A comprehensive method of single-case data analysis: Interrupted Time-Series Simulation (ITSSIM).

Single-case experimental methods are used across a range of educational and psychological research. Single-case data are analyzed with a variety of methods, but no statistic has demonstrated clear superiority over other methods. The time-series nature of single-case designs requires special consideration for baseline trend and autocorrelation when estimating intervention effect size. However, standard correction methods are limited because they assume precise statistical estimation of trend and autocorrelation. Unlike standard correction methods, Monte Carlo simulation methods can address the poor precision of single-case effect size indices. This paper presents the rationale for a new simulation method, Interrupted Time-Series Simulation (ITSSIM). A small field test was also conducted, and ITSSIM performed similarly to sophisticated multilevel methods for single-case research. ITSSIM is accessible as a free software application that requires no prior knowledge of statistical computing or syntax. ITSSIM may be used to estimate the effect size of a single interrupted time-series (AB design), and multiple ITSSIM effect size estimates may be combined via meta-analysis. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Using the Relational Coordination Instrument With a Diverse Patient Sample.

BACKGROUND: The Relational Coordination (RC) instrument has been used extensively in the context of health care interprofessional coordination. However, the instrument's applicability to patient experiences of their interactions with professionals is largely untested. OBJECTIVES: This study's objectives were to determine: (1) whether the RC instrument could be modified for phone administration to yield internally consistent results when used with a diverse group of patients with complex health needs; and (2) whether the RC factor was invariant across patients of differing education, levels of emotional problems, race, and ethnicity, thereby showing similar interpretation of items across these groups. RESEARCH DESIGN: The RC instrument was administered through a phone survey to patients in Texas (n=346) who reported receiving care coordination. Data collection occurred between 2014 and 2016. Cronbach α coefficients and confirmatory factor analysis were used to determine whether the original set of RC items could be used for phone surveys with patients. Factorial invariance testing was used to assess how consistently the instrument was interpreted across patient subgroups. RESULTS: The RC scale generally met acceptable α statistic and confirmatory factor analysis thresholds for internal consistency. Factorial invariance results indicated that the scale also generally performed consistently across patient subgroups. CONCLUSIONS: This study provides preliminary evidence that the RC instrument can be used for surveying diverse patient populations. Future use of this instrument with patients can better reflect their experiences as partners with professionals in improving their health.

Can Anger Be Helpful?: Soldier Perceptions of the Utility of Anger.

Studies have found that soldiers returning from combat deployment report elevated levels of anger and aggression. The present study examined the perception that anger was helpful in performing occupationally related duties and whether this perception was associated with mental health problems, somatic symptoms, and functioning. Soldiers (N = 627) completed a survey 4 months after their deployment to Afghanistan and again 3 months later. When examining anger over time, findings revealed four groups of different latent classes: low stable (resilient), high stable (chronic), decreasing over time (improved), and increasing over time (delayed problems). For two of the groups (chronic and delayed problems), perceiving anger as helpful was closely related to anger reactions. Perceiving anger as helpful was also associated with worse mental health symptoms. Further work in understanding how to mitigate this positive perception of anger in prevention initiatives may be useful in addressing anger reactions.

Depression and health-related quality of life among persons with sensory disabilities in a health professional shortage area.

OBJECTIVE: The authors examined depression and health-related quality of life among individuals with self-reported sensory impairments living in a health professional shortage area. RESEARCH METHOD: Health surveys of residents were conducted in 2006 and 2010. Responses were analyzed by groups of residents reporting vision loss, hearing loss, dual hearing and vision loss, and no sensory loss. In 2006, the total sample size was n = 2,591, and in 2010, it was n = 3,955. MAIN OUTCOME MEASURES: The CESD-5 scale (Shrout & Yager, 1989) was included in 2006, and the PHQ-9 (Kroenke, Spitzer, & Williams, 2001) was included in 2010. Rates of depression on the CESD-5 were determined by the recommended cut-off scores and on the PHQ-9 by the recommended algorithm. The Centers for Disease Control (CDC) Healthy Days instrument (Moriarty, Zack, & Kobau, 2003) was used in both surveys to assess health-related quality of life. RESULTS: In both surveys, individuals who reported sensory loss had higher rates of depression and lower health-related quality of life than individuals with no reported sensory loss. CONCLUSIONS: Individuals reporting sensory loss had high rates of depression and a compromised quality of life compared to respondents without these impairments. These data imply strategic community-based health care services, including mental health initiatives, may be indicated for individuals with sensory loss living in underserved regions. Implications for rehabilitation psychology research, service, and policy are discussed as innovations in these areas are needed to better understand and address the disparities that may compromise the overall well-being of residents of underserved communities. (PsycINFO Database Record

