18 Jun The purpose of this assignment is to allow you to practice the critical analysis of the contents of research articles. When you identify a research article, yo
The purpose of this assignment is to allow you to practice the critical analysis of the contents of research articles. When you identify a research article, you want to begin by assessing whether the source of the article is scholarly and current. Once you have verified these elements, it is important to determine what the researchers were attempting to investigate, how the study was carried out, and what the outcomes were.
For this Assignment, you will critically examine the elements of a scholarly article. Because you will need to choose research articles that represent each type of methodology when you create your Final Project Annotated Bibliography, it is essential for you to understand the contents of a research article.
To Prepare
- Review the media programs and blog found in the Learning Resources which will introduce you to the critical elements of a scholarly article, how to identify them, and how to read scholarly articles.
- Review the Haas and Ray (2020) article found in the Learning Resources. You will use this article to complete this Assignment.
- Review the Scholarly Article Content Analysis Worksheet Preparation Guide, the Scholarly Article Content Analysis Worksheet including the brief case conceptualization found in the Learning Resources and consider the “client” for any counseling implications. Note: you will use this Worksheet to complete this Assignment.
Assignment
- Complete the Scholarly Article Content Analysis Worksheet for the Hass & Ray (2020) article.
- Analyze the contents of the article and apply the findings to the case conceptualization included in the worksheet.
- Critically analyze the article and identify all components:
- Is the article scholarly?
- What is the problem/purpose?
- What is(are) the research question(s)?
- Who are the participants?
- What are the ethical/cultural considerations?
- What data /information was collected from participants?
- How did the researchers describe the results/answer to the research question?
- How does this research apply to the case study?
COUN 6626: Research Methodology and Program Evaluation
Week 4 Scholarly Article Content Analysis
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Case Conceptualization: Orion is a 4-year-old African American child. He comes into counseling referred by his primary pediatrician. Orion has been diagnosed with an autism spectrum disorder. He has difficulty with communication, has deficits in empathizing with others’ intentions, and struggles with single-mindedness. Orion’s parents and preschool teacher have noticed a pervasive pattern of emotional dysregulation which includes frequent episodes of hysterical crying. Orion’s parents are concerned that he is not going to be promoted to kindergarten next year if he does not improve his ability to relate positively with others and improve his ability to regulate his emotions. |
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Article: Haas, S. C., & Ray, D. C. (2020, July 6). Child-Centered Play Therapy with Children Affected by Adverse Childhood Experiences: A Single-Case Design. International Journal of Play Therapy. Advance online publication. (Can be found in Resources in Week 4.) |
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1. Is the article above a peer-reviewed, scholarly source? Provide your answer below and outline the steps and process you took to find the selected research article. How do you know your selected article is peer reviewed? Why is it important to use a peer-reviewed article? Tip: Peer review is part of the editorial process an article goes through before it is published in a peer-reviewed journal. Once an article is submitted to a peer-reviewed journal, the journal editors send that article to "peers" or scholars in the field to evaluate the article. To determine if a journal is peer reviewed (also sometimes called refereed journals), try one or both steps: (a) Look up the journal in the UlrichsWeb.com (available on the A-Z Database List in the Walden Library database) and determine whether it is identified as peer reviewed. Ulrich's is a directory. It is a searchable list of periodicals (magazines, journals, newspapers, etc.). It provides information about each periodical such as publisher, scope, and whether the journal uses peer review. (b) Examine the journal’s website and review the submission and editorial process for evidence of peer review. |
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2. What is the (a) problem the researchers were investigating/purpose of the research and (b) research question the researchers were trying to answer? This is a 2-part question. Your Answer here should describe the problem the researchers were investigating/purpose of the research and include the research question the researchers were trying to answer? This is a 2-part question. Tip: All studies have a research question that drives the investigation (what the researchers are trying to learn). Sometimes this is formally stated while other times the reader must discover this information which can usually be found in the Abstract or the Introduction section. Usually there is a section that is named “Purpose of the study”. The Results section or the Discussion section will provide the answer(s) to the research question. Research studies can use either quantitative, qualitative, or mixed methods to investigate the question. Sometimes researchers are investigating more than one intervention and so research questions may include multiple parts. Be sure to review all parts of the inquiry or use multiple questions to explain.
