The prevalence of community programmes and policies to prevent childhood obesity in a diverse sample of US communities: the Healthy Communities Study

INTRODUCTION

This manuscript describes the prevalence and attributes of community programmes and policies (CPPs) to address childhood obesity documented as occurring in 130 diverse US communities.

METHODS

Key informant interviews (N = 1420) and document abstraction were used to identify and characterize CPPs to promote physical activity and healthy nutrition occurring during a 10-year retrospective study period. Data were collected in 2013-2015 and analysed in 2016.

RESULTS

Across all 130 communities, 9681 distinct CPPs were reported as occurring by key informants. Of these, 5574 (58%) focused on increasing physical activity, 2596 (27%) on improving nutrition and 1511 (16%) on both behaviours. The mean number of CPPs per community was 74.0, with a range of 25 to 295 across all communities. Most CPPs occurred more than once (63%) and on average lasted 6.1 years. The greatest number of reported CPPs occurred in school settings (44%).

CONCLUSIONS

Communities showed a wide range of investment in the amount of CPPs occurring in settings that affect opportunities for children to engage in physical activity and healthy nutrition. The pattern of implementation of CPPs showed variation over time, with an increase in more recent years. This observational study provides new and valuable information about what US communities are doing to prevent childhood obesity.

The longitudinal relationship between community programmes and policies to prevent childhood obesity and BMI in children: the Healthy Communities Study

BACKGROUND

Although a national epidemic of childhood obesity is apparent, how community-based programmes and policies (CPPs) affect this outcome is not well understood.

OBJECTIVES

This study examined the longitudinal relationship between the intensity of CPPs in 130 communities over 10 years and body mass index (BMI) of resident children. We also examined whether these relationships differ by key family or community characteristics.

METHODS

Five thousand one hundred thirty-eight children in grades K-8 were recruited through 436 schools located within 130 diverse US communities. Measures of height, weight, nutrition, physical activity and behavioural and demographic family characteristics were obtained during in-home visits. A subsample of families consented to medical record review; these weight and height measures were used to calculate BMI over time for 3227 children. A total of 9681 CPPs were reported during structured interviews of 1421 community key informants, and used to calculate a time series of CPP intensity scores within each community over the previous decade. Linear mixed effect models were used to assess longitudinal relationships between childhood BMI and CPP intensity.

RESULTS

An average BMI difference of 1.4 kg/m² (p-value < 0.01) was observed between communities with the highest and lowest observed CPP intensity scores, after adjusting for community and child level covariates. BMI/CPP relationships differed significantly by child grade, race/ethnicity, family income and parental education; as well as community-level race/ethnicity.

CONCLUSIONS

These results indicate that, over time, more intense CPP interventions are related to lower childhood BMI, and that there are disparities in this association by sociodemographic characteristics of families and communities.

Behavior analysis and public policy

The Task Force on Public Policy was created to examine ways for behavior analysts to be more functional citizen scientists in the policymaking arena. This report informs readers about the contexts and processes of policymaking; and it outlines issues regarding the roles of behavior analysts in crating policy-relevant conceptual analyses, generating research data, and communicating policy-relevant information. We also discuss a possible role for the professional association in enhancing analysis, research, and advocacy on policies relevant to the public interest.

Training public-speaking behavior: an experimental analysis and social validation

The effect of an instructional package on public-speaking behaviors was analyzed in two experiments. The instructional package was designed to teach public-speaking trainees to look at the audience, make gestures, and perform a number of speaking behaviors. The results of Experiment I, with a university student serving as the trainee, showed that the percentage of each category of public-speaking target behavior increased only after the instructional package was introduced for that category. The results of Experiment 2, with three low-income paraprofessional staff members of a neighborhood service center serving as trainees, showed that the percentage of target behaviors increased after the instructional package was introduced for the respective trainee. Audience ratings of public-speaking performance were correlated with direct observations of target responses. All trainees showed marked improvements in audience ratings from pretraining to posttraining. This study demonstrated an effective procedure for training public-speaking behaviors.

