Program: In-school tutoring programs for at-risk youths
Evidence-based practice is a complex and conscientious process of decision-making which relies on the available evidence as well as client characteristics, preferences and situations. The aim of preventing substance abuse is to protect individuals, especially juveniles from the adverse physical, emotional, psychological and other negative consequences of drug and alcohol abuse (Das et al., 2016). This is in the best interest of the teens, the community and institutions within the community. Therefore, in-school tutoring programs for youths at risk of drug addiction and substance dependence is an evidence-based practice. Implementing these programs in schools would align the teens’ behaviors with the socially acceptable and culturally-relevant norms. In return, the benefits would be experienced by all individuals and groups in the society at large.
In this project, attention is given to evidence-based practices as the area of practice within which the program of in-school tutoring for youths at-risk is being examined. The paper covers a wide range of information regarding the topic by first briefly analyzing the three articles in this area, followed by the history of evidence-based practices as the selected area of practice prior to the analysis of its current status and continuous evolution in US. Policies governing drug treatment practices are also given attention. Towards the end, there is a critical reflection upon the current practices by suggesting the best approaches to achieve the objectives of in-school tutoring as a way of moving forward to positively impact on individuals, institutions and the community at large and ultimately achieve the goals of evidence-based practices.
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Articles Informing Evidence-Based Practices
Article 1: Evidence-Based Practice: The Psychology of EBP Implementation
The article by Rousseau & Gunia, (2016) focuses on the definition of evidence-based practice as an approach used in different professions mainly focusing attention on the quality of evidence as the main determinant of the effectiveness of decision-making and (remedial) action or a way forward to a particular situation. This article reviews research on the implementation of EBP by identifying critical underlying physical, social and psychological factors affecting the use of EBP. From the findings indicated in this article, critical factors that facilitate implementation of EBP include institutional policies, professional competence, availability of resources, supportive culture and support by the available social systems. On contrary factors such as psychological problems among clients, complexity of the subject matter and cultural incompatibility can impede effective implementation of EBP. Personal experiences also impact adversely on the implementation of EBP by limiting the quality of the forms of evidence employed.
The article proceeds into identifying and analyzing critical competencies in the implementation of EBP and the underlying challenges to the acquisition of these competencies. These competencies include communication skills, professionalism, experience in the dynamics of the specific contexts, and the level of understanding and mastery of relevant knowledge in a particular EBP field, evidence search and appraisal, outcome evaluation, question formulation, critical thinking abilities, and functional competencies among others competencies. However, lack of these competencies limits EBP implementation. The findings of this article are organized around the three key contributors to EBP namely Motivation, Practitioner ability and Opportunity to Practice among others. Throughout the article, important links between EBP and Psychology are established alongside important contributions that can be gained by engaging in psychological research aimed at the development and implementation of EBP.
Article 2: Effectiveness of Brief School-Based Interventions for Adolescents: A Meta-analysis of Alcohol Use Prevention Programs
This article by Hennessy & Tanner-Smith, (2015) is a meta-analysis that offers a summary of the effectiveness of implementing school-based brief alcohol interventions (BAIs) among teens alongside possible iatrogenic impacts as a result of deviancy training in group-based interventions. This meta-analysis establishes that preventive interventions for adolescents are important priorities within school contexts. Although several interventions have been developed and employed across schools, their effectiveness varies significantly between different studies. This meta-analysis was therefore to assess how effective universal school-based prevention programs are on the use of alcohol among adolescents. From the findings, it is seen that school-based interventions have an overall small but a positive impact on the adolescent use of alcohol up to one year following program implementation for any age of teens for both boys and girls. When it comes to the universal preventive interventions, small effect sizes have the potential to make a big difference.
In the conclusion section, Hennessy & Tanner-Smith suggest the need to consider alcohol prevention education as an important part of wider policy approach and the need to consider it an educational practice that has been proven to be effective, hence evidence-based. Authors add that interventions need to focus on specific ingredients that are geared towards alcohol prevention among youths. Future research should also continue with the development and testing of the implementation interventions that have already demonstrated the potential to reduce the use of alcohol among adolescents. Finally, the authors recommend that in order to improve the effectiveness of alcohol interventions, related evidence-base should continuously be developed.
