This study examined the strength of delusional beliefs during the modification of delusional verbalizations of a 5 1 year-old chronically mentally ill inpatient. The changing-criterion design was used to document the effectiveness of a behavioral treatment package to alter the rate of delusional responses to personal background questions. The results revealed a stepwise decline in the frequency of delusional responses. Generalization effects to novel interviewers were obtained. No changes were obtained on the subject's ratings of delusional beliefs, with the subject assigning ratings of absolute conviction to his beliefs throughout the duration of the study.

The multiple-baseline across responses design was used to assess the effectiveness of a beliefmodification treatment package to alter the intensity of three delusional beliefs of a chronically mentally ill inpatient. Results revealed reductions in belief intensity to zero levels for all three beliefs. Generalization effects were obtained for an individualized interview and psychiatric rating scale. These results were maintained through a 6-month follow-up period.

The ability of two female and one male chronically institutionalized adult mental patients to comprehend and retain feedback on individualized problem behaviors and the effect of that feedback on changes in the occurrences of those behaviors were examined. Feedback on five problem behaviors was provided to each subject within a small therapy group setting employing a multiple baseline across subjects experimental design. Comprehension and retention tests occurred two, five, and seven days following the feedback in the small groups, while the rates of the occurrences of the problem behaviors were time-sampled throughout the subjects' waking day via use of the Time-Sample Behavioral Checklist (Paul, 1987). Results indicated that, although there were no changes in the rates of occurrence, these subjects were able to retain and understand the feedback on their problem behaviors. Implications for further investigations and for the utility of feedback with chronically institutionalized adults are discussed.

This study used the changing-criterion design to document the effectiveness of a behavioral training package to alter the topography of a complex behavior. In this case, bed-making was established for a severely debilitated adult mental patient who was chronically institutionalized. Experimental control was demonstrated by a step-wise progression in performance to the final target behavior. The changing-criterion design provides an effective record of the shaping process and is sufficiently flexible for other single-subject design elements to be included.

This paper involves a series of personal reflections on the deleterious impact of excessive bureaucracy and other institutional forces on the psychosocial treatment of the chronically mentally ill. The writer appeals to three groups of mental‐health practitioners—behavior analysts, practicing clinicians, and academic clinicians—to promote cultural change by advocating a restructuring of large‐scale bureaucracies with the concurrent establishment of multiple community‐based associations.