Courteous service: Its assessment and modification in a human service organization

We evaluated strategies to increase behaviors associated with courteous provision of service by 3 staff members of a human service agency. Training included written instructions, practice, and performance feedback. A lottery procedure was introduced to maintain courteous service after training. The results of a multiple baseline design across the 3 participants showed marked increases in courteous behaviors following training. These effects were maintained at 3-, 5-, and 8-month follow-ups. Consumers' satisfaction with service also increased. These findings suggest that simple training and reinforcement procedures can enhance courtesy afforded those who receive service from public and nonprofit organizations.

Community applications of instructional technology: training low-income proctors

A community education system might be most effectively implemented in low-income communities if it were deliverable by neighborhood residents. A proctor training manual, designed to teach neighborhood residents how to administer standardized learning units to their peers, was analyzed in two experiments. The results of Experiment I showed that the percentage of occurrence of proctor behaviors increased after completion of the manual. Supplementary data suggest that specified proctor behaviors generalize to actual instructional situations. The results of Experiment II showed that the percentage of occurrence of trainee behaviors was higher when instructional packages were administered by trained proctors than when administered by untrained proctors. This study demonstrates an effective procedure for training low-income community residents to serve as proctors for a community education system.

Consequence analysis: Its effects on verbal statements about an environmental project

Typically, citizens lack relevant information concerning possible consequences of proposed environmental projects. Despite federal requirements for citizen participation in decisions about proposed roadway projects, no systematic procedures exist for educating citizens as to the possible consequences of such projects. The effects of a consequence analysis procedure on community residents' verbal statements about the favorability of a proposed roadway project were assessed. The consequence analysis procedure involved asking residents to rate the desirability and magnitude of each of 48 possible consequences of the proposed roadway project. Following the intervention, overall ratings of favorability of the project changed for nine of ten residents. Community residents' ratings of the quality of participants' justifications of their position on the roadway issue provided evidence of generalization to this collateral behavior.

Some values guiding community research and action

The dual purposes of applied research-contributing to understanding and improvement-are only partially served by method systems that encourage studying (with increasing precision) a narrow range of questions of modest societal importance. To optimize contributions to challenging societal problems, a field's cherished standards should be adapted to support more adventuresome forms of community research and action. This paper outlines 10 values for community research and action, based on insights from the fields of behavioral and community psychology. These values-reflect the goals and challenges of establishing collaborative relationships with research participants, determining research goals and methods, designing and disseminating interventions, communicating research findings, and advocating for community change. Critical challenges are outlined, and implications for the field and its clients are discussed.

Evaluating municipal policy: an analysis of a refuse packaging program

The effect of a municipal enforcement program to improve residents' packaging of refuse was analyzed in a multiple-baseline design across two areas of a city. The enforcement program involved instruction concerning refuse-packaging regulations, collection only of appropriately packaged refuse, and feedback notices to residents concerning the reasons for noncollection of their inadequately packaged refuse. Both the number of violations and the percentage of residences violating each day were markedly reduced during the enforcement program. Furthermore, sanitation workers considered that the packaging of refuse and the safety and efficiency of refuse collection had improved. This study served as a pilot evaluation of a policy change in the city sanitation department, and was functional in determining the direction of that policy.

Community applications of instructional technology: teaching writers of instructional packages

A community education program, to develop a variety of performance competencies in large numbers of neighborhood residents, requires a technology for preparing learning units administerable by community members themselves. The effects of a writing manual, designed to teach nonprofessionals to prepare such instructional packages, were analyzed in two experiments. Experiment I employed a multiple-baseline design across three university student trainees. The results showed that appropriate program writing increased by 75% after completion of the manual. The results of Experiment II, with two low-income neighborhood residents serving as trainees, showed that packages produced by trained writers resulted in a greater increase in skill activities than sets of training stimuli produced by untrained writers.

