Level 1 research: Where the rubber meets the road in the treatment of serious mental and physical health problems.

Level 1 research (Hawkins & Matthews, 1999) is an underutilized strategy for monitoring clinical cases, demonstrating accountability in applied settings, and maximizing applied clinicians’ effectiveness in the delivery of the psychological service. Two single-case examples are presented using Level 1 research to guide the clinician(s) to socially acceptable resolution of problems. The first case is a 14-year-old girl in an out-of-home care setting who presented seriously escalated disruptive behavior, including assault. She had an extensive history of sexual and physical abuse and a diagnosis of borderline personality disorder. Moreover, she was a candidate for an extensive series of cranial facial surgeries for a badly repaired cleft palate. However, without emotional and behavioral stability, the cranial facial team would not operate. Level 1 research strategies were used to modify a token economy, monitor and teach treatment fidelity, identify setting events, monitor effects of medication and intensive psychotherapy, and ultimately as evidence for behavioral and emotional stability. The second case is a 12-year-old boy with escalating nocturnal enuresis who lived in a residential care setting. Ongoing Level 1 data (including an enuresis item) were already being easily and efficiently collected through the use of a 12-item behavioral problems checklist (Parent Daily Report; Chamberlain & Reid, 1987). Interventionist used the charted bed wetting item for descriptive analyses and to monitor interventions.

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