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The ability to perform everyday life occupations is a critical component in both evaluation and intervention for persons with mental retardation (MR). While the ability to perform personal and instrumental activities of daily living (ADL) has always been important for occupational therapy (OT) practice, there is an absence in OT literature and research with a focus on ADL and persons with MR. The overall aim of this thesis was to evaluate the validity of the Assessment of Motor and Process Skills (AMPS) for evaluation and intervention of ADL ability for persons with MR. In order to evaluate the evidence of validity of the AMPS ability measures based on relation to level of MR, two groups of participants with MR were evaluated with the AMPS (,#=22; #= 39). The results indicated expected moderate relationships between ADL motor and ADL process ability measures and level of MR, despite different methods used for evaluating level of MR. The results also indicated that the results of the AMPS evaluation could be used to directly describe and measure the consequences in performance of ADL tasks for persons with different levels of MR. The evidence of validity of the AMPS was further examined in a study including participants with different types of developmental disabilities (e.g., MR, cerebral palsy, spina bifida) (#=1724). An application of many-faceted Rasch analysis was used to examine goodness-of-fit of the responses for the tasks, skill items, and participants included in the study. All tasks and all items except one demonstrated acceptable goodness-of-fit to the model on the ADL motor and ADL process scales. An expected proportion of participants demonstrated acceptable goodness-of-fit on the ADL motor scale. On the ADL process scale, a slightly lower proportion of participants than expected demonstrated acceptable goodness-of-fit. The results indicated further that persons with more severe levels of MR and persons with more limited ADL process abilities demonstrated different response patterns across tasks and possibly items. The evidence of validity of the internal structure of the AMPS scales was also evaluated between persons with mild and moderate MR (#=178; #=170). Group specific ADL motor and ADL process skill item hierarchies were generated using many-faceted Rasch analyses and compared. The hierarchies of ADL motor and ADL process skill items remained stable across groups, indicating evidence of validity of the AMPS scales when used to evaluate persons with MR. The results also indicated that although participants with moderate MR demonstrated overall lower mean ADL motor and ADL process ability, they did perform some specific ADL motor and ADL process skills at a similar level as persons with mild MR. Finally, the utility of the AMPS ability measures for detecting change were examined in an intervention study including three female participants with moderate MR. The study was based on a single case design and evaluated the effectiveness of a structured occupational therapy intervention program. Improvements were found for the participants in relation to the implementation of the program, but the pattern of changes were different between the participants and across the dependent variables. ADL process ability was the only variable that improved across all participants. The results supported the ADL process abilities as sensitive measures for detecting changes in ADL ability of persons with MR. In conclusion, the results of these studies contribute to the evidence of validity of the AMPS ability measures and scales, specifically in relation to the evaluation of persons with MR. The finding that an OT program resulted in improved ADL process ability also suggest that the results of the AMPS can be used to plan as well as evaluate outcomes of OT practice. Further research is also suggested in order to improve validity evidence and utility of the AMPS when used with persons with MR. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 2003</p>

Text in English / This exploratory study creates a post-modern narrative context for psychotherapy and extends these ideas to an individual living with a psychiatric disorder, namely obsessive-compulsive disorder. The present study explores OCD through the ecosystemic perspective and aims to obtain a holistic understanding of an individual's experience of living with OCD and to describe the recursive connections between OCD and the individual's ecological context. This investigation includes the re-authoring therapy of Michael White and David Epston and the application of their ideas to the individual's life story. A qualitative method within the naturalistic paradigm is employed focussing on the unique experience of the individual, which allows for an understanding of the individual's personal meaning. The dominant narratives, that emerged from the individual's life story, were deconstructed. Significant shifts in attribution of meaning took place. / Psychology / M.A.(Clinical Psychology)

