The document outlines a case study involving a social worker developing a single-subject research study proposal to evaluate their intervention with a client, Paula Cortez. It provides background on Paula's medical and psychiatric issues, including recent stressors of an unwanted pregnancy and threats from the father. It also includes a dialogue between Paula's treatment team discussing concerns about her ability to care for the pregnancy given her non-compliance with medications and mental health issues. The assignment is to submit a 5-page research proposal identifying the problem being addressed, proposed intervention and evaluation plan using valid measures to determine effectiveness.

1. Assignment 1: Creating a Single-System (Subject) Design Study
The steps at the heart of single-system (subject) research are
part of the everyday practice of social work. Each day social
workers implement interventions to meet clients’ needs and
monitor results. However, conducting proper single-system
(subject) research entails far more than these simple day-to-day
practices. Proper single-system research requires a high degree
of knowledge and commitment. Social workers must fully
understand the purpose of single-system (subject) research and
the variations of single-system (subject) design. They must
develop a hypothesis based upon research and select the right
design for testing it. They must ensure the reliability and
validity of the data to be collected and know how to properly
analyze and evaluate that data. This assignment asks you to rise
to the challenge of creating a proposal for a single-subject
research study.
To prepare for this Assignment, imagine that you are the social
worker assigned to work with Paula Cortez (see the case study,
“Social Work Research: Single Subject” in this week’s
resources). After an initial assessment of her social, medical,
and psychiatric problems, you develop a plan for intervention.
You also develop a plan to monitor progress in your work with
her using measures that can be evaluated in a single-system
research design. As a scholar practitioner, you rely on research
to help plan your intervention and your evaluation plan.
Complete the Cortez Family interactive media in this week’s
resources. Conduct a literature search related to the chronic
issues related to HIV/AIDS and bipolar mental disorder. Search
for additional research related to assessing outcomes and
theoretical frameworks appropriate for this client. For example,
your search could include terms such as motivational
interviewing and outcomes and goal-oriented practice and

2. outcomes. You might also look at the NREPP database
identified in Week 1, to search for interventions related to
mental health and physical health.
Submit
a 5-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 treatment
·
The intervention approach, including length of time, so that it
can be replicated
A summary of the literature that you reviewed that led you
to select this intervention approach
·
The purpose for conducting a single-system (subject) research
evaluation
·
The measures for evaluating the outcomes and observing change
including:

3. Evidence from your literature search about the nature of the
measures
The validity and reliability of the measures
How baseline measures will be obtained
How often follow-up measures will be administered
·
The criteria that you would use to determine whether the
intervention is effective
·
How the periodic measurements could assist you in your
ongoing work with Paula
References (use 5 or more)
Dudley, J. R. (2014).
Social work evaluation: Enhancing what we do.
(2nd ed.) Chicago, IL: Lyceum Books.
· Chapter 9, “Is the Intervention Effective?” (pp. 226-244: Read
from “Client Satisfaction & Effectiveness” to “Target Problem
Scale”)
Document: Corcoran, K., & Hozack, N. (2010). Locating
assessment instruments. In B. Thyer (Ed.),
The handbook of social work research methods
(2nd ed., pp. 65–74). Thousand Oaks, CA: Sage. (PDF)
Copyright 2010 by Sage Publications, Inc.

4. Reprinted by permission of Sage Publications, Inc. via the
Copyright Clearance Center.
Document: 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)
Copyright 2010 by Sage Publications, Inc.
Reprinted by permission of Sage Publications, Inc. via the
Copyright Clearance Center.
Tankersley, M., Cook, B. G., & Cook, L. (2008). A preliminary
examination to identify the presence of quality indicators in
single-subject research.
Education & Treatment of Children,
31(4), 523–548.
Laureate Education (Producer). (2013b).
Cortez family
[Interactive media]. Retrieved from
Cortez Family: A Meeting of an Interdisciplinary Team
Paula has just been involuntarily hospitalized and placed on the
psychiatric unit, for a minimum of 72 hours, for observation.
Paula was deemed a suicidal risk after an assessment was
completed by the social worker. The social worker observed that
Paula appeared to be rapidly decompensating, potentially
placing herself and her pregnancy at risk.
Paula just recently announced to the social worker that she is

5. pregnant. She has been unsure whether she wanted to continue
the pregnancy or terminate. Paula also told the social worker
she is fearful of the father of the baby, and she is convinced he
will try to hurt her. He has started to harass, stalk, and threaten
her at all hours of the day. Paula began to exhibit increased
paranoia and reported she started smoking again to calm her
nerves. She also stated she stopped taking her psychiatric
medications and has been skipping some of her
HIV
medications.
The following is an interdisciplinary team meeting being held in
a conference room at the hospital. Several members of Paula’s
team (HIV doctor, psychiatrist, social worker, and OB nurse)
have gathered to discuss the precipitating factors to this
hospitalization. The intent is to craft a plan of action to address
Paula's noncompliance with her medications, increased
paranoia, and the pregnancy.
Physician
Dialogue 1
Paula is a complicated patient, and she presents with a
complicated situation. She is HIV positive, has Hepatitis C, and
multiple foot ulcers that can be debilitating at times. Paula has
always been inconsistent with her HIV meds—no matter how
often I explain the need for consistent compliance in order to
maintain her health. Paula has exhibited a lack of insight into
her medical conditions and the need to follow instructions.
Frankly, I was astonished and frustrated when she stopped her
wound care treatments and started to use chamomile tea on her
foot ulcers. Even though we have educated her to the negative
consequences of stopping her meds, and trying alternative
medications instead, she continues to do so.

