Use of the Minimum Data Set to rate incontinence severity.

OBJECTIVES: To assess the relationship of the MDS incontinence severity ratings to direct measures of incontinence frequency. DESIGN: Two methods of measuring incontinence were compared: the MDS rating as recorded by nursing home (NH) staff and physical checks for wetness performed by research staff. SETTING AND PARTICIPANTS: A total sample of 293 older residents from nine nursing homes located in Iowa, the State of Washington, and the Los Angeles area were assessed once. A subsample of 49 incontinent residents were assessed twice, before and after the implementation of a prompted voiding program. INTERVENTION: This study is a part of a larger study evaluating the use of a computer-aided incontinence management system (IMS). Incontinent residents were assessed, and, if they met predefined criteria, they were treated with prompted voiding. MEASUREMENTS: Three measures of incontinence were used: the MDS rating recorded by NH staff, physical checks for wetness performed by NH staff while assessing residents for and treating them with prompted voiding, and physical checks for wetness performed independently by research staff. RESULTS: There was a statistically significant correlation (r = .49; P < or = .001) between research staff wet checks and the MDS ratings, but wetness checks performed by NH staff had an insignificant correlation with MDS ratings (r = .003; P < 0.914). There was wide variability within and between NHs in the correlation. For residents who were placed on the prompted voiding program, the pre to post wet rate, as measured by research staff, improved significantly (from 28 to 14%; t = 6.73; df = 48; P < .001), whereas the pre to post MDS ratings did not change significantly (from 1.7 to 2.0; t = -1.42; df = 48; P < .075). CONCLUSIONS: Although the MDS appears to identify incontinent NH residents accurately, its clinical utility may be limited by disagreements between actual wet check data and MDS categorical severity rankings for residents known to be incontinent. The wide variability between direct observational measures of wetness and the MDS scores denoting incontinence severity we observed may limit the potential usefulness of the MDS for detecting changes in incontinence severity. It is possible that more information and instructions are needed for staff completing the MDS if the goal is to discriminate between different levels of incontinence severity and measure changes over time in response to therapeutic interventions.

Alaska nursing home takes national role in addressing urinary incontinence.

Urinary incontinence affects over half of all residents in the nation's 25,000 nursing homes. While incontinence assessment, treatment and management techniques have been validated under "laboratory" conditions, the practicality of maintaining the systems pose difficulties for most nursing homes. An evaluation of a new automated system for managing urinary incontinence indicates that a nursing home in Anchorage, Alaska, has successfully implemented and maintained the new system for over ten (10) months. Researchers found that The Mary Conrad Center quickly reduced wetness rates in the target group from 25 percent prior to implementation of the program, to about eight percent and have been able to reduce wetness rates to even lower levels in subsequent months. The evaluation provides critical evidence that nursing homes can implement and maintain the comprehensive system. If further testing in other facilities result in similar findings, the system stands to impact the quality of care for over one million nursing home residents affected by urinary incontinence.

An experimental analysis of a program to reduce retail theft.

A program for elementary school-aged youth, designed for and implemented by a retail business, was evaluated. The program included visual instructions to youth, tokens (exchangeable for special prizes) for appropriate verbal behavior, visual feedback to youth, and rewards for reducing merchandise loss, all continued to a criterion level. A 54% reduction in losses of popular youth merchandise was achieved.

The applicability of a helicopter patrol procedure to diverse areas: A cost-benefit evaluation.

The residential burglary deterrent effects of a helicopter patrol procedure were investigated in four separate areas with a multiple baseline technology. The helicopter was flown during an 8:00 a.m. to 4:00 p.m. period in two high density population areas of approximately 9.82 and 14.71 square miles and two low density population areas of 117.49 and 89.97 square miles. The helicopter patrol reduced residential burglaries without crime displacement in the two high density areas but had no deterrent effects in the low density areas. The costs of the helicopter patrol were justified by the benefits that resulted from the reduced home burglaries in the two high density areas. Because the helicopter patrol program is funded by general tax revenues, there is a disparity between those people paying for the procedure (all residents of Nashville) and those citizens that receive the burglary deterrent benefits (only residents of high-density areas). This distribution of benefit limitation suggests two courses of action: (1) The helicopter should be flown only in high population density areas even though the low population density areas are also victimized by high burglary rates. (2) A more comprehensive burglary reduction program must be developed so that effective deterrence can be realized in low density areas. These latter techniques would supplement helicopter patrol strategies and thus form a comprehensive burglary deterrent package that has an equitable benefit distribution.

Evaluation of outpatient client progress: time-series telephone interview data.

A cost-efficient information system that allows for the continual monitoring of the verbal reports of mental health outpatient behavior was designed and implemented. Verbal descriptions of patients' problem behaviors were collected during baseline, therapy, and post-therapy periods using a telephone interview procedure. Descriptive data were presented for 25 patients, demonstrating that: (a) adequate baseline measures can be taken to evaluate therapy interventions, (b) there are wide differences among patients' reports as to the change in frequency of problems that occurs, and (c) patients' reported satisfaction with therapeutic services may be inconsistent with their verbal reports of behavioral change.

Police evaluation research: an experimental and cost-benefit analysis of a helicopter patrol in a high crime area.

The significance of a helicopter patrol procedure directed toward prevention of home burglaries was evaluated from experimental and cost-benefit perspectives. The helicopter patrolled one city zone from 9 a.m. to 5 p.m. for two 12-day periods. Each 12-day period was separated by a baseline period in which only normal patrol-car levels were maintained. Significantly reduced burglary levels during the intervention periods, compared to baseline periods, documented the experimental significance of the helicopter procedure. The cash costs of implementing the patrol procedure were compared to two estimates of the resulting cash benefits. This latter cost-benefit analysis was supplemented by a discussion of the intangible costs and benefits of the helicopter procedure. Taken together, these analyses documented that the marginal costs of the helicopter intervention were exceeded by all estimates of benefits.

