Synopsis Proforma for Registration of Subject For

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SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Mrs. SAI LEKSHMI S B

FIRST YEAR M.SC (NURSING)

PSYCHIATRIC NURSING

YEAR 2012-2013

INDIAN ACADEMY COLLEGE OF NURSING

HENNUR CROSS, HENNUR MAIN ROAD

BANGALORE – 560 043

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

FOR

DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Mental retardation is a condition that affects thoughts, feelings or behaviors of someone. Who is strong enough to make social integration problematic, or cause personal suffering, leading to personality change and experience , while most people don’t know and don’t understand the feelings you’re experiencing. With increasing age the depression phase became more frequent and longer, so that increases the risk of suicide. Disposition of genetic and biological factors associated with environmental factors thought to be the cause. In a social or academic setting, children are expected to possess a relatively independent mastery of basic social skills, such as maintaining personal space, using an appropriate voice volume, and complying with instructor direction. Children with mental retardation frequently display a myriad of difficulties with such skills, accompanied by other inappropriate behaviors. These behaviors often hinder functioning in academic or social settings and may include hitting screaming, biting, and/or invading personal space. Mental retardation makes a person incapable of living an independent life. In India, family bears the main burden of caring for such persons unlike in the developed world. It is highly prevalent and highly disabling condition.1

Token economies are a system of reinforcement that provides children with a tangible reward for specific behaviors. These rewards or “tokens,” may accumulate so the child may exchange their tokens for a reinforcing item or activity. Token economies have shown to be an effective intervention for decreasing inappropriate behaviors. Token economies have been applied in a wide range of settings. While there are several advantages to the use of this procedure, there are obstacles that may impede its implementation and therapeutic efficacy. These include: staff training, client resistance, circumvention of the contingencies, and non-responsiveness of subjects. Studies employing token programs with psychiatric patients, retardates, children in classroom settings, delinquents, and autistic children are reviewed. Although token economies are successful while in operation, the issue of generalization of behavior gains or resistance to extinction has not been given careful consideration. Inasmuch as generalization is perhaps the most crucial issue, several procedures are presented that are designed to facilitate maintenance of performance when reinforcement is withdrawn. Methodological suggestions for investigations on token reinforcement in applied settings are presented.2

The objective of this study was to investigate the effects of a token economy system in comparison to social praise on the manifest behaviors of learning disabled students at an elementary school in Bangalore. The null hypothesis of this study was that there would be no significant difference between a token economy system in comparison to social praise on the manifest behaviors of learning disabled students Token economy have been used in class room setting as a reward system and it is based more around behavioral modification of mentally disable children3.

6.1 NEED FOR THE STUDY

Mental retardation frequency described as a black plague of the eighties or the modern epidemic has become an important and major issue. The main objective of this study was to assess andompare the prevalence of a wide range of emotional and behavioral problems in mentally retarded children with and without intellectual disability children with sever impairment of social interaction, abnormalities of language development involving both speech and behavioral problems consisting mainly of repetitive stereotypic active4.

An estimated 10% of the world’s population experiences some form of disability or impairment (WHO Action Plan 2006-2011). The term ‘disability’ has many different meanings; the Global Burden of Disease (GBD) however, the number of people with disabilities is increasing due to population growth, ageing, emergence of chronic diseases and medical advances that preserve and prolong life, creating overwhelming demands for health and rehabilitation services (Srivastava and Khan 2011). In South-east Asia, the prevalence of mental retardation ranges from 1.5 – 21.3% of the total population, depending on definition and severity of disability (Mont 2007). Despite the increase in prevalence of disability worldwide, due to various reasons, not much attention has been paid to its evaluation, management and prevention (WHO 2002). It is generally considered that 3% of the World population constitutes persons with mental retardation. In 2005, the prevalence rate of mental retardation in India varies from 0.2 to 32.7 per 1000 population. In the year 2008, in India, more than 20 million children are suffering with mental retardation.3In Karnataka, there are around 9.4 lakh mentally retarded persons and out of them 3.67 lakh are children, these children are being taught in 210 private schools where there are 1500 special educators5

The proposed study is a systematic replication of research conducted in 2012. Token economies are used with individual students or a group of students. "Token economies have been used with an astonishing wide range of populations and age groups and in numerous educational treatment settings. The behaviors displayed by student with, interfere with the learning process. These behaviors do not lead to success limited, recent research is available that evaluated the effects of token economies combined with responses cost procedures on high school students exhibiting emotional and behavioral disabilities that currently reside and are receiving therapeutic treatment in a state run psychiatric hospital. Ward (2011) conducted a similar research study and determined that a token economy with embedded response cost is an effective intervention procedure in world wide identified as emotional and behaviorally disordered in a large public high school located in the Midwest6

In India the increasing use of token economies has been warranted by its impressive results in altering a wide range of behaviors with diverse treatment populations. However, a close examination of the literature reveals a relatively consistent percentage of treatment failures. Evidence is reviewed which demonstrates that the failure of some patients to respond to the token economy has laboratory precedents. Possible explanations for unresponsiveness of patients to token reinforcement are entertained. The implications for the operant paradigm represented by these failures are discussed. Finally, several solutions are suggested to decrease the number of patients who fail to respond7

