Drafting a Process Evaluation 6311

However, he notes that Paula is generally non-compliant with her medication. This has led to her hospitalization to stabilize her condition. The psychiatrist notes that Recent life events have complicated Paula's situation. In particular, the psychiatrist notes that Paula has been affected by her recent pregnancy, which she got by a man who has been back trolling her. As a result, Paula has been forced to decompensate by engaging in smoking to calm her nerves. Reportedly, Paula disclosed to her social worker that she is neither taking her medication nor eating, informing the decision to hold her for 72 hours at the hospital.

The report from the OB nurse seems encouraging especially considering that Paula has been diagnosed with her mental problem-specifically a bipolar condition. With a series of other medical problems, including HIV and Hepatitis dealing with pregnancy at the age of 43 poses a great risk to her health. However, Paula has only attended two of her appointments, complicating her condition if not addressed. According to the report by Paula's social worker, she has been rebellious, especially after being admitted to the hospital. This has changed their working relationship since Paula feels her confidence was betrayed. Nonetheless, considering her psychiatric issues, it was difficult to contemplate how Paula would handle her pregnancy. More worrying was how she would provide for the needs of her unborn child.

The Intervention Approach

Persons living with HIV/AIDS face different challenges, especially in following treatment recommendations to improve and maintain an optimal health status (Bromberg et al., 2020). The situation becomes complex when HIV-infected persons have other underlying mental health problems. For the case of Paula, having been diagnosed with bipolar and a constantly unstable social life has made her health condition worrying leading to the admission to the hospital. Studies have equally shown an overlap between mental disorders and HIV infection (Haines et al., 2021). These mental disorders include bipolar disorder and major depressive disorder. For Paula, she has been diagnosed with the latter. Indeed, it is estimated that the prevalence of HIV among individuals with serious mental problems ranges from 1 to 24 percent (Brown et al., 2021). The consequence of having SMI is that it affects medication adherence. For instance, the presence of stress and depression affects the immune response. Thus, failure by the patient to take prescribed medication increases the risk of worsening the current condition and for opportunistic diseases to attack. Essentially, this calls for the integration of holistic clinical management care that should comprise psychiatric and social work care to ensure all patient needs are met and addressed effectively.

Most importantly, studies have shown that non-adherence to psychiatric medication can disrupt mood, effectively affecting adherence to other medications. If these issues are not addressed, the client may develop other risk behaviours such as suicide sedation and neurocognitive impairment. One particular risk behaviour identified in Paula's case is engaging in smoking. Since she is pregnant, engaging in such behaviours does not only affect her health but also increases the risk of her unborn child. According to the assessment of the interdisciplinary committee, it was anonymously concluded that Paula was deemed a suicidal risk prompting the need to hold in her hospital to monitor her condition. Harbouring suicide thoughts is a common sign among individuals diagnosed with SMI and HIV. Depressive disorders and substance use are highly predictive behaviour to suicidal ideation.

Additionally, neuropsychological impairment is another common behaviour associated with people living with HIV and serious mental infections. This affects the judgment and ability to make rational decisions. Most importantly, it exacerbates other negative outcomes, including the inability to follow medication guidelines.

A Summary of the Literature

Given the information provided regarding the client, it is important to recognize multiple health problems present to develop an effective intervention. In particular, the practitioners need to be aware of the existing mental health problem to provide a robust approach in addressing Paula’s case. The interventions used in the treatment of Paula should include both developed and others that will be developed along the process. The intervention I would recommend for the client is a behavioural intervention, specifically behavioural therapy that will integrate a case manager and a technological technique such as text messaging. The intervention effectively improves client adherence to both psychiatric treatments and HIV medication (Brown et al., 2021). The intervention focuses on reducing risk behaviours such as unprotected sex, which increases the risk of other health problems such as sexually transmitted infections. Research has also showcased that an individual with multiple co-occurring conditions can be treated successfully with appropriate supportive resources, medication adherence and increased monitoring of the patient’s progress (Remien et al., 2019).

