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11/27/2018
1
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
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
INGHAM INSTITUTE
of APPLIED MEDICAL RESEARCH
• BIRRG is based at the IIAMR
• 7 research streams: Injury & Rehabilitation, Cancer, Mental Health
Griffith University November 2018
Intervention studies and SW
INTERVENTION RESEARCH
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Griffith University November 2018
Intervention studies and SW
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)
Griffith University November 2018
Intervention studies and SW
NATURAL OBSERVATION
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
SOCIAL WORK AUDIT
Griffith University November 2018
Intervention studies and SW
N-of-1 DESIGNS
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Griffith University November 2018
Intervention studies and SW
N-of-1 DESIGNS
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
PREMATURE EJACULATION – GRISSSIX MONTHS LATER - TREATMENT CONCLUDED
9
8
7
6
5
4
3
2
1
DissatisfacitonImpotence
Avoidance Infrequency
Non-Sensuality
PremEjac
Non-communication
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
PROGRAM
(i) Visual inspection
(ii) Demonstrate control
(iii) Outcomes
(iv) Impact
- Social acceptability of
an intervention
Griffith University November 2018
Intervention studies and SW
GROUP-BASED DESIGNS
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Griffith University November 2018
Intervention studies and SW
TRANSLATIONAL
RESEARCH FRAMEWORK
Programs of research to address:
Family resilience
Unemployment
Mental health including suicide
Not a linear process
Ideas
Anger management
program
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
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
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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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Griffith University November 2018
Intervention studies and SW
EMPLOYMENT:
IMPROVING VOCATIONAL OUTCOMES
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
MENTAL HEALTH
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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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Griffith University November 2018
Intervention studies and SW
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
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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
Griffith University November 2018
Intervention studies and SW
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