Intervention in Healthcare: Main Techniques
The intervention designed for the patient is an evidence-based strategy that also considers relevant individual information. The presented problem to be addressed concerning Miya, the patient, is to help improve her relationships with her mother while also rebuilding sobriety and reducing the adverse influence of depressive symptoms. The intervention entails behavioral counseling, a schedule of prescription medication, the ongoing assessment of co-occurring health challenges, as well as consistent follow-up intended to prevent relapse in drug abuse. The combination of therapy with medication is a multi-dimensional approach toward addressing the complex problem of substance abuse. While therapy is intended to help the patient understand the reasons behind her harmful behaviors, medication is necessary as a targeted tool that would enable an individual to overcome addiction, which has chemically developed in the brain (Herman & Roberto, 2015). Approaching addiction from both angles is expected to bring the most benefit to the patient.
Independent Variable: Intervention
Techniques of the Intervention
The main technique implemented during the intervention is cognitive behavioral therapy (CBT). As applied to substance use disorders, CBT entails teaching individuals with addiction to recover by finding connections between their emotions, feelings, and actions and increase awareness of how they may influence the process of recovery (McHugh, Hearon, & Otto, 2010). CBT has been extensively studied in research literature because of the wide range of benefits associated with its implementation. Specifically, the approach has been shown to positively influence contingency management, relapse prevention and other treatments, motivational interventions, as well as combination treatments (McHugh et al., 2010). In Miya’s case, CBT will offer a broad range of advantages because the method recognizes that drug addiction is a chronic illness and that it is not easy to treat, implying that therapy would take time. CBT ensures repetitive procedures that are evidence-based and patient-oriented, thus enabling Miya to stop using substances, stay sober, and contribute to society in a way that she finds valuable and productive.
Because of the objective to improve the patient’s relationship with her mother, behavioral couples therapy (BCT) was integrated into the CBT technique. As suggested by O’Farrell and Schein (2000), the aim of BCT is to build and strengthen support for substance abstinence and improve the relationship among cohabiting individuals who seek help for such issues as drug abuse. Studies have shown that BCT helps individuals struggling with substance abuse increase the number of positive activities contributing to recovery, improve their communication skills with the people who are close to them, engage in active listening and the expression of personal feelings, as well as enhance their ability to negotiate for requests (O’Farrell & Schein, 2000). In combination with medication treatment, BCT provided a comprehensive targeted treatment of the patient that considers both the psychological and pharmacological perspectives. BCT is an important technique because it has allowed to overcome the issue of resentment about substance abuse on the part of Miya’s mother and work on eliminating the feelings of distrust and fear (O’Farrell & Schein, 2000). While Miya was able to express her thoughts and emotions about her past behaviors, her mother had the opportunity to listen actively and share her own contemplations.
The Extent of the Implemented Intervention
The evidence-based practice intervention was carried to a great extent in accordance with the intended plan. Some challenges occurred during behavioral couples therapy because several conflicts took place between Miya and her mother, which caused some disruptions during sessions. However, the disputes were instrumental for illustrating the critical issues of the relationship and show the two people how addiction influenced each of them in their own ways. Miya showed high adherence to the developed medication schedule and attended individual BCT sessions, thus showing implementation fidelity in the dose and participant responsiveness dimensions (Breitenstein et al., 2012).
Fidelity Checks
Dependent Variable: Quantitative
Research Design
Repeated measures design was implemented for testing intervention fidelity and implied the same participants taking part in each condition of the independent variable. The intervention could be likened to a longitudinal study, in which changes with participants will inevitably take place, and it is important to record such changes consistently to track the progress. In addition, a repeated measures test was implemented to identify the patient’s adherence to treatment as well as her progress during cognitive behavioral therapy. Because the outcomes and application of CBT processes change throughout treatment, it is essential to explore the relationship between the therapeutic effects and CBT implementation throughout the process of therapy, and repeated measures design allowed to determine whether the different strategies carried out during the intervention changed.
The choice of repeated measure design for the quantitative component of fidelity checking was attributed to three important factors. First, the research design is often implemented when there is a limited number of participants because it allows reducing the variance of estimates as related to treatment effects, thus allowing statistical inferences made with fewer subjects. Second, the method has shown high-efficiency levels as repeated measure design allows a considerable number of experiments to be carried out more quickly (Camacho, Page, & Hooke, 2020). Besides, there is no need to train participants about how data collection will take place because the process is easy and not time-consuming. Third, the chosen method of quantitative data collection allowed to monitor how participants change over time in both long- and short-term situations.
