No Slide Title · 2018. 12. 13. · 11/27/2018 3 Griffith University November 2018 Intervention...

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Griffith University November 2018

Intervention studies and SW

INTERVENTION RESEARCH:

EXPERIENCES FROM THE COAL FACE

Grahame Simpson PhD

Professor

School of Human Services and Social Work

Griffith University

Director

Brain Injury Rehabilitation Research Group

Ingham Institute of Applied Medical Research



GETTING STARTED

An intervention:

• ‘ a purposive action intended to alter a behavior, reduce risk, or

improve outcomes’ (CDC, 2007)

• …can be delivered at individual, family, organizational, regional,

national or international level (Fraser et al 2009)

• Programs and policy are also interventions,

the focus here will be on intervention per se

Themes

• How are interventions developed?

• Is there an effect?

• Can the effect be attributed to the intervention?

Policy Program

Intervention



TRAUMATIC BRAIN

INJURYCauses:

Domestic violence, shaken babies,

road crashes, assaults, gunshot,

sporting injuries, falls, blast injuries

Definition:

…results in deterioration in cognitive, physical, emotional or independent functioning.

It can be as a result of accidents, stroke, brain tumours, infection, poisoning, lack of oxygen, and degenerative neurological disease. (AIHW 2006a)

Social impact includes risk of substance abuse, unemployment, homelessness,

social isolation, incarceration, mental health problems including suicide

Estimated annualized incidence between 100-300 per 100,000

Estimated individual lifetime cost between 2.5 and 4 million dollars



BRAIN INJURY REHABILITATION

RESEARCH GROUPBrain Injury Rehabilitation Research Group

Clinical Research TeamLiverpool Brain Injury Rehabilitation Unit

Health Services Research TeamNSW Brain Injury Rehabilitation Directorate

Professor, Research Group DirectorSenior Research Fellow

Research Assistant

Project staff

Post-doctoral Research FellowsHDR Research Students

Visiting Research Scholars

Clinical Director and Co-ChairNetwork Manager

Data and Information ManagerOutcomes Manager

Project ManagerProject Officers

Research Assistants



INGHAM INSTITUTE

of APPLIED MEDICAL RESEARCH

• BIRRG is based at the IIAMR

• 7 research streams: Injury & Rehabilitation, Cancer, Mental Health



INTERVENTION RESEARCH

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TYPES OF INTERVENTION STUDIES

Natural observation

N-of-1 designs

Quasi-experimental designs

Randomised controlled designs

Intervention research does not happen in a vacuum – supported

by observational research, psychometric studies, and

literature reviews (narrative, scoping, systematic)



NATURAL OBSERVATION



NATURAL

OBSERVATION: AN IP SW SERVICE

Natural observation- establishing activity type

- data mining and prospective audits

of practice

What are we doing? - establishing activity type

National Allied Health Activity Codes

Indicators for Intervention codes

- issue of intensity

On average families received

24 hours of SW intervention

Range 1-6 family members



EVALUATION

Information

• Reduce confusion

Counselling

• Reduce distress

Environmental resources

• BUT hard to evaluate the

accessing services & resources

Issue of control

- can’t withdraw services

- comparison to an external service

0

5

10

15

20

25

30

POMSConfusion

POMSFatigue

POMS Anger GHQ-28Anxiety

GHQ-28Depression

GHQ-28 Total

Chart Title

Admission Discharge

0

10

20

30

40

50

60

70

GHQ 28Liverpool

GHQ 28Boverie

CohesionLiverpool

CohesionBouverie

ConflictLiverpool

ConflictBouverie

Chart Title

Pre Post F'up

IP unit Admission vs discharge (n=18)

Liverpool v Bouverie comparision



SOCIAL WORK AUDIT



N-of-1 DESIGNS

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N-of-1 DESIGNS



Design: A-B design, 3 time points

Intervention: - targeting Premature Ejaculation

- standard sex therapy intervention modified for TBI

- Cross-disciplinary collaboration between sexual health and rehabilitation

- 3 face to face meetings, 3 follow-up phone calls

Measurement: Golombok Rust Inventory for Sexual Satisfaction

A-B DESIGN



PREMATURE EJACULATION – GRISSSIX MONTHS LATER - TREATMENT CONCLUDED

9

8

7

6

5

4

3

2

1

DissatisfacitonImpotence

Avoidance Infrequency

Non-Sensuality

PremEjac

Non-communication



Serious inappropriate sexual behaviour

Design: Withdrawal/Reversal design BCBC

Intervention:

