SOCW 6311Walden University evidence-based practices discussion
Due 3/7/19Respond to at least two colleagues by doing all of the following☹Be very detaile din response, please answer each instruction unfr each bulleted item, USE 3APA reference and use bulleted points Identify strengths of your colleagues’ analyses and areas in which the analyses could be improved. Address his or her evaluation of the efficacy and applicability of the evidence-based practice, his or her identification of factors that could support or hinder the implementation of the evidence-based practice, and his or her solution for mitigating those factors.Offer additional insight to your colleagues by either identifying additional factors that may support or limit implementation of the evidence-based practice or an alternative solution for mitigating one of the limitations that your colleagues identified. Response to Reginald Describe the practice and the evidence supporting it. Explain why you think this intervention is appropriate for Jake. The evidence-based practice I chose for Jake is an intervention called VetChange. This intervention is designed to help Operation Iraqi Freedom veterans to reduce drinking to a safer level, allowing for a goal of either moderation or abstinence (Brief et. al., 2018). This intervention is targeted towards younger veterans who have alcohol use disorder. Due to high rates of PTSD in veterans problems with alcohol misuse have been reported following deployment. Jake is displaying the same signs and symptoms targets in regards to co-occurring disorders of PTSD and Alcohol Use D/O. Brief et. al. noted (2018), heightened levels of psychological distress that can trigger alcohol cravings, individuals who are motivated to drink in order to alleviate psychological pain may be at high risk for drinking to cope with PTSD symptoms. There was a meta-analysis of online alcohol interventions that found that these types of interventions were associated with a reduction in alcohol consumption and increased adherence to low risk drinking guidelines. Then provide an explanation for the supervisor regarding issues related to implementation. Identify two factors that you believe are necessary for successful implementation of the evidence-based practice and explain why. Then, identify two factors that you believe may hinder implementation and explain how you might mitigate these factors. One issue regarding implementation would be the lack of diversity in the RCT. Out of the 523 study participants, 451 were male and 413 were white. Although this may serve well for Jake Levy, there is a clear discrepancy in cultural considerations. M any mental health agencies neglected to recognize the growing diversity around them. Often, people from non-majority cultures found programs off-putting and hard to access. They avoided getting care, stopped looking for care, or if they managed to find care, they dropped out (SAMHSA, 2009c). For successful implementation of this intervention, staff should be trained with military personnel, certified drug and alcohol therapist and display an exceptional gift for technology. Another factor would be to prove that this intervention is effective and appropriate for Jake. Supportive research on the outcomes of web based alcohol interventions could help therapist feel more comfortable to refer clients to this type of treatment. One factor that may hinder implementation is billing. For example, some insurance companies may not approve web based therapy therefore not paying for services. Even though a web based therapy may be more cost effective, 8 weeks can add up quickly. Another factor that may hinder implementation is a concern about private and confidential information being spewed onto the Internet. Confidentiality is already a major concern in some therapy as is, being on the Internet and divulging private information that may be at risk to leak or be hacked can be nerve wrecking to stakeholder, clients and practitioners. References Brief, D. J., Solhan, M., Rybin, D., Enggasser, J. L., Rubin, A., Roy, M., . . . Keane, T. M. (2018). Web-based alcohol intervention for veterans: PTSD, combat exposure, and alcohol outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 10(2), 154-162. http://dx.doi.org/10.1037/tra0000281 Substance Abuse and Mental Health Services Administration. (2009c). Family psychoeducation: Getting started with evidence-based practices. *********************************************************************************************** Response to Meghan Evaluation and Evidence of EBP for Levy Case The selected evidence-based practice for Jake Levy is Cognitive Processing Therapy (CPT). This therapy has been used for a variety of clients in the trauma population and has shown effectiveness with military members. With CPT the therapist aids the client in identifying problem areas with their thinking of the event, which is causing the current issues (CEBC, 2018). The therapy attempts to help the client, “accept the reality of the traumatic event, feel emotions about the traumatic event an reduce avoidance, decrease