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3. Describe the sample/participants in the study. Provide your answer below and include details about the participants, or information about the population (sample) used in the research study. Be sure to include how many participants were included in the study and any distinguishing characteristics Tip: Participants are also known as the sample. Quantitative studies generally have larger samples sizes than qualitative studies. Case studies may have one main “case” which may include a single person, a family, a group, or community. You want to describe who (e.g., demographics) and how many persons participated in the study.
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4. Did the researchers secure permission to conduct the study and/or secure informed consent from the participants? Were there any cultural concerns noted or do you have any concerns about bias? Your Answer here should provide a snapshot of the participants and whether permission to conduct the study was gained. Also be sure to discuss informed consent of the participants. Were there any cultural concerns about this study that you noticed? Tip: Cultural considerations are related to research procedures. Consider whether there were cultural elements that may have changed the way the study took place such as language barriers, the need for an interpreter, and whether the sample matches the population that the researchers say they are studying. The key is to consider what cultural factors are pertinent to the research question. If you say you are studying an intervention for depression, the sample needs to include persons with depression. If a study is not specific to race or gender, for example, that does not make it culturally insensitive if the research didn’t set out to learn about that intervention specifically applied to race or gender. |
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5. Identify exactly what data was collected by the researchers in the study. Is the data quantitative (numeric data such as scores on assessments like the Iowa Basic Skills Test (IBST) or the Beck Depression Inventory (BDI)? If there are assessment instruments used – are they numerical results or narrative results? Is the data qualitative (for example, clinical intake interviews or a narrative behavioral observation? Your answer (2 parts) should include information about qualitative, quantitative, or mixed methods. Tip: The variables (e.g., substance abuse) or characteristic (e.g., geographic location) being investigated is usually found in the Introduction and Method sections (and sometimes the Abstract). For example: if a researcher is investigating an intervention for the treatment of depression. The variable may be “level of depression” and the data collected could be scores on the Beck Depression Scale. All data points represent something the researcher is trying to investigate. Data can be quantitative (like a measurement, frequency, or score that is represented by a numeral) or qualitative (data captured using written or spoken words, observations, or photos). This includes things like student academic or behavioral records, historical documents, records, or artifacts like diaries or case notes. 6. What was the outcome or the general result of the research study? What is the answer to the research question? Your answer here should be a 2-part answer. What was the result? What was the answer to the research question? Tip: The Discussion section is where what the authors present how the results can be applied when working with clients or students. The authors will articulate their greatest take away from the study outcomes and what they view as most important to know to meet the needs of clients or students with similar needs. |
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7. Based on your understanding of the results of the research study presented, discuss how the outcomes can be generally applied to your future counseling practice. Your answer here should discuss how the outcomes of this research study could be used in your future practice. Tip: The authors identify if the results of the investigation support their hypothesis and present the major findings. The Results section and the Discussion section present the answer to the question the researchers were trying to learn. Keep in mind that when you are investigating an intervention, the results could be mixed. In other words, the intervention might be successful, not successful, or partially successful.
