The Effect Of Instrument-Specific Rater Training On Interrater Reliability And Counseling Skills Performance Differentiation

The purpose of this study was to explore the effect of instrument-specific rater training on interrater reliability (IRR) and counseling skills performance differentiation. Strong IRR is of primary concern to effective program evaluation (McCullough, Kuhn, Andrews, Valen, Hatch, & Osimo, 2003; Schanche, Nielsen, McCullough, Valen, & Mykletun, 2010) and counselor education (Baker, Daniels, & Greeley, 1990; Jennings, Goh, Skovholt, & Banerje-Steevens, 2003; Lepkowski, Packman, Smaby, & Maddux, 2009). The ability to differentiate between low and high performances of counseling skills is central to informing the classroom instruction of counseling students and the supervision of early clinical experiences (Byrne & Hartley, 2010; Fitch, Gillam, & Baltimore, 2004; Paladino, Barrio-Minton, & Kern, 2011). Participants were randomly assigned to one of four groups defined by whether they received instrument-specific training and the performance level of the counseling skills they assessed. Data was collected using the Universal Counseling Skills Assessment (UCSA) administered traditionally and through the Dynamic Scoring Interface (DSI). The researcher used a 2 X 2 factorial ANOVA, independent samples t-tests, intraclass correlation coefficients, and Fisher’s r to z transformations to analyze the data’s validity across the groups and reliability within the groups. Results that brief instrument-specific training and a structure scoring procedure can significantly strengthen IRR. The results of the analyses are discussed within the context of their implications for counselor education and future research possibilities

Risk factors and effective assessment of concussion in an athletic population

Background Concussion is one of the highest burden injuries within contact sports and comes with a high health and financial cost. Inadequet evidence exists identifying intrinsic risk factors to concussion, leaving sports medicine departments with limited options to reduce injury incidence. Common comorbidities to concussion include dysfunction of the vestibular-oculomotor system and are commonly assessed as part of sideline concussion tests. Physical exertion is known to have a delirious impact on many bodily functions but it is unclear what impact high intensity exercise, akin to sporting participation, has on the vestibular-oculomotor system. Aims The aims of this thesis were to investigate whether two different measure of neck function, strength and proprioception, are associated with concussion incidence in male professional rugby players and To investigate the impact of high intensity exercise on the vestibular-oculomotor system in a mixed gender and activity group. Methods Neck strength and proprioception was assessed in 390 professional players and concussion incidence and exposure data were collected to analyse associations with concussion risk through a full season. The Vestibular-Oculomotor Screening (VOMS) tool was assessed pre and post high intensity exercise in 75 participants. Deterioration of test scores was used as a marker of declining vestibular-oculomotor function. Results Significant associations were found between both neck strength and proprioception, and concussion rates leading to the identification of two risk factors to concussion in male professional rugby players. The impact of high intensity exercise on VOMS was shown to be significant in all groups including, different genders, activity levels and sports participated in. Conclusion The evidence surrounding the assessment of concussion and its risk factors are important lines of investigation within sports medicine research and work must continue in order to open the door to interventional studies that may eventually reduce the risk of this high impact injury

Cognitive behavioural therapy versus supportive therapy for persistent positive symptoms in psychotic disorders: The POSITIVE Study, a multicenter, prospective, single-blind, randomised controlled clinical trial

Background: It has been demonstrated that cognitive behavioural therapy (CBT) has a moderate effect on symptom reduction and on general well being of patients suffering from psychosis. However, questions regarding the specific efficacy of CBT, the treatment safety, the cost-effectiveness, and the moderators and mediators of treatment effects are still a major issue. The major objective of this trial is to investigate whether CBT is specifically efficacious in reducing positive symptoms when compared with non-specific supportive therapy (ST) which does not implement CBT-techniques but provides comparable therapeutic attention. Methods: The POSITIVE study is a multicenter, prospective, single-blind, parallel group, randomised clinical trial, comparing CBT and ST with respect to the efficacy in reducing positive symptoms in psychotic disorders. CBT as well as ST consist of 20 sessions altogether, 165 participants receiving CBT and 165 participants receiving ST. Major methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, analysis by intention to treat, data management using remote data entry, measures of quality assurance (e.g. on-site monitoring with source data verification, regular query process), advanced statistical analysis, manualized treatment, checks of adherence and competence of therapists. Research relating the psychotherapy process with outcome, neurobiological research addressing basic questions of delusion formation using fMRI and neuropsychological assessment and treatment research investigating adaptations of CBT for adolescents is combined in this network. Problems of transfer into routine clinical care will be identified and addressed by a project focusing on cost efficiency. Discussion: This clinical trial is part of efforts to intensify psychotherapy research in the field of psychosis in Germany, to contribute to the international discussion on psychotherapy in psychotic disorders, and to help implement psychotherapy in routine care. Furthermore, the study will allow drawing conclusions about the mediators of treatment effects of CBT of psychotic disorders. Trial Registration Current Controlled Trials ISRCTN2924287