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Evidence-Based Practice Question, Evidence Synthesis and Critical Appraisal

Evidence-Based Practice Question, Evidence Synthesis and Critical Appraisal

Sample Answer 

Evidence-Based Practice Question, Evidence Synthesis, and Critical Appraisal

Cultural Adaptation of Child Maltreatment Parenting Programs

Part 1

Client Background, Problem, and Context

Child maltreatment has adverse mental and physical health effects on the child. Exposure to different experiences of physical or psychological abuse in the family setting predisposes the child to short-term and long-term negative developmental outcomes. These include mental health disorders, poor capacity for socio-emotional self-regulation, and maladaptive physical development, such as growth faltering and poor cognitive development (Altafim & Linhares, 2016; Prinz, 2016). Several interventions have been designed and implemented at different intervention levels to protect children from maltreatment.

Parenting educational programs are by far the most popular interventions for child maltreatment. These programs prevent child maltreatment by empowering high-risk parents with knowledge of child development and imparting positive parenting skills (Altafim & Linhares, 2016). However, the majority of affected families experience recurrences of child maltreatment despite participating in parenting programs (Lee et al., 2018). These negative outcomes imply that these interventions poorly address the parenting needs of at-risk families. Affected children, therefore, remain exposed to the adverse effects of maltreatment.

Evidence-Based Practice Question

Does a culturally-sensitive parenting educational intervention (I) for at-risk parents for child maltreatment (P) reduce the occurrence of child maltreatment (O) compared to a standard parenting program (C)?

Significance of Problem

Cultural adaptation of parenting programs can potentially provide a solution for the current effectiveness concerns of parenting programs. Contributors to child maltreatment are multidimensional and variable across different socio-cultural settings. A culturally sensitive parenting program provides a strategy for addressing the unique parental and contextual factors that encourage child mistreatment (Prinz, 2016). Low cultural acceptability has been linked to conflicting outcomes of parenting programs (Lachman et al., 2017). Additionally, cultural adaptation of the programs may also increase the effectiveness of the interventions in reducing child maltreatment by enhancing parental participation and retention in these programs (Mogro-Wilson et al., 2018). Therefore, a culturally-sensitive program will provide an intervention with a long-term impact on child maltreatment prevention.

Part 2

Answer to the Practice Question

Evidence-based strategies for enhancing the cultural sensitivity of parenting educational programs include mechanisms for cultural tailoring such as parent-centered goal setting and capacity-oriented education, and strategies for cultural adaptation program characteristics.

Cultural tailoring

Cultural tailoring is an important characteristic of culturally-sensitive parenting programs. Interventions that are grounded in the cultural values and practices of clients have been shown to be effective in predicting positive parental outcomes such as a reduction in negative parenting and observed child-led play (Lachman, et al., 2017). Cultural tailoring involves allowing parents to formulate their own goals for child behavior based on local cultural norms and values on parent-child interactions such as respect and responsibility. Similarly, cultural tailoring also involves designing the programs in order to improve mutually-identified parenting capacities and competencies rather than focusing on preventing child maltreatment and violence. Accordingly, behavioral objectives of intervention should be based on the need to improve parenting competencies rather than reduce maladaptive parenting practices (Altafim & Linhares, 2016). Some of the parent-centered competencies that have been recommended by studies involving parent and professional participants include the capacity for emotional self-regulation, parental self-esteem and assertiveness, parent-child communication, conflict resolution and negotiation, and mechanisms for formulating rational norms and controls that encourage positive discipline (Martínez-González et al., 2016). This approach is consistent with the tangible-goal-setting practice in which the parents are empowered with the skills necessary for forging a healthy relationship with their children.

Program Characteristics

One program characteristic that portrays cultural sensitivity in a parenting educational program is the inclusion of tangible program benefits and goals. Tangible program benefits influence the effectiveness of parenting programs through their impact on the rates of enrollment and retention of participants. Parenting interventions that enable clients to formulate and achieve personally beneficial goals and gain tangible benefits while meeting their parental obligations have a positive impact on parental retention. Accordingly, such incentives and benefits should be tailored to address the specific socioeconomic barriers to program participation and the personal needs of the individual parents (Mejia et., 2015; Mogro-Wilson et al., 2018). Examples of tangible elements that encourage enrollment and retention include incentives for participation, credible case management referrals, and ancillary elements such as employment training. Transport incentives that have been investigated in previous studies include bus passes and the use of central pick-up locations (Mogro-Wilson et al., 2018). Conceivably, tangible program benefits and goals are premised on the perception of at-risk parents for child maltreatment as consumers of the program rather than offenders.

