Discussion Post Responses

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.
• Must contain at least 1      reference and citation. Can use the      referenced materials from the colleague’s original post.

Colleague #1 – Xebra

RE: Discussion – Week 2
 

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 Levy case, it is evident that Jakes psychological functioning has declined drastically due to his PTSD. As a result, he drinks more than he should and lacks involvement in his sons life. Although Jake is being prescribed medication for his symptoms, an evidence-based intervention I would rely on for Jake is cognitive processing therapy. [It] involves modifying maladaptive cognitive coping strategies related to traumatic events (Reich, Nemeth, Acierno, 2019). Studies utilizing this intervention have provided positive results is social adjustments, family relationships, psychosocial functioning etc. I believe that this will be an excellent intervention due it being the focus of dissemination mandates across the U.S. Department of Veteran Affairs health-care system. In addition, It would alleviate problems associated with his ptsd, such as his excessive drinking. With the appropriate skills to target his emotions and behavior this will would be beneficial. From recent studies CPT has been known to make improvements in the core PTSD symptom effortful avoidance (individual level factor), which was associated with an improvement in housework adjustment, but with a decline in extended family adjustment (Monson et al., 2012).  

Provide an explanation for the supervisor regarding issues related to implementation. Identify two factors that you believe are necessary for successful implementation of the evidence-based practice and explain why. 

In regards to implementing any evidence-based practice, it is essential to assess whether or not the evidence-based practice will work in the best interest of the client. Once this is established there are other major issues that would hinder implementation. For example, the cost to fund and evidence-based practice within an organization. Stakeholders are hesitant to support practices that they are unsure will produce positive result, especially if it is costly. In addition, another limitation might be that not enough research supports it. Another limitation that may come about is the stigma associated with it as well. To begin to implement a successful evidence-based practice, it is essential to manage the change process and accepting additional training and coaching. Coaching minimizes resistance, increases positive perceptions of the program and implementation, and enhances skills development; coaching also helps manage expectations and normalize the implementation (Substance Abuse & Mental Health Services Administration, 2012). The coaching aspect prepares professional to successfully deliver an intervention appropriately. For example, let’s say an intervention calls for a spiritual aspect of the intervention, it would be proactive to identify if there are any barriers that would hinder him/her from engaging in a particular intervention. 

Then, identify two factors that you believe may hinder implementation and explain how you might mitigate these factors

An obvious factor that might hinder implementation would be if the clinician decides to consider her wants and needs for the client versus actually acting in the best needs of the clients overall health. In addition, what can be considered to be some potential challenges that might hinder implantation lies in being resistant to change, unrealistic expectations, and program adaptations, lack of continued training tools, funding, lack of administrative support etc. To address these factor it is best to, improve services, linkages, support and infrastructure; evaluate fidelity to ensure the program is being skillfully delivered, use fidelity measures and indicators developed specifically for this purpose; Maintain integrated, fully functioning core program components (Substance Abuse & Mental Health Services Administration, 2012).

References:

Reich, K., Nemeth, L., & Acierno, R. (2019). Evidence-based psychotherapy interventions to improve psychosocial functioning in veterans with PTSD: An integrative review. Journal of Psychosocial Nursing & Mental Health Services, 57(10), 24-33. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.3928/02793695-20190531-04 

Monson, C.M., Macdonald, A., Vorstenbosch, V., Shnaider, P., Goldstein, E.S.R., Ferrier Auerbach, A.G., & Mocciola, K.E. (2012). Changes in social adjustment with cognitive processing therapy: Effects of treatment and association with PTSD symptom change. Journal of Traumatic Stress, 25, 519-526. doi:10.1002/jts.21735

Substance Abuse and Mental Health Services Administration. (2012). A road map to implementing evidence-based programs. Retrieved from http://web.archive.org/web/20151010063916/http://www.nrepp.samhsa.gov/Courses/Implementations/resources/imp_course.pdf

Colleague #2 – Upsidetowns

RE: Discussion – Week 2

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.

             The evidence-based practice that this writer selected for Jake ultimately was Eye Movement Desensitization and Reprocessing (EMDR). The use of EMDR in patients/clients who are suffering from Post-Traumatic Stress Disorder (PTSD) involves allowing clients to process within a short time frame, the negative or traumatic thoughts, emotions, and memories from past events/incidents. EMDR involves no homework assignments for the client and the reprocessing sessions promotes more of an associative process that reveals connections of triggered memories by current life experiences rather than having an extended focus on the traumatic event, which is typically seen in Cognitive Behavioral Therapy (Shapiro, 2014). This writer believes that this intervention is best for Jake due to his onset of PTSD following his tour in Iraq. EMDR can assist Jake because it utilizes brief moments of him reliving the traumatic event while the clinician directs his eye movements, causing him to focus his attention on something else, which has been shown to be less emotionally upsetting (Gotter, 2019).

Then provide an explanation for the supervisor regarding issues related to implementation. Identify two factors that you believe are necessary for successful implementation of the evidence-based practice and explain why.

             Explanation for the supervisor would consist of acknowledging that EMDR is controversial due to the many interpretations that it may have; however, EMDR has proven to have positive results in clients with PTSD because it alters the emotions, thoughts and responses that has occurred from the traumatic event (Shapiro, 2007).

Then, identify two factors that you believe may hinder implementation and explain how you might mitigate these factors. Be sure to include APA citations and references.

             Two factors that this writer believes may hinder implementation would be the controversial opinions about the therapy and possibly being able to fund this treatment. Ways to mitigate would be to utilize strong advocacy skills, coupled with research findings that has proven results and securing the use of this treatment to be funded through the state or insurance.

References

Shapiro F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente journal, 18(1), 71–77. https://doi.org/10.7812/TPP/13-098

Gotter, A. (2019). EMDR Therapy: What you need to know. https://www.healthline.com/health/emdr-therapy

Shapiro, F. (2007). EMDR, adaptive information processing, and case conceptualization. Journal of EMDR Practice and Research, 1, 68–87.

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