A Psicoterapia Analítica Funcional (FAP) baseia-se no behaviorismo radical e propõe como mecanismo de mudança a modelagem de comportamentos clinicamente relevantes (CCR) na interação terapêutica. Diversas pesquisas tem comprovado a eficácia desse mecanismo de mudança, porém um estudo detalhado das variáveis envolvidas nessa modelagem se faz necessário. Nesse sentido, o presente estudo teve como objetivos verificar os efeitos sobre os CCRs produzidos por dois tipos de intervenções: FAP não sinalizada (FAPNS) e FAP sinalizada (FAPS), e comparar essas intervenções com intervenções analítico comportamentais com foco em análise de contingências externas à terapia (ACE). As intervenções FAPNS consistiram na modelagem de CCRs na interação terapêutica. Já as intervenções FAPS, além da modelagem continham as seguintes variáveis: 1. sinalização e descrição pelo terapeuta da ocorrência de CCRs na interação com o cliente; 2. descrição do terapeuta ao cliente do impacto que os CCRs produzem nele (com relação a sentimentos, pensamentos, etc.); e 3. paralelos realizados pelo terapeuta dos comportamentos do cliente em sessão e fora dela.. Foi utilizado um delineamento intra-sujeito de reversão, de tratamentos múltiplos (A1 B1 A2 C1 A3 B2 A4 C2 A5) para estudar os efeitos dessas intervenções em dois clientes com problemas em relacionamentos interpessoais. A ordem de apresentação das fases foi alternada para cada participante. As sessões foram filmadas e analisadas utilizando o instrumento Functional Analytic Psychotherapy Rating Scale FAPRS. Foram analisadas 27 sessões de cada participante. Os resultados corroboram que a modelagem dos CCRs é o mecanismo de mudança na FAP, visto que os CCRs2 aumentaram de frequência e os CCRs1 diminuíram nas fases em que a FAPS ou FAPNS foram introduzidas. Com o delineamento utilizado conseguimos observar as reversões nas frequências de CRBs nas mudanças entre as fases FAP e ACE. Não foram encontradas diferenças evidentes entre as duas formas de intervenção, FAPS e FAPNS, indicando que a modelagem ocorre quando o terapeuta apresenta a consequência adequada aos CCRs, independente da descrição dos comportamentos / Functional Analytic Psychotherapy (FAP) is based on radical behaviorism and proposes that the shaping of clinically relevant behavior (CRB) is the instrument of behavioral change. Many researches demonstrated this mechanism, but a detailed analysis of the variables is necessary. The objective of this research was to study the effects of two different FAP interventions on CRBs: Non-signalized FAP Interventions (FAPNS) and signalized FAP interventions (FAPS), and compare those interventions with sessions of behavioral psychotherapy, with focus on analysis of contingencies external to therapy (ACE). FAPNS interventions consist of shaping the client´s behavior throughout the course of therapeutic interaction. FAPS interventions, in addition to shaping CRBs during therapeutic interaction, contain the following variables: 1) signaling and description by the therapist of the occurrence of CRBs during the interaction with the client, 2) description of the CRBs impact on the therapist (e.g., the therapists feelings, thoughts, etc., produced by the clients CRBs), and 3) description of parallels between CRBs and the clients behavior outside therapeutic setting. We used a within-subject withdrawal design with multiple treatments (A1 - B1 - A2 - C1 - A3 - B2 - A4 - C2 - A5) to study those variables in two clients with interpersonal relationship problems. We controlled the order of presentation of each phase for the participants. The sessions were filmed and then coded using the Functional Analytic Psychotherapy Rating Scale-FAPRS. 27 sessions of each participant were analyzed. The results show that the shaping process of CRBs is the main mechanism of change in FAP since the CRBs 2 increased while the CRBs 1 decreased during FAPS and FAPNS phases. We observed the reversion of CRBs frequencies between FAP and non FAP phases (ACE), but we did not find differences between FAPS and FAPNS interventions. This indicates that the shaping process of CRBs occur when the therapist presents the precise consequences for each CRBs, even if the consequences do not include the description of the behaviors that take place between therapist and client

