APA Format and No Plagiarisma 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 treatmentThe intervention approach, including length of time, so that it can be replicatedA summary of the literature that you reviewed that led you to select this intervention approachThe purpose for conducting a single-system (subject) research evaluationThe measures for evaluating the outcomes and observing change including:Evidence from your literature search about the nature of the measuresThe validity and reliability of the measuresHow baseline measures will be obtainedHow often follow-up measures will be administeredThe criteria that you would use to determine whether the intervention is effectiveHow the periodic measurements could assist you in your ongoing work with PaulaLike before use file attached just APA format and NO Palagrism
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The problem(s) that are the focus of treatment
Paula Cortez is a 43-year-old female who recently found out she is pregnant. She has
comorbid conditions consisting of having a diagnosis of Bipolar Disorder, Hepatitis C, and is
HIV positive. In addition to her HIV diagnosis, other medical conditions include her right hand
being semi-paralyzed and foot ulcers that occasionally flare up limiting her mobility. Paula has a
history of non-compliance with her mental health and medical medications, leading to previous
decompensation episodes and several involuntary psychiatric hospitalizations. Until recent
stressful events, it had been three years since her last hospitalization. The involuntary
hospitalization was due to increased paranoia and suicidal ideations. Due to her limited insight
about her medical conditions, Paula’s lack of compliance with prescribed medications can lead to
a decline in her physical health. One main concern is that Paula lacks social support and has
recently shared with her social worker that her child’s father has been harassing her and is
causing distress. Based on her presenting issues, Paula’s treatment will focus on addressing her
medical conditions, mental health issues, and pregnancy, while building on her strengths and
supporting her weaknesses. Throughout her treatment outcomes that will be measured include
improved insight into her issues and how they can affect her pregnancy, compliance with
medications, improvement of mental health and symptoms.
The intervention approach, including length of time, so that it can be replicated
After an evaluation of Paula’s presenting problems and expected outcomes, the best
intervention strategy will consist of an Assertive Community Treatment (ACT) approach. ACT
is a long-term treatment solution designed to reduce recidivism in psychiatric hospitalizations
while supporting community placement. ACT is a wraparound service that includes a
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multidisciplinary team that focuses on the individuals with severe and persistent mental illness.
The team involves case management, outpatient services, psychoeducation, collaborative care,
and peer support (Management Strategies to Reduce Psychiatric Readmissions, 2015). Other
components of the approach involve court directed services which do not apply to Paula. Paula
will receive optimum benefit from the ACT intervention after she has been engaged for a period
of one year.
A summary of the literature that you reviewed that led you to select this
intervention approach
People with serious mental illness have several barriers that contribute to their poor health
outcomes due to their limited ability to seek and comply with good health practices. In the focus
of primary care providers, when these individuals to seek care they typically are presenting with
acute symptoms, leading to their more chronic conditions being overlooked (Vanderlip,
Williams, Fiedorowicz, & Katon, 2014). In regards to their mental health care, they are often
non-compliant with follow-up appointments, have poor medication compliance, and have a poor
appreciation for their mental illness causing decompensation episodes, contributing to increased
chance of substance abuse and potential contacts with law enforcement. These individuals also
are more likely to lack appropriate family and social support. The assertive community outreach
approach is designed to provide wraparound services that are individualized for the client so that
they have consistent support without having multiple providers. The psychiatrist provides
medication management to treat the mental illness. A social worker provides psychoeducation to
the client on an individual basis and implements skills such as motivational interviewing.
Motivational Interviewing (MI) addresses ambivalence in treatment goals. Research has shown
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that motivational interviewing leads to better treatment engagement and higher motivation than
those who did not receive this intervention (Kortrijk, Mulder, Roosenschoon, & Wiersma, 2010).
Additionally, research has indicated that less motivated individuals that receive MI can
potentially benefit more from ACT (2010). ACT teams can include peer support services which
consist of individuals who are recovered mental health patients who provide support and
mentoring to the patient (Management Strategies to Reduce Psychiatric Readmissions, 2015).
Peer support has been connected to lower hospital readmissions (2015). Case managers are a key
component of the ACT team. Case management services include assessing the client’s needs,
planning, and collaborating and coordinating care with other care providers (2015). They are
involved with monitoring and evaluating their care. Case management services also encompass
social, educational, vocational, and other services that might be indicated for the patient (2015).
They are central to the patient and their systems and prove to be the primary link between the
patient and their multidisciplinary team.