symptoms of PTSD and depression, and to improve day-to-day living” (CEBC, 2018, p 2). Evidence to support CPT provides results showing clinical reductions in PTSD symptoms from a study completed with U.S Army soldiers who were diagnosed with PTSD (Morland et al., 2011). Forbes et al. (2012) provide results from a study of veterans in Australia. Their study uses CPT for treatment at a veterans’ community-based counseling agency. Their results showed significantly greater improvement for those who were receiving CPT rather then usual treatment. Their study also showed that CPT use reduced symptoms of anxiety and depression and improvement in their relationships with friends and family (Forbes et al., 2012). Rationale for EBP Chosen Cognitive Processing Therapy (CPT) appears to a beneficial EBP for Jake because it has shown significant reductions in PTSD symptoms for those who are or were in the military who have been exposed to traumatic events. Jake has presenting PTSD symptoms and has flashbacks. He has begun using alcohol to cope with his symptoms (Plummer, Makris, & Brocksen, 2014). With CPT he will be able to accept the reality of the event while decreasing the emotions which are forming negative beliefs about the event such as guilt and anger. Once is able to decrease the negative emotions and symptoms related to the traumatic event, he will be able to move forward with day-to-day living which will include improving relationships with friends and family. He will also have developed appropriate coping skills, which will assist in decreasing his dependence of alcohol to cope. Implementation of CPT In order to successfully implement CPT it is important to complete the pre-implementation assessments in training to assess the clinician’s knowledge and comfort level with use of CPT techniques (CEBC, 2018). Another necessary component to successful implementation is completing the training associated with CPT. It is also important to complete all requirements to be CPT approved trainer, and then to follow-up to renew status as a trainer (CEBC, 2018). Having the appropriate licensure and certification to provide the therapy will help better the implementation of the program. A factor that might hinder implementation is low fidelity which is the adherence to the elements of the program and skill delivery (Stirman et al., 2017). Another factor that might hinder implementation of the program is “turnover at the agency or organizational context may impact sustained EBP delivery of CPT” (Stirman et al., 2017, p 2). In order to mitigate issues hindering the implementation of CPT it is important to ensure proper training is in place for CPT to be provided. It is important that follow-up is provided to asses the progress of the clinician using CPT after being trained, and if further training is needed then it should be provided. Turnover is common with most human service fields, due to low pay or burnout. It is important to try to ensure that those who are struggling are provided with supervision and allowed to take time for self-care to prevent turnovers. The organizational method of the agency should have a systematic process in the CPT practice in order to ensure appropriate implementation. References Forbes, D., Lloyd, D., Nixon, R. D. V., Elliott, P., Varkera, T., Perry, D.,...Creamer, M. (2012). A multisite randomized controlled effectiveness trial of Cognitive Processing Therapy for military-related posttraumatic stress disorder. Journal of Anxiety Disorders, 26(5), 442-452. doi:10.1016/j.janxdis.2012.01.006 Morland, L. A., Hynes, A. K., Mackintosh, M. A., Resick, P. A., & Chard, K. M. (2011). Group Cognitive Processing Therapy delivered to veterans via Telehealth: A pilot cohort. Journal of Traumatic Stress, 24(4), 465-469. doi:10.1002/jts.20661 Plummer, S.-B., Makris, S., & Brocksen S. (Eds.). (2014). Sessions: Case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader]. Stirman, S. W., Finley, E. P., Shields, N., Cook, J., Haine-Schlagel, R., Burgess, J. F., Jr., … Monson, C. (2017). Improving and sustaining delivery of CPT for PTSD in mental health systems: a cluster randomized trial. IMPLEMENTATION SCIENCE, 12. https://doi-org.ezp.waldenulibrary.org/10.1186/s13... The California Evidence-Based Clearinghouse for Child Welfair. (2018). Cognitive processing therapy. Retrieved from http://www.cebc4cw.org/home/ My References (You have from initial post) Plummer, S.-B., Makris, S., & Brocksen S. (Eds.). (2014). Sessions: Case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].Cramer, H. et al. (2018). Yoga for posttraumatic stress disorder – a systematic review and meta-analysis. BMC Psychiatry, 18, 72.Substance Abuse and Mental Health Services Administration. (2009). Family Psychoeducation: Getting Started with Evidence-Based Practices. HHS Pub. No. SMA-09-4422, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human ServiceWahbeh et al. (2014). Complementary and alternative medicine for post-traumatic stress disorder symptoms: A systematic review. Journal of Evidence-based Complementary and Alternative Medicine, 19(3), 161–175.