Article 3: Treatment Rooted in Culture; Tying Drug and Alcohol Programs to Immigrants' Backgrounds
The article by Sachs, (1999) displays the role of culture in drug and alcohol programs by presenting the case of an immigrant named Mohammed Arif who came to America from Pakistan and was not until he came across a rehabilitation center operated by immigrants from South Asia that his problem met a solution. Arif counsels other immigrants emphasizing on the role of cultural conformity in counseling, rehabilitation and treatment of drug addiction. The use of a western Indian phrase Nav Nirmaan, meaning ''new beginning'' has brought tremendous changes in the area of counseling and has seen many enroll in the native rehabilitation centers in America. Sachs presents many other examples of the instances that involved culturally-relevant drug and alcohol programs and emphasizes on the role of language and culturally-convenient and compatible programs in facilitating such evidence-based programs. Other immigrants with whom such culturally relevant programs have worked in US include individuals from Russia and Korea. The basic adage from this article is that drug and alcohol programs can be more effective and evidence-based if they are tailored in culturally-relevant manner.
Brief History of Evidence-Based Practice
Evidence-based practice has its roots in the field of medicine. It began with conventional experiments to investigate the effectiveness of practices such as bloodletting (Forte, Timmer & Urquiza, 2014). In 1972, Archie Cochrane recommended proper testing health care strategies and establishing their effectiveness and using controlled studies to provide the basis and evidence of healthcare. Guyatt et al in 1992 introduced the concept of evidence-based practice and this shifted the emphasis from the former unsystematic clinical experience to clinical decision-making.
Presently, EBP is based on clinically relevant research. Although many criticize EBP that it over-relies on research and that it has taken a long time to become fully integrated in the medical profession, it is has nevertheless transformed medical and other related professions. According to Sackett, (1997), EBP is a combination between research and clinical expertise, taking into account the preferences of the client. Since then, EBP has been widely embraced in various areas including but not limited to nursing, speech pathology, dentistry, public health, psychology and social work. In the Evidence-based Health Care Teachers and Developers conference held in Sicily in 2003, Sicily Statement was prepared to aid in introducing the broader and deeper concept of EB decision making in health care (Dawes et al., 2005).
The practice of health care practitioners is applicable in a wide range of clinical environments and this is likely to influence decision-making using evidence based practice. Satterfield et al., (2009) developed a transdisciplinary model for evidence-based practice. The model depicts three core EBP components namely; best available evidence from research, clinical expertise, and patient’s preferences. These components are also applicable within a broader organizational or clinical context. This implies that organizational context is an additional component in EBP.
Current Status of EBP US
The US is the leading country worldwide in terms of implementation and practice of evidence-based health care (Melnyk et al 2012). Throughout the learning institutions in the country, evidence-based practice is guided by the scope and standards of practice. The mission of this scope is to enhance whole student wellness and learning by advancing school nursing practice. The vision is to achieve student access to health and learning all day, every day. The scope includes six practices under the standards of school nursing practice. These practices include assessment, diagnosis, outcomes identification, planning implementation (which involves coordination of care, health teaching and health promotion, consultation, perspective authority and treatment) and evaluation. The scope further involves 12 additional standards of professional performance namely ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice and research, quality of practice, professional practice evaluation, resource utilization, environmental health, and program management (Texas School Nurses Organization, 2017).
These standards of professional practice together constitute a complete and well established health care and wellness system in the institutions of learning that caters for physical, psychological, emotional and other aspects of wellness. As such, EBP covers areas of drug and substance prevention in schools and it is not only a function of the school nursing department but requires a combination of efforts at the institution, individual and community levels to achieve the ultimate goal of EBP in schools in US.
Trends and Evolution of Evidence Based Practice in School
Substantial expansion and progress of EBP in the recent past has been made in the area of development of the prevention programs for adolescents’ drug and substance abuse. The most successful and effectively functioning interventions are targeted to the prevention of salient protective and risk factors among individuals, families, and the community at large. EBP at these levels are hinged on the evidence from relevant theories in the field of psychology, nursing, medicine and other relevant fields regarding etiology of drug and substance use and abuse. Prior to the implementation of a particular program in schools, there is need to establish the effects of that program from the existing literature and research. There should also be proper dissemination methods for such a program and lastly, its positive impacts should override the negative impacts and it should be unanimous among the relevant stakeholders (Texas School Nurses Organization, 2017).