Paula has been diagnosed with HIV and is currently undergoing Highly Active AntiRetroviral Therapy (HAART), which is a combination of an effective treatment of drugs that
control the progression of the HIV (Pande &Hande, 2014). Patients who have been diagnosed
with HIV/AIDS have their own set of challenges such as being burdened with daily doses of
cumbersome pills, food limitations, negative effects caused by drug interactions, reduced quality
of life (2014), just to name a few. As a result of the challenges, HAART has a poor compliance
rate. It is, however, safe for use with pregnant and breastfeeding women, as it helps reduce the
incidence of passing the infection to the baby. When a mother delivers, the infant will require
specific treatment methods for a period of 6 weeks (2014). When taken properly, HARRT can be
very effective in treating several conditions related to the effects of the HIV virus. However, the
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treatment requires a 95 percent compliance rate with medications, proper storage of the
medication, and avoidance of treatments that might alter blood levels (2014). Individuals who
are receiving this treatment would benefit from supportive services in order to improve
compliance.
The purpose for conducting a single-system (subject) research evaluation
Single-system research (SSR) offers benefits that other research methods cannot
accomplish. In social work research, the most relevant objective is to determine what will work
in the practice setting to accomplish specific goals, under a specific set of conditions, and for
which population. SSR provides research that contributes quality outcomes because the tests are
performed under the most optimal and rigorous conditions (Mattaini, 2010). Research utilizing
SSR methods provides knowledge about interventions that are not only individualized, but also
can be generalized (2010). Because one subject is studied in natural settings and interventions
are adjusted and manipulated based on the individual client’s circumstances and/or progress.
Single-system designs plot the changes made by the client and observe whether the interventions
are causing the changes in behavior as they occur and the design focuses on the impacts of the
worker-introduced interventions (Dudley, 2014, p. 86).
The measures for evaluating the outcomes and observing change
The focus of Paula’s treatment is to improve her insight into her issues and increase
compliance with medications in efforts to decrease her adverse medical and mental health
symptoms. Some measures that can be used to evaluate outcomes include direct observations,
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self-monitoring by the client, standardized instruments completed by the client or other raters, the
use of goal attainment scales (GAS), or behaviorally anchored rating scales (BARS) (Mattaini,
2010, p. 246). Although working with the client to develop a charting system that allows the
client to record and track their own progress is an option for self-monitoring, the better
alternative is to avoid planning the self-monitoring intervention and simply monitor
improvements through interactions with the client and introduce further experimental
manipulation as needed. In Paula’s case her plan will include attending all of her medical
appointments with her physician treating her HIV condition, attending all of her appointments
with her psychiatrist, her social worker, case manager, and her Obstetrician Gynecologist
(OBGYN) who will provide her with their own treatment interventions. The expectation would
be that Paula would report that she has attended all of her appointments as required, takes her
medication daily, as prescribed, and report an absence or decrease in mental health issues.
Baseline measures are obtained by Paula’s treatment history and self-report of her behavior of
medication non-compliance, re-admissions to psychiatric hospitalization due to psychotic
symptoms of paranoia and suicidal ideations. Paula’s progress will be measured by her reports
during her meetings with each provider. Self-reports about medication compliance and symptom
improvement will be obtained from Paula on a bi-weekly basis with each provider. Standardized
instruments completed by other raters such as her treatment providers will be utilized. Her
physician will test her blood levels for compliance with medications and also through direct
observations, monitor the improvements in her foot condition that worsens when she is not
compliant with medications. Her psychiatrist will use rating scales completed by Paula that test
the improvements of her symptoms of anxiety, depression and suicidal thoughts, as well as selfreports of improvements and medication compliance. Her social worker will utilize Paula’s self-
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report to address these symptoms and her case manager will measure through observation,
Paula’s compliance with medical appointments because she will be primarily coordinating her
care.
The criteria that you would use to determine whether the intervention is effective
I would determine that the ACT intervention is effective if Paula has not had any
hospitalizations, shows an improvement in health conditions, and reports having significantly
improved insight about her conditions.
How the periodic measurements could assist you in your ongoing work with Paula
Utilizing the periodic measurements will help provide me in my work with Paula by
helping her see the significant progress that she has made and improve her self-esteem by
reinforcing the fact that she has made significant progress. Building on her strengths and
improving her weaknesses will help with motivational interviewing with Paula. Furthermore,
she will be able to become more independent.
References
Dudley, J. R. (2014). Social work evaluation: Enhancing what we do. (2nd ed.) Chicago, IL:
Lyceum Books.
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Management Strategies To Reduce Psychiatric Readmissions (2015). Effective Healthcare
Program. Number 21. Retrieved from
https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/psychiatricreadmissions_technical-brief.pdf
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)
Pande, P., Hande, S. (2014). HAART (Highly Active Anti-Retroviral Therapy): An Overview.
Journal Marine Medical Society, 16(2), 106-109. Retrieved from
http://www.marinemedicalsociety
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].
Vanderlip, E., Williams, N., Fiedorowicz, J., & Katon, W. (2014). Exploring Primary Care
Activities in ACT Teams. Community Mental Health Journal, 50(4), 466-473.
doi:10.1007/s10597-013-9673-8
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