6. Psychiatrist
Dialogue 1
As Paula’s psychiatrist for close to 10 years, I have followed
her progress in and out of the hospital for quite a while—and I
know her very well. She is often non-compliant with her
medications, randomly stopping them after she reports she
doesn’t like the way they make her feel. She has been
hospitalized to stabilize her medications several times over the
last 10 years, although she has managed to stay out of the
psychiatric unit for the last three. Recently, she had seemed to
appreciate the benefits of taking her medications and her
compliance has much improved. She had been seeing her social
worker regularly, and her overall mental health and physical
health were improving. This has changed recently, after several
stressful life events. We learned that Paula was pregnant by a
man she met briefly at a local flower shop. She also reports he
has been harassing her with threatening phone calls and
unwarranted visits to her home. Paula disclosed to the social
worker that she was neither eating nor taking her medication—
and she had not gotten out of bed for days. Her decompensation
was rapid and extremely worrisome and, therefore, called for a
72-hour hold.
OB Nurse
Dialogue 1
I have not known the patient long, but it does appear that she is
trying her best to deal with a very difficult situation.
Pregnancies are stressful times for even the healthiest of
women. For Paula to learn she is pregnant at 43—in addition to
her HIV and Hepatitis status and her bipolar diagnosis—must be
so overwhelming. Adding to this, she has come to her two
appointments alone and stated she has no one to bring along

7. with her. When I inquired about the father of the child, she said
he’s a bad man and he won’t leave her alone. She seemed truly
frightened of him and appears convinced he will hurt her.
Social Worker
Dialogue 1
When Paula came to me and told me she was pregnant, I was
indeed shocked by this announcement. She had never mentioned
dating anyone, and with her multiple medical and psychiatric
issues, I never thought this would be an issue we would address.
Paula and I have developed a strong working relationship over
the last two years, and she has shared many private emotions
and thoughts. This relationship has been tested, though, since I
suggested she be admitted to the hospital. Paula was furious
with me, accusing me of locking her up and not helping her. It
will take time to repair our working relationship. Once I rebuild
that rapport, we will need to work together to find a way to
address all of her concerns. We will need a plan that will
address her medical needs, her psychiatric needs, and the needs
of her unborn child.
Physician
Dialogue 2
As far as her pregnancy, if Paula doesn’t take her
HAART
medications religiously, she risks having a baby who is HIV
positive. I am concerned about how she is going to care for a
baby with her multiple medical issues. On the practical side, I
wonder how she will physically care for this child. She has a
semi-paralyzed right hand and walks with a limp. Additionally,
when her foot ulcers flare up, she can barely put pressure on her
feet. Newborns take a lot of time and energy, and I am not sure

8. she has the capacity to handle the needs of an infant—let alone
a toddler. I have not made any formal recommendations to Paula
regarding whether to continue the pregnancy, but I have told
Paula that, if she does decide to have the child, she must take
her HAART medications every day. I explained that this is vital
to her health and the health of her unborn child.
Psychiatrist
Dialogue 2
When her social worker, who I am in regular contact with,
informed me that Paula announced she was pregnant, I was
obviously concerned. Knowing Paula as well as I do, I felt I
could be honest with her and give her my opinion about the
situation. I told her that she should abort. Based on her medical
history, including her physical and mental health disabilities, I
did not believe she had the capacity to care for this unborn
child. She has absolutely no support at all, outside of the
treatment team, and would have no familial assistance to take
care of this child. My recommendation for abortion was only
solidified when we had to involuntarily hospitalize her. I fear
that Paula cannot take care of herself, and she cannot be trusted
to take her medications. If she does decide to continue with the
pregnancy, my recommendation would be that she stay on the
psychiatric unit for her entire pregnancy. That way, we will
know that she is taking her medications and that the fetus is
safe.
OB Nurse
Dialogue 2
Paula is most definitely a high-risk pregnancy, but that does not
mean she can’t have a healthy baby. If she keeps up with her
HAART medications and comes to her prenatal visits, there’s no

9. reason this baby can’t be born healthy and HIV negative. My
larger concern is with the pain medications she takes for her
foot ulcers. There is a slight chance the baby will be born
addicted to them. We would have to plan for a stay in the
NICU
if that occurs. While Paula clearly started to decompensate and
exhibited some very risky behaviors recently, I think we should
try and understand the stress she has been under. While it is not
my place to tell the patient what she should do about a
pregnancy, I don’t see that we would have to recommend
termination.
Social Worker
Dialogue 2
Paula has overcome many obstacles in her life, but a baby—at
her age and with her medical profile—is very different. Paula
has made many bad decisions in her life, and the decision to
keep this baby may or may not be the best for both her and the
child. That being said, if her decision is to continue the
pregnancy, we need to find a way to face the mountain of
obstacles. She has little to no social support, and there will be
many difficulties she will face caring for the baby alone. Paula
also has limited financial resources and will need to apply for
WIC
and Medicaid. There are the numerous supplies that we will
need to obtain, such as a crib, clothing, diapers, and formula.
She has historically been unreliable about following up with
referrals, so she is going to need a lot of encouragement and
support. Honestly, I may not believe this pregnancy is a good
idea, although I would never tell her that—that’s not up to me
or anyone else. We all, ultimately, need to accept her decision
and move on. Our goal now is to help Paula make it safely
through this pregnancy and work on a plan to help her care for
this baby once it is born. I don’t agree that she should be kept

10. on the psychiatric unit for the next seven or eight months.
Allowing Paula to play an active role in preparing for the baby
is an important task, and she will need to be out in the
community and in her home taking care of things. We have to
show that we believe in her and her willingness to manage this
situation to the best of her ability. We need to affirm her
strengths and support her weaknesses.