Develop a feasible measurement plan to monitor treatment progress for that client or assignment, 640 discussion help

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For this week's discussion, think of a client or situation in your own practice or assignment. Develop a feasible measurement plan to monitor treatment progress for that client or assignment. Describe what would be measured (in observable terms), who would measure, when and where they would measure, and with what measurement instrument.

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Chapter 12 Monitoring Client Progress Monitoring Client Progress •  For several decades researchers have urged practitioners to use single case designs to evaluate their practice. –  Because of feasibility constraints in implementing these designs, very few practitioners actually use these designs in practice. •  These constraints include the need to collect a large number of data points across multiple phases. •  Most problematic is the baseline phase because it requires the delay of treatment. Monitoring Client Progress •  If practitioners follow the full five-step EBP process, the use of single case design techniques can be streamlined. –  Once practitioners reach step 5, they do not need to derive internally valid inferences to establish the effectiveness of the intervention. That concern is addressed in earlier steps leading to the selection of the intervention with the best available evidence. Monitoring Client Progress •  Step 5 in the EBP process is focused on monitoring whether the client achieved desired outcomes and: –  Determining whether the selected intervention is working, or in need of adjustment. –  Supporting client commitment to the process –  Gathering additional information from the client to explore any blips or unexpected changes in targeted outcomes. A Practitioner-Friendly Design •  Because the key purpose of step 5 in the EBP process is to monitor client progress, a simplified variation of the single subject design approach can be used. A Practitioner-Friendly Design •  The client and practitioner should discuss a target level as a goal for treatment. –  If this target is reached, then the chosen intervention was sufficient. –  If not, the treatment can be adjusted. The B+ Design •  This design is simply the B phase of an AB design, with the possible addition of one pre intervention data point. •  When the desired level of progress is reached and sustained long enough to justify discontinuing the intervention, the B phase can be discontinued in a manner no different from usual practice. Monitoring Progress With the B+ Design •  Results suggesting that the desired reduction in problem behavior is achieved during the intervention (phase B). Monitoring Progress With the B+ Design •  Results indicating that the initially selected intervention was not appropriate for the client, and a different intervention was successful. Monitoring Progress With the B+ Design •  This approach is not intended to establish internal validity. –  Rather, it provides a way to determine whether the intervention isn’t working for the client. –  Recall that even among empirically supported interventions, some clients will not benefit from the intervention, or will not benefit to a satisfactory level. Feasible Assessment Techniques •  Before generating graphed data, a plan for monitoring progress is needed. •  This requires answering four questions: –  What to measure? –  Who should measure? –  With what measurement instrument? –  When and where to measure? What to Measure? •  The choice of what to measure requires that the problem or treatment goal: –  Be translated into something that is observable, –  Be feasible to measure, and –  Have a reasonable chance of changing from one data point to the next. A Simple Scale •  If an appropriate and feasible existing measurement instrument is not available, a simple scale can be created. This scale can be modified to fit different clients and programs by changing the word depression to anxiety, worry, confidence, etc. Measuring Frequency or Duration •  Instead of measuring an overall approximation of a mood or other emotion over time, the frequency or duration of actual behaviors or cognitions can be tracked. –  Example: A depressed client can track the number of hours slept each night, the number of suicidal thoughts each day, etc. Who Should Measure? •  There are four options regarding who should measure: –  The practitioner. –  The client. –  A significant other (e.g. parent, partner, teacher). –  Existing records. Who Should Measure? •  Each of these approaches has trade-offs in terms of advantages and disadvantages. •  Any approach may be used on its own or in combination with others. •  Choose an approach that is most feasible and clinically useful given your practice situation. Who Should Measure? •  Practitioner –  Advantage: The practitioner can ensure that the measurement is completed and performed properly. –  Disadvantages: •  Measurement requires the practitioner’s presence. •  The practitioner’s observation may be obtrusive and bias the client’s report of behaviors. •  The burden is on the practitioner. Who Should Measure? •  Client –  Advantages: •  There are some phenomena that only the client can observe and report on (e.g., thoughts). •  This approach saves the practitioner time. –  Disadvantages: •  The client might not follow through consistently with measurement. •  Self-report can be biased. Who Should Measure? •  Significant other –  Advantages: •  This saves practitioner time. •  For very young, or impaired clients, this may be the only feasible option. •  The significant other may be able to observe less obtrusively than the practitioner. –  Disadvantages •  The significant other might not follow through consistently. •  The measurement can be biased. Who Should Measure •  Available records –  Advantages: •  This is less obtrusive than other options. •  Feasibility because the data are already collected. •  It enables developing a reconstructed baseline. –  Disadvantages: •  Measurement is limited to those pieces of information that are available. •  There may be difficulty gaining access to some types of records. •  The data may not be collected accurately or systematically. With What Measurement Instrument? •  There are three main instrument options: 1.  Behavioral recording forms. 2.  Individualized rating scales. 3.  