Teaching a problem‐solving strategy to closed head‐injured adults

Abstract

A m a . IlIino is 62 90 6 NANCY E. MARCHAND-MARTELLA DEBRA BRAUNLING-MCMORROWThis study developed and evaluated a program for teaching a problemsolving strategy to closed head-injured adults. Four general areas were targeted for training: Community Awareness and Transportation; Medication, Alcohol, and Drugs; Stating One's Rights; and Emergencies, Injuries, and Safety. The program featured cue cards, response-specific feedback, modeling, self-monitoring, positive reinforcement, response practice, self-correction, and individualized performance criterion levels. It was evaluated via pre-and posttraining generalization assessments that involved phone calls, interviews, and staged interactions in the natural environment. The experimental group (N = 3) received baseline, training, and pre/posttraining assessments, whereas the contrast group (N = 3) received only pre/posttraining assessments. The posttraining results revealed that the experimental subjects' problem-solving skills had generalized somewhat, whereas the contrast group showed little change from pre-to postassessment. The program appears t o offer some promise as a method of teaching a problem-solving strategy. INTRODUCTIONBecause of the rapid advancement of medical technology, an increasing number of persons who survive severe brain injury can expect to have a normal life span (Haberman, 1982;Hackler & Tobis, 1983;Levin, Benton, & Grossman, 1982). Yet, these individuals often require extensive services for an extended period of time, inasmuch as they usually have some degree of permanent impairment of their cognitive processes (Hagen, 1982). These impairments can result in deficits in (1) memory, concentration and learning; (2) psychosocial adjustment; (3) oral and written communications; and (4) problem solving (Blanton & Gouvier, 1986;Daniel, Webster, & Scott, 1986;Torkelson, Jellinek, Malec, & Harvey, 1983).One deficit that has received little attention thus far is lack of problem-solving skills. This is unfortunate because residual deficits in problem solving can create significant obstacles for head-injured individuals. Consider that they often remain disorganized in decision making, are unable to retain, analyze, and compare the conditions of a problem, react impulsively, and demonstrate a lack of insight and an inability to make corrections and evaluate solutions (Goldstein & Ruthven, 1983).Problem solving has been defined and described in a variety of ways. For example, D'Zurilla and Goldfried (1971) defined it as "the process or technique by which one attempts to 'discover' a solution to a problem" (p. 109). Accordingly, they emphasized teaching individuals t o select the best solution after generating several alternatives. Problem solving has also been defined as learning to geqerate a solution on the basis of the information provided (Ross & Ross, 1978). Thus, the content of the solution is emphasized in training problem-solving skills.The present study focused on the latter training approach because brain-injured individuals often exhibit def...

Problem‐solving skills training: Social validation and generalization

“…In their excellent review, Tisdelle and St. Lawrence (1986) suggested that training programs need to begin empirically demonstrating the relevance of the program's skill objectives instead of simply relying on clinical intuition as has been past practice. The social validity procedures employed here and in our previous research (Foxx et al, 1988;Foxx et al, 1989) appear to offer one such way of identifying those skill components or processes that do represent actual problem solving and hence that should be taught. Consider that the targeted components or processes ("Where would you look for help"?, "Who would you talk to"?, and "What would you say"?)…”

“…One, it increased the likelihood that the students would attend to each other's responses and feedback since they were required to respond to all of the situations each session by providing either an initial solution or an alternative one. This led to increased interaction among them since they frequently gave each other corrective and positive feedback and kept them from becoming bored or inattentive (see Foxx et al, 1988). This requirement also enhanced the effects of response practice since they had more opportunities to rehearse a strategy for each problem situation which may have reduced their errors, helped them retain new material (see Kent-Udolf, 1984), and acquire the strategy quickly.…”

“…Thus, our data merely represent the subjects' verbal responses to problem situations, i.e., what they say they would da, rather than their actual performance in those situations. To date, only three studies (Foxx et al, 1989;Foxx et al, 1988;Tisdelle & St. Lawrence, 1988) have conducted in vivo assessments of the generalization of problem-solving skills and none have done so with individuals who are mentally handicapped. Thus, the development of more natural evaluations of generalization continues to be an important area of research and the actual use of trained problem-solving skills by persons who are mentally handicapped remains to be demonstrated convincingly.…”

“…All conditions were the same as baseline except: (1) the trainer verbally reviewed the four criterion questions for solving problems prior to the start of each session, and following the second and fourth situations. Verbal review was used in lieu of the cue cards used in our previous research (Foxx et al, 1988;Foxx et al, 1989) because one student was unable to read, (2) the trainer provided feedback and prompted and coached the students to provide a correct solution if one or more of the criterion questions in their solution was incorrect or missing. A least to most directive prompting and coaching format was used.…”

“…The present study devebppd a training program that combined elements of both app4.-g' because it focused on the "content" of the solutions as well as the process by which this content could be produced. As a result, the program sought to teach a problemsolving strategy and represented an extension of earlier research that taught such a strategy to head-injured adults (Foxx, Marchand-Martella, Braunling-McMorrow, & McMorrow , 1988;Foxx, Martella, & Marchand-Martella, 1989) and inpatient adolescents (Foxx, Kyle, Faw, & Bittle, in press).…”