare professions to systematically link patient assessment data and their analysis to actual clinical decision making. Such systems will help make behavioral healthcare practice more accountable, thereby strengthening the argument for psychiatric patients to gain parity in healthcare benefits.

Translating research into practice: the implementation of an in-home crisis intervention triage and treatment service in the private sector.

This report focuses on the implementation and evaluation of a 24-hour-a-day, in-home crisis intervention, triage, and treatment service in a 110,000 member health maintenance organization. The in-home crisis intervention service averted the need for hospitalization in 80% of referred patients presenting for inpatient admission. A two-year analysis, involving more than 600 patients, found nearly four times fewer severe psychiatric relapses requiring readmission among patients triaged by the crisis intervention service, compared to patients hospitalized without going through its service. The service saved approximately 3,347 days of hospital-based psychiatric care over the two-year study period. This program evaluation data, combined with previous research, documents that for the vast majority of hospitalized psychiatric patients, intensive in-home crisis intervention and treatment services are a more effective and cost-efficient form of care.

Further generalization technology: Accounting for natural covariation in generalization assessment.

In recent years, the assessment of generalization effects has become a major priority of applied behavior analysis. In this paper we propose a set of procedures to increase the accuracy of generalization assessments by accounting for the degree of natural covariation between treated and untreated behaviors. Scatterplot analyses were used (a) to assess the amount of baseline and postbaseline covariation between behaviors, (b) to determine if the observed generalization effect was due to a preexisting covariation between the behaviors, and (c) to assess if there is a significant change in the strength of the relationship between the behaviors as a function of the intervention. Six hypothetical sets of data are used to demonstrate how these procedures provide more accurate and detailed generalization assessment.

The effects of reciprocal peer tutoring and group contingencies on the academic performance of elementary school children.

We evaluated the effects of reciprocal peer tutoring combined with group reinforcement contingencies on the arithmetic performance of 12 underachieving fifth-grade students. Results indicated that the intervention increased the students' arithmetic performance to a level indistinguishable from their classmates during treatment and 12-week follow-up phases. Pre-, post-, and follow-up sociometric data indicated that the students who participated in the treatment groups increased their amount of peer affiliation with other treatment group members.