A Psicoterapia Analítica Funcional (FAP) aponta a relação terapêutica como meio de promoção de mudanças clínicas. Os comportamentos do cliente em sessão são classificados como CCR1s (comportamentos problema), CCR2s (comportamentos de melhora) e CCR3 (descrições funcionais a respeito do próprio comportamento). É papel do terapeuta atuar sobre esses CCRs com o intuito de aumentar CCR2 e CCR3, bem como diminuir a emissão de CCR1, o que é planejado por meio das regras: estar atento aos CCRs (regra 1), evocar diretamente CCRs (regra 2), consequenciar CCRs (regra 3), observar os efeitos do seu comportamento sobre o comportamento do cliente (regra 4) e fornecer interpretações analítico-funcionais e implementar estratégias de generalização (regra 5). Compreende-se que a similaridade funcional do contexto terapêutico com outros ambientes do cliente possibilita o acesso do terapeuta à classe de comportamentos alvo de intervenção clínica e que, ainda, é papel do terapeuta evocá-los diretamente, componente da FAP expresso pela regra 2. As pesquisas que investigam o mecanismo de mudança da FAP têm enfatizado o papel da consequenciação (regra 3) sobre a mudança comportamental observada nos clientes, entretanto, há indícios de que tal mudança seja também resultado de um processo evocativo ocorrendo em sessão, responsável por produzir o aumento da emissão de CCR2s e diminuição de CCR1s quando a FAP é conduzida. Sendo assim, o objetivo do presente estudo foi o identificar quais os efeitos da evocação direta pelo terapeuta na FAP (variável independente) sobre os CCRs do cliente em sessão (variáveis dependentes), sendo utilizado delineamento experimental de caso único de reversão, com arranjo A-B1-BC1-B2-BC2 para uma cliente, com controle da inserção da evocação (arranjo A-BC1-B1-BC2-B2) para outro cliente. A fase A foi correspondente à linha de base, com realização de análise de contingências externas, as fases B corresponderam à condução de FAP sem evocação direta e as fases BC, à FAP completa. As sessões foram categorizadas com o Functional Analytic Psychotherapy Rating Scale (FAPRS) pela terapeuta e aferidoras de concordância, foi aplicado semanalmente o Outcome Questionnaire (OQ-45.2) que possibilitou o acompanhamento da evolução global dos clientes. Após três meses do encerramento do estudo, foi realizada uma sessão de follow-up com cada cliente, a qual indicou a manutenção de progressos com os mesmos. Como resultado no FAPRS, registrou-se o abrupto aumento de CCR2s e diminuição de CCR1s quando a evocação direta foi inserida, o aumento de CCR1 e diminuição de CCR2 quando a mesma foi retirada, bem como a replicação dessas duas fases e de seus efeitos sobre os comportamentos dos dois clientes. Nas fases em que a evocação não esteve presente, as porcentagens de CCRs assemelharam-se às observadas na linha de base. Observou-se também a importância da consequenciação com função evocativa, o que sustenta que a evocação e a consequenciação atuam de forma complementar. Tais resultados solidificam a proposta de que a produção de CCR2 nas sessões FAP tenha também por base a existência de processos evocativos atuantes, já que diante da ausência da evocação, registrou-se imediata diminuição de sua ocorrência. Nesse sentido, a evocação direta pode ser destacada como possuindo impacto relevante no mecanismo de mudança dessa psicoterapia / Functional Analytic Psychotherapy (FAP) points to the therapeutic relationship as a way of promoting clinical changes. The client behaviors in session are classified as CRB1s (problem behaviors), CRB2s (improvement behaviors) and CRB3 (functional descriptions regarding any client´s behavior). FAP therapist should act on these CRBs in order to increase CRB2 and CRB3 and to reduce the emission of CRB1, which is planned by using the rules: to be aware of CRBs (rule 1), to evoke CRBs directly (rule 2), to contingently respond to CRBs (rule 3), to observe the effects of therapist´s behavior on client´s behavior (rule 4) and to provide analytic-functional interpretations and implement generalization strategies (rule 5). It is understood that the functional similarity of the therapeutic context to other client environments allows the therapist to access the class of target behaviors of clinical intervention and that it is also the role of the therapist to directly evoke them, a component of FAP expressed by rule 2. Researches focused on investigate the mechanism of change in FAP have emphasized the role of consequence (rule 3) on behavioral change observed in clients, however, there