The Positive Assessment: A Model for Integrating Well-Being and Strengths-Based Approaches into the Child and Adolescent Psychiatry Clinical Evaluation

The Positive Approach to the Psychiatric Assessment: A Randomized Trial of a Novel Interviewing Technique

OBJECTIVE

This pilot study compared a novel communication strategy, the positive approach to the psychiatric interview, with the traditional approach to see if the positive approach can be taught to psychiatric residents; reproduced with standardized patients; measured with a structured scale, the "Positive Approach Outcome Measure," by blinded raters; and used to improve rapport (assessed with the Bond score), a key driver of engagement.

METHODS

Thirty psychiatric residents were randomly assigned to conduct two psychiatric interviews with standardized patients. The standardized patients completed the Working Alliance Inventory-Short Revised, an assessment of the therapeutic alliance. T tests and linear regression examined the effect of the training on the outcome of interest, the Bond score.

RESULTS

The Bond scores for the positive approach group (M = 19.27, SD = 2.87) and the traditional approach group (M = 16.90, SD = 3.44) were statistically significantly different (p = 0.05). All residents trained in the positive approach received a positive score on the Positive Approach Outcome Measure while none of the traditional approach-trained residents attained the threshold. The inter-rater reliability for the blinded raters was high (0.857), as was the intra-rater reliability (1.0).

CONCLUSIONS

The positive approach can be taught to residents and reproduced consistently and was associated with improvement in a key driver of treatment engagement: rapport. The positive approach may be an important, inexpensive intervention to improve treatment engagement and ultimately treatment outcomes.

A better start literacy approach: effectiveness of Tier 1 and Tier 2 support within a response to teaching framework

The Better Start Literacy Approach (BSLA) is a strengths-based approach to supporting children's literacy learning in their first year of school. Previous research has shown the approach is effective at accelerating foundational literacy knowledge in children with lower levels of oral language. This study examined the impact of the BSLA for children with varied language profiles and across schools from diverse socioeconomic communities. Additionally, a controlled analysis of the impact of Tier 2 teaching within a response to teaching framework was undertaken. Participants included 402 five-year-old children from 14 schools in New Zealand. A randomised delayed treatment design was utilised to establish the effect of Tier 1 teaching. Analyses showed a significant Tier 1 intervention effect for phoneme awareness, letter-sound knowledge, non-word reading and non-word spelling. There was no difference in intervention effects across socioeconomic groupings. Children were identified for Tier 2 teaching after 10 weeks of Tier 1 implementation. The progress of 98 children in response to Tier 2 teaching was compared to 26 children who met Tier 2 criteria but received only Tier 1 teaching within this study. Children in the Tier 2 group scored significantly higher on phonological awareness, non-word reading, and spelling than the control group at the post-Tier 2 assessment point, after controlling for pre-Tier 2 scores. The results suggest that a proactive strengths-based approach to supporting foundational literacy learning in children's first year of school benefits all learners. The findings have important implications for early provision of literacy learning support in order to reduce current inequities in literacy outcomes.