Another program element that influences parental retention is the quality of parent-staff relationships. A supportive staff-client relationship that involves both a personal appeal and genuine concern for the welfare of the client has been identified as an important contributor to program retention. Staff relationships also include the quality of staff-parent communication patterns. Flexible communication between the program and the parents also influences parental commitment to the intervention. Communication patterns such as texting, phone calls, and in-person visits help to maintain a positive relationship and contact between the parents and the program. Flexible communication also involves using alternative contacts, such as friends and close relatives of participants, to help locate clients when they are unavailable through the provided contact information. Communication modalities, such as voice calls, provide a strategy for maintaining the parent-program contact between follow-ups (Mogro-Wilson et al., 2018). Similarly, in-person visits provide avenues for the program provider to gain a clear perspective of the client’s socioeconomic realities and cultural background (Mejia et., 2015; Mogro-Wilson et al., 2018).

Level of Evidence

The majority of the evidence supporting the effectiveness of cultural tailoring of parenting programs is compelling high-level evidence. Three of the studies supporting the evidence utilized or included a randomized controlled trial (RCT) design (level I evidence) (Altafim & Linhares, 2016; Lachman et al., 2017; Mogro-Wilson et al., 2018). Specifically, the effectiveness of cultural tailoring strategies, such as parenting capacity- or competency-building, is obtained through RCT designs. Parental competency-based adaptation of educational interventions is also supported by level II evidence from a meta-analytic systematic review of combinations of RCTs and non-RCT studies investigating the effectiveness of parenting programs. For example, out of 7 studies examining the efficacy of the parental capacity-based educational program, 6 studies utilized an RCT study design with an intragroup and between-group comparison of pre-intervention and post-intervention outcomes building (Altafim & Linhares, 2016). Similarly, the utilization of culturally-sensitive program characteristics, including the use of tangible benefits and supportive staff-parent relationships, is supported by findings of an RCT with a qualitative component conducted by Mogro-Wilson et al. (2018). The Martínez-González et al. (2016) study utilized a quasi-experimental design pre-test and post-test design, making its evidence a level II type. Considering that the present practice question concerns the effectiveness of a social service intervention, the best evidence for answering the practice question should be obtained from studies utilizing a randomized controlled trial design. Since the evidence is mainly obtained from RCTs, it can potentially address the cultural sensitivity practice question.

Methodological Strength

            The studies supporting the evidence on cultural adaptation of parenting interventions are generally methodologically robust. The RCT component of the Mogro-Wilson et al. (2018) study utilized the largest sample size of 348 participants with randomization through enrollment, followed by the Martínez-González et al. (2016) that involved 311 participants (parents and professionals). These sample sizes are significantly larger compared with other studies examining the effectiveness of parenting programs (Martínez-González et al., 2016). Therefore, these sample sizes do not limit the generalizability of the evidence. Additionally, both studies combined quantitative and qualitative methods to collect and analyze data. The Martínez-González et al. (2016) study was a multi-setting pre-test and post-test evaluation of parenting programs implemented in 26 different settings. Although the study was not conducted under controlled conditions, both at-risk and non-at-risk families participated in the study, enabling some extent of inclusion. Similarly, in the metanalytic systematic review by Altafim & Linhares (2016), 23 studies assessing 16 different types of parenting interventions were assessed, with 90% of the studies resulting in improvement in child behavior. Considering that the other studies also evaluated the evidence using different types of educational interventions, it is significantly credible. Additionally, the studies were conducted in socio-culturally diverse settings, including developing countries (Altafim & Linhares, 2016; Martínez-González et al. (2016), low-income communities (Lachman et al., 2017; Mejia et. 2015), and involving ethno-racially diverse participants (Mogro-Wilson et al., 2018). Finally, the measures and instruments used in the study had remarkable internal consistency and validity estimates, with the majority of the measures having Cronbach alpha scores of above .72 (Lachman et al., 2017; Martínez-González et al., 2016; Mejia et. 2015). As such, the findings from each of the included studies demonstrate remarkable complementarity in answering the current practice question.

Applicability of Evidence

The body of evidence in these studies adequately addresses the practice question. The findings of each of the studies directly relate to the cultural-sensitivity practice problem in parenting programs. Cultural acceptability and appropriateness are the major shortcomings of current parental programs and directly contribute to the short-lived impact of these interventions. The mechanisms of cultural adaptation recommended in the studies are transferable and easy to integrate into different types of parenting interventions. Similarly, the evidence is also relevant to the practice question since the participants in the majority of the studies are at-risk parents for child maltreatment.