Some promising dimensions for behavioral community technology

In recent years, the search for effective and replicable approaches to planned change in communities has escalated. Applied behavior analysts have participated in these efforts to remedy existing community problems and to increase the capacities of community residents to meet their goals. Examples of behavioral technologies for community settings are described and their advantages are noted. Criteria for more contextually appropriate community technologies are suggested and strategies for developing behavioral methods according to these criteria are described. This paper outlines some promising dimensions for behavioral community technology and discusses several possible limitations to a behavioral approach to addressing societal problems.

A review of collaborative partnerships as a strategy for improving community health

Collaborative partnerships (people and organizations from multiple sectors working together in common purpose) are a prominent strategy for community health improvement. This review examines evidence about the effects of collaborative partnerships on (a) community and systems change (environmental changes), (b) community-wide behavior change, and (c) more distant population-level health outcomes. We also consider the conditions and factors that may determine whether collaborative partnerships are effective. The review concludes with specific recommendations designed to enhance research and practice and to set conditions for promoting community health.

Promising community-level indicators for evaluating cardiovascular health-promotion programs

Rigorous evaluation of community-based programs can be costly, particularly when a representative sample of all members of the community are surveyed in order to assess the impact of a program on individual health behavior. Community-level indicators (CLIs), which are based on observations of aspects of the community other than those associated with individuals, may serve to supplement individual-level measures in the evaluation of community-based programs or in some cases provide a lower-cost alternative to individual-level measures. Because they are often based on observations of the community environment, CLIs also provide a way of measuring environmental changes--often an intermediate goal of community-based programs. The Centers for Disease Control and Prevention convened a panel of experts knowledgeable about community-based program evaluation and cardiovascular disease (CVD) prevention to develop a list of CLIs, and rate their feasibility, reliability and validity. The indicators developed by the panel covered tobacco use, physical activity, diet and a fourth group that were considered 'cross-cutting' because they related to all three behaviors. The indicators were subdivided into policy and regulation, information, environmental change, and behavioral outcome. For example, policy and regulation indicators included laws and ordinances on tobacco use, policies on physical education, and guidelines for menu and food preparation. These indicators provide a good starting point for communities interested in tracking CVD-related outcomes at the community level.

A model memorandum of collaboration: a proposal

The authors propose a model memorandum of collaboration for use by state and community partnerships, support organizations, and grantmakers in working together to build healthier communities. Described as an idealized social contract, the model memorandum lays out interrelated responsibilities for the key parties.

The Community Tool Box: a Web-based resource for building healthier communities

Building healthier cities and communities requires an array of community-building skills that are not always taught in formal education. The Community Tool Box (http://ctb.ukans.edu) is an Internet-based resource for practical, comprehensive, accessible, and user-friendly information on community-building, which both professionals and ordinary citizens can use in everyday practice. It connects people, ideas, and resources, offering more than 200 how-to sections and more than 5,000 pages of text.

Effects of a replication of a multicomponent model for preventing adolescent pregnancy in three Kansas communities

CONTEXT

A significant amount of attention has been devoted to the complex issue of teenage pregnancy and to programs for reducing pregnancy among adolescents. Careful evaluations of such programs are needed to ascertain what strategies will be most effective at reducing teenage pregnancy.

METHODS

A pretest-posttest comparison group design was used to analyze the effects of a comprehensive multicomponent school and community intervention on estimated pregnancy rates and birthrates among young people in three Kansas communities: Geary County, Franklin County and selected neighborhoods of Wichita.

RESULTS

There were high levels of program activity in all three communities during the intervention period, including teacher training and sexuality education for students. Survey respondents rated highly such project interventions as the extension of school-linked clinic hours to accommodate student schedules and support groups established in middle schools. Between 1994 and 1997, the proportions of adolescents reporting that they had ever had sex decreased significantly among all ninth and 10th graders in Geary County, from 51% to 38% among females and from 63% to 43% among males. In Franklin County, more males in grades 11 and 12 reported using condoms in 1996 (55%) than had done so in 1994 (39%). Age at first intercourse remained relatively stable in Franklin and Geary counties during the intervention period. The estimated pregnancy rate among adolescents aged 14-17 decreased between 1994 and 1997 in Geary Country, while it increased in comparison areas. The estimated pregnancy rates among 14-17-year-olds decreased in both Franklin County and its comparison communities. The birthrate declined both in one target area of Wichita and in its comparison area from 1991-1993 to 1994-1996. Over the same time period, the birthrate increased in a second target area of Wichita, while it decreased in the comparison community.

