Discussion: Barriers in electronic patient scheduling

Discussion: Barriers in electronic patient scheduling ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Barriers in electronic patient scheduling Evidence based practice is essential to effective social work practice. For this assignment, you are required to (a) identify a current practice problem relevant in your current agency (i.e., working with resistant clients, engaging clients when they don’t talk much, having negative perceptions about your client, counter transference, etc.), (b) after identifying your practice problem, conduct an extensive literature search as it relates to your practice problem that provides you with a complete understanding of the practice problem. Based on your findings in the literature, what did you discover that will help you address your practice problem? How might your research guide your work in your field agency? After reviewing the literature/research and comparing it to the practice problem, the student is expected to do the following: 1. Briefly discusses the literature (Please locate literature on flaws in the foster care system) 2. Briefly identifies the practice problem (Build financial capability for all Nearly half of all American households are financially insecure, without adequate savings to meet basic living expenses for three months. We can significantly reduce economic hardship and the debilitating effects of poverty by adopting social policies that bolster lifelong income generation and safe retirement accounts; expand workforce training and re-training, and provide financial literacy and access to quality affordable financial services. 3. Briefly explains how the literature will be used to address the practice problem while engaging in the agency. . Discussion: Barriers in electronic patient scheduling seu_act500_ctrubric_mod04.pdf evidence_based.pdf practitioner_perspectives_o SEU ACT500 Critical Thinking Rubric – Module 4 Exceeds Expectation Content, Research, and Analysis 15-20 Points Requirements Includes all of the required components, as specified in the assignment. Problem 4-1 Problem 4-2 Problem 4-3 Problem 4-4 Meets Expectation Below Expectation Limited Evidence 9-14 Points Includes most of the required components, as specified in the assignment. 0-3 Points Includes few of the required components, as specified in the assignment. 0-3 Points Fails to demonstrate adequate comprehension of the concept. 0-3 Points Fails to demonstrate adequate comprehension of the concept. 0-3 Points Fails to demonstrate adequate comprehension of the concept. 0-3 Points Fails to demonstrate adequate comprehension of the concept. 15-20 Points All components are correct, with no errors or omissions. 9-14 Points Some significant but not major errors exist. 4-9 Points Includes some of the required components, as specified in the assignment. 4-9 Points Some major errors or omissions exist. 15-20 Points All components are correct, with no errors or omissions. 9-14 Points Some significant but not major errors exist. 4-9 Points Some major errors or omissions exist. 15-20 Points All components are correct, with no errors or omissions. 9-14 Points Some significant but not major errors exist. 4-9 Points Some major errors or omissions exist. 15-20 Points All components are correct, with no errors or omissions. 9-14 Points Some significant but not major errors exist. 4-9 Points Some major errors or omissions exist. Total points possible = 100 Evidence-Based Practice or Evidence-Guided Practice: A Rose by Any Other Name Would Smell as Sweet [Invited Response to Gitterman & Knight’s “EvidenceGuided Practice”] Bruce A. Thyer Gitterman and Knight (2013) expand upon the original model of evidence-based practice (EBP) by proposing an approach they label evidence-guided practice (EGP). They justify this by highlighting some supposed limitations of the original EBP model and by presenting some additional features to amend EBP into EGP. I attempt to show that the limitations they say characterize EBP are not actually a part of the real EBP model and are based upon either a misreading of the EBP literature, or by overlooking some of the features of EBP. I also try to demonstrate that most of the add-on elements to EBP they propose to label EGB are actually already present in the original model of EBP. One of their add-ons, an increased reliance upon formal theory as evidence, in addition to empirical research, seems to me a retrograde step and will perpetuate the harmful influence of some aspects of theory in social work practice. However, I judge their EGP model to be an improvement upon current social work practice, which largely tends to ignore empirical research findings to assist in decision making.Discussion: Barriers in electronic patient scheduling I t is encouraging to see such distinguished social workers as Alex Gitterman and Carolyn Knight (2013) address the issue of evidence-based practice (EBP), try and identify some of the shortcomings of EBP, and propose some constructive improvements for the model of EBP, resulting in a related perspective they label “evidence-guided practice” (EGP). In their article I find a number of points about EBP and its supposed limitations that have appeared in the social work literature, as well as a number of new ideas. Their goal is