Additionally, the body of evidence includes interventions that are resource-sparing. This is because the evidence has been generated from studies conducted feasibly in both low-resource low-income settings and resource-abundant developed countries. Therefore, few additional resources are required to tailor the programs to suit the preferences, values, and needs of most at-risk parents for child maltreatment. Furthermore, the findings are specific and unequivocal, including parent-centered goal-setting, capacity-oriented education, utilization of tangible benefits, and development of supportive staff-parent relationships. In addition, the evidence is based on RCT studies, indicating that the recommendations have been evaluated in actual practice environments. As such, the body of evidence is practice-ready since little modification is required in its translation.

Reference

Altafim, E. R. P., & Linhares, M. B. M. (2016). Universal violence and child maltreatment prevention programs for parents: A systematic review. Psychosocial Intervention25(1), 27-38.

Lachman, J. M., Cluver, L., Ward, C. L., Hutchings, J., Mlotshwa, S., Wessels, I., & Gardner, F. (2017). Randomized controlled trial of a parenting program to reduce the risk of child maltreatment in South Africa. Child abuse & neglect72, 338-351.

Lee, E., Kirkland, K., Miranda-Julian, C., & Greene, R. (2018). Reducing maltreatment recurrence through home visitation: a promising intervention for child welfare involved families. Child abuse & neglect86, 55-66.

Martínez-González, R. A., Rodríguez-Ruiz, B., Álvarez-Blanco, L., & Becedóniz-Vázquez, C. (2016). Evidence in promoting positive parenting through the Program-Guide to Develop Emotional Competences. Psychosocial intervention25(2), 111-117.

Mejia, A., Calam, R., & Sanders, M. R. (2015). Examining delivery preferences and cultural relevance of an evidence-based parenting program in a low-resource setting of Central America: Approaching parents as consumers. Journal of Child and Family Studies24(4), 1004-1015.

Mogro-Wilson, C., Hayes, C., Loomis, A. M., Drake, A., Martin-Peele, M., & Fifield, J. (2018). Supporting Recruitment and Retention of Young African-American and Hispanic Fathers in Community-Based Parenting Interventions Research. Advances in Social Work18(4), 1068-1084.

Prinz, R. J. (2016). Parenting and family support within a broad child abuse prevention strategy: Child maltreatment prevention can benefit from public health strategies. Child abuse & neglect51, 400.

van der Kooij, I. W., Bipat, S., Boer, F., Lindauer, R. J., & Graafsma, T. L. (2018). Implementation and evaluation of a parenting program to prevent child maltreatment in Suriname. American journal of orthopsychiatry88(3), 295.

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Question 


Evidence-Based Practice Question, Evidence Synthesis and Critical Appraisal

Social Work 635

Assignment 1: Evidence-Based Practice Question,

Evidence Synthesis and Critical Appraisal

(35% of Course Grade) 

Due the week of Unit 7

 During the course of the semester, each student will be working towards the preparation of three assignments related to effectively serving a specific client by: 1) locating and critiquing the best available evidence for practice decisionmaking; 2) identifying appropriate assessment tools and interventions; and 3) evaluating the effectiveness of interventions designed to meet the needs of adults with regard to their mental health and wellness.

Evidence-Based Practice Question, Evidence Synthesis and Critical Appraisal

Evidence-Based Practice Question, Evidence Synthesis and Critical Appraisal

Evidence-based Practice (EBP) is defined as a process for making practice decisions in which practitioners integrate the best available research evidence with their practice expertise and with client attributes, values, preferences, and circumstances. As such, Assignment 1 represents the first three stages of this process.  The assignment has two parts, which together should not exceed 6 pages, double-spaced.

For the first portion of the assignment, students are expected to formulate a health or mental health evidence-based practice question that is of interest to them and directly impacts their work with a specific adult or older adult client. The question should address a specific practice challenge or issue about which you need to learn more in order to engage, assess, or intervene with your client most effectively. In selecting a meaningful practice question, students should consider their existing knowledge of the particular client-of-focus, the local service context, agency capacity, and available resources, and their relevant experiences addressing similar problems or working with others who have similar backgrounds or needs.

The second portion involves locating and critically appraising a small body of relevant empirical evidence representing the best available evidence to answer the practice question.  As part of the process of bridging the gap between research and practice, social work students should be able to assess the quality, extent, and applicability of available scientific evidence, and to translate that evidence into practical knowledge used for applied decision-making.

Part 1: Client Problem and Evidence-Based Practice Question that includes the following information: (approximately 1 page)

  • Client Background, Problem, and Context: Provide a brief description of the client issue or problem that will be the focus of this assignment, along with relevant client background information, including dimensions of diversity/difference. Also, provide basic information about the setting or context for service delivery.
  • Evidence-Based Practice Question: Include a single practice question addressing an identified knowledge need related to client engagement, assessment, or intervention. While there are many types of questions and ways in which to develop an appropriate practice question, please keep your question very specific and focused on your selected client-of-focus.  To assist you in developing your question, please refer to the question formulation content in your asynchronous material.  It will be ideal to employ the PICO(T) framework in specifying the question.
  • Rationale/Significance of Problem: In one paragraph, address the significance of the question-of-focus. Students should provide a compelling argument for the importance of answering the proposed practice question and the role of the information in practice decisionmaking. Make sure to utilize and cite suitable resources from online reports, peer reviewed journals, and existing records as supporting references for your rationale.