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8. How does this research article apply to the case study at the top of the worksheet? Your answer here should include how you think this research article could be used in the case at the top of this worksheet. Would this research be applicable to the case of Orion? If not, why? If so, how? Tip: While there are similarities and differences between the article and the case study on the worksheet, describe how the general outcomes from the article relate to the case study. Explain your insights into how the information from the article could be useful to meet the needs of the case study. NOTE: As a counselor, what did you interpret from the outcomes of the research study in the article that you could use in developing treatment goals or action plans for the child in the case study on the worksheet? |
© 2020 Walden University 1
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Child-Centered Play Therapy With Children Affected by Adverse Childhood Experiences: A Single-Case Design
Sara C. Haas Northern Arizona University
Dee C. Ray University of North Texas
We conducted single-case research with 2 participants to explore the influence of child-centered play therapy (CCPT) on children who had 4 or more adverse childhood experiences (ACEs) and analyzed data collected from the Strength and Difficulties Questionnaire on a weekly basis and the Trauma Symptoms Checklist for Young Children at pre- and posttest. Both participants demonstrated significant improvement in total difficulties and prosocial behaviors, revealing potential therapeutic benefits for the use of CCPT with children who have 4 or more ACEs. The discussion of study results includes implications for practice, suggestions for future research, and limitations.
Keywords: child-centered play therapy, adverse childhood experiences, single-case design
Adverse childhood experiences (ACEs) can be defined as traumatic and stressful experi- ences occurring in childhood (Felitti et al., 1998). Categories for ACEs include physical abuse, sexual abuse, emotional abuse, emo- tional neglect, physical neglect, mental illness, substance abuse, separation/divorce, domestic violence, incarceration, and living in foster care (Felitti et al., 1998; Wade et al., 2016). The commonality between all of the categories is a self-report of feeling maltreated or living in household dysfunction during childhood. The Centers for Disease Control and Prevention (CDC, 2019) noted that over 50% of adults in the United States have reported experiencing at least one ACE, and 15% have reported experi- encing four or more ACEs. Adverse experi- ences occurring in childhood have been found
to have a profound influence on the health and well-being of children and adults (Clarkson Freeman, 2014; Felitti et al., 1998; Wade et al., 2016). The resulting trauma that, over multiple events, leads to complex trauma is a common outcome and response to the experiencing of adverse experiences (Substance Abuse and Mental Health Services Administration [SAM- HSA], 2018). Although various mental health interventions have been proposed to address the symptoms resulting from ACEs and childhood trauma, there is still little evidence to support positive treatment outcomes for children who have experienced ACEs. Child-centered play therapy (CCPT) fosters connections and rela- tionships in a safe, therapeutic environment, lending to the potential of CCPT being an ef- fective intervention with children who have ex- perienced multiple ACEs.
Broad Spectrum of ACEs Outcomes
Adverse experiences occurring in childhood have been found to have a profound influence on the health and well-being of adults (Felitti et al., 1998; Wade et al., 2016). ACEs have long- term effects on physical and mental health, ad- dictive behaviors, criminal activities, and adult relationships. As a result of ACEs, adults may
This article was published Online First July 6, 2020. X Sara C. Haas, Department of Educational Psychology,
Northern Arizona University; X Dee C. Ray, Department of Counseling and Higher Education, University of North Texas.
Correspondence concerning this article should be ad- dressed to Sara C. Haas, Department of Educational Psy- chology, Northern Arizona University, 15451 North 28th Avenue, Phoenix, AZ 85053. E-mail: [email protected]
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International Journal of Play Therapy © 2020 Association for Play Therapy 2020, Vol. 29, No. 4, 223–236 ISSN: 1555-6824 http://dx.doi.org/10.1037/pla0000135
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have a higher risk for health symptoms that lead to death and a shortened life span, as well as fatigue and lack of energy that impact the per- ceived quality of life (Felitti et al., 1998). Sub- sequent mental health issues, such as posttrau- matic stress, depression, anxiety, hopelessness, stress, and even suicidal behavior, appear to be linked to a person’s ACEs. Generally, affective disorders, as well as depressive and anxiety disorders, in adulthood are likely to be corre- lated with adverse experiences in childhood (Spinhoven et al., 2010). Grasso, Dierkhising, Branson, Ford, and Lee (2016) found that if children had multiple types of ACEs during any time of childhood, early childhood, middle childhood, or adolescence, the participants were affected developmentally and had a persistent amount of stress into adolescence and adult- hood.