CONCLUSIONS

This evaluation of a comprehensive multicomponent program for adolescent pregnancy prevention contributes to our understanding of this model and its replicability in diverse communities. Ongoing program evaluation is important for developing initiatives and for refining strategies so they respond to local conditions.

Evaluating community coalitions for prevention of substance abuse: the case of Project Freedom

In the United States alone, there are more than 2,000 community coalitions to address local concerns about abuse of alcohol, tobacco, and other drugs. This article describes an evaluation system used to examine the process, outcome, and impact of coalitions for the prevention of substance abuse. The evaluation addresses five key questions: (a) Was the community mobilized to address substance abuse (Process)? (b) What changes in the community resulted from the coalition (Outcome)? (c) Is there a change in reported use of alcohol and other substances by youths (Outcome)? (d) Does the coalition have a community-level impact on substance abuse (Impact)? and (e) Is community-level impact related to changes facilitated by the coalition (Impact)? To address these and other questions, using eight core measurement instruments, the evaluation system collects 15 distinct measures. This evaluation system is illustrated with a multiyear study of Project Freedom, a substance abuse coalition in a large midwestern city.

Evaluating a statewide partnership for reducing risks for chronic diseases

We describe a case study evaluation of Kansas LEAN, a statewide partnership with the mission of reducing risks for chronic diseases through dietary and exercise modification. We used a case study design to examine five primary questions related to process and outcome: (a) were the goals of the partnership important to constituents? (process), (b) were constituents satisfied with the partnership (process), (c) were community or systems changes (new or modified programs, policies, or practices) facilitated by partnership efforts (outcome)?, (d) were these changes important to the partnership's mission (outcome)?, and (e) what critical events helped facilitate community changes (outcome)? several measurement instruments--a monitoring and feedback system, constituent surveys, and semistructured interviews--were used to address key evaluation questions. Kansas LEAN is a strong statewide partnership with involvement from key representatives throughout Kansas. It is an ongoing, comprehensive health promotion program that plans and implements multiple components, in a variety of settings, to create awareness, behavior change, and a supportive environment. Kansas LEAN has facilitated several important community or systems changes related to its mission. We conclude with a discussion of the challenges of evaluating partnerships that seek to reduce risks for chronic diseases.

Developing capacities of youth as lay health advisors: a case study with high school students

Youth lay health advising, a form of support or helping, is an important potential resource for preventive intervention. This article describes a case study of a youth lay health advising program designed to provide high school students with support and guidance to handle challenges and concerns related to their health and quality of life. First, the planning, program development, and implementation of the approach are described. Second, a rapid formative evaluation presents quantitative and qualitative information on adolescent issues faced, the types and content of interactions, and peer helper satisfaction with the program. Third, the strengths and challenges of the peer helping program and the role of youth as lay health advisors are discussed. The article concludes with a discussion of the implications for practitioners on this approach to building the capacity of adolescents as lay advisors for community health.

Evaluating the effects of a community coalition's efforts to reduce illegal sales of alcohol and tobacco products to minors

Minors' access to alcohol and tobacco is a major public health concern because of the many deaths and disabilities associated with use and the ease with which minors purchase these products. We evaluated the effects of a community-based substance abuse coalition's efforts to reduce alcohol and tobacco products to minors. The intervention--implemented entirely by coalition members--consisted of adults and minors issuing citations to clerks in supermarkets, convenience stores and liquor stores, who were willing to sell alcohol and tobacco products to minors and issuing commendations to clerks who refused to sell. For those liquor stores receiving the citizen's surveillance, there was a marked decrease in alcohol sales to minors, from 83% to 33%; and in those liquor stores not experiencing the intervention, there was a smaller decrease in alcohol sales, from 45% to 36%. This study's findings suggest that citizen surveillance and feedback may be effective in reducing alcohol sales to minors when the intervention is fully implemented, but may be ineffective, at least in these doses, with tobacco sales.