Part 2: Summary and Critical Appraisal of the Body of Available Evidence (approximately 4-5 pages)

For the next stage of the direct practice- focused project for this course, students will locate, synthesize and critically appraise the best available scientific research evidence (including systematic reviews, meta-analyses, and/or individual/original empirical research studies) that addresses their respective practice question.

Students are asked to identify approximately 5-8 relevant, peer-reviewed empirical articles, preferably published within the past 5-7 (and not more than 10) years. In determining the exact number of references to use, please consider the evidence needed to help you establish a satisfactorily clear, confident, and complete answer. That is, relatively few articles may be needed if one or more highly relevant and applicable evidence syntheses is located; conversely, more articles will be needed if each provides a relatively more limited answer to the question.

Students will then synthesize and critically appraise the selected group of articles as an aggregate body of available evidence for practice.  In a narrative of approximately 4 double-spaced pages, you are asked to answer your practice question and to provide insightful, critical commentary on the strength, quality, extent, and relevance/applicability of the body of evidence.  It is recommended that you provide specific attention to each of the following:

  • Answer to the Practice Question: Given the findings reported in the body of evidence reviewed, what is the best available answer you can assemble for the identified practice question?
  • Level of Evidence: Identification and appraisal of the overall level of evidence would address things such as the following: Where does this body of evidence fall in the evidence hierarchy? Is that consistent with what you would hope or expect to find for studies addressing the type of question you have asked? 
  • Methodological Strength/Rigor of the Study Methods and Procedures: Address the general level of methodological strength or limitation of the studies in this body of evidence and the implications for the respective forms of validity (i.e., internal, external, measurement). Specifically: How strong were the sampling methods used and the resulting study samples? How strong were the measurement approaches and instruments? How strong were the designs used? How rigorously were the studies executed, procedurally?  What are the validity-related implications of each?
  • Applicability of Evidence: Comment on the degree to which the body of evidence presents findings that are applicable to your work with your client-of-focus, and identify the specific applications or limitations that you have identified. Some topics to consider include: How applicable and relevant are the findings from this body of evidence to your practice question? How confidently and/or completely does this knowledge guide your practice decisionmaking?  What limitations or concerns might there be in applying the findings from the selected body of evidence to your work with your identified client?

While elements of individual articles will be highlighted (i.e., as an example) when making your assessment of the broader body of evidence, please be aware that this critical appraisal should not critique each article, in turn.  Rather, critical commentary should address your observations and assessment of the broader body of relevant evidence as a whole.  Support the rationale for your overall appraisals with reference to specific articles, as needed.

Please provide in-text citations where needed.  The full list of the references for this body of literature should follow at the end of the assignment. 

Academic Paper Formatting Guidelines (APA Manual 6th edition)

The paper should be double-spaced, with 12-point font and 1-inch margins on all sides. Use subheadings to organize your paper, as necessary. Reference a minimum of five recent peer-reviewed empirical journal articles. Editorial and referencing styles specified in the APA Publication Manual 6th Edition can be found at: http://apastyle.apa.org/.

The title page should be formatted as follows:

SOWK 635 – [Current Semester]

Assignment #1: Evidence-Based Practice Question,

Evidence Synthesis and Critical Appraisal

 [Original Title] 

[Student Name]

 [Date]

[Course Instructor]

The evaluation of the assignment will be based on whether you addressed all aspects of the assignment, as well as the quality, completeness and clarity of your written work (graduate-level writing, organization, flow, depth, mechanics of writing such as grammar, spelling, etc.).

Proofread your work and abide by the academic integrity guidelines. Students are encouraged to seek assistance from the writing coaches in Learning Support for proofreading and editing their work.  Details are available at http://libguides.usc.edu/SOWKlearningsupport.  It is expected that students will be responsible for submitting their own work and not the work of other students.  If you study with other students, be conscious of shaping and writing your own paper. Please note: Turnitin automatically scans all papers upon submission to the platform. Students found to be in violation of the academic integrity guidelines may be referred for judicial review.  An overview of the University’s guidelines on academic integrity can be found at the following URL: http://www.usc.edu/student-affairs/SJACS/forms/AcademicIntegrityOverview.pdf 

Submit the assignment on time.  Each instructor will decide upon the format of the submission either in class, via turn-it-in or emailed. The assignment will be penalized 4 points for each day it is late.

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