admirable—to improve upon the practice models which can promote social workers’ efforts to improve practice outcomes. I share this goal and it is in this spirit that I will try and address what I believe to be some misconceptions in their presentation of EBP—misconceptions which, once corrected, demonstrate that EBP already possesses most of the features of their proposed alternative, evidence-guided practice. It goes without saying that I appreciate their willingness to engage in this dialog, as well as the invitation from the co-editors of Families in Society to author this response. It is worth noting that the first article introducing the topic of evidence-based practice to a social work audience appeared in this journal (Gambrill, 1999). To begin my response in a simplified manner, it seems to me that Gitterman and Knight (2013) make some claims about the model of EBP and say it is associated with certain limitations or undesirable features, which I will generically call Features ABC. They propose their alternative model, EGP, which is said to possess the more desirable attributes of Features XYZ. What I will try and do in this response is to demonstrate that the undesired Features ABC said to characterize EBP, are actually not a part of the EBP model. Moreover, I will try and demonstrate that the desired Features XYZ are acFamilies in Society: The Journal of Contemporary Social Services ©2013 Alliance for Children and Families ISSN: Print 1044-3894; Electronic 1945-1350 tually already present in EBP. Thus, there is no need for any modification or amplification of EBP as it is presently construed in the primary sources of information about this practice model. Undesired Features Said to Be Associated With Evidence-Based Practice Evidence-based proponents argue that social workers should base their practice decisions on a critical review of available intervention strategies for particular client’s challenges and difficulties. The intent is to identify and employ those techniques that have been found to help an individual, family, or group with a specified problem. Discussion: Barriers in electronic patient scheduling The social worker selects the most relevant, empirically verified approach. (Gitterman & Knight, 2013, p. 70) This misrepresentation asserts that the social worker selects the intervention based on the research evidence. There is no apparent role for client input or consideration of other factors, such as environmental considerations. In reality, EBP is much more holistic than that. So that the reader has a clear understanding of what EBP really is, I provide the definition published originally in Evidence-Based Medicine (now in its fourth edition): Evidence-based medicine (EBM) requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances….By patient values we mean the unique preferences, concerns and expectations each 2013, 94(2), 79–84 DOI: 10.1606/1044-3894.4283 79 Families in Society | Volume 94, No. 2 patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient….By patient circumstances we mean their individual clinical state and the clinical setting. (Straus, Glasziou, Richardson, & Haynes, 2011, p. 1, emphasis in original) Understanding this definition of real EBP is crucial to avoid any implication that EBP is only about research evidence. It is equally about client values, expectations, and circumstances. Research does not trump these other considerations—they are all equally and compellingly important. This is largely ignored in presentations on EBP which appear in the social work literature and convey the impression that in EBP one merely selects the best supported treatments. This is a massive distortion and its repetition is likely responsible for some of the resistance to this approach. Since the professions of social work and medicine have different functions, social work’s renewed reliance on medical tenets is puzzling. (Gitterman & Knight, 2013, p. 71) 80 No, EBP requires one to search the current best literature to find out what methods of assessment and intervention possess the greatest amount of scientific support. There is no a priori assumption that the answer already exists, only the mandate that one seek out the available evidence. And there is no assertion that one must use the “best” evidence, if the most promising interventions are somehow unsuitable. Discussion: Barriers in electronic patient scheduling Amputation of the hands of convicted thieves might effectively deter nascent criminals from stealing, but the ethics and laws of our country prohibit cruel and unusual punishment. If a client is clinically depressed, the research might well indicate that cognitive behavior therapy (CBT) is a well-supported treatment. If, however, the client was intellectually disabled and unable to comply with the self-monitoring and homework exercises required of CBT, the evidence-based social worker may suggest an intervention less well-supported. A practitioner can still adhere to the original EBP model while not offering the best research-supported interventions if there are conflicting or counterproductive ethics, client preferences and values, or environmental considerations present. This flexibility is inherent in the approach. This is the hoary canard that EBP is a medical model. It is not. It originated in medicine, but