is evidence that such a change is the result of an evocative process occurring in session, which is responsible for producing increased CRB2s and decreased CRB1s emissions when FAP is conducted. Thus, the goal of this investigation was to identify the effects of direct evocation by the therapist in FAP (independent variable) on client CRBs in session (dependent variables), using an experimental design of a single-case experimental procedure, with design A -B1-BC1-B2-BC2 for one client, with control of the insertion of the independent variable (design A-BC1-B1-BC2-B2) to another client. Phase A corresponded to the baseline, without systematic use of FAP, phases B corresponded to FAP without direct evocation and phases BC, to the use of complete FAP. The sessions were categorized with the instrument Functional Analytical Psychotherapy Rating Scale (FAPRS) by the therapist and independent coders. The Outcome Questionnaire (OQ-45.2) was applied weekly, allowing the therapist to monitor the overall evolution of clients and after three months of the end of the phases, a follow-up session was conducted with each client, which indicated the maintenance of the observed effects. As a result in FAPRS, it occurred the abrupt increase of CRB2s and decrease of CCR1s when direct evocation was inserted, the increase of CRB1 and decrease of CRB2 when it was withdrawn, as well as the replication of these two phases and their effects on the behaviors of the two clients. In the phases in which evocation was not present, the percentages of CRBs were similar to those observed in baseline. It was also observed the importance of the consequences with evocative function, which maintains that the evocation and the consequences provided by the therapist act in a complementary way. These results solidify the proposal that the increase of CRB2 in FAP is also based on the existence of evocative processes, since in the absence of evocation it is observed its immediate decrease. Therefore, direct evocation can be highlighted as having a relevant impact on the mechanism of change of this psychotherapy

The aim of this study is to give an in-depth understanding of the representations of a depressed woman who killed her baby. The representations under study is based on “The motherhood constellation” by Stern (1995) and focus on the woman’s representation of her mother as mother-of-herself-as-child, herself-as-mother and her representations of her children. Pregnancy is an important phase in a woman’s life. Parent-infant psychotherapies are a rapidly growing field of infant mental health as many psychological problems have their roots in infancy. Neglect, trauma and abuse and prolonged maternal depression can cause a child to develop a range of problems. The work of Winnicott (1965a) and Bion (1988) put the mother’s fantasy life about her infant as one of the major building blocks of the infant’s construction of a sense of identity (Stern, 1995). Fraiberg (Fraiberg, Adelson&Shapiro, 1980) with her “ghosts in the nursery” revolutionised this perception by placing the maternal representation at the core of the parent-infant clinical situation (Stern, 1995). The way the research developed and the nature of the research problem necessitated a pure qualitative mode of enquiry. A single case study was done about the representations (of self-as-mother, mother-as –mother–of–self-as-child- and of the children) in an extreme case where the mother’s depression led to her murdering her baby. Data collection was done through semi-structured interviews and documents from the psychiatric hospitals she attended. Data was also obtained from field notes, before and after the interviews and also while transcribing the audio-taped interviews. Data analysis was done by the procedures of data reduction and organising it into categories on the basis of themes as described by Neuman (2000). Coding and analytic memo writing were done. The relationships between concepts were examined and linked to each other and interweaved into theoretical statements. The researcher argues that not enough is done to enhance the relationship between a mother and her foetus, and later her baby. The concept of maternal representations is the only approach that opens the possibility to start working at the earliest point of prevention, because intervention can start during pregnancy. Intervention during pregnancy is ideal because defence mechanisms are less rigid during pregnancy and women are more in touch with their entire life cycle and the whole system is more open for change. The ghosts can be chased out of the nursery by helping the mother to see the repetition of the past in the present. The affective link, recognising and remembering the feelings help a parent not to repeat the past in the present - “…it is the parent who cannot remember his childhood feelings of pain and anxiety who will need to inflict his pain upon his child” (Fraiberg, Adelson&Shapiro, 1980, p. 182). / Thesis (PhD (Psychotherapy))--University of Pretoria, 2006. / Psychology / unrestricted

