Assignment: Creating a Single-System (Subject) Design Study

The steps at the heart of single-system (subject) research are part of the everyday practice of social work. Each day social workers implement interventions to meet clients’ needs and monitor results. However, conducting proper single-system (subject) research entails far more than these simple day-to-day practices. Proper single-system research requires a high degree of knowledge and commitment. Social workers must fully understand the purpose of single-system (subject) research and the variations of single-system (subject) design. They must develop a hypothesis based upon research and select the right design for testing it. They must ensure the reliability and validity of the data to be collected and know how to properly analyze and evaluate that data. This assignment asks you to rise to the challenge of creating a proposal for a single-subject research study.

To prepare for this Assignment, imagine that you are the social worker assigned to work with Paula Cortez (see the case study, “Social Work Research: Single Subject” in this week’s resources). After an initial assessment of her social, medical, and psychiatric problems, you develop a plan for intervention. You also develop a plan to monitor progress in your work with her using measures that can be evaluated in a single-system research design. As a scholar practitioner, you rely on research to help plan your intervention and your evaluation plan.

Complete the Cortez Family interactive media in this week’s resources. Conduct a literature search related to the chronic issues related to HIV/AIDS and bipolar mental disorder. Search for additional research related to assessing outcomes and theoretical frameworks appropriate for this client. For example, your search could include terms such as motivational interviewing and outcomes and goal-oriented practice and outcomes. You might also look at the NREPP database identified in Week 1, to search for interventions related to mental health and physical health.

By Day 7

Submit a 5- to 7-page proposal/research plan for single-system (subject) evaluation for your work with Paula Cortez. Identify the problems that you will target and the outcomes you will measure, select an appropriate intervention or interventions (including length of time), and identify an appropriate evaluation plan.

Include a description of:

  • The problem(s) that are the focus of treatment
  • The intervention approach, including length of time, so that it can be replicated
    • A summary of the literature that you reviewed that led you to select this intervention approach
  • The purpose for conducting a single-system (subject) research evaluation
  • The measures for evaluating the outcomes and observing change including:
    • Evidence from your literature search about the nature of the measures
    • The validity and reliability of the measures
    • How baseline measures will be obtained
    • How often follow-up measures will be administered
  • The criteria that you would use to determine whether the intervention is effective
  • How the periodic measurements could assist you in your ongoing work with Paula

Required Readings

Dudley, J. R. (2014). Social work evaluation: Enhancing what we do. (2nd ed.) Chicago, IL: Lyceum Books.
Chapter 9, “Is the Intervention Effective?” (pp. 226-244: Read from “Client Satisfaction & Effectiveness” to “Target Problem Scale”)

Document: Corcoran, K., & Hozack, N. (2010). Locating assessment instruments. In B. Thyer (Ed.), The handbook of social work research methods (2nd ed., pp. 65–74). Thousand Oaks, CA: Sage. (PDF)
Copyright 2010 by Sage Publications, Inc.
Reprinted by permission of Sage Publications, Inc. via the Copyright Clearance Center.

Document: Mattaini, M. A. (2010). Single-system studies. In B. Thyer (Ed.), The handbook of social work research methods (2nd ed., pp. 241–273). Thousand Oaks, CA: Sage. (PDF)
Copyright 2010 by Sage Publications, Inc.
Reprinted by permission of Sage Publications, Inc. via the Copyright Clearance Center.

Plummer, S.-B., Makris, S., & Brocksen S. (Eds.). (2014b). Social work case studies: Concentration year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
Read the following section:
“Social Work Research: Single Subject” (pp. 70–72)

Tankersley, M., Cook, B. G., & Cook, L. (2008). A Preliminary Examination to Identify the Presence of Quality Indicators in Single-subject Research. Education & Treatment of Children, 31(4), 523-548

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:

Paula Cortez 

Identifying Data: Paula Cortez is a 43-year-old Catholic Hispanic female residing in New York City, NY. Paula was born in Colombia. When she was 17 years old, Paula left Colombia and moved to New York where she met David, who later became her husband. Paula and David have one son, Miguel, 20 years old. They divorced after 5 years of marriage. Paula has a five-year-old daughter, Maria, from a different relationship. Presenting Problem: Paula has multiple medical issues, and there is concern about whether she will be able to continue to care for her youngest child, Maria. Paula has been overwhelmed, especially since she again stopped taking her medication. Paula is also concerned about the wellness of Maria. Family Dynamics: Paula comes from a moderately well-to-do family. Paula reports suffering physical and emotional abuse at the hands of both her parents, eventually fleeing to New York to get away from the abuse. Paula comes from an authoritarian family where her role was to be “seen and not heard.” Paula states that she did not feel valued by any of her family members and reports never receiving the attention she needed. As a teenager, she realized she felt “not good enough” in her family system, which led to her leaving for New York and looking for “someone to love me.” Her parents still reside in Colombia with Paula’s two siblings. Paula met David when she sought to purchase drugs. They married when Paula was 18 years old. The couple divorced after 5 years of marriage. Paula raised Miguel, mostly by herself, until he was 8 years old, at which time she was forced to relinquish custody due to her medical condition. Paula maintains a relationship with her son, Miguel, and her ex-husband, David. Miguel takes part in caring for his half-sister, Maria. Paula does believe her job as a mother is to take care of Maria but is finding that more and more challenging with her physical illnesses. Employment History: Paula worked for a clothing designer, but she realized that her true passion was painting. She has a collection of more than 100 drawings and paintings, many of which track the course of her personal and emotional journey. Paula held a fulltime job for a number of years before her health prevented her from working. She is now unemployed and receives Supplemental Security Disability Insurance (SSD) and Medicaid. Miguel does his best to help his mom but only works part time at a local supermarket delivering groceries.  Paula currently uses federal and state services. Paula successfully applied for WIC, the federal Supplemental Nutrition Program for Women, Infants, and Children. Given Paula’s low income, health, and Medicaid status, Paula is able to receive in-home childcare assistance through New York’s public assistance program.

