Analysis of the Efficacy of an Intervention to Improve Parent-Adolescent Problem Solving.

We conducted a two-group longitudinal partially nested randomized controlled trial to examine whether young adolescent youth-parent dyads participating in Mission Possible: Parents and Kids Who Listen, in contrast to a comparison group, would demonstrate improved problem-solving skill. The intervention is based on the Circumplex Model and Social Problem-Solving Theory. The Circumplex Model posits that families who are balanced, that is characterized by high cohesion and flexibility and open communication, function best. Social Problem-Solving Theory informs the process and skills of problem solving. The Conditional Latent Growth Modeling analysis revealed no statistically significant differences in problem solving among the final sample of 127 dyads in the intervention and comparison groups. Analyses of effect sizes indicated large magnitude group effects for selected scales for youth and dyads portraying a potential for efficacy and identifying for whom the intervention may be efficacious if study limitations and lessons learned were addressed.

Analysis of Participant Reactivity in Dyads Performing a Videotaped Conflict-Management Task.

Videotaping is used frequently in nursing research. A threat to the validity of videotaping is participant reactivity, that is, being recorded by a camera may influence the behavior of interest. This paper's purpose is to report how youth ages 10 to 14 years old and their parent viewed participation in a videotaped conflict-management task. Five dyads, who were part of a randomized clinical trial testing an intervention to promote parent-child communication, participated in a structured interview. All parents were mothers. Youth were eighth graders. Three were boys and two were girls. Findings indicated that (a) dyads felt that the videotaped interaction had a progression of feeling unnatural in the beginning to feeling natural toward the end, (b) dyads found it relatively easy to choose a topic of discussion, and (c) dyads felt that the discussions were meaningful. Based on these data, recommendations for researchers to reduce participant reactivity are provided.

Substitution of hospital staff in concurrent utilization review.

Substitution of hospital staff performing concurrent utilization review (CUR) was evaluated using a production process framework. There were no differences in the number of reimbursement denials or denied days among 4 job classifications of hospital staff performing CUR, indicating that educational preparation of staff did not affect outcomes. The implications are that hospitals could substitute assistive staff in place of registered nurses to complete the CUR function, potentially increasing the availability of professional nurses.

Responses of hospital utilization review staff to reimbursement denials.

Utilization review (UR) is a strategy used by the managed care industry to monitor and control utilization of health care resources. The concurrent UR process requires that hospital staff report clinical information to payers, who either certify or deny reimbursement. Conflicts may arise when hospital staff disagree with denial decisions. The authors analyzed the various responses of a medical center UR staff to payer denials and found that although denials were not frequent, they were perceived negatively by hospital staff. Improving and standardizing communication among providers, payers, and patients is one means of reducing conflict and frustration in the event of reimbursement denial.