SCED: Bridging research and clinical practice

By Julianne Wilner Tirpak, PhD

Research may seem out of reach for most healthcare providers working in primarily treatment-based settings like hospitals and clinics. Even those with strong foundations in clinical research may feel daunted by the requirements to get a research study up and running. From pursuing grant funding to developing the infrastructure to collect and manage data, not to mention the time it takes to conduct treatment studies with enough patients to possibly find effects, the list of barriers to research continues to grow. Moreover, managing clinical responsibilities while conducting research poses additional challenges to time and resources. And yet, researchers actively engaged in providing clinical care are well-positioned to generate some of the most relevant and important empirical questions about treatment efficacy. So, what is a clinical researcher to do?

Single-case experimental design (SCED) is a great, low-cost way to evaluate changes in symptoms during treatment, ideal for conducting research in clinical settings. This method utilizes a within-subject design, in which a clinician can present various interventions, or components of interventions, to a single subject across treatment phases to evaluate if/what aspects of treatment engage an outcome or mechanism of interest. As each participant serves as their own control, this approach can provide strong internal validity.

For those on the frontlines providing clinical care, SCED mirrors the naturalistic course of treatment in many cases. For example, if a therapist is working with a client with anxiety and starts with a cognitive restructuring intervention (i.e., challenging patterns of thinking that may be unhelpful to the patient’s experience), and after several sessions, the client does not appear to be benefiting from this approach, the clinician might switch to a more behavioral intervention such as exposure therapy (i.e., gradually helping the patient face their fears). SCED draws on this approach using similar, a priori hypotheses and study design. It also relies on critical clinical skills. SCED necessitates the clinician administering the intervention(s) to be flexible while maintaining structure in session and adherence throughout treatment.

SCEDs can also be a great resource to address the need for preliminary data to support larger grant applications. This approach may lend itself well to demonstrating a proof of concept for intervention delivery, and even initial comparisons between interventions, with a larger study as a logical next step for evaluation. For those preparing grant applications or resubmissions that may require a quick turnaround of pilot data, running a SCED study can be a relatively efficient and focused way to collect and analyze relevant data, that may not require much if any, funding to roll out. Clinical researchers in training positions (e.g., graduate school, post-doctoral fellowship, etc.) may find SCED particularly appealing and relevant for funding opportunities for smaller-scale and/or time-limited research (e.g., dissertation studies, fellowship funding mechanisms, etc.). Of course, SCED remains a worthwhile approach to include in larger grant funding mechanisms as well.

In terms of publishing results from SCED research, many journals have relevant submission types that lend well to case single-case research. Manuscripts that present data from SCEDs can be appropriate for original research submissions. Case studies also may be an appropriate avenue for publishing SCED research, with the amount of data presented and the use of graphical representation potentially setting the manuscript apart from traditional case studies that tend to rely primarily on observation and general description. Furthermore, journals with clinically-focused audiences (e.g., therapists, counselors, other mental healthcare workers) may be particularly receptive to SCED research, given the generalizability.

The observations made by healthcare workers are integral to continuing to understand and refine treatments. The individuals who work with patients are best poised to provide clinical observations that will help improve clinical care. While running full large scale research studies is often out of reach for these providers, SCEDs may offer a way for these clinicians to evaluate and share their knowledge in a way that is accessible to them and works toward the shared goal of improving healthcare.