Researching Evidence
Based Practice

In determining what evidence-based treatment tools to
utilize with a client, it needs to be looked at what is most effective and what
will work with this particular individual client. The
history of the client need to be taken into consideration as well as their
current situation. Another area which needs to be addressed is the ability of
the agency to effectively implement the practice. Areas which need to be
considered are specialized training needed to implement, cost,
strengths/weaknesses of the practice, and the overall measurement research
outcomes. 

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Client History

Tiffani Bradley is a 16-year old heterosexual, Caucasian
female (Plummer, Makris, & Brocksen, 2014). Tiffani has a history of
emotional, physical, sexual and psychological abuse in which she reports three
prior arrests for prostitution (Plummer, et al., 2014). Tiffani reports she has
had several treatments for sexually transmitted diseases and has for the last
two years been social isolated except for Donald, John “T”, other women who
were also being trafficked and those who paid to have sex with her (Plummer, et
al., 2014). Tiffani reports feelings of low self-esteem/self-worth, fear, and
anger (Plummer, et al., 2014). Tiffani reports she would like to complete her
GED, obtain employment, and her own place (Plummer, et al., 2014).

Evidence-Based Practices

Boston Consortium Model:
Trauma-Informed Substance Abuse Treatment for Women:

Boston Consortium
Model: Trauma-Informed Substance Abuse Treatment for Women (BCM) is a
trauma-informed substance abuse and mental health treatment which utilizes a
trauma recovery and empowerment model of treatment (Substance Abuse and Mental
Health Services Administration (SAMHSA), n.d.a). BCM addresses the correlations which can be found between a client’s
addiction, mental health disorders, trauma, and sexual risk behaviors working
to develop positive coping skills with the client which will allow them to heal
from their trauma background (SAMHSA, n.d.a). Areas of focus within the
treatment practice are: “alcohol and/or drug abuse, mental health needs,
interpersonal violence, leadership, and effective assertive communication skills”
(SAMHSA, n.d.a).

The measurement outcomes for BCM
take into consideration substance use
and related problem severity, mental health symptomatology, posttraumatic
stress symptoms, HIV sexual risk
behaviors, and perceived power in one’s relationship (SAMHSA, n.d.a). In
addressing the area of substance abuse, the quasi-experimental measurement
showed a decrease after a six-month period, twelve-month and continuous
decreasing on recurring follow up (SAMHSA, n.d.a). The quasi-experimental
measurement outcome for mental health symptoms shows symptoms are being
reported in fewer instances over a twelve-month time period (SAMHSA, n.d.a).
Posttraumatic stress symptoms measured a similar outcome with continued
decreasing symptoms (SAMHSA, n.d.a). Those individuals who were at risk of HIV
sexual risk behaviors also showed outcome measurements decreasing (SAMHSA,
n.d.a).

Say It Straight:

            Say It Straight (SIS) is a communication training program
which teaches adolescents and adults empowering communication skills and
behaviors in order to increase their self-efficacy, self-awareness, social and
personal responsibility (SAMHSA, n.d.b). This evidence-based practice is
designed to decrease negative behaviors such as: “substance use, eating
disorders, bullying, violence, precocious sexual behavior, and behaviors that
can result in HIV infection” (SAMHSA, n.d.b). The process of this program
consists of role playing, body sculpting, journaling, and group discussion to
assist the client in identifying the disempowering behaviors which led them to
where they find themselves currently (SAMHSA, n.d.b). The goal is to increase
the client’s integrity, compassion, courage, and resiliency (SAMHSA, n.d.b).

            The measurement outcomes to determine
if SIS is effective are: alcohol and/or drug-related school suspensions, intentions
to use assertive refusal skills, criminal offenses, communication skills, and intentions
to use assertive refusal skills in sexual situations (SAMHSA, n.d.b).  SIS was measured pre-experimental as well as
quasi-experimental. Each of these measurement outcome areas showed a decrease
in behaviors, an increase in using effective communications skills such as the
use of “I” statements and an increase in utilizing assertive communication
skills to refuse in negative situations (SAMHSA, n.d.b).

Recommendations for
Tiffani’s Treatment

Factors which need to be considered prior to implementing
a treatment program for Tiffani are: her substance abuse, the extensive trauma
she has endured, lack of primary support system, and her need to develop positive
coping skills (Plummer, et al., 2014).

Social Work Skills. There are several social work skills
which would need to be utilized with Tiffani. Tiffani may not feel like she has
had anyone really listen to her story of trauma as she had been arrested for
prostitution and instead of being seen as a victim of human trafficking, she
became further victimized by the judicial system (Plummer, et al., 2014). It
would be important to provide Tiffani with active listening, empathy, and to
work on building a rapport with her. In utilizing the social work skill of
active listening, it would be inherent to summarize and to use reflection in
order to let Tiffani know that we are hearing what she has to say as well as to
ensure we are interpreting what she is saying correctly. As her social worker,
we need to utilize the social work skill of observation. Tiffani has
experienced several years of trauma, both while living at home and upon leaving
home. It is important the social worker be aware of sudden changes in Tiffani’s
mood or behavior which may be a sign of something being triggered emotionally
for her.

Training of
Evidence-Based Practices. BCM is
a costly evidence-based practice in that the trainer requires $20,000 as well
as travel expenses (SAMHSA, n.d.a). The training consists of an on-site, 8-day
training with all training materials included in the cost (SAMHSA, n.d.a). BCM
is estimated to cost approximately $3,500 per client and this is contingent on
other treatment systems such as mental health/substance abuse treatment
(inpatient or outpatient) already being in place (SAMHSA, n.d.a).

SIS is more cost effective in that the practice is a 3-4-day
intensive training workshop in which agencies send their employees to a
specific location (Say It Straight, 2017). The cost of the training is
approximately $850 plus travel expenses per individual, however, one person can
go through the Master SIS training and become a trainer for their agency (Say
It Straight, 2017). SIS can be implemented in schools, mental health or
substance abuse treatment centers, detention centers, etc.    

National Registry of Evidence-Based
Programs and Practices

As a beginning researcher, I believe the registry would be
beneficial in acquiring evidence-based practices. It took a few searches to
discover what I was looking for in the case of Tiffani, however, once
discovering how to utilize the search engine effectively, I did find what it
was that I felt would be effective practice. The fundamental idea to using this
registry is using key words on what it is that needs to be treated.

Once finding an evidence-based practice I believe would
benefit Tiffani, this would increase my confidence in the knowledge that other
client’s symptoms, substance usage, and negative behaviors have decreased by
utilizing this treatment modality. In researching the practices, I noted there
were a few that did not provide much information regarding the outcomes or
validity. These would have to be further researched prior to being implemented.
  

Conclusion

In deciding what
evidence-based treatment practice to use, we must be mindful of the cost needed
to implement and continue to have the practice in place. If a practice is not
cost-effective where it is able to be sustained over time, then other practices
need to be considered. In deciding what evidence-based treatment to utilize with
Tiffani, SIS would be an effective approach and treatment modality. This practice
would assist her with developing effective communication skills needed to empower
her to make more positive choices, develop self-efficacy, and increase her self-esteem.
This treatment model would assist her in working through the trauma she has experienced.

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