Health-related quality of life of rural clients seeking telepsychology services.

Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services (n = 94) had low health-related quality of life (HRQOL), often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients (n = 40) was associated with an improvement in mental health-related quality of life (d = 0.70, P < .001). These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas.

Incorporating nonoverlap indices with visual analysis for quantifying intervention effectiveness in single-case experimental designs.

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.

Interpersonal problems and personality features as mediators between attachment and intimate partner violence.

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.

Assessing depression in rural communities.

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.

Small N designs for rehabilitation research.

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.

Use of technology to increase access to mental health services in a rural Texas community.

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.

Robust regression for single-case data analysis: how can it help?

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.

Construction and validation of the Intragroup Marginalization Inventory.

This study reports the development and validation of the Intragroup Marginalization Inventory (IMI). The IMI consists of three scales that assess the extent to which an individual perceives interpersonal distancing from family, friends, and ethnic group community members. Intragroup marginalization is defined as the interpersonal distancing that occurs when an acculturating individual is believed to exhibit behaviors, values, and beliefs that are outside the heritage culture's group norms. Intragroup marginalization is based on social identity theory that asserts that groups maintain their identity by the distinctive behaviors of its members. When an acculturating individual displays behaviors or attitudes that differ from the heritage culture group's norms, the group may respond to the threat with social alienation of the transgressor. The results support the IMI's validity via a) content validity in the development of the items, b) construct validity in the selection of the factors based upon an exploratory factor analysis, c) the replicability of the factors based upon a confirmatory factor analysis, and d) discriminant validity through examining the relationship of the factors with other established measures.

Factor analysis of the personal authority in the family system questionnaire.

The factor structure of the Personal Authority in the Family System Questionnaire (PAFS-Q) has been used in numerous studies, but the factor structure has not been examined since its development in 1984. This study examined the factor structure of the PAFS-Q. Findings suggest a six-factor solution with important differences from those reported when the PAFS-Q was developed. The main differences between this study and the original factor analysis are that this study found separate Mother and Father Intimacy factors instead of a single Intergenerational Intimacy factor and the original Spousal Fusion and Spousal Intimacy factors were not separate factors in the current study. Implications and future directions for research are also discussed.

The relationship between visual analysis and five statistical analyses in a simple AB single-case research design.

This study explored some practical issues for single-case researchers who rely on visual analysis of graphed data, but who also may consider supplemental use of promising statistical analysis techniques. The study sought to answer three major questions: (a) What is a typical range of effect sizes from these analytic techniques for data from "effective interventions"? (b) How closely do results from these same analytic techniques concur with visual-analysis-based judgments of effective interventions? and (c) What role does autocorrelation play in interpretation of these analytic results? To answer these questions, five analytic techniques were compared with the judgments of 45 doctoral students and faculty, who rated intervention effectiveness from visual analysis of 35 fabricated AB design graphs. Implications for researchers and practitioners using single-case designs are discussed.

The developmental course of Personal Authority in the Family System.

The present study examined the differences in participants' intergenerational family relationships across the following three age/stage groups based on Williamson's (1991) theory of Personal Authority in the Family System (PAFS) and adult developmental theory (Levinson, 1986): ages 18-23, 24-29, and 30-45. The most noteworthy variables were intergenerational intimacy and intimidation with mothers and fathers, with significant but less contribution by intergenerational triangulation with fathers. Results indicated that each successively older group reported significantly less intimacy and less intimidation with each parent, and less triangulation with fathers than the previous younger group. Small gender differences were also present, but without an interaction with age/stage groups. Females reported slightly healthier intergenerational relationships with parents than did males. Finally, implications for clinical practice are presented.