Patrol evaluation research: a multiple-baseline analysis of saturation police patrolling during day and night hours.

The effects of a carefully monitored and increased police patrol on the report of crime were examined in four patrol zones. Overall patrol movement was increased to four times normal levels and slow patrol movement (under 20 mph) to around 30 times normal levels for 10 days. The patrol was active in two zones between 9:00 a.m. and 5:00 p.m. and in the other two zones between 7:00 p.m. and 3:00 a.m. A multiple-baseline design and time-series statistical analyses showed statistically reliable changes in reported levels of Part I crime (such as robbery, burglary, and aggravated assault) during both night patrols, but not in the day patrols. In both night-patrol zones, there were also reliable increases from saturation patrol to postsaturation patrol in report of Part I crime after the night patrol was terminated. Neither of the day patrols showed significant crime report changes on termination. Despite statistically reliable decreases in report of crime during nighttime hours, the value of saturation patrolling as a crime-prevention technique was questioned on cost/benefit grounds.

A parent advice package for family shopping trips: development and evaluation.

THIS ARTICLE REPORTS ON THE PRIMARY STEPS IN THE DEVELOPMENT OF PARENT ADVICE FOR POPULAR DISSEMINATION: (a) developing advice for one specific problem situation, family shopping trips; (b) testing the advice program for benefit to children and convenience to adults; and (c) packaging the advice so it can be used successfully by interested parents. Systematic observation of 12 families using the written advice package on shopping trips revealed its effectiveness in reducing child disruptions and increasing positive interactions between parents and children. These findings, along with interview information from families, showed that the package is usable, effective, and popular with both parents and children, and thus is ready for dissemination to a wide audience of parents-a step that in itself should involve research and evaluation.

The problem of early outpatient terminations from community mental health centers: a problem for whom?

This study examined the relationship between the number of client contacts with a mental health center and the client's evaluation of the services. Responses to 3 structured ratings of the center's services and free response comments were obtained from 130 former outpatients. None of the structured evaluation ratings was related to the number of contacts, but clients with several contacts were more negative in their free response comments. In addition, clients who had dropped out of therapy evaluated services as highly as clients whose therapy reached a normal termination. These results question the traditional assumptions that early terminations usually occur because of client dissatisfaction and represent treatment failures.

Shoplifting prevention: providing information through signs.

Shoplifting is one of the most frequent crimes in the United States, yet there is no agreement about effective prevention procedures. Since most prevention strategies are aimed at either increasing public awareness of the severity of the consequences or increasing the threat of detection, procedures that contain these elements were evaluated. Posting signs around a department of a department store pointing out that shoplifting is a crime, etc., partially reduced shoplifting rates. When merchandise that was frequently taken was identified by signs and stars, shoplifting decreased to near zero. Publicity campaigns to inform the public of consequences for shoplifting may produce desirable results, but identifying likely shoplifting targets, which may increase the likelihood of detection, effectively reduces shoplifting rates.

Elective mutism in a first grader: the remediation of a complex behavioral problem.

Teachers frequently deal with unusual and perplexing behavioral problems in their classes. This study demonstrates how spontaneous and prompted speech were produced in a six-year-old mute by a first-grade teacher and her aide. A reinforcement system for peer-prompted speech and spontaneous speech was employed in three separate school classes in a multiple-baseline fashion. The reinforcement system produced prompted and spontaneous speech in each situation. Postchecks in the second grade indicated the child was still speaking and conversing spontaneously with his peers. This study suggests a method that teachers can use in the classroom to deal with this severely handicapping condition.

Social evaluation research: the evaluation of two police patrolling strategies.

In most social evaluation research it is difficult to achieve the degree of experimental rigor possible in an applied behavioral study. This study illustrates how the evaluation researcher can increase experimental rigor in the analysis of social interventions. In the first evaluation, a variation of the time-series design that offered maximum experimental control given the limitations of the situation, was employed to evaluate the effects of a specialized home-burglary police patrol. This design revealed that no effects could be attributed to the patrol. In the second evaluation, a multiple baseline-like design was possible in determining the effects of a police walking patrol. This design revealed that the patrol produced an increase in crime reporting but not in arrests. Social interventions often occur in a manner that allows varying degrees of experimental analysis. The evaluation researcher must attain optimal experimental analysis given the limitations of each social intervention.

Modification of deficits in reading for comprehension.

Subjects were asked to read a passage orally and then to answer questions about the passage. When praise and pennies were given for correct answers, the percentage of correct answers increased in two sixth-grade subjects whose reading for comprehension was tested to be 2 yr below grade level. The behavior of these subjects was compared to that of two subjects whose reading for comprehension was tested to be on grade level. Although no evidence for changes in the accuracy of answering comprehension questions is found in the previous literature, the percentage of correct answers in the children with deficits increased to approximately the same level as the children tested to be on grade level.

Control of an obscene "verbal tic" through timeout in an elementary school classroom.

A classroom teacher modified the behavior of a 10-yr-old student who had a high rate of obscene vocalizations accompanied by facial twitches. In the first phase, the subject was instructed to repeat rapidly the most frequent obscene word in four daily 15-min sessions. This procedure reduced the frequency of obscene vocalizations, but not to an acceptable level. Subsequently, the teacher was able effectively to control the target behavior using a timeout procedure.