Tailored to individual presentation based on a

case formulation

B Phase: Behavioural strategies to limit

disinhibition

C Phase: Facilitated access to

sex worker

Measure: Overt Behaviour Scale

WITHDRAWAL/

REVERSAL DESIGN



PROGRAM

(i) Visual inspection

(ii) Demonstrate control

(iii) Outcomes

(iv) Impact

- Social acceptability of

an intervention



GROUP-BASED DESIGNS

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TRANSLATIONAL

RESEARCH FRAMEWORK

Programs of research to address:

Family resilience

Unemployment

Mental health including suicide

Not a linear process

Ideas

Anger management

program



QUASI-EXPERIMENTAL DESIGNS

(i) QE designs without control group

(ii) ………………with control group but no pretest

(iii) ………………with control group and pre-tests

(iv) Interrupted time series design

Harris et al 2006


Intervention studies and SWBUILDING FAMILY

RESILIENCE: DEVELOPING S2SLiterature

review

Empirical study

(N=61)Focus groups

Strength2Strength

Sessions Literature

review

Focus groups Empirical

Study

Steering

committee

brainstorm

Session 1

Session 2

Session 3

Session 4

Session 5

• De novo psycho-educational program

(Full 10 hour, Abbreviated 5 hour)

• Project team of experienced rehabilitation

Swers (metro and rural)

• Steering committee included consumer

representatives



EVALUATION OF S2SControlled trial – Untreated control

group design with dependent pretest

and posttest

Usual care + S2S Vs Usual care alone

Delivered by Swers at participating sites

Primary outcome: Resilience

Secondary outcomes:

Caregiver strategy use, self-efficacy,

burden, positive affect, negative affect



STRENGTH 2 STRENGTH

• Translation (scalability)

Facilitator training over past 5 years

Challenges of fidelity and off-label use

• Efficacy and Replication/adaptability

Michigan Institute of Rehabilitation

US NIDILRR for a parallel 3 arm RCT

• Feasibility/Adaptability

Mater Hospital Brisbane - Adapt S2S for families

supporting adolescents/young adults with AOD



S2S:PHONE BASED

Feasibility & Acceptability Pilot

Intensity of S2S – would the 5 hour version also have an effect?

One group pre-post design (incl follow-up)

Narrative Evaluation of Intervention Interview

Client Satisfaction Questionaire-8

Consumer feedback

Efficacy

User Feedback Survey

(therapist)

Delivery logistics

Pre

m (SD)

Post

m (SD)

F/up

m (SD)

Pre vs

Post t

stat

Pre vs

F/up t

stat

Resilience (W&Y) 133.5 (31.6) 138.6 (22.7) 146.8 (18.6) -.559 -1.682

DASS – Depression 4.5 (2.8) 4.4 (3.5) 1.8 (2.0) .096 3.721***

DASS – Anxiety 3.5 (3.3) 2.9 (2.9) 2.4 (2.7) 1.116 .568

DASS – Stress 4.6 (3.5) 4.3 (3.3) 2.8 (2.0) .444 1.594

CD-RISC 67.0 (14.3) 72.1 (17.1) 77.8 (10.9) -.814 -2.093*

CBS 52.4 (10.3) 51.5 (10.4) 47.3 (12.1) -.133 2.243**

CAMI 68.2 (19.5) 76.0 (14.2) 79.9 (13.2) -2.086* -2.672**

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EMPLOYMENT:

IMPROVING VOCATIONAL OUTCOMES



VIP JOURNEY

Study name Study type Time frame Funding

H2W Service description 2007-2009 LBIRU

VPP Observational study 2011-2013 $200K

VIP 1.0 Efficacy study 2015-2017 $1.3 million

VIP 2.0 Scalability 2018-2021 $1.8 million

• Two different programs

Fast Track for return to pre-injury employment

New Track for new employment

• Controlled trial (Intervention vs usual care)

• Primary outcome Employed vs not employed (indicator)

• 3 private VR Providers

• 75 clients with ABI at 6 BIRP sites across NSW over 3 yrs

• Matched controls from 5 non-participating BIRP sites

• Trial completed in September 2017



EVALUATING VIP 2.0

RE-AIM FRAMEWORK (Glasgow et al, 1999)