Procedures
To facilitate the consistency of the measurements intended to test the fidelity of the intervention, data was collected after every session with Miya and the sessions involving her mother. Every session, Miya was asked questions regarding her adherence to the medication schedule, her level of satisfaction with self-care, the level of engagement in the care process, and the level of rapport with her therapist. The questionnaires were used to facilitate quick and efficient data collection and involved Likert-type scale questions that were easy to answer and did not take much time. The Likert scale ranged from ‘strongly agree’ to ‘strongly disagree’ responses with the total scores obtained by summing all items, with a higher sum of scores pointing to higher acceptability levels.
Measures
The main objective of the measurement was to evaluate intervention fidelity by testing the adherence of the patient to her treatment, which is a signifier of the fact that the intervention was carried out to a full extent and as expected. Important variables that were measured included the patient’s compliance with her medication schedule, the level of accountability taken during self-care practices, the level of adherence to behavioral treatment and the prescribed medication, and the level of satisfaction with treatment (Breitenstein et al., 2012). The measures were important to assure continued validity of the intervention, maintain its consistent implementation, and allow for observations across a wide range of settings.
Dependent Variable: Qualitative
Research Design
The two methods used for checking the fidelity of the intervention concerning Miya were self-report measures and observations. Self-report is a method that involves information acquired directly from the practitioner and intervention participants. Instead of using checklists, the reports were gathered directly from Miya and her mother and focused on finding out whether they received the intended components of the intervention. The self-report method was chosen because it is easy to carry out and does not require any additional resources apart from time. Observations were used to evaluate the fidelity of intervention implementation as a way to check whether self-reporting was accurate, thus offering a more objective assessment. A third-party observer was invited to evaluate several sessions with Miya to provide a comprehensive evaluation of the environment in which the intervention was carried out. It also allowed detecting non-verbal forms of expression that could have pointed to the extent of the patient’s engagement. Besides self-reported data collection and independent observations, Miya was encouraged to keep a journal. Journaling is a strategy intended to reinforce the intervention tools and materials as well as help the patient understand how she can cope with stress and symptoms of depression when undergoing treatment for a drug abuse disorder (Toly et al., 2016). Therefore, the research design of the qualitative component of fidelity checks focused on understanding the perspectives and opinions of Miya and her mother as well as the effectiveness of the procedures that were carried out.
Procedures
Because the method of assessing the fidelity of intervention delivery entails the combination of qualitative and quantitative measurements, it was important to collect the qualitative data on a consistent basis. The self-report fidelity checks were implemented after a series of two cognitive behavioral therapy sessions with Miya individually and with Miya and her mother. After the two sessions were completed, the patient and her relative were briefly asked a series of questions regarding the alignment of their expectations and the actual intervention that was being carried out. An independent third-party professional performed the objective observations every four sessions with Miya and every three sessions with Miya and her mother. Such in vivo observations did not interfere with the sessions in any way, the observer did not ask any follow-up questions or made suggestions. The main purpose was to provide commentary on the feasibility of the procedures being carried out without having any influence on it.
Measures
The main objective of the qualitative assessment of intervention fidelity was to understand whether the participants were receiving the entire range of benefits. In the qualitative perspective, the opinions and attitudes of the patient and her mother mattered the most, with the increased focus placed on whether the intervention reached the goals that it was intended to reach. Self-reported data from the patient, her mother, and the practitioner was recorded on audio, transcribed, and then analyzed using thematic analysis. The themes revealed as a result of thematic analysis were instrumental for showing important perspectives and opinions about how the participants of the intervention and the professional carrying out the intervention had. Overall, the mixed-methods design of checking intervention fidelity allowed to approach measurement from both qualitative and quantitative perspectives.
References
Breitenstein, S. M., Gross, D., Garvey, C. A., Hill, C., Fogg, L., & Resnick, B. (2012). Implementation fidelity in community-based interventions. Research in Nursing & Health, 33(2), 164-173. Web.
Camacho, K., Page, A., & Hooke, G. (2020). An exploration of the relationships between patient application of CBT skills and therapeutic outcomes during a two-week CBT treatment. Psychotherapy Research, 2020, 1-11.
Herman, M. A., & Roberto, M. (2015). The addicted brain: understanding the neurophysiological mechanisms of addictive disorders. Frontiers in Integrative Neuroscience, 9, 18. Web.
McHugh, K., Hearon, B., & Otto, M. (2010). Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 2010, 511-525.
O’Farrell, T., & Schein, A. (2000). Behavioral couples therapy for alcoholism and drug abuse. Journal of Substance Abuse Treatment, 18(1), 51-54.
Toly, V. B., Blanchette, J. E., Musil, C. M., & Zauszniewski, J. A. (2016). Journaling as reinforcement for the resourcefulness training intervention in mothers of technology-dependent children. Applied Nursing Research, 32, 269-274. Web.