ECONOMICS

RESPONSE 1

Respond to two colleagues by doing all of the following:

· 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.

Colleague 1: Jared

Post an evaluation of the evidence-based practice that you selected for Jake. Describe the practice and the evidence supporting it. Explain why you think this intervention is appropriate for Jake.

In the case video (Laureate Education, 2013c), the supervisor discusses the value of meeting a client first before selecting a treatment. I wholeheartedly agree with this. Some of the practices such as meditation and yoga that the social worker suggested could be offensive to the client (I ran into this situation during my first practicum). Further, what works for one client well may not work well for another client, despite there being studies that were able to show a benefit for study participants. Indeed, a hallmark of evidence-based practice is a combination of research, clinical expertise and client values (Wampold & Imel, 2015). For client values and clinical expertise to be applied, one must first meet the client and build a trusting relationship where pertinent things about the client can be discovered.

Because there is a lack of information in the case video about the client (Laureate Education, 2013), I am prevented from having a good explanation of why any intervention is appropriate beyond that which the research states is an effective intervention for veterans with post-traumatic stress disorder (PTSD). Thus, based on this limited amount of information, I would select Seeking Safety as the evidence-based practice for Jake. Seeking Safety is an intervention listed in the National Registry for Evidence-Based Practices and Programs for treating trauma, among other things such as substance abuse. In fact, its dual focus is one of the hallmarks of the treatment as substance abuse often accompanies trauma (Najavitas, 2003).

There are some essential things that must be focused on when treating someone with trauma. For instance, it is important to normalize one’s experience of PTSD symptoms (DeCarvalho & Whealin, 2012). Seeking Safety begins with psychoeducation to normalize ones experience and educate one on what is happening or why they are experiencing the things they are experiencing (Najavitas, 2003). While it is true that we do not know if Jake has a drug issue, Seeking Safety with its focus on treating substance use, it would either treat Jakes substance issue, or it would provide him the tools to stay drug-free. With PTSD, there are many symptoms such as a tendency to isolate (American Psychiatric Association, 2013). Seeking Safety specifically works on treating PTSD symptoms and would help Jake with managing anxiety, difficulties with the interpersonal (Najavitis, 2003) and other factors that would affect functioning in life (Najavitis, n.d.). Indeed, while Seeking Safety does help those with PTSD, it does so by focusing on solutions and building social supports instead of diving into the trauma narrative (Desai, Harpaz-Rotem, Najavitas, & Rosenheck, 2008). Lastly, Seeking Safety has been specifically studied in the veteran population which increases the validity of this method with another veteran (Najavitas & Hien, 2013; Lenz, Henesy, & Callender, 2016). Thus, based on what little is know about Jake from the case video, Seeking Safety appears to be a safe choice of an intervention to treat Jake.

Then provide an explanation for the supervisor regarding issues related to implementation.

There should not be an issues related to implementation. Seeking Safety can be administered on a one to one or group basis (The California Evidence-Based Clearinghouse for Child Welfare, 2018). Of course, there are many unknowns about Jake. Thus, issues could arise once more information is known about Jake.

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.

Seeking Safety is an easy intervention to implement. During my first 500 hour practicum, I led a Seeking Safety group. However, in the beginning, I had no manual and was forced to use that which I could find for free until the agency ordered me the manual. I was allowed great liberty with what was taught until I received the manual. However, I would suggest that having a manual is extremely beneficial to successfully implementing the practice. After all, the research was done on participants who sat under the treatment that was led by the manual. Thus, while some benefit would occur by covering the topics of the program, it likely would be hindered by not covering the material appropriately. Another factor that could affect implementation is the setting of the implementation. Seeking safety definitely could be implemented on a one to one basis. However, I feel that it can be implemented better in a group. This adds benefit to aspects of the intervention where discussion of the clients are prompted.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: Author.

The California Evidence-Based Clearinghouse for Child Welfare. (2018). Seeking Safety for adults. Retrieved from http://www.cebc4cw.org/program/seeking-safety-for-adults/

DeCarvalho, L. T., & Whealin, J. M. (2012). Healing stress in military families: Eight steps to wellness. Hoboken, NJ: John Wiley et Sons.

Lenz, A. S., Henesy, R., & Callender, K. (2016). Effectiveness of seeking safety for co-occurring posttraumatic stress disorder and substance use. Journal of Counseling & Development, 94(1), 51-61. doi:10.1002/jcad.12061

Najavitis, L. M. (n.d.). Implementing Seeking Safety therapy for PTSD and substance abuse:. Illinois Department of Human Services’ Office of Alcoholism and Substance Abuse. Retrieved from http://www.bhrm.org/media/pdf/guidelines/PTSD.pdf

Najavitis, L. M. (2003). Seeking safety: A treatment manual for PTSD and substance abuse. New York, NY: The Guilford Press.

