client and clinician can have a common understanding and reference point for measuring change (Bickman et al., 2016). The process of measuring change can take several forms, typically either individualized clinician-developed measurements based on client goals or standardized instruments that can be borrowed from published data (Lewis et al., 2015). An outcome evaluation starts when the clinician asks how she can help her client reduce particular symptoms, such as depressive symptoms, social isolation, or anxiety (Lewis et al., 2015). From that first question, and despite the obstacles discussed previously, the clinician should consult the literature about current treatments for the symptom (e.g., hopelessness, social isolation, anxiety, or a combination of symptoms). This literature can be found on government websites (e.g., the National Institute of Mental Health [www.nimh.nih.gov] or the National Institutes of Health [www.nih.gov]) or other professional websites. The clinician can determine from the literature which treatments show effectiveness, which fit with the client’s situation, and which will work within the context of the clinician’s practice (i.e., it is determined that the clinician is competent and otherwise able to perform the intervention; Lewis et al., 2015). When an appropriate intervention is identified, the clinician can begin to design a way to evaluate the client's progress. One way to measure clinical progress is to use a single- system design (Graham et al., 2013). Single-system designs differ from randomized control designs that are found in large empirical studies in that a single client is evaluated at a time (Graham et al., 2013). Single-system designs can also be used to evaluate single entities, such as a group, neighborhood, community, or state. However, for the scope of this section, the term refers to the practice evaluation of one client (Graham et al., 2013). A single- system design , also known as a single-subject design , is a time-series design that measures clinical progress from the pre-intervention phase (also called the baseline ) to the intervention phase to the post-intervention phase (Graham et al., 2013). There are several specific designs from which a clinician can choose. The following examples will illustrate the different types of designs (Graham et al., 2013): “During the intake session, the clinician suspects that the client is experiencing a depressive episode. The clinician gives the client the Beck Depression Inventory (BDI), which confirms that the client is depressed. The score for the BDI is the baseline measure because the treatment has not yet begun (A = a measurement with no treatment given). The clinician knows from reading the literature that a cognitive-behavioral approach may be effective in reducing the depressive symptoms. Once the
baseline measure of depression is determined (A), the client continues to come to therapy once a week for an hour. The score of the BDI during the fourth session is determined (B). This simple design is called an AB design , with A symbolizing the BDI score without treatment and B symbolizing the measure of the BDI with treatment.” The following example illustrates an ABAB design: A measurement of the BDI given at baseline (A); treatment begins (B); a temporary cessation of treatment (A); then a measurement after the resumption of treatment (B): • The clinician uses the BDI to identify a client’s level of depression before treatment begins (A). • After four weeks of therapy, the therapist takes another measure of the client’s depression (B) and continues therapy. • The client tells the clinician that she is going on vacation for three weeks (i.e., temporary cessation of treatment). At the first session, when the client returns, a measure of depression is taken because there has been no therapy in the last three weeks (A). • Therapy resumes. Four weeks later, the client retakes the inventory (B). • The clinician and client compare the four scores—the baseline measure before therapy begins (A), the four- week mark during therapy (B), when the client returns after three weeks without treatment (A), and four weeks after therapy resumes (B). There are other types of single-system designs, such as ABAC, that take a baseline measurement of the depressive symptoms, begin an intervention, remove the intervention for a period of time, and then introduce a new intervention (Graham et al., 2013). Still another design, the ABBBB, takes a baseline measurement of depressive symptoms, adds the intervention, and then increases the intensity of the intervention to see if depressive symptoms abate (Graham et al., 2013). A clinician can select the single-system design that is most appropriate for the client, given the current context and circumstances. Another measure to use in clinical practice is the Goal Attainment Scale (GAS; Bard-Pondarré, 2023). One advantage to using the GAS is that the dimensions of measurement are not predetermined as they are in a standardized measure (Bard-Pondarré, 2023). The dimensions for assessment evolve from a discussion and consensus about the goals between the clinician and the client (Bard-Pondarré, 2023). The client and clinician can determine the desired goals to be met and the weight or importance to the client’s life the achievement of each goal should have. Table 7 is an example of the Goal Attainment Scale form (Bard-Pondarré, 2023).
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Book Code: PCIL1525
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