No abstract

The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.

A multiple baseline, within subject, controlled design was used to examine the effectiveness of a temperature biofeedback procedure augmented with autogenic and relaxation training, in the treatment of four patients who met the criteria for the migraine syndrome. Before treatment was begun, each patient recorded baseline data on hourly ratings of headache intensity and amount of analgesic medication used. The treatment package consisted of: (1) instructions aimed at generating favorable therapeutic expectations; (2) modified relaxation training; (3) use of autogenic phrases; and, (4) fingertip temperature feedback. In accord with the multiple baseline design, this package was introduced to individual patients sequentially in such a way that the effect of treatment was observed in headache and medication records of one patient before treatment was introduced to the next patient.

The Credit-Incentive System, a modified token economy, is a means of motivating the participation of day hospital patients in therapeutic activities through the use of contingent rewards. Credits are earned by patients for engaging in a wide variety of prosocial tasks and activities and can be spent for coffee, a free lunch, special time with professional staff, recreational events, and time off from the treatment centre. The receipt of credits is accompanied by social approval and recognition from the staff and other patients. Evaluations have shown that the credit system doubles the participation rate of patients in a partial hospitalization programme. The system also enhanced group cohesiveness, provides practice and feedback for cognitive re-integration, and offers opportunities of learning self-management. The results of two experiments suggest that the symbolic and social rewards mediated by the credits are the most important components of their effectiveness.