Additionally, ACEs appear to be linked to later substance abuse and criminal activity. Sub- stance abuse issues are highly correlated with an increased number of ACEs (Felitti et al., 1998), a consistent finding across cultures (Brockie, Dana-Sacco, Wallen, Wilcox, & Campbell, 2015; Giordano, Ohlsson, Kendler, Sundquist, & Sundquist, 2014). Regarding criminal activ- ity, researchers have linked juvenile offenders and an increased number of ACEs (Baglivio & Epps, 2016). Fox, Perez, Cass, Baglivio, and Epps (2015) found that the number of ACEs experienced by serious, violent, and chronic offenders was statistically significantly higher than the number of ACEs for offenders who had one violation, suggesting that the identification of ACEs could be one indicator in determining youth who are at a higher risk of becoming serious, violent, and chronic offenders.
ACEs Outcomes During Childhood
Although research has been conducted on the effects of ACEs in adulthood, there are substan- tially fewer studies exploring the effects of ACEs during childhood. Burke, Hellman, Scott, Weems, and Carrion (2011) found that children who experienced four or more ACEs had a significantly higher probability of having learn- ing and behavior problems. Utilizing the Na- tional Survey of Child and Adolescent Well- Being (NSCAW) and the Child Behavior Checklist (CBCL; Achenbach, 1991), Clarkson Freeman (2014) examined the prevalence and
relationship between ACEs and internalizing, externalizing, and total problems for 2,830 chil- dren 6 years of age and younger. Overall, chil- dren who had four or more ACEs were more likely to exhibit problematic behaviors than children who did not experience ACEs (Clark- son Freeman, 2014). Escueta, Whetten, Oster- mann, O’Donnell, and the Positive Outcomes for Orphans Research Team (2014) examined the psychosocial well-being and cognitive de- velopment of orphaned and abandoned children who experienced ACEs in five low-income countries. They found that exposure to poten- tially traumatic events was determined to be a predictor of emotional difficulties. Child re- search on ACEs reveals a dose– effect response whereby the more ACEs reported, the higher the number and intensity of negative outcomes (Grasso et al., 2016; Jimenez, Wade, Lin, Mor- row, & Reichman, 2016; Thurston, Bell, & Induni, 2018). Although research on ACEs while participants are still in childhood is lim- ited, there is evidence to suggest that children exhibit the deleterious consequences of ACEs during and immediately following adverse events.
The CCPT and ACE Connection
As children grow and develop, influences from caregivers have the potential to disconnect them from their natural organismic valuing pro- cess. Although the organismic valuing process still remains, children begin to rely more on external messages from caregivers and become less attuned to their organismic valuing process, placing greater emphasis on what others value (Turner, 2012). Children’s self-structure changes to integrate the way they view them- selves and their actual experiences (Wilkins, 2010). Children strive to be protected, nurtured, and cared for by others. Because of the need to be positively regarded by others, children rely on an external locus of control and create con- ditions of worth. Conditions of worth are mes- sages created to earn love or acceptance from others by conforming to demands, expectations, and positive evaluations from others (Wilkins, 2010). Children may begin to have beliefs of only being accepted when their conditions of worth are met. Children experience incongruity because they no longer take in all experiences through their organismic valuing process; in-
224 HAAS AND RAY
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stead, experiences are taken in through the filter of a rigid self-perception influenced by the val- ues of others (Wilkins, 2010).
Because of the nature of the conditions pro- vided to children who have experienced ACEs, they may develop extremely negative and abu- sive self-regard, which can become the focus of their self-concepts and influence their decisions and attitudes toward themselves (Power, 2012). Children who experience ongoing adverse and traumatic experiences likely live in a world of fear (Hawkins, 2014). Whereas typical self- structures are fluid and allow for new experi- ences to help shape the way children view ex- periences (Rogers, 1957), the self-structures of children who have ongoing adverse or traumatic experiences are rigid (Wilkins, 2010). The ri- gidity of self-structure occurs because their con- ditions of worth continue to contribute to their negative self-regard. Children’s understanding of the world and reality might be altered and viewed through a more negative lens. Ongoing confirmation of negativity serves the purpose of maintaining the rigidity of the self-structure. The utilization of negative behaviors ensures that others will treat them in ways matching their current self-concept (Clarkson Freeman, 2014).