Najavitis, L. M., & Hien, D. (2013). Helping vulnerable populations: A comprehensive review of the treatment outcome literature on substance use disorder and PTSD. Journal of Clinical Psychology, 69(5), 433-479. doi:10.1002/jclp.21980

Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. Retrieved from https://books.google.com

Colleague 2: Kamran

Jake is a 31-year-old married veteran, he experienced and witnessed a traumatic event on a deployment to Iraq one year ago. Jake is currently taking the medication Paxil for his Post Traumatic Stress Disorder (PTSD) symptoms. He has difficulty sleeping, heart palpitations, and moodiness. He is drinking alcohol heavily to avoid dealing with his feelings which is negatively affecting his marriage, children, and employment (Plummer, Makris & Brockson, 2014).

The evidenced-based intervention that I selected for Jake that I believe would be effective for him was Cognitive Processing Therapy (CPT), This practice will focus on the client’s avoidance of painful memories or reminders that prevents an actual processing of the past traumatic memory. He may be harboring false beliefs about the causes and results of the trauma which are creating strong negative emotions. CPT for PTSD is primarily a cognitive therapy.  The therapy will first focus on distorted beliefs about the trauma he experienced such as denial and self-blame. Then throughout this process, clients are taught to challenge their beliefs and assumptions through Socratic questioning and the use of daily worksheets. Once dysfunctional beliefs are deconstructed, more balanced self-statements are generated and practiced. It may help him to write detailed accounts of the most traumatic incidents during his deployment. The goal in CPT is that clients learn to make sense of their trauma and incorporate this understanding into their beliefs about themselves, others, and the world in a balanced way. Treatment can be delivered in individual or group format conducted by social workers, psychologists, psychiatrists, and other mental health therapists licensed to provide psychotherapy.  (SAMHSA, n.d).

An explanation I would give to the supervisor regarding the implementation of CPT is that I would educate my supervisor that this treatment is not new or experimental and has roots dating back to the 1980’s. and has been confirmed effective by evidence-based research. The other factor to note about the intervention is that first implementation would be simple and straightforward because the intervention could be done by the social worker without having to pay for copyright use or learning specific skills. Treatment consists of typically 12 sessions (range 10-15) conducted once or twice weekly for 60 minutes each (90 minutes in a group setting (SAMHSA, n.d). I would also mention a supporting study using CPT for PTSD was conducted using treatment-seeking veterans with military-related PTSD from Australia who was randomly allocated to receive 12 twice-weekly 60-minute sessions of CPT individually and in a group setting, demonstrated significant improvement scores from baseline to posttreatment (Forbes et al., 2012), (Laureate Education, 2013c).

The two factors that I believe may hinder implementation of CBT in the Jake Levy case is his cooperation and making sure that he attends both the individual and group components of the intervention. I would try to stress the importance of total compliance with the program for it to be effective. Along with that, I would have to be aware of the adverse effects related to CPT which may include mild to moderate increases in PTSD symptoms, anxiety, depression, and distress when the client begins to focus on his trauma. Based on research findings, on average, clients do not report a worsening of symptoms after starting CPT, and any worsening that does occur is generally short-lived (SAMHSA, n.d).

References

Forbes, D., Lloyd, D., Nixon, R. D. V., Elliot, P., Varker, T., Perry, D., Bryant, R. A., & Creamer, M. (2012). A multisite randomized controlled effectiveness trial of cognitive processing therapy for the military-related posttraumatic stress disorder. Journal of Anxiety Disorders, 26, 442–452.

Laureate Education (Producer). (2013c). Levy family episode 2 [Video file]. Retrieved from https://class.waldenu.edu

Plummer S.B,  Makris S.., & Brockson S.M. (2014) Sessions: Case Histories. “The Levy Family”. Laureate International Universities Publishing, Inc.

Substance Abuse and Mental Health Services Administration (n.d.) NREPP: SAMHSA’s registry of evidence-based practices and programs. Retrieved June 5, 2018, from https://www.nrepp.samhsa.gov

 

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RESPONSE 2

Respond  to two colleagues in one of the following ways:

· Compare the greatest challenge your colleague has identified to the one you posted.

· Explain whether you think your colleague’s strategy for addressing the situation is likely to be effective and why.

Colleague 1: Angela

Analysis of the supervisor’s role in the Phoenix House

The supervisor has the role of supervising four full-time social workers and two social work interns from a local university. The supervisor’s role is more of a leadership role vs a management role. She is charged with ensuring staff are performing to goals of the program. She is also charged with training and mentoring personnel as she has oversight of two interns. Lauffer explains, leadership focuses on the individual traits of those people identified as leaders while management focuses on contexts, including the design of work systems and the organizational arrangements in the workplace. (Lauffer, 2011, pg. 245).

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