Dimensions Descriptors

REACH Absolute number, proportion and representativeness

of individuals participating in VIP 2.0

EFFECTIVENESS Impact of intervention on outcomes

ADOPTION Absolute number, proportion and representativeness

of settings and intervention agents initiating VIP 2.0

Vic Partnership survey

IMPLEMENTATION Fidelity with which program is delivered

Adapted Case management taxonomy

MAITENANCE Extent to which program becomes part of usual care

at policy and/or service delivery area

• Place 200 clients in

competitive employment

• Roll out across all 12

adult BIRP units in NSW

• Training 16 private VR

providers

• Partnership model

between BIRP units and

providers



MENTAL HEALTH



RANDOMISED CONTROLLED TRIALS

• Parallel, cross-over, cluster

• Allocation – simple, block, stratified

• Report according to CONSORT 2010 checklist

• Quality appraisal tools include PEDRO scale,

Downs & Black



HOPELESSNESS

PRE and POST T’X

• Window to Hope is a 20 hour

10 session CBT group-based program

targeting chronic hopelessness after

severe TBI

• Evaluated as part of NHMRC EC

Fellowship

• Phase II RCT (n=17) parallel two arm (T’x

vs Waitlist) design

• WtoH effective in reducing hopelessness

• Clinically significant change

• Change sustained at 3 month follow-up

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WINDOW TO HOPE:

A REPLICATION

STUDY

Adaptation to the US military

setting Matarazzo et al 2013

Treat (n=15) vs wait-list (n=20)

Higher levels of background psychiatric

conditions including PTSD

Controlling for baseline scores, WtoH

effective at reducing hopelessness at T2

Brenner et al JHTR 2017 Griffith University November 2018


ACT-ADJUST RCT

Severe

Moderate

5

10

15

20

25

30

DA

SS-2

1 S

tres

s sc

ore

Baseline Post-intervention 1 month followup

ACT

Severe

Moderate

5

10

15

20

25

30

DA

SS-2

1 D

epre

ssio

n s

core

Baseline Post-intervention 1 month followup

ACT

• ACT may be a ‘good fit’ as a

therapeutic approach in

facilitating adjustment after TBI

• 10 session @ 15 hour group-based program

• Parallel group RCT with two arms

Treatment group (n=10) vs an active control

(Befriending group, n=9)

• Primary outcome: Psych flexibility

• Secondary outcomes: Depression, stress



EVIDENCE-INFORMED

SUICIDE PREVENTION POLICY

• I-care participants have high suicide rate

• Window to Hope, ACT-Adjust

• RCT testing delivery of Act-Adjust by

phone vs face-to-face

(Equivalence or non-inferiority trial)

• Workshop to train therapists in delivery

of WtoH and Act-Adjust



SAIL

SELF-ADVOCACY

INDEPENDENT

LIVING

)

Study Phases Outputs

Initial development of SAIL in practice Program manual and workbook, 2005-2012

Develop outcome measures Personal Advocacy Activity Scale (PAAS),

Self-Advocacy Scale (SAS)

Feasibility pilot (n=9) Hawley et al 2017 Brain Injury

Phase II or Phase III RCT (NIDILRR funding AUD$958,030), 2018-2020



INTERVENTION RESEARCH

• Targeted field of practice

• Sustained programs of research

• Close integration with literature reviews and observational

studies

• Conducted from individual practitioners through to broader

systems level

• Close collaboration between clinicians, industry and

researchers

• Importance of measurement

• Position SW in roles of practice leadership and innovation

at the local state, national and international levels



THANK YOU

Professor Grahame Simpson

School of Human Services and Social Work

Griffith University

Brain Injury Rehabilitation Research Group

Ingham Institute of Applied Medical Research

Social Worker-Clinical Specialist

[email protected]

https://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwit2aefhcDaAhVGtJQKHYT3DNsQjRx6BAgAEAU&url=https://www.youtube.com/watch?v%3Dm3QCdy63Wqc&psig=AOvVaw2weowZTqwJ4swAEEJJHud4&ust=1524010915310844

No Slide Title · 2018. 12. 13. · 11/27/2018 3 Griffith University November 2018 Intervention...

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