Social History: Paula is bilingual, fluent in both Spanish and English. Although Paula identifies as Catholic, she does not consider religion to be a big part of her life. Paula lives with her daughter in an apartment in Queens, NY. Paula is socially isolated as she has limited contact with her family in Colombia and lacks a peer network of any kind in her neighborhood. Five (5) years ago Paula met a man (Jesus) at a flower shop. They spoke several times. He would visit her at her apartment to have sex. Since they had an active sex life, Paula thought he was a “stand-up guy” and really liked him. She believed he would take care of her. Soon everything changed. Paula began to suspect that he was using drugs, because he had started to become controlling and demanding. He showed up at her apartment at all times of the night demanding to be let in. He called her relentlessly, and when she did not pick up the phone, he left her mean and threatening messages. Paula was fearful for her safety and thought her past behavior with drugs and sex brought on bad relationships with men and that she did not deserve better. After a couple of months, Paula realized she was pregnant. Jesus stated he did not want anything to do with the “kid” and stopped coming over, but he continued to contact and threaten Paula by phone. Paula has no contact with Jesus at this point in time due to a restraining order. Mental Health History: Paula was diagnosed with bipolar disorder. She experiences periods of mania lasting for a couple of weeks then goes into a depressive state for months when not properly medicated. Paula has a tendency toward paranoia. Paula has a history of not complying with her psychiatric medication treatment because she does not like the way it makes her feel. She often discontinues it without telling her psychiatrist. Paula has had multiple psychiatric hospitalizations but has remained out of the hospital for the past 5 years. Paula accepts her bipolar diagnosis but demonstrates limited insight into the relationship between her symptoms and her medication. Paula reports that when she was pregnant, she was fearful for her safety due to the baby’s father’s anger about the pregnancy. Jesus’ relentless phone calls and voicemails rattled Paula. She believed she had nowhere to turn. At that time, she became scared, slept poorly, and her paranoia increased significantly. After completing a suicide assessment 5 years ago, it was noted that Paula was decompensating quickly and was at risk of harming herself and/or her baby. Paula was involuntarily admitted to the psychiatric unit of the hospital. Paula remained on the unit for 2 weeks. Educational History: Paula completed high school in Colombia. Paula had hoped to attend the Fashion Institute of Technology (FIT) in New York City, but getting divorced, then raising Miguel on her own interfered with her plans. Miguel attends college full time in New York City. Medical History: Paula was diagnosed as HIV positive 15 years ago. Paula acquired AIDS three years later when she was diagnosed with a severe brain infection and a Tcell count of less than 200. Paula’s brain infection left her completely paralyzed on the right side. She lost function in her right arm and hand as well as the ability to walk. After a long stay in an acute care hospital in New York City, Paula was transferred to a skilled nursing facility (SNF) where she thought she would die. After being in the skilled nursing facility for more than a year, Paula regained the ability to walk, although she does so with a severe limp. She also regained some function in her right arm. Her right hand (her dominant hand) remains semi-paralyzed and limp. Over the course of several years, Paula taught herself to paint with her left hand and was able to return to her beloved art. Paula began treatment for her HIV/AIDS with highly active antiretroviral therapy (HAART). Since she ran away from the family home, married and divorced a drug user, then was in an abusive relationship, Paula thought she deserved what she got in life. She responded well to HAART and her HIV/AIDS was well controlled. In addition to her HIV/AIDS disease, Paula is diagnosed with Hepatitis C (Hep C). While this condition was controlled, it has reached a point where Paula’s doctor is recommending she begin a new treatment. Paula also has significant circulatory problems, which cause her severe pain in her lower extremities. She uses prescribed narcotic pain medication to control her symptoms. Paula’s circulatory problems have also led to chronic ulcers on her feet that will not heal. Treatment for her foot ulcers demands frequent visits to a wound care clinic. Paula’s pain paired with the foot ulcers make it difficult for her to ambulate and leave her home. Paula has a tendency not to comply with her medical treatment. She often disregards instructions from her doctors and resorts to holistic treatments like treating her ulcers with chamomile tea. When she stops her treatment, she deteriorates quickly. Maria was born HIV negative and received the appropriate HAART treatment after birth. She spent a week in the neonatal intensive care unit as she had to detox from the effects of the pain medication Paula took throughout her pregnancy. Legal History: Previously, Paula used the AIDS Law Project, a not-for-profit organization that helps individuals with HIV address legal issues, such as those related to the child’s father . At that time, Paula filed a police report in response to Jesus’ escalating threats and successfully got a restraining order. Once the order was served, the phone calls and visits stopped, and Paula regained a temporary sense of control over her life. Paula completed the appropriate permanency planning paperwork with the assistance of the organization The Family Center. She named Miguel as her daughter’s guardian should something happen to her. Alcohol and Drug Use History: Paula became an intravenous drug user (IVDU), using cocaine and heroin, at age 17. David was one of Paula’s “drug buddies” and suppliers. Paula continued to use drugs in the United States for several years; however, she stopped when she got pregnant with Miguel. David continued to use drugs, which led to the failure of their marriage. Strengths: Paula has shown her resilience over the years. She has artistic skills and has found a way to utilize them. Paula has the foresight to seek social services to help her and her children survive. Paula has no legal involvement. She has the ability to bounce back from her many physical and health challenges to continue to care for her child and maintain her household.

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