Solution-focused family therapy with three aggressive and oppositional-acting children: an N = 1 empirical study.

The efficacy of Solution-Focused Family Therapy (SFFT) for helping three families with aggressive and oppositional-acting children (aged 8-9) was examined. The N = 1 multiple-baseline design with three replications used validated measures, a treatment manual, and a treatment integrity measure. The interventions lasted from four to five sessions. SFFT appeared to be effective with the families at post-treatment and 3-month follow up.

Evaluation of the accuracy of two regression-based methods for estimating premorbid IQ.

Two premorbid IQ estimation procedures were compared in a normal, non-brain-impaired sample and a clinical sample of known brain-impaired individuals. The methods used for comparison were the purely demographically based regression index (DI) developed by and the Oklahoma Premorbid Intelligence Estimate (OPIE) equation by, which uses demographic information combined with current performance tasks. The data for the normal sample were gathered from the WAIS-R standardization sample of 1880 subjects. The clinical sample was 100 patients with known cognitive impairment who had been referred to a private neuropsychology practice. The DI appeared to provide the most clinical utility as an estimate of premorbid IQ in a cognitively impaired sample. Significant differences between the two methods for specific locations of brain injury were not observed.

Link among therapist and parent relationship, working alliance, and therapy outcome.

On the basis of interpersonal and intergenerational family theories, this study examined (a) the association between therapists' reported relationship with their parents and clients' report of the working alliance at 3 points in the therapy process (i.e., after the 3rd, 7th, and final sessions); (b) the association between clients' report of the working alliance at 3 points in the therapy process and outcome, and (c) the association between therapists' reported relationships with parents and outcome. With 20 therapist-client dyads, results indicated that the therapist-parent relationship, measured by the Personal Authority in the Family System Questionnaire, predicted working alliance at the 3rd, middle, and final sessions of therapy. Additionally, working alliance predicted outcome. Of particular note, the results indicated that both healthy (i.e., intimacy and individuation) and less healthy (i.e., fusion and triangulation) therapist-parent relationship patterns contributed to the client's perception of a positive working alliance.

Five-factor model (Big Five) personality traits and universal-diverse orientation in counselor trainees.

In this study the authors explored the relationship between five-factor model (FFM: Big Five) personality traits (J. M. Digman, 1990; R. R. McCrae & O. P. John, 1992; J. S. Wiggins & P. D. Trappnell, 1997) and universal-diverse orientation (UDO; M. L. Miville et al., 1999) in counselor trainees. FFM traits were measured using the NEO-Personality Inventory-Revised (P. T. Costa & R. R. McCrae, 1992). Statistically significant relationships were found between UDO and one of the Big Five personality traits (Openness to Experience) in counselor trainees. Further regression analysis suggested a relationship between UDO and a particular facet of Openness to Experience, Openness to Aesthetics. This finding suggests that counselor trainees who are open to the creative expressions of others may be comfortable working with a wide variety of clients. These results suggest that counselor training that encourages experiences of aesthetic diversity in addition to an exploration of values may promote trainees' ability to work with diverse clients.

Methodological and statistical considerations for threats to internal validity in pediatric outcome data: response shift in self-report outcomes.

OBJECTIVE: To examine conceptual models of response shift, research design, and internal validity issues in the context of longitudinal outcome research using self-report measures such as pediatric quality of life. METHODS: Growth modeling was introduced and illustrated using a previously published data set (Clay, Wood, Frank, Hagglund, & Johnson, 1995) of adjustment in children with juvenile rheumatoid arthritis, diabetes, and healthy controls. RESULTS: Demonstrations revealed that growth modeling may detect response shift and may also model the time and shape of the response shift. CONCLUSIONS: Growth modeling provides one avenue to investigate response shift, thereby addressing an important threat to internal validity in longitudinal outcome research such as quality of life in children with chronic illness.