Children who have experienced multiple or ongoing ACEs are likely to need experiences that contradict the traumatic experiences that have influenced their rigid self-structures. CCPT is an intervention that promotes the rela- tionship between therapist and child as the pri- mary healing agent in therapy (Landreth, 2012). Child-centered play therapists hold the belief that children innately have the capacity within them to work through and make sense of mal- adaptive behaviors when provided with the nec- essary environment (Landreth, 2012). CCPT therapists provide the core conditions of person- centered theory— congruence, empathic under- standing, and unconditional positive regard (UPR)—to create a therapeutic relationship with children (Landreth, 2012). As a child slowly perceives and integrates the therapist attitudinal conditions, the child is able to form a new self-structure. When counselors are free of expectations while unconditionally positively regarding clients, children are able to grow and develop (Rogers, 1957). Although the self- actualizing tendency may have been halted through adverse events, it is still a dynamic
force inside of a child. By experiencing UPR and empathic understanding, a child can begin to integrate new experiences and establish a more fluid self-structure (Ray, 2011). The flu- idity of self-structure will provide the child with the ability to accept more positive experiences without rejecting them fully. In essence, CCPT offers an alternative positive childhood experi- ence to counteract the negative impact of con- ditions and disrupted relationships experienced during adverse events. Additionally, CCPT in- volves the facilitation of parent consultation in order to address the environmental facilitation of relationships and stability for the child.
Although CCPT research has not been con- ducted on ACEs as a singular construct, histor- ical and recent research on CCPT supports the use of intervention with children with individ- ual ACEs. Intervention research has been con- ducted on the individual ACEs of sexual abuse, witnessing domestic violence, and refugee trau- ma. Kot, Landreth, and Giordano (1998) uti- lized intensive CCPT with children who wit- nessed domestic violence. The experimental group demonstrated a statistically significant in- crease in self-concept and a statistically signif- icant reduction of externalizing and total behav- iors. Scott, Burlingame, Starling, Porter, and Lilly (2003) conducted 7 to 13 CCPT sessions with 26 participants aged 3 to 9 years old who were sexually abused and found that whereas the child self-report results showed progress, the parent reports did not show significant changes. Scott et al. hypothesized that children began to feel different before external changes were observable by parents. Schottelkorb, Dou- mas, and Garcia (2012) compared the effective- ness of CCPT to trauma-focused cognitive– behavioral therapy (TF-CBT), finding that CCPT had a statistically significant impact with children who suffered from refugee trauma. CCPT research was also conducted with chil- dren living in poverty. Although poverty is not considered an ACE, Wade et al. (2016) demon- strated that living in poverty was correlated with experiencing ACEs. Bratton et al. (2013) exam- ined the effectiveness of CCPT with 54 children enrolled at a low-income preschool and found that the CCPT group had a statistically signifi- cant decrease of disruptive behaviors, aggres- sion, and attention problems. Bratton et al. dem- onstrated the effectiveness of using CCPT to reduce the problem behaviors of children in
225CCPT WITH CHILDREN AFFECTED BY ACES
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lower-socioeconomic-status preschools. CCPT has been shown to be effective with selected individual ACEs, lending to the hypothesis that CCPT may be effective with children who have experienced multiple ACEs.
Purpose of Study
The purpose of this study was to investigate the impact of CCPT on children who have ex- perienced four or more ACEs. Specifically, we examined the effect of CCPT on the child’s emotional symptoms, interpersonal relation- ships, and problem behaviors. A single-case design was implemented, and data were col- lected throughout baseline, intervention, and follow-up phases for two children participating in CCPT. The guiding research question for this study was as follows: What is the impact of CCPT on the emotional symptoms, conduct problems, hyperactivity and inattention, peer relationship problems, prosocial behavior, and posttraumatic stress of children who experi- enced four or more ACEs?