Similarly, considering that Paula is pregnant, I would also consider integrating pre-exposure prophylaxis (PrEP) to prevent infecting the unborn child with HIV. The recommended intervention will be applied for at least one month with weekly evaluation to determine how the client responds to medication guidelines (Remien et al., 2019). The time will also allow the interdisciplinary team to conduct individual tests and establish the suitability of the intervention to the needs of the client in the short and long-term

The Purpose for Conducting a Single-System (Subject) Research Evaluation

Single system (subject) refers to quantitative research that focuses on studying the behaviour details of the participant in a group, usually between 2 and 10 (Kenyon et al., 2021). There is a difference between the single system (subject) research and group research. Typically group research often focuses on a large number of participants and evaluates their behaviour. The primary purpose of a single-subject system design is to facilitate the evaluation of participants' responses to the intervention used to address the problem at hand. Intentionally, it serves the purpose of studying one participant at a time. Thus, for Paula, single-system subject research evaluation will play a significant role in understanding the health problems and how to address them to improve her quality of life effectively.

The Measures for Evaluating the Outcomes and Observing Change

Measures of evaluating the outcomes for Paula's intervention include a series of repeated actions to evaluate the performance of strategy during treatment. Particularly, the measures are utilized to determine the trend in treatment data and determine the effectiveness of the treatment method. It will also provide the researcher with a guideline in establishing the need for change if the intervention is deemed ineffective.

Table 1: Task completion scores

Table 2: Problem changing scores

Evidence from Your Literature Search about the Nature of the Measures

Research shows that a single system subject requires a strong measurement to facilitate the identification of a series of quality indicators regarding the health problem being investigated by a patient. For example, it is critical for these measures to include descriptions and characteristics of the participants, settings, and independent and dependent variables. The measures are essential in establishing a baseline design that will inform the observations made by the participants.

The Validity and Reliability of The Measures

Observation is one of the most direct and precise techniques of measuring behaviour change. The observation is true as long as at least one observer reaches a common conclusion. This allows for the calculation of interobserver reliability, enhancing the credibility of the results. In particular, observation can be essential in tracking variables such as the number of times the patient misses out on medication, repeated patterns during therapy sessions and immediate response to a certain decision. The reliability and validity of measures are less subjective to interferences, judgment and estimates used in other measures.

How Baseline Measures Will Be Obtained

Baseline measures provide the level of behaviour (the DIV) as it occurs naturally before implementing the intervention (Hart et al., 2018). It serves two critical purposes: the descriptive function and the predictive function. The baseline should showcase the trend before and after the intervention. A trend can be defined as an indicative illustration of the behaviour direction. Notably, the baseline may show no trend, a decreasing trend and an increasing trend. The researcher's responsibility is to initiate the intervention in an ascending baseline if the goal is to decrease the behaviour. In contrast, the intervention for a descending baseline is applicable if the aim is to increase the behaviour.

How Often Follow-Up Measures Will Be Administered

Considering that the recommended intervention will run for at least one month before concluding whether it is effective, the follow-up measures will be administered weekly. Notably, repeated measurements are critical in identifying the client's status. Also, it will be essential in establishing the baseline phase before and after the intervention.

The Criteria That You Would Use to Determine Whether the Intervention Is Effective

To determine the effectiveness of the intervention, I would document the target outcome variables. For example, for the case of Paula, it is important to determine her adherence to medication and psychiatric treatment. These should be recorded for purposes of establishing baseline data for comparison purposes.

How the Periodic Measurements Could Assist You in Your Ongoing Work with Paula

With Paula exhibiting multiple health problems, periodic measurements come in handy, especially in recording and documenting the occurrence of events. Essentially, these records can be utilized in making intermittent decisions regarding the progress made by the client (Caneiro et al., 2019). Additionally, to enhance the effectiveness of the intervention, baseline data variables can be compared with periodic measurement observation to identify gaps and make necessary changes. This will, in particular, aid the management of multiple health problems by marking how the client is responding and improving the independence of each health complication.

References