Visually Interpreting Your Client’s Progress

Visual Analysis Systematic process for interpreting results of single-case design data Visual examination of graphed data within and between different conditions (e.g., baseline, intervention) Allows you to analyze your client’s progress in real time and use this practice-based evidence to make the right decisions to help your clients in a dynamic process

Dimensions of Change Is change occurring? Is change for the better or worse? Is the pace of change sufficient? Is the change large enough—is it meaningful and sufficient to the client?

When Change is Off Track Try a different intervention or modify the current intervention Check the status of the “helping alliance,” “client motivation to change,” environmental and biological factors in the client’s life including social support, etc. Extend the date for goal achievement

When Change is Off Track (cont’d) Revise the goal or objective Refocus your efforts on other problems Collect more information Return to the assessment/case conceptualization phase Refer to another social worker or other professional

Figure 6.2.

Data Pattern Particular arrangement of data in terms of in terms of level, trend, variability, cyclicity, overlap, immediacy, permanency, and practical significance

Within Phase Data Patterns Level Trend Variability

Level Value on the vertical axis around which a series of outcome data converge Last two or three data points in a phase are especially important indicators of level if they are higher or lower than the overall level

Figure 6.3.

Median Measure of central tendency which divides a distribution of values in half when the values are arranged in numerical order (or the average of the middle two values in a set with an even Number of values)

Trend Overall direction of a data path within a phase or across phases of a single-system design line graph: No trend Negative trend (also referred to as a “descending” or “decelerating” trend because values are decreasing over time) Positive trend (also referred to as an “ascending” or “accelerating” trend because values are increasing over time)

Figure 6.4.

Improving Trend Overall direction of a data path within a phase is moving in the desired direction (e.g., descending if lower values of the outcome are desirable, and ascending if higher values of the outcome are desirable)

Deteriorating Trend Overall direction of a data path within a phase is moving in an undesirable direction (e.g., descending if higher values of the outcome are desirable, and ascending if lower values of the outcome are desirable)

Slope Typical amount of change in an outcome from day-to-day, week-to-week, or whatever unit is involved

Variability Degree to which data points deviate from the overall trend

Figure 6.5.

Stable Baseline Pattern of baseline data that exhibits relatively little variability over time and little or no trend

Variable Baseline Pattern of baseline outcome data that do not fall within a relatively small range of values (i.e., they are variable)

Baselines Revisited Period of time during which an outcome is measured repeatedly in the absence of an intervention Confirm or disconfirm that the problem exists Establish the extent of the problem Develop and explore hypotheses useful for case conceptualization and intervention planning Determine whether the problem is getting better or worse and the pace of change Estimate what would happen to the client’s outcome without intervention

Figure 6.6.

Between Condition Data Patterns Level Trend Variability Immediacy of change Overlap

Figure 6.7.

Figure 6.8.

Figure 6.9.

Figure 6.10.

Figure 6.11.

Figure 6.12.

Figure 6.13.

Figure 6.14.

Figure 6.15.

Figure 6.16.

Figure 6.17.

Figure 6.18.

Immediacy of Change Amount of time it takes for a change in level, trend, or variability to occur after a condition change (e.g., baseline to intervention)

Figure 6.19.

Overlap Degree to which data in adjacent phases share similar quantitative values—the more the overlap the less the difference between adjacent phases, and the less the overlap the greater the difference

Figure 6.20.

Figure 6.21.

Figure 6.22.

Change Without a Pre-Intervention Baseline B-only design Design consisting of an intervention phase (B) during which the outcome is measured repeatedly B+ design Design consisting of one pre-intervention outcome measurement followed by an intervention phase (B) during which the outcome is measured repeatedly

Figure 6.23.

Figure 6.24.

Figure 6.25.

Figure 6.26.

Number of Observations More information—more accurate decisions When in doubt, if practical and ethical, continue to collect information More within-phase variability, more observations necessary During intervention--enough observations to make sure problem is resolved sufficiently After intervention—monitor outcome long enough to ensure that change is lasting

Number of Observations (cont’d) Baseline Enough to establish the presence and extent of the problem Enough to identify environmental influences on the problem to use in case conceptualization and intervention planning Unnecessary if outcome never occurs Unethical with outcomes such as self-injurious behaviors

Potential Limitations of Visual Analysis Under some circumstances different people, experts and novices alike, draw different conclusions from the same data Decision errors possible

Decisions Regarding Change

Increasing the Validity of Decisions Regarding Change Increase number of observations Reduce within-phase variability Measure outcomes accurately Use intervention appropriate to the problem Implement intervention with fidelity Use intervention with larger effect