The MMPI-168(L) and ADD in assessing psychopathology in individuals with mental retardation: between and within instrument associations

An abbreviated version of the Minnesota Multiphasic Personality Inventory, the MMPI-168(L), modified for use with clients who have moderate or mild mental retardation, was administered to 58 clients, most of whom had co-existing dual psychiatric diagnoses. Another recently developed instrument, the Assessment of Dual Diagnosis (ADD), was administered by interviewing a knowledgeable care giver. Correlations were examined among the raw scores on the 13 ADD scales and T scores of the 13 MMPI-168(L) scales. Contrary to expectations few correlations were found between the scales of the two instruments including scales purported to assess similar psychological constructs. The major exception was the Mania scale of the MMPI-168(L), which correlated moderately well with the Schizophrenia and Dementia scales of the ADD. Client age correlated strongly and negatively with scores on the Conduct Disorder and Sexual Disorder scales of the ADD. Finally, intra-instrument scale correlations were surprisingly large and, from a clinical and diagnostic perspective, meaningful. However, the large number of intra-instrument correlations showed that the scales of both instruments possess considerable overlap, which could make differential diagnosis problematic. It is suggested that it might be necessary to administer both instruments, and carefully consider behavioral history, to accurately diagnose psychiatric disturbances or personality characteristics of individuals with mental retardation. (C) 2002 Elsevier Science Ltd. All rights reserved

Research in action: using positive deviance to improve quality of health care

<p>Abstract</p> <p>Background</p> <p>Despite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build on the established principle of 'positive deviance' to propose an approach to identifying practices that improve health care quality.</p> <p>Methods</p> <p>We synthesize existing literature on positive deviance, describe major alternative approaches, propose benefits and limitations of a positive deviance approach for research directed toward improving quality of health care, and describe an application of this approach in improving hospital care for patients with acute myocardial infarction.</p> <p>Results</p> <p>The positive deviance approach, as adapted for use in health care, presumes that the knowledge about 'what works' is available in existing organizations that demonstrate consistently exceptional performance. Steps in this approach: identify 'positive deviants,' <it>i.e</it>., organizations that consistently demonstrate exceptionally high performance in the area of interest (<it>e.g</it>., proper medication use, timeliness of care); study the organizations in-depth using qualitative methods to generate hypotheses about practices that allow organizations to achieve top performance; test hypotheses statistically in larger, representative samples of organizations; and work in partnership with key stakeholders, including potential adopters, to disseminate the evidence about newly characterized best practices. The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance exists, and where there is an engaged constituency to promote uptake of discovered practices.</p> <p>Conclusion</p> <p>The identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality.</p