ACP- Single Case Experimental Study (SCED)

Length: 3,000- 5,000 words (excluding references and appendices only)

Introduction

The overall aim of this assignment is to produce a report of a single case quasi-experimental or experimental design (SCED) study conducted with a client whilst on placement. Please note, this is a separate and additional assignment to your usual clinical practice report. Accordingly, the same client cannot be used for both. Typically, this study will constitute part of a trainee's ongoing clinical work on placement. As with clinical practice reports, it is not crucial that this case results in a successful clinical outcome, but reflection on the outcome is necessary. Please note that qualitative or biographical case studies are unsuitable for this assessment. Detailed guidance on conducting and reporting a single-case study is provided during teaching and is also available on Blackboard.

Ethical Clearance and Consent

The trainee is responsible for ensuring that the conduct of the evaluation is ethically sound, and to ensure that any relevant ethical permissions are granted prior to the implementation of the project. The process of attempting to obtain consent for treatment should be described. If you have any doubts, please contact your personal tutor or the Department of Psychology Ethics Sub-committee.

Format

The single case experimental study should be written up according to the following format:

Title Brief summary of case/issue

Introduction Nature of clinical problem in general terms (do not include specific clinical details here), concise summary of relevant background literature and how it relates to the case. Consider and refer to relevant NICE guidance, provide justification for single case approach and background to method. Provide focus of present study, the evidence base for the intervention being tested, the rationale for the study and the specific experimental hypotheses. 

Methods Include a brief and confidential description of the client (participant), description of the methods and choice of measures used, in sufficient detail to allow replication by others. Describe the SCED design including a detailed description of the content and timing of idiographic and nomothetic outcomes measures, the psychometric properties of the nomothetic measure(s), whether/how procedures for calculating reliable and clinically significant change can be applied to the selected measures, the setting, brief and confidential clinical details of the client, summary of the formulation, description of the intervention (e.g. number/duration of sessions and the protocol used- if available). Where possible a three-column treatment adherence table should be provided detailing the session number, content of that session and connection to the treatment protocol or evidence base, explanation as to the lack of this is required if not. If a diagrammatic formulation were used these need to be in the method. Examples of the idiographic data collection tools (e.g. observational schedules by staff, daily diaries, parent diaries of child behaviour) should be placed in an Appendix and care should be taken to ensure that they are anonymous.

Consent for treatment The process of attempting to obtain consent for treatment should be described. It is likely that this will be affected by the approach adopted in the particular service, age and capacity of clients to give consent. Approaches taken to ensure either that the client is giving informed consent or that issues around duty of care have been considered in relation to clients who are unable to give informed consent should be included.

Results The number of sessions attended should be reported (baseline, each phase of the study and in total) and also whether the client completed treatment. Baseline phases should be assessed for trend using both visual analysis and statistical analysis (e.g. Tau). When significant baseline trend(s) arise(s), statistical analyses which adjust for baseline trend should be employed (e.g. Tau-U/baseline- corrected Tau). Individual study phases should be assessed for serial dependency (autocorrelation). The results should contain a time series graph of each idiographic measure that clearly labels each of the phases on the intervention with trend lines fitted for each phase. A table of means and Standard Deviations for each idiographic measure, for each phase, should be provided. Idiographic outcome measures should be assessed for between phase change using a minimum of three nonoverlap tests (e.g. TAU, PND, PEM, PAND, NAP, IRD) with recognition of the strengths and limitations of each test used. These findings should be reported in a table and interpreted using the established guidelines (calculations and graphs shuld be included in the appendices). While some of these tests can be calculated by hand, results should be verified using available analysis programs (e.g. Shiny web calculators, R- resources for using these programs are available on Blackboard). The scores on nomothetic measure(s) should be presented in a table that contains reliable and clinical change analysis and also the relevant clinical and community norms on that measure. Graphs should be of a high standard of presentation and clearly labelled. 

Discussion An evaluation of the psychometric outcomes, in relation to the original hypotheses should be presented, along with a critical evaluation of the methods, design and analysis employed. Reference to the findings in relation to the evidence base, how the intervention was generalised in the client's life and clinical relevance and personal reflections should be included. 

Guidance on methods

The design of the submission needs to either be quasi-experimental or a SCED. The design of quasi-single case experiments is A/B. It is advantageous but not necessary to have a follow-up phase (i.e. an A/B-FU design) in which the idiographic measures continue to be collected and the nomothetic measure(s) are collected at the final follow-up. Trainees are also encouraged to consider completing a true SCED in which a cross-over design is used (e.g. A/B/C where B is systemic therapy and C is CBT) or where there is a treatment removal component (i.e. ABA or ABAB). All designs need to be agreed in clinical supervision, and treatment withdrawal particularly considered due to the associated ethical issues. 

Guidance on settings and interventions

The case can be conducted on an adult, child, learning disability or older adult placement and can be either in-patient, out-patient, or community clinical work. The main pre-requisite is that an intervention is introduced (i.e. A/B), therefore the study can be implemented in a wide variety of clinical contexts. The setting will dictate who will collect the data and this needs to be a rational choice. Multiple data collectors (e.g. the client and a family or staff member) may be indicated, and potentially advantageous, however all measures should be designed in collaboration with the client. The intervention tested needs to be an evidenced-based approach. 

Guidance on measures

The frequency of the idiographic measure needs to be at least daily. Idiographic measures should consider containing a blend of intensity, duration and frequency measures that assess the clinical concerns of the case. There needs to be at least three idiographic measures that are heterogeneous (assess different targets) and the case can contain contril idiographic measures. The idiographic outcome measures can be collected by the client, staff, parent or carer. The data collection duration for the initial baseline period should be at least 14 observations (data points), while the sum of treatment phase observation should be at least 28. The nomothetic measure(s) needs to be matched to the presenting problem of the client. At least one valid and reliable nomothetic measure needs to be used. Process measures can be taken (e.g. measures of the therapeutic alliance) but are not essential and can be reported in the same manner as the nomothetic outcome measures.

Other information

It is recognised that the work reported for the ACP-SCED may not form the complete intervention. If the trainee is involved in other related work with the client at a different level of intervention this should be briefly acknowledged so that the contextual issues are clear. If a different staff member contributes to the delivery of any of the intervention phases, then this should be reported. An interactive working FAQs document with answers and resources for common SCED questions is available here: https://docs.google.com/spreadsheets/d/1Jpq8lH-GVKIjWBtldYeiF63S1JuS2nK5Uppyn7dxsjc/edit?usp=sharing and also on Blackboard. Trainees can add questions to the document, and it will be continually updated. 

Conclusion

The purpose of this assessment is to provide an opportunity for trainees to apply quantitative methods to the study of single clinical cases. Please discuss the suitability of any clinical referral appropriate to this project with your relevant clinical supervisor before beginning to plan your study. If you require any further advice, please do not hesitate to contact your Academic Tutor.

Please note that only one ACP should be submitted for any one deadline.