The need to monitor the standards of care provided in settings for the long term psychiatrically disabled has become increasingly recognized. A critical review of the literature indicated that no comprehensive assessment procedure existed for settings providing some form of rehabilitation. However, five important aspects of care in each setting were identified: (i) Treatment Practices, (ii) Unit Management Practices, (iii) Community Contact Practices, (iv) The Physical Environment and (v) Staffing Resources.

A series of questionnaires was devised—The Model Standards Questionnaires—to assess each of these aspects of care. The questionnaires can be used to provide a profile of particular settings quality of rehabilitation and as a means of identifying how the quality of that rehabilitation might be improved.

The research comparing imaginal and in vivo exposure in the treatment of clinically significant fear, recently reviewed by James (1986), is reexamined from the perspective of bioinformational theory and the concept of emotional processing. Fear is assumed to be stored in long term memory as a network of propositionally-coded information, which has to be processed if treatment is to be successful. Emotional processing is indicated by activation of fear responses and their habituation within and across treatment sessions. Consistent with the theory, our review indicates that successful treatment via imaginal and in vivo exposure is indeed related to activation and habituation of fear responses; interference with processing has a negative impact upon fear reduction, regardless of the specific treatment techniques employed. Furthermore, some apparently discrepant findings in the available research literature can be understood in terms of the theories cited. These ideas provide a useful perspective from which to plan future research efforts and to advance our understanding of the processes underlying reduction of pathological fear.

A behaviourally based Programme was developed to assist parents with problem children. The Programme was intended for the typical social service clientele of single parent, low income or state benefit families and may be administered by social workers or assistants conversant with the Programme Manual. The Programme consists of six 90 min sessions run at weekly intervals during which a variety of behavioural techniques are taught, largely through role play, with a seventh follow up session a month later.

The Programme was evaluated by a range of before and after measures on both a treatment group and a waiting list control group and maintenance of treatment gains was tested at three and, for some measures, six months interval. The Programme significantly reduced: the perceived number and intensity of child behaviour problems; parental depression, inward irritability and outward irrirability; and the level of perceived chlid conduct problems, impulsivity and anxiety. It significantly improved parents' chlid management skills. Improvement in parental depression and irritability was maintained at three months and reduction in chlid beviour problems was tested for and found at both three and six months.

A schizophrenic patient and his family were provided with a nine month multi-component behavioural intervention programme as part of a controlled study. The patient was at high risk of relapse according to the High EE status of his parents. Multiple outcome measures were used to assess the efficacy of the programme. The components of the intervention are described in detail, and the specificity of component effects in this case are examined. Given the methodological limitations of this type of study, it is not possible to demonstrate conclusively intervention effects in the case reported. However, following the intervention the relapse rate of the patient was reduced, his social functioning improved and the EE status of his parents changed from High to Low.

A male gymnast who had represented his country in Olympic gymnastics and had developed a maladaptive mental approach to performing on the pommelled horse in competition was given stress inoculation training in order to help him overcome his difficulties. Preliminary interviews revealed that immediately before competing he became very tense, his arms started to shake and he had doubts about being able to complete his routine. In addition, he was unable to use visualization, a technique which he used for mental preparation on the other five pieces of apparatus in Olympic gymnastics competitions. Further interviews also strongly suggested that the subject had developed an unconscious set of negative self-statements. An intervention programme comprising 12 sessions of training in relaxation, visualization and making positive self-statements was implemented. Recorded interviews and comments made by the subject on completion of the training indicated that the programme had been successful. For many years the subject had experienced problems performing on the pommelled horse and he had frequently suffered falls in competition. Towards the end of the stress management training programme his performance began to improve. He also became more confident and he used his stress coping skills in competition. In the National Championships he was able to relax, visualize his routine and make positive self-statements. Shortly after this competition he successfully completed his routine to a high standard without any falls to win the individual title in the Midlands Regional Championships. In a subsequent international match he again successfully performed his routine to a high standard.