Policies that Govern Evidence-Based Practice in US
The following is a statement that was approved as a policy of the American Psychological Association (APA) by the APA Council of Representatives during the August, 2005 meeting:
Evidence-based practice in psychology (EBPP) is an integration of the best research available with relevant clinical expertise in the contexts of patient characteristics, patient culture, and their preferences. This definition of EBPP is parallel to the definition of evidence-based practice that was adopted by the Institute of Medicine (2001, p. 147). "Evidence-based practice is therefore the integration of best existing research evidence with the relevant clinical expertise and patient preferences and values." The purpose of EBPP is to enhance effective psychological practice and promote public health through application of empirically supported principles of psychological assessment, therapeutic relationship case formulation, and intervention.
From this definition and policy statement about the scope of EBP, it is evident that EBP entails the following briefly explained components and basic policies under each component.
Best Available Research- Researchers and practitioners should come together and jointly ensure the existing research on psychological practice clinically relevant and also internally valid. Assuming that interventions which are yet to be studied in controlled trials are ineffective is not of much importance. However, it is important to rigorously evaluate highly used psychological practices and interventions developed both in the laboratory and in the field while indentifying barriers to conducting this research and systematically addressing them (Institute of Medicine, 2015).
Clinical Expertise - The clinical expertise of psychologists encompasses a range of pertinent competencies which promote positive therapeutic outcomes. These competencies include: Ability to conduct assessments and develop diagnostic judgments, making crucial clinical decisions, procession and use of interpersonal skills and expertise, continued self-respect, acquisition and nurturing of interpersonal skills, evaluation and use of research evidence, understanding of the influence of cultural, contextual and individual differences on treatment, seeking available resources to support that practice, and finally, possessing a cogent rationale for the relevant clinical strategies.
Patients’ Characteristics, Values and Contexts - Patients’ contexts should be regarded through the following considerations:
Variations in the presentation of their problems and disorders, concurrent symptoms or syndromes, etiology, and behavior;
Chronological age, developmental history, developmental status, and life stage;
Sociocultural and familial factors such as gender, ethnicity, family structure, gender identity, disability status race, religion, social class, and sexual orientation;
Environmental context such as health care disparities and stressors such as unemployment, age and family, and institutional racism;
Personal preferences, preferences related to treatment and values such as goals, worldviews, treatment expectations and beliefs). Some of the effective treatments approaches involve interventions that are directed towards others in the patient's physical environment, including parents, caregivers, and teachers. A central aim of EBPP is maximization of patient choice among a wide range of effective alternative interventions.
Clinical Implications- Clinical decisions need to entail patient involvement and collaboration on the basis of the best and clinically-relevant evidence as well as consideration of the possible benefits, costs, alongside resources and options available. The treating psychologist is responsible of making the ultimate judgment about a given treatment plan or intervention. It is overall crucial to involve an informed patient in their treatment decisions. Such treatment decisions should not be made by untrained individuals who are unfamiliar with the case specifics.
How the Program Should Move Forward
Evidence-based practice is currently applied in schools as a subordinate to the institutional programs and some schools do not have an active and well established program involving in-school tutoring programs for youths at high risk of drug and substance abuse. It would be more helpful for the school management boards to implement a more serious approach that involves all the students right from a tender grade attending such programs. This would help to expose youths to the understanding of the dangers of engaging in drug and alcohol abuse. Additionally, schools should closely collaborate with parents and the community at large to bring in more input to the program while extending the program beyond the boundaries of the school to the community where the negative impacts of drug and alcohol abuse are apparent.
Conclusion
Evidence-based practice is a wide area of practice that does not just involve medicine and nursing but extends to other areas of treatment including treatment of drug and alcohol abuse. Within this area of practice, in-school tutoring for adolescents at high risk of suffering from the negative effects of drug and alcohol abuse has been used throughout the paper as the relevant program to be implemented under evidence-based practice, effectiveness of fundamental areas within this practice and constraints that may hinder its applicability. Further the history of EBP, its evolution and current trends have also been given to enable a contemporary professional apply the practice in the right contexts and via the right channels. Towards the end of this paper, there is a succinct explanation of the policies underlying implementation of EBP in the US specific to major components of EBP.
References
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