Discussion: Choosing and Using Single-System Design

 
If a Social Worker conducts an intervention that might alter the outcome, the social worker can measure changes in clients’ progress. For example, types of measures can include but are not limited to anxiety, depression, and stress. With these types of measures, you can see and graph results. This design is usually used with one client system (individual, family, or a small group) and is not generalizable to a larger population.
Only by studying a similar client system placed under comparable conditions and combining these results can the social worker draw general conclusions about the intervention and outcome variable for a client system for potential changes. A social worker conducting a single-system design (SSD) research study has similar goals and must follow an organized process to generalize results to the same client system. The results of several successful single-system design studies must be combined for an intervention to qualify as an evidence-based.
This week, you evaluate the applicability and evaluation of a single-system (subject) design and make recommendations to improve that design. Then, you create a proposal for a single-system (subject) research design.

 
Many people receive their first introduction to the scientific method in their early school years. The first experiments which students undertake typically involve plants, chemicals, or small animals in a tightly controlled experimental environment. These experiments enable students to establish a relatively clear cause-and-effect relationship between the outcome of the experiment and the manipulation of the variables.
As soon as a researcher introduces a human element, proving a cause and effect relationship becomes more difficult—as the researcher cannot enact total control of another person even in an experimental environment. Social workers serve clients in highly complex real-world environments. Clients often implement recommended interventions outside of social workers’ direct observation. Yet, evidence-based research calls for social workers to establish cause-and-effect relations between selected interventions and client outcomes as much possible. To meet this challenge, social workers must understand the study designs available to them and all of the variations of that design that can increase the rigor of the experiment and improve the likelihood of verifying a cause-and-effect relationship.
In this week’s case study, you decide whether the social worker in the case study has appropriately chosen a single-system (subject) design and implemented it in such a way that it can be considered an appropriate example of evidence-based research.
To prepare for this Discussion, read the case study Social Work Research: Single Subject and criteria for using single-system (subject) designs as evidence of effective practices in this week’s resources. Consider whether the study design described in the case study will serve the purpose of evaluating the program’s practice approach (case management with solution-focused and task-centered approaches). Consider whether these approaches are well suited to evaluation by the types of measurement used in the study. Consider to what objective measurement the numerical scales used to measure problem-change and task completion corresponds. Consider what new knowledge and evidence for the efficacy of the treatment approaches Chris has generated with her study.

Post an evaluation of the proposed study design described in the case study file. Explain whether the outcome of Chris’ study with her client George would lead you to adopt the model of case management with solution-focused and task-centered approaches, and substantiate your choice. Provide recommendations for improvements should Chris and her colleagues wish to submit the study to the evidence-based practice registry. Include a rationale for your recommendations.

 
Social Work Research: Single Subject
Chris is a social worker in a geriatric case management program located in a midsize Northeastern town. She has an MSW and is part of a team of case managers that likes to continuously improve on its practice. The team is currently using an approach that integrates elements of geriatric case management with short-term treatment methods, particularly the solution-focused and task-centered models. As part of their ongoing practice, the team regularly conducts practice evaluations. It has participated in larger scale research projects in the past.
The agency is fairly small (three full-time and two part-time social work case managers) and is one of several providers in a region of approximately 50,000 inhabitants. Strengths of the agency include a strong professional network and good reputation in the local community as well as the team of experienced social workers. Staff turnover has been almost nonexistent for the past 3 years. The agency serves about 60–70 clients at any given time. The clients assisted by the case management program are older adults, ranging from their early 60s to over 100 years of age, as well as their caregivers.
To evaluate its practice approach, the team has decided to use a multiple-baseline, single-subject design. Each of the full-time case managers will select one client new to the caseload to participate in the study. The research project is explained to clients by the respective case manager and informed consent to participate is requested.
George was identified by Chris as a potential candidate for the evaluation. As a former science teacher who loved to do research himself, he agreed to participate in the project. George is 87 years old, and although he is not as physically robust as he once was, at 5 feet 9 inches tall, he has a strong presence. He has consistent back pain and occasional flare-ups of rheumatoid arthritis. His wife of 45 years passed away two summers ago after a long fight with cancer. After his initial grief, he has managed fairly well to adapt to life on his own. George entered the program after being hospitalized for fainting while at the grocery store. A battery of medical tests was conducted, but no specific cause of his fainting attack could be found. However, the physicians assessed signs of slight cognitive impairments/dementia and suggested a geriatric case management program.
An initial assessment by the case manager showed the need for assistance in the following areas: 1) personal care, 2) decrease in mobility, and 3) longer-term planning around living arrangement and home safety. The case manager also thought that George could benefit from setting up advance directives, which he did not want to discuss at that time. They agreed that the case manager could bring this topic up again in the future.
As part of the practice process, the case manager used clinical rating scales that were adapted from the task-centered model. At the beginning of each client contact, case manager and client collaboratively evaluated how well the practice steps (tasks) undertaken by client and/or case manager were completed using a 10-point clinical scale. Concurrently, they evaluated changes to the respective client problems, also using a 10-point clinical scale. George was able to actively participate in the planning and implementation of most care-related decisions. During the course of their collaborative work, most needs were at least partially addressed. Two tasks were completed regarding personal care, two regarding mobility, and three addressing home safety issues. Only personal mobility was still a minor problem and required some additional work.
After finishing the reassessment at 3 months, Chris completed gathering and evaluating the data for the single-subject design (SSD). As promised, she also provided George with the finished SSD findings. The following is an overview of the data that was collected for this case:
Plummer, Sara-Beth, Sara Makris, Sally Brocksen. Social Work Case Studies: Concentration Year. Laureate Publishing, 10/21/13. VitalBook file.

 Single-Case (SC) Design • Used to evaluate the effect of interventions or policy changes on individual cases or systems • Sample size is one (one person, couple, family. E.g.) • Repeated measures are taken of a target problem before and during the implementation of an intervention • The phase that occurs before intervention is called the baseline phase (it is a control phase; we use it to assess the extent of the problem before intervention) • We compare data patterns collected during the baseline phase with the patterns observed during the intervention phase • The baseline phase is referred to as phase A: Help establish nature and extent of problem • The intervention phase is referred to as phase B: Enables us to establish a goal for intervention (e.g., to decrease problem A from X to Y times/day) • Goal: Stable pattern during baseline; trend during intervention • Stability during baseline helps us control for threats to internal validity that refer to processes that were underway before treatment begins (maturation, reactivity, and regression toward the mean)