Health marketing in the supermarket: using prompting, product sampling, and price reduction to increase customer purchases of lower-fat items

Reducing purchase and consumption of higher-fat foods is an important health objective for the nation since these behaviors are associated with cardiovascular disease and some cancers. Public health agents attempt to promote health-related behaviors, such as purchases of lower-fat foods, by changing key features of relevant environments. This study examined the effects of a marketing intervention in a supermarket on customer purchases of lower-fat products. Customers of one store of a major supermarket chain participated in this study. Direct observations of customer purchases of lower-fat milk, salad dressings, and frozen desserts were conducted. The supermarket intervention consisted of prompting, product sampling, and price reduction (store coupons). Using an interrupted time series design with switching replications, we found low to moderate increases for the lower-fat counterparts of milk, frozen desserts, and salad dressing. The greatest increase in purchases was found with frozen desserts. Findings from this study suggest that prompting, product sampling, and price reduction can increase customer purchases of some lower-fat products. Implications of these findings for the development and evaluation of health marketing interventions are discussed.

Using empowerment theory in collaborative partnerships for community health and development

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development.

Promoting the use of advance directives. An empirical study

OBJECTIVE

To examine the effects of a practical method to increase patient completion and filing of advance directives.

METHODS

Randomized controlled trial to examine the effects of structured discussions, information, and mailed reminders on completion of advance directives by internal medicine outpatients.

MAIN OUTCOME MEASURE

Presence of advance directives in patients' medical files. Secondary analyses include (1) participant satisfaction with procedures, (2) data on delayed effects of discussion, and (3) data on discrepancies in patients' completion of forms.

RESULTS

Six months following the intervention, 23% of patients in the experimental group and 3% of patients in the control group had directives on file. The findings were statistically significant. Patients, nurses, and physicians were satisfied with intervention procedures. Chart reviews at 6 weeks and 6 months indicated that intervention effects were delayed.

CONCLUSIONS

Structured discussions and follow-up mailings substantially increased use of advance directives and were time effective and cost-effective.

Home access modifications: effects on community visits by people with physical disabilities

We examined the effects of access modifications to home entrances of people with physical disabilities on their reported community outings. An interrupted time-series design was used, in which the introduction of ramps was staggered across the homes of 6 people with moderate to severe mobility impairments. Four participants reported increases in weekly outings following installation of ramps at their entrances, and 2 reported a small decrease. These findings suggest that reducing the response requirements of access to and from the residence of people with mobility impairments may increase community visits, but may be insufficient given other environmental barriers in the community.

A contextual-behavioral model of empowerment: case studies involving people with physical disabilities

When people with disabilities, ethnic minorities, older adults, women, and others lack power, they usually experience adverse conditions disproportionate to other members of society. Empowerment--the process by which people gain some control over valued events, outcomes, and resources--is an important construct for understanding and improving the lives of people of marginal status. This manuscript presents a contextual-behavioral model of empowerment and its application in collaborative research with people with physical disabilities. The eight case studies illustrate 18 tactics for promoting empowerment that flow from the model. The case studies show the use of different combinations of empowerment tactics in a variety of contexts: (a) setting improvement agendas from the perspective of people with disabilities, (b) enforcing ordinances that preserve access to parking spaces designated for people with disabilities, (c) enabling access to homes through housing modifications, (d) enhancing support available through mutual-aid groups, (e) developing skills for recruiting mentors, (f) promoting self-directed behavior change with personal and health concerns, (g) enhancing skills for personal self-advocacy, and (h) building the capacities of groups of people with disabilities for systems advocacy. Finally, we discuss issues that may contribute to research and action related to empowerment.