A review of an experimental program offering psychotherapy with mentally retarded children in Bangalore the article considers the rationale of offering psychotherapy to these children a psychiatric division of mentally retarded children in terms of the absence, presence and type of emotional and behavioral disorders, and the basis of selection of these children it includes a brief discussion of the modifications of usual modes of token economy for adaptation to this group.In the last decade, the token economy has been extended widely across populations and behaviors in treatment, rehabilitation, and community settings. Outcome research has expanded as well to include large-scale program evaluations and comparative and combined treatment studies of the token economy. In a previous review (Kazdin & Bootzin, 1972), several obstacles were identified for the effective application of the token economy. 8

These included identifying procedures to enhance program efficacy, to train staff, to overcome client resistance, and to promote long-term maintenance and transfer of training. New issues have become salient in the last decades that pertain to the extension of the token economy to institutional settings. The investigator interested in this study because mentally retarded children could able to cope with token economy .The positive results motivated the researcher to conduct such a study9

6.2 REVIEW OF LITERATURE

The review of literature is defined as a broad comprehensive, in depth systematic and critical review of scholarly publications, unpublished scholarly print materials, audio visual material and personal communication .Review of literature is an important step in the development a research project. It involves the systemic identification, factors and summary of written materials that contain information on research. Review of literature refers to an extensive, exhaustive and systematic examination of publications relevant to the study , It Is an essential part of every research ,which helps to support the hypothesis under the study and critically analyze the structure and content of the research report.

For the present study the review of literature is organized under the following headings.

1:- Studies related to behavioral problems in mentally retarded children

2:- Studies related token economy

3:- Studies to the effectiveness of token economy

1:- Studies related to behavioral problems in mentally retarded children Ayllon in 2008 reported a token economy in a psychiatric child health care centre in Ireland he assessed that children anger at the system and rejection of tokens also many of the reinforced activities seem puerile eg; games, crafts, child likes parties this shown higher rate of score in class rooms However important qualifies need to be high lighted to place the follow-up data. 10

Jennifer R. Bailey, in 2011 University of Mississippi, Room conducted a study to assess the effect of token economy program in a foster care facility manner, This case study describes with the an’ ongoing efforts to institute a token program in a foster care facility. Adjustment problems and oppositional behavior in the residential as well as class room prompted the facility to contract for consultative token economy therapy services. Consultants spent approximately 20 hr a week in to observe resident–caregiver interactions; he designed a comprehensive token program targeting inappropriate child behavior, and training and monitoring implementation of the program. Although the study reported a increased level of behavioral modification and defiant behave. .11

Johnny L Matson in 2011 comparative study done at England between mentally retarded children of 5-10 years. The objective of the study was to find out the gender differences in incidences and intensity of behavioral variations amongst children. Incidental purposive sampling technique was used in the selection of the tokens. The obtained results were statistically. The results revealed that considerable amount of therapy prevailed amongst the sample. It was seen that girls on the whole had more intensity of behavioral variation in compare to boys12

Jessica A Boisjoli in 2007 a co -relational study done by is to assess efficiency of children in token economy therapy among mentally retarded children with behavioral problems in Santander, Iran. The respondents comprised of 400 students. Questionnaire was used for data collection which includes efficiency of children .to select tokens according to therapy. Result shows that there is a significant variation in selection. In addition, there is a significant difference between male and female child whereby female shows higher in their behavioral problems. 13

Orji Tobias in 2011 a survey conducted by on local schools at Nigeria of 198 students participated. There was a significant variation in student’s behavior of course. Approximately 44%student experienced behavioral problems during test. A Spearman correlation analysis indicated that children of course were positively correlated with therapy Student’s ability to manage time was however negatively correlated with test. Further, student age was significantly associated with male students reporting less behavioral problems compare to female student26 A comparative study done by Kayak and Rao in 2010 in India conducted by among school students, and to a comparison group of 471 high school and upper primary students. Fully 40% of were found to have high greed behavioral problem, versus 17% of students in the comparison populations. Statistically, a behavioral problem was found to be significantly higher for high school students compared to other student. The calibration for the Westside scale appears to be similar to that of other widely used scales. in all, 60% of students had moderately high level problem or higher14

2:- Studies related token economy

Tar box, Ghezzi, and Wilson (2006), in a study conducted by in USA the effects of token economies on young child with mental retardation were investigated. A token reinforcement program was designed to increase attending (eye-contact for 3 seconds) to a tutor in a day treatment center. The student aimed to earn 10 tokens to exchange for a reinforce of a 90 second break from the activity. During the subsequent condition, 5 tokens were added to the initial 10 tokens needed. However, during conditions where the student did not receive a break, and when their reward was delayed, there was a decline in the appropriate behavior of attending15

Lhiegbuten in 2010 at Nigeria conducted a study to effectiveness of token economy therapy he developed token economy in several element in class room training included the opportunities for role playing, model making, and feed back, The progress was quite effective and which produce marked changes in first training of staff implement the treatment was extensive in altering student department. 16

Alan.E. Kazdin in 1982 conducted a study to evaluate the efficacy of token economy therapy in class room settings at Europe ,he has expanded as well as included large scale program evaluation comparative and combined treatment .The study has been implemented in kinder gradate through 3rd grad Research has examined whether particular client variable contribute to response .Considerable evidence exists that children who do not respond initially to the program respond some alterations are made in the contingencies. 17

Melvin in 2007 did a study from the in caption of token economy, several methods have been evaluated and include variations of instructions, modeling and role playing in selected 9 schools from Boreal and informative feed back and direct reinforcement using approval and attention, special privileges or tokens such as money trading stamps.Results indicate the use of token economy is generally perceived to be effective as a treatment for mild and moderate psychological difficulties. 18