Suppose you’re asked to evaluate the outcomes of your chosen EBP intervention on your client, Paula, from Week 1. 

Paula Cortez was diagnosed with HIV, Bipolar Disorder, and is pregnant. She quit taking her medications and has not gotten out of bed for days. Paula’s unborn child, medical and psychiatric needs are decompensating. According to the NASW Code of Ethics (2021), “Social workers limit clients’ right to self-determination when, in the social workers’ professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others”.
How would you do so? Which single-subject design (e.g., AB, ABC, ABAB, BAB) would you choose and why?

ANSWER

Evaluating the Outcomes of an EBP Intervention for Paula Cortez: A Single-Subject Design Approach

Introduction

Paula Cortez, a client diagnosed with HIV, Bipolar Disorder, and currently pregnant, presents a complex case that demands a careful evaluation of the outcomes of the Evidence-Based Practice (EBP) intervention implemented during the past weeks. Paula’s decision to discontinue her medications and her deteriorating medical and psychiatric condition, including her pregnancy, requires a critical assessment of the intervention’s effectiveness. In line with the NASW Code of Ethics (2021), social workers must consider limiting clients’ right to self-determination when their actions pose a serious, foreseeable, and imminent risk to themselves or others. In this context, we will explore the use of a single-subject design to evaluate the outcomes of the intervention.

Choosing a Single-Subject Design

Single-subject designs are well-suited for situations involving individual clients, as they allow for the systematic and repeated measurement of the client’s behavior over time. In Paula’s case, we are dealing with a complex set of conditions and circumstances that necessitate close monitoring and assessment. Among the various types of single-subject designs (AB, ABC, ABAB, BAB), the ABAB design would be most appropriate in this scenario.

Rationale for Choosing the ABAB Design

Baseline Measurement (A): In the ABAB design, the first phase (A) involves a baseline measurement where we collect data on Paula’s behavior and condition before the intervention. This phase helps establish a stable baseline to determine the extent of her medication non-compliance, psychiatric symptoms, and overall well-being. It allows us to document the severity of the issues and provides a basis for comparison.

Intervention Phase (B): Following the baseline phase, the intervention (B) is implemented. In Paula’s case, this involves a comprehensive EBP intervention designed to address her medication adherence, psychiatric stability, and prenatal care needs. The intervention should include a combination of medical, psychiatric, and social work interventions to support her holistic well-being.

Reversal Phase (A): After a significant period of intervention, the ABAB design includes a reversal phase (A) where the intervention is temporarily withdrawn or reduced. This phase allows us to assess whether any improvements observed during the intervention phase are indeed linked to the intervention or if they are due to other factors. It helps us understand the intervention’s true impact on Paula’s outcomes.

Second Intervention Phase (B): The final phase (B) reintroduces the intervention to determine if the improvements observed during the initial intervention phase can be replicated. This phase assesses the intervention’s consistency and its continued effectiveness.

Benefits of the ABAB Design

Internal Validity: The ABAB design provides robust internal validity by allowing for repeated measures and comparisons between baseline and intervention phases. This strengthens the credibility of any observed changes.

Assessment of Intervention Effects: By implementing the reversal phases (A), the design helps differentiate between the effects of the intervention and potential confounding variables, providing a clearer picture of the intervention’s impact.

Ethical Considerations: Given the ethical considerations outlined in the NASW Code of Ethics, the ABAB design aligns with the need to assess whether Paula’s actions pose a serious, foreseeable, and imminent risk to herself and her unborn child. It allows us to make informed judgments about the necessity of limiting her right to self-determination in the interest of her well-being and that of her child.

Conclusion

In the case of Paula Cortez, who is facing significant health and psychiatric challenges while pregnant, the ABAB single-subject design is a well-suited method to evaluate the outcomes of the EBP intervention. This design provides a structured approach to assess the effectiveness of the intervention while considering the ethical imperative of limiting self-determination when there is a serious risk to the client and others. It allows for data-driven decisions about Paula’s treatment and care, ultimately aiming to optimize her well-being and the health of her unborn child.