Method
Participants
Research participants included two children recruited from a university-based counseling clinic that serves community clients located in the southwestern United States. The clinic is an instructional and training-based clinic that serves clients across the life span. The majority of clients (60%) are children under the age of 12. Child clients served through the clinic typ- ically come from families of low socioeco- nomic status and low educational attainment. Participants met the following inclusion crite- ria: (a) between the ages of 4 and 9 years old, (b) score of 4 or higher on the Adverse Child- hood Experiences Checklist, and (c) not partic- ipating in other forms of counseling over the course of the study. Four participants were ini- tially identified for participation. However, two of the participants, who were also siblings, were dropped from the study because of home dis- ruption during the course of the study, resulting in the completion of the study by two partici- pants. The individual information for each par- ticipant is provided in the following sections.
Pseudonyms were used to maintain confidenti- ality.
Participant 1
Justin is an 8-year-old White American male who resides with his biological mother, sister, and maternal grandmother. Background infor- mation was reported by Justin’s mother. Justin qualified for the study because of his exposure to eight categories of ACEs: emotional abuse, emotional neglect, physical neglect, domestic violence, household substance abuse, household mental illness, parental separation, and incar- cerated household member.
Prior to the divorce between Justin’s mother and father, Justin’s mother reported that Justin witnessed the perpetration of domestic violence upon his mother by his father. Justin’s father was incarcerated multiple times for drugs and violence against Justin’s mother and her prop- erty. Justin’s father had a history of depression and was openly suicidal in Justin’s presence. Justin also verbalized negative thoughts about his self-worth and felt responsible for mediating between his parents. At intake for participation in the current study, Justin’s mother reported that Justin verbalized wanting to live with his father despite his fears and often blamed his mother for his father’s behavior. Justin’s mother reported that Justin had difficulty regulating emotions and cried and screamed at school. She was often asked to pick him up from school because of his difficulty.
Participant 2
Megan is a 9-year-old White American fe- male who resides with her biological father, stepmother, and multiple siblings who are step- siblings or half-biological siblings. Background information was reported by Megan’s father and stepmother. Megan qualified for the study be- cause of her exposure to eight categories of ACEs: sexual abuse, emotional neglect, physi- cal neglect, domestic violence, household sub- stance abuse, household mental illness, parental separation, and incarcerated household mem- ber.
Megan’s biological mother and father were separated when she was an infant. Her biolog- ical mother accused her father of sexually abus- ing Megan, resulting in invasive medical exam- inations. However, there were no findings that
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Megan’s biological father was physically abu- sive. Megan’s father and stepmother reported that as a young child, Megan witnessed her mother being physically abused by her mother’s boyfriend. During custodial visits with her mother, Megan was often unsupervised and found with dirty clothes and diapers when picked up by her father. Megan’s biological mother died from a drug overdose when Megan was 3 years old. At intake for the present study, Megan’s father reported that Megan frequently expressed low self-worth and a lack of belong- ing in her family.
Instruments
Adverse Childhood Experiences Checklist. The original Adverse Childhood Experiences (ACE) Checklist (Felitti et al., 1998) is a 10- item checklist that assesses adults for the past experiences of ACEs. The total number of ACEs checked provides participants with their ACE numbers. Felitti et al. (1998) introduced the original ACEs adult checklist, which in- cluded items related to physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, mental illness, substance abuse, separation/divorce, domestic violence, and incarceration. Wade et al. (2016) modified the adult checklist to incorporate extended ACEs, including witnessing violence, felt dis- crimination, lack of neighborhood safety, feel- ing bullied, and living in foster care. The orig- inal checklists were designed for adults to answer about their childhoods. For the purposes of the present study, the ACE Checklist was modified for language in o