Standardized scales. Behavioral Recording Forms •  An instrument is needed to record actual behaviors by clients or significant others. •  There are two options: –  Frequency recording, which is recording the number of times the target behavior occurs. –  Duration recording, which is recording how long the behavior lasts when it does occur. •  The key is select or construct a form that is simple and nonaversive for the person who will use it. Behavioral Recording Forms •  Clients and significant others can use simple techniques to track the behavior throughout the day, such as: –  Moving coins from one packet to the other. –  Using an inexpensive golf score counter. –  Keeping a small card or notepad with them. •  Regardless of the technique used, a form will be needed to record these numbers over time. Other Tips for Behavioral Observation •  Limit the number of things being recorded to no more than one or two. •  Establish clear guidelines as to when and where to record. •  Train the observer to make sure he or she knows how, when, where, and for how long to record the behavior. Individualized Rating Scales •  When the focus is on the magnitude of a target problem or treatment goal, an individualized rating scale can be used such as the one below. Tips for Constructing Individualized Rating Scales •  The number of scale points should not exceed 11, and it may be best to keep the number between 5 and 7. •  Fewer than 5 scale points may not be adequately sensitive to small, but meaningful changes. •  The length of the blank spaces between points should be equal. •  Label at least the lowest, middle, and highest scale points with terms like none, moderate, and severe. •  Include a space where the client can record the time of day the scale was completed. Tips for Using Individualized Rating Scales •  Scales should be completed often enough to detect changes, but not so often as to be a burden. •  If they are easy to use, they can be completed up to several times a day. A daily score can be calculated as the average of the day’s scores. •  Scales should be completed at roughly the same predesignated times each day. Standardized Scales •  Whether measuring behaviors, cognitions, moods, or attitudes, a standardized scale may be used. •  These scales involve the uniform administration of the same scale items in the same way for different people. •  They can vary in length and complexity. Standardized Scales •  Advantages: –  Typically, standardized scales have had their reliability or validity tested. –  They may have also been tested for sensitivity. –  They may have also been tested with different populations and cultures. –  This saves the practitioner the time and burden of constructing a scale or other measure. Standardized Scales •  Disadvantages: –  Existing standardized scales may not fit the set of problems or goals specific to your client. –  Some standardized scales are copyrighted and expensive. –  Some scales require special training to use and interpret. –  They can also be lengthy. Standardized Scales •  Should you choose to use a standardized scale, it should be evaluated in terms of its: –  Reliability. –  Validity. –  Sensitivity. –  Applicability to your client’s culture and other characteristics. –  Feasibility. When and Where to Measure •  Deciding when and where to measure is influenced by decisions on what, who, and how you will measure. –  Example: If a standardized scale is used, the scale probably will be administered during your session with a client no more than once a week •  In general, measurement should occur as often as possible without becoming too burdensome for the practitioner or client. Pinpointing changes over time provides a better basis for ascertaining the factors responsible for the change Summary •  As an evidence-based practitioner: –  Employ critical thinking and question authority –  Seek the best scientific evidence to inform your practice decisions by engaging in the steps of the EBP process. Keep in mind that the research evidence does not dictate what you should do; you must also integrate this evidence with your expertise and the unique realities of your practice situation. Summary •  Start by formulating your EBP question, such as: –  What factors predict desirable or undesirable outcomes? –  What’s it like to have had my client’s experiences? –  What assessment tool should be used? –  What intervention, program or policy has the best effects? Summary •  Next, search for the best research evidence pertaining to your question. –  You probably will need to rely heavily on electronic literature databases. –  Use search terms and strategies such as Boolean operators. –  Keep in mind that you need not read every study you find–use titles and abstracts to focus on the ones that seem most relevant. –  To save time, first search for systematic reviews and meta-analyses. Summary •  Once you find relevant research evidence, critically appraise its quality and relevance to your clients and practice situation. –  Distinguish between limitations and fatal flaws. –  Critically appraise the research by using standards appropriate to your EBP question of interest and the type of study conducted. –  Use those studies with less serious flaws to guide your practice. Summary •  Once an intervention, assessment tool, program, or policy is selected and implemented construct a plan to measure outcomes and consider making adaptations as needed. Recall that even the best interventions, programs, and policies don’t work for everyone. Looking Ahead •  Various efforts are under way to make EBP more feasible for practitioners such as: –  Partnerships between researchers and practitioners to address barriers. –  Training and education efforts to help practitioners and agencies implement EBP. –  Increased attention to implementation issues in research and practice. Looking Ahead •  Remember that EBP can present challenges, but it is consistent with a client-centered and ethical approach to practice. •  EBP is relatively new, and more resources and supports are constantly being developed. •  Do the best you can, even if it means cutting corners when necessary. •  Ultimately the goal of EBP is to empower clients and communities and enhance their well-being.
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Running head: FEASIBLE MEASUREMENT PLAN

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Feasible Measurement Plan
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FEASIBLE MEASUREMENT PLAN

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Feasible Measurement Plan
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