Daniel F. Brossart

The most common method of single-case data analysis is visual analysis, but interrater reliability among visual raters tends to be poor. A new paradigm of visual analysis is presented and tested with the goal of addressing this persistent limitation. In traditional visual analysis, graphs are viewed and rated one by one. However, in the ranking and pairwise comparison methods introduced here, graphs are compared to each other and sorted from least to most evidence of intervention effectiveness. Four visual raters scored a set of 30 previously published single-case graphs using a traditional rating method as well as the ranking and pairwise methods. As in previous studies of visual analysis, the raters failed to achieve acceptable interrater reliability with the traditional rating approach (α = 0.641). However, interrater reliability increased to satisfactory levels when graphs were scored with ranking (α = 0.847) and pairwise comparison (α = 0.860). Visual analysis scores based on the pairwise method were also used to evaluate the performance of three single-case effect size statistics.

Despite evidence that people with serious mental illness benefit from receiving primary care within mental health care settings, there is little research on this type of integration. The objective of this study was to characterize how providers and patients experienced implementation of primary care into specialty mental health services. During site visits, study team members interviewed staff and conducted focus groups with patients at 10 United States community mental health centres then beginning to integrate primary into their practices. One year later, follow up phone interviews with key centre staff informants validated and updated findings. Data analysis included thematic coding of results from staff interviews and patient focus groups. Findings included the importance of the scope of primary care services provided on site, given limited alternatives available to patients; rapid scale-up; overcoming challenges in provider recruitment and retention; and adaptations to engage patients as well as to improve communication between mental health and primary care providers. Providers and patients perceived improvements through integrated care. However, the majority of patients were uninsured, and the funding was short term. The long-term viability of integrated care for community mental health centre patients may hinge on adequate, predictable public funding.

Tau (τ), a nonparametric rank order correlation statistic, has been applied to single-case experimental designs with promising results. Tau-U, a family of related coefficients, partitions variance associated with changes in trend and level. By examining within-phase trend and across-phase differences separately with Tau-U, single-case investigators may gain useful descriptive and inferential insights about their data. Heuristic data sets were used to explore Tau-U’s conceptual foundation, and 115 published single-case data sets were analyzed to demonstrate that Tau-U coefficients perform predictably when they are well understood. An understanding of Tau-U’s theoretical basis and unique limitations will help investigators select the appropriate statistical method to test their hypotheses and interpret their results appropriately. Limitations of Tau-U include as follows: vague or inconsistent Tau-U terminology in published single-case research; arithmetic problems that lead to unexpected and difficult-to-interpret results, especially when controlling for baseline trend; Tau-U methods are difficult to graph visually, and a comparison with visual raters found that several Tau-U effect size statistics are weakly correlated with visual analysis.

The field of neuropsychological rehabilitation frequently employs single case experimental designs (SCED) in research, but few if any, of the published studies use the effect sizes recommended by the American Psychological Association. Among the available methods for analysing single case designs, this paper focuses on nonoverlap methods. This paper provides examples and suggestions for integrating visual and statistical analysis, pointing out where contradictions may occur and how to be a critical consumer.

Objectives: Examined the severity of depressive symptoms and the rates of probable depression assessed by different instruments that were included in two separate surveys of residents in a predominately rural region of the United States.Method: Surveys of the Brazos Valley region in south central Texas were conducted and responses to the short form of the Center for Epidemiological Studies‐Depression scale (in the 2006 survey) and the Patient Health Questionnaire‐9 (in the 2010 survey) were analyzed.Results: Regardless of instrument used, results indicate that women and African Americans are at greater risk for depression in this underserved region, but no unique effects were found for rural residency.Implications: Implications for research, assessment, program planning, and policy are discussed.

We examined whether hostile dominant interpersonal problems (HDIP), antisocial features, and borderline features mediated the relationship between attachment (anxiety or avoidance) and intimate partner violence (IPV) with a sample of 132 male partner abusers. We conducted two path analyses with avoidant attachment as the predictor in one model and anxious attachment as the predictor in a second model. In both models, HDIP, antisocial features, and borderline features were the mediators with IPV as the criterion. For both models, the attachment variable had statistically significant path values to the mediating variables. However, neither antisocial nor borderline features had statistically significant path values from the mediating variable to the criterion variable (IPV). Only HDIP had a statistically significant path value from the mediating variable to the criterion variable in both models. However, only the avoidant model produced a statistically significant specific indirect effect indicating that HDIP clearly mediated the relationship between attachment and IPV. Results suggest that partner abusive men with predominantly avoidant and, to a lesser degree, anxious attachment may be at increased risk for addressing conflicts in a coercive, controlling, and vengeful manner that is manifested in physical aggression toward a partner. Further, interpersonal constructs may be better measures of psychopathology and provide more relevant clinical targets than personality constructs with male partner abusers.

Rehabilitation research presents unique and challenging problems to investigators during both the design and analysis periods. Statistical issues regarding sample size requirements for an adequately powered study may be in direct conflict with realistic recruitment and subject retention goals. Issues of underpowered studies, sample size requirements, and recruitment goals plague rehabilitation research. Randomized clinical trials (RCTs) are typically narrow in scope and thus lack generalizability to everyday, yet specific, clinical problems; they are also costly and time-consuming and require large numbers of participants for randomization to have optimal, desired effects. Further, the RCT design may not be applicable to assistive technologies and environmental modifications-vital components of disability and rehabilitation research-nor is it appropriate in situations in which theoretical models of change are lacking or premature. Single-case designs are better suited for studies in which understanding and changing patient behavior and functional status are primary goals and the targeted sample sizes are less than 30 and frequently less than 10. Theoretical, methodological, and clinical reasons for using experimental and quasi-experimental single-case designs are presented. Recommendations for designing and conducting single-case studies that contribute to the evidence base are also discussed.

The Leon County Health Resource Commission sought to increase access to mental health services for their rural community. The commission formed a network of partners who collaborated to increase free transportation to mental health services outside the community and developed a telehealth-based counseling program through a counseling psychology training program. Learning opportunities emerged during the development and implementation of these activities for both the students and the community in how to successfully utilize and sustain this service. This article describes the telehealth counseling model, presents lessons learned in the process, and presents recommendations for others interested in utilizing similar strategies.

This study examined the degree to which outliers were present in a convenience sample of published single-case research. Using a procedure for analyzing single-case data Allison & Gorman (Behaviour Research and Therapy, 31, 621–631, 1993), this study compared the effect of outliers using ordinary least squares (OLS) regression to a robust regression method and attempted to answer four questions: (1) To what degree does outlier detection vary from OLS to robust regression? (2) How much do effect sizes differ from OLS to robust regression? (3) Are the differences produced by robust regression in more or less agreement with visual judgments of treatment effectiveness? (4) What is a typical range of effect sizes for robust regression versus OLS regression for data from “effective interventions”? Results suggest that outliers are common in single-case data. The effects of outliers in single-case data are explored, and the implications for researchers and practitioners using single-case designs are discussed.