This thesis aimed to study how Robotic Process Automation (RPA) can be successfully utilised by a large international company. By adopting a single case-study research approach the author have examined a large international company's utilisation of RPA; what value it associates with the technology, together with bottlenecks and risks that may prevent the company from receiving such value. The case-intrinsic focus rendered a comprehensive set of findings in relation to the research target, which was then compared and contrasted to a thoroughly established theoretical background. The study can report a relative high degree of correspondence with previous research, although important data points either find little bearing or none at all in said research. Most notably, the case-company viewed value associated with RPA utilisation to go beyond immediate yields and thus identified incentives from indirect value. Furthermore, obstacles like inefficient communication and coordination networks, together with lack of time and low-quality development, were identified as significant findings with little base in previous research. In conclusion the study claim to have provided a deeper understanding of key features and concepts necessary to consider for successful RPA utilisation. / Syftet med denna uppsats är att studera hur Robotic Process Automation (RPA) kan framgångsrikt användas av ett stort internationellt bolag. Genom att anamma en fallstudie (single-case study) som forskningsansats har författaren undersökt ett stort internationellt bolags användning av RPA; vad för värde bolaget associerar med teknologin, samt vilka flaskhalsar och risker som kan förhindra bolaget att uppnå detta värde. Med ett intrinsikalt fokus på det enskilda fallet renderades ett omfattande set av forskningsresultat i relation till forskningssyftet. Studien kan rapportera en relativt hög korrespondensgrad gentemot tidigare forskning, även om signifikanta datapunkter antingen finner lite uppbackning eller ingen alls i tidigare forskning. Mest anmärkningsvärt, i relation till värde, är att bolaget anser värdet med RPA-användning sträcka sig förbi omedelbara effekter. Således finner bolaget incitament från indirekt värde. Även flaskhalsar och risker så som ineffektiv kommunikation och koordination, samt tidsbrist och lågkvalitativ RPA-utveckling, identifierades som signifikanta forskningsresultat med lite uppbackning i tidigare forskning. Sammanfattningsvist menar studien på att ha bidragit till en djupare förståelse av nödvändiga koncept att överväga för en framgångsrik användning av RPA.

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Background Individuals with intellectual disabilities need continued supports in completing daily living tasks to increase the likelihood of achieving independence. Fortunately, research has shown that assistive technology, and particularly video prompting helps support independent living for individuals with intellectual disabilities. Aims This study investigated the efficacy of a highly customizable task analysis smartphone application in assisting three young adults with intellectual disabilities learn how to cook three different multistep recipes. Materials & Methods Three young adults with intellectual disabilities enrolled in a four-year postsecondary education program (PSE) participated in a multiple probe design across participants to examine the effect of a Task Analysis app on the participants' completion of three cooking tasks. Results In this present study, the use of video prompting to teach a daily living skill resulted in large and meaningful effect size gains of 99%–100% for all three participants, as measured by Tau-U. Discussion Video prompting is an effective instructional strategy which allows the user to self-prompt and manage their ability to successfully complete daily living skills. In this current study, video prompting made a substantial difference in the safety of participants. Conclusion The use of video prompting can decrease the reliance on others (e.g., teachers and caregivers), improve self-confidence of the user, and improve the user's level of autonomy.

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