An experimental evaluation of an incentive program to reduce serum cholesterol levels among health fair participants

OBJECTIVE

To evaluate the impact of a health fair and incentive program on the reduction of serum cholesterol levels among participants.

DESIGN

Pretest-posttest control group design, with a 6-month delay between pretest and posttest screenings.

SETTING

Health fair program for employees of a large midwestern school district.

PARTICIPANTS

Volunteer sample among persons with serum cholesterol levels above 5.17 mmol/L (200 mg/dL). Participants were randomly assigned to experimental (N = 29) and comparison groups (N = 34).

INTERVENTION

The intervention consisted of four components: a health fair, health risk information, announcement of follow-up screening, and an incentive program. The incentive program consisted of five $100 cash prizes for reducing serum cholesterol levels by 20% or below 5.17 mmol/L (200 mg/dL). The comparison group received only the first three components.

MAIN OUTCOME MEASURE

Serum cholesterol levels were measured by a venipuncture, nonfasting, chemical analysis process.

RESULTS

The experimental group showed a 13.2% reduction in serum cholesterol levels, and the comparison group exhibited an 11.3% reduction (P < .05).

CONCLUSIONS

A health fair, consisting of information on the level of risk and how to reduce risk, and announcement of follow-up screening and incentives can reduce the risk for cardiovascular disease.

A methodology for monitoring and evaluating community health coalitions

Community coalitions are prominent mechanisms for building local capacities to address health and social concerns. Although there are case studies and descriptive reports on coalitions, there is little empirical information about coalition process and outcome. This paper describes a case study using a methodology for monitoring and evaluating community health coalitions. Data are fed back to coalition leaders and members, funding agents, and other relevant audiences as part of the development process. The monitoring system provides data on eight key measures of coalition process and outcome: the number of members, planning products, financial resources generated, dollars obtained, volunteers recruited, services provided, community actions and community changes. Illustrative data are presented for two different community health coalitions. Finally, challenges and opportunities in evaluating community coalitions are discussed.

Reducing risk of pressure sores: effects of watch prompts and alarm avoidance on wheelchair push-ups

People who use wheelchairs are at risk for developing pressure sores. Regular pressure relief, in the form of a wheelchair push-up, is one way to reduce the likelihood of pressure sores. We examined the effects of antecedent (i.e., instructions, audible prompts) and consequent (i.e., alarm avoidance) events on wheelchair push-ups, using a multiple baseline analysis with 2 participants with spina bifida. Results suggest that the combined procedure was more effective than either antecedent or consequent events alone, and there is some evidence suggesting maintenance of effects over time.

Effects of environmental design and police enforcement on violations of a handicapped parking ordinance

This study presents two experiments that evaluate strategies to reduce violations of a handicapped parking ordinance. The first experiment compared effects of upright versus ground handicapped parking signs on percentage of intervals in which cars were parked illegally. Introducing upright signs produced an immediate reduction in the percentage of intervals of inappropriate use of parking spaces. The second experiment examined effects of a police enforcement program on percentage of intervals of inappropriate use of parking spaces and frequency of inappropriately parked cars. Results showed consistent reductions in percentage of intervals of inappropriate use and number of inappropriately parked cars compared with a control site where no enforcement program was introduced. Implications of the research data for law enforcement and public policy are discussed.

Experimental evaluation of public policy: the case of state legislation for child passenger safety

Observations of children in automobiles were made in seven states before and after implementation of legislation requiring use of child passenger safety devices. Increases in safe seating for children covered by state laws and children under 1 year old were observed in three of the five states implementing legislation during this study. Decreases in safe seating for these age groups were observed in two states, however. Increases in safe seating for children from 1 to 5 years old were observed in four of these five states. Although methodological limitations require cautious interpretation, these data suggest the impact child safety seat laws may have on compliance. Implications of this research for policies on child passenger safety and the importance of exploiting naturally occurring public experiments are discussed.

