Enhancing accountability in behavioral consultation through the use of single-case designs.

Abstract

Single-case design and progress monitoring methodologies are efficient and cost-effective strategies for increasing accountability for indirect service provision. Single-case design conceptualizes the treatment of an individual as an experimental process that can be monitored over time and evaluated for effectiveness. Increasingly in clinical, counseling, and educational settings, interventions are administered through indirect service (i.e., behavior consultation) due to the large unmet need within children's mental health and the limited number of child-focused professionals available to address these challenges (Kataoka, Zhang, & Wells, 2002; Meyers & Nastasi, 1999). Single-case methodologies offer clear feedback and treatment evaluation through charted progress monitoring that consultees can understand and interpret. Keywords: behavior consultation, single-case designs, accountability, visual analysis. Historically, psychological service provision has most often occurred without direct accountability for service outcomes. Practitioners report that the techniques that they use in clinical were learned during their training and then altered based on trial-and-error experience (Hayes, Barlow, & Nelson-Gray, 1999). This subjective of altering and administering treatment techniques may occur due to the need to adapt known techniques to an individual client's needs given resource constraints. While the primary goal of any treatment is that the client benefits, designing a treatment that facilitates the quantitative analysis of treatment change results in the ability to both a) establish a correlation between the client's treatment and outcome and b) develop empirical support for the future use of the treatment for a similar presenting problem and client. One way to address the need for increased accountability for service outcomes in applied settings is through single case design outcome and progress monitoring methodologies. Single case design conceptualizes the treatment of an individual as an experimental process that can be monitored over time and evaluated for effectiveness. Rather than relying on anecdotal evidence of change as a result of the intervention, single case interventions are designed for the unique presenting needs of a client, and then the impact of the individual's intervention is monitored over the course of implementation using data collection and analysis techniques. The past 10 years have witnessed an increasing commitment to within the fields of education and psychology. The evidence-based practice movement developed out of calls for increased accountability and transparency in service provision. The field of psychology has committed to researching and documenting the usefulness of psychosocial treatments for mental health problems (Kazdin & Weisz, 2003). Similarly, in the field of education, recent legislative mandates such as the No Child Left Behind Act have emphasized the need for educational practitioners to use instructional techniques that have research-based support (U.S. Department of Education, 2007). As professionals involved in the cognitive and social-emotional development of the nation's youth, psychologists, social workers, and educators need to develop efficient systems for evaluating and documenting the effectiveness of their service provision. This article presents a model for using single-case design methodology to evaluate the effectiveness of interventions, and in particular interventions delivered through indirect service approaches.