Models of change should be broadened so that treatment is seen as a complex system of parts, facilitating a nexus of cognitive, social and behavioural changes, embedded within a broader system of events and processes catalysing change. Such a model helps explain the relative absence of between-treatments outcome differences in UKATT and in the alcohol problems treatment and more general psychotherapy research literatures.

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Through the use of an illustrated story-pair technique, kindergarten, secondgrade, fourth-grade, and college subjects were asked to make attributions in a way that called for the use of the multiple sufficient cause schema, one of the schemata defined in Kelley's attribution theory. The results indicated that the kindergarteners did not use the schema (or any other systematic mode of attribution), whereas the responses of the fourth-graders and the college subjects were overwhelmingly consistent with use of the schema. The secondgraders fell in between these two extremes. Close inspection of the fourth-grade and college data, however, suggested that they may have been generated by two somewhat different attribution processes-the college data by a true use of the schema and the fourth-grade data by a simpler, more primitive process which was presented and discussed.

Implementation of the resultant AN-SNAP classification has been proceeding since 1998 in some Australian jurisdictions. The development and implementation of a classification such as AN-SNAP provides the possibility of having a consistent approach to collecting palliative care data in Australia as well as a growing body of experience on how to progressively improve the classification over time.

No abstract