Experimental evaluation of public policy: the case of state legislation for child passenger safety

Observations of children in automobiles were made in seven states before and after implementation of legislation requiring use of child passenger safety devices. Increases in safe seating for children covered by state laws and children under 1 year old were observed in three of the five states implementing legislation during this study. Decreases in safe seating for these age groups were observed in two states, however. Increases in safe seating for children from 1 to 5 years old were observed in four of these five states. Although methodological limitations require cautious interpretation, these data suggest the impact child safety seat laws may have on compliance. Implications of this research for policies on child passenger safety and the importance of exploiting naturally occurring public experiments are discussed.

On differentiation in applied behavior analysis

Distinct types of activity in the field of applied behavior analysis are noted and discussed. Four metaphorical types of activity are considered: prospecting, farming, building, and guiding. Prospecting consists of time-limited exploration of a variety of beaviors, populations, or settings. Farming consists of producing new behaviors in the same setting using independent variables provided by the researchers or normally available in the setting. Building consists of combining procedural elements to create new programs or systems or to rehabilitate aspects of existing programs. Guiding involves pointing out connections between the principles of human behavior and the problems, populations, settings, and procedures with which researchers are (or could be) working. Advantages of each sphere are noted, and benefits of this division of labor to the field as a whole are discussed.

Enhancing leadership skills for community self-help organizations through behavioral instruction

Group members with skills to lead effective meetings are valuable resources of any community organization. The effects of a behaviorally based textbook and training procedures designed to teach members of community self-help groups to chair effective meetings were analyzed. Measures were collected during regularly scheduled meetings on chairperson performance, member participation, and the closure of discussion topics. The results showed that the use of specified chairperson activities increased after training for each of two chairperson trainees. Further, outcome data suggest that more decisions were made. These findings suggest that the chairperson training procedures may enhance the leadership and decision-making resources of community self-help groups.

Creating and using social technologies for community empowerment

Powerlessness appears to be associated consistently with widespread problems of living. Recently, enhancing community empowerment has been suggested as an important emphasis for human service professionals. This manuscript illustrates a role for human service professionals in creating and using social technologies to facilitate empowerment . Seven case studies are presented that represent seven frequently cited goals of empowerment efforts. Finally, the ethics of the empowerment strategy are analyzed and other implications of designing and using empowerment technologies are considered.

Training counseling and problem-solving skills with university students

Often nonprofessionals lack specific instruction in relevant counseling and problem-solving skills. The effects of training procedures on counseling and problem-solving behaviors were examined experimentally with university students. The procedures involved the use of behavioral specifications, rationales, situational examples, study guides, and practice plus feedback on performance. Following training, the average percentage of occurrence of counseling and problem-solving behaviors increased to 89%. Generalization data in sessions with actual clients and expert ratings of the overall quality of counseling provided evidence of generalization to other settings and other evaluative dimensions of counseling and problem-solving performance.

Training counseling skills: an experimental analysis and social validation

A community development perspective suggests the value of using local resources to solve local problems. Two low-income staff of a community service center served as nonprofessional counselors after receiving a training program consisting of written instructions, practice, and performance feedback. The effects of the 40-hour training program were positive for both counseling and problem-solving skills. There was also evidence of generalization of counseling performance across clients, problems, and time. In addition, expert judges' ratings of performance were obtained as a measure of social validity. These findings suggest that the training procedures are effective in enhancing the counseling and problem-solving skills of low-income nonprofessionals.

Behavioral assessment of occupational skills of learning disabled adolescents

Little information is available on the levels of basic living skills of learning disabled adolescents. Using direct observation techniques, this study analyzed the differences in levels of occupational skills between LD youths and their non-LD peers. The results showed low levels of employment-related skills for both groups of high school adolescents. However, the non-LD high school students performed significantly better on the job-related skills than their LD peers. These differences were more marked for nonsocial interaction skills than for social skills. These findings suggest the need for methods of teaching LD youths the skills of finding and retaining employment.