is itself atheoretical with respect to etiology (biological or psychosocial), neutral with respect to who provides the services (physicians versus social workers), and neutral with respect to what those services should be (e.g., biological or psychosocial). In contrast, the medical model asserts that a given condition has a biological etiology, interventions are focused on biological interventions such as drugs or surgery, and the service providers should be physicians. EBP possesses none of these features of the medical model. EBP is a broadly scientific model but its origins in medicine need no more imply adherence to a medical model than the use of split-plot factorial studies in social work research means that one is following an agricultural model (from whence R. A. Fisher derived this type of experimental design in statistical science). The disciplinary backgrounds of the founders of a model need have no direct bearing on that model’s applicability to social work. EBP is being widely adopted across all the health care and human service professions because of its utility in operationalizing a more scientific approach to practice, not because it is somehow intrinsically medical. It depends. Sometimes complex social problems require complex interventions, and sometimes they respond well to simple interventions. EBP lends itself equally well to simple as well as complex interventions. Witness the large amount of work being undertaken in the field of social policy using the traditional EBP model (Boruch, 2012; Bogenschneider & Corbett, 2010; Vanlandingham & Drake, 2012) Discussion: Barriers in electronic patient scheduling and the fine work of the Coalition for Evidence-Based Policy (see http://coalition4evidence.org). A review of the completed systematic reviews available on the websites of The Campbell Collaboration (http:// www.campbellcollaboration.org) and The Cochrane Collaboration (http://www.cochrane.org) reveals many examples of complex health and social problems (e.g., the effectiveness of welfare-to-work programs) which have been extensively investigated using high-quality research studies. What alternative to evidence-based practice do we have to tackle complex social problems? The status quo? Evidence-based practice proposes that specific interventions exist to solve most types of problems, and social workers can find them and then use the most effective—the “best”—intervention. (Gitterman & Knight, 2013, p. 71) Evidence-based social work practice emphasizes studies that typically involve brief, cognitive, and skill-focused interventions…less straightforward, harder-to-measure problems and interventions are excluded. (Gitterman & Knight, 2013, p. 71) Complex social problems do not lend themselves to narrow and discrete interventions that are the foundation of evidence-based practice. (Gitterman & Knight, 2013, p. 71) Thyer | Evidence-Based Practice or Evidence-Guided Practice: A Rose by Any Other Name Would Smell as Sweet Similar complaints have been registered with respect to the application of randomized controlled trials (RCTs) in general. If the advocates of longer term and more complex interventions fail to undertake credible evaluations of their own methods, whose fault is that? Are we surprised that a new model such as EBP is initially explored with simpler practice issues rather than more complex ones? There is a natural progression to the types of intervention research studies needed to investigate the effectiveness of treatments, usually from simpler to more complex problems, interventions, and environments. This can take many years. But it is being done. There is nothing with the original model of EBP to preclude more complex studies. In any event, this supposed limitation is being overtaken by events since RCTs, meta-analyses, and systematic reviews are being conducted on complex problems and interventions. To illustrate, the December 2011 issue of the Clinical Social Work Journal contains a number of articles discussing a widely cited meta-analysis of the effectiveness of longterm psychodynamic psychotherapy. Discussion: Barriers in electronic patient scheduling See also Roseborough, McLeod, and Bradshaw (2012) for an innovative social work outcome study on psychodynamic psychotherapy, and Drisko & Simmons (2012) for a comprehensive survey of the evidence base for psychodynamic psychotherapy. EBP places no limitations on the types of problems investigated or interventions tested. If an intervention can be applied, its outcomes can be evaluated. If client functioning can be validly measured, the potential impacts of intervention can be assessed. More complex interventions and problems increase the difficulty of the task but they do not preclude it. The realities of contemporary social work practice work against a purely evidence-based orientation. Most social workers simply do not have access to bibliographic databases and the peer-reviewed literature, both of which are required to practice from an evidence-based foundation…practicing social workers lack the skills and expertise necessary to operate from an evidence-based foundation. (Gitterman & Knight, 2013, p. 72) The increasing ease of access to these databases and literature is rendering this point moot. Much useful information is available via open-access electronic sources (see, for example, Gary Holden’s wonderful resource Information for Practice, available at http:// ifp.nyu.edu/); government-maintained websites, such as the National Registry for Evidence-Based Programs and Practices, supported by the Substance Abuse and Mental Health Services Administration (see http:// www.nrepp.samhsa.gov); and the National Coalition for Evidence-Based Policy, cited above. Greater num- bers of colleges grant library access privileges to their alumni. At one point, office computers were said to be too expensive to be made widely available for use by social workers. Time took care of that problem. The problem of limited access to the research literature is similarly being taken care of. Regardless, this limitation is one that is shared with Gitterman and Knight’s alternative, EGP, which also requires access to such databases and literature. It is embarrassing and limiting for us to assert that our graduates lack the skills and expertise necessary to operate from an EBP perspective. Again, if true, whose fault is this? Are social workers any less intelligent or research-trained than, say, nurses, public health workers, or other largely bachelor’s- and master’s-level professions which have widely adopted EBP? We have barely begun focusing our professional training in the research skills needed to effectively engage in EBP (Shlonsky, 2009)—namely how to formulate answerable questions (Gambrill & Gibbs, 2009), track down the best available literature (Rubin & Parrish, 2009), critically analyze it (Bronson, 2009), apply any lessons learned to our work with our own clients, and evaluate our effectiveness in carrying out EBP. Instead, we teach a wide array of research methods with little connection to those needed to carry out EBP (e.g., how to conduct a survey study), in lieu of how to conduct outcome research on our own practice—a crucial skill needed for EBP. Discussion: Barriers in electronic patient scheduling Desired Features Said to Be Associated With Evidence-Guided Practice We intentionally use the term evidence-guided to refer to an approach to practice in which interventions are suggested, rather than prescribed, by research findings…it also recognizes the uniqueness of the individual and the inherent dignity and worth of the person. Evidence-guided practice reinforces client empowerment and clients’ right to selfdetermination…it adopts an ecological view of client problems and worker interventions. (Gitterman & Knight, 2013, p. 72–73, emphasis in original) Yet, these features are also true of EBP. The evidence in EBP is only used as a guide, and taken into account when considering clients’ preferences and values, professional ethics, and clinical and environmental circumstances. It only takes a reading of the primary sources describing EBP to realize this. For example, here is what the founder of the term evidence-based medicine, Gordon Guyatt, asserted as central to this model: As a distinctive approach to patient care, EBM involves two fundamental principles. First, evidence alone is never sufficient to make a clinical decision. 81 Families in Society | Volume 94, No. 2 Decision makers must always trade the benefits and risk, inconvenience and costs associated with alternative management strategies, and in doing so consider the patients values. (Guyatt & Rennie, 2002, p. 8, emphasis added). Knowing the tools of evidence-based practice is necessary but not sufficient for delivering the highest quality of patient care. In addition to clinical expertise, the clinician requires compassion, sensitive listening skills, and broad perspectives from the humanities and social sciences. These attributes allow understanding of patient’s illnesses in the context of their experience, personalities and cultures…For some of these patients and problems, this discussion should involve the patient’s family. For other problems-attempts to involve other family members might violate strong cultural norms. (Guyatt & Rennie, 2002, p. 15, emphasis added) Understanding and implementing the sort of decision-making process patients desire and effectively communicating the information they need requires skills in understanding the patient’s narrative and the person behind that narrative… Most physicians see their role as focusing on health care interventions for their patients….they focus on individual patient behavior. However, we consider this focus too narrow….Physicians concerned about the health of their patients as a group, or about the health of the community, should consider how they might contribute to reducing poverty (Guyatt & Rennie, 2002, p. 16, emphasis added) Any presentation of EBP that solely focuses on applying research evidence to make important practice decisions and ignores the unique features of individual clients or larger societal or contextual issues is either a mischaracterization, a misunderstanding, or uninformed. Unlike evidence-based practice, EGP explicitly recognizes relevant theory. Theories, as well as research, provide significant guidelines for practice…. Evidence-guided practice reflects…a solid grounding in theory. (Gitterman & Knight, 2013, p. 74) This is a legitimate observation, but I consider the atheoretical nature of EBP to be a strength, not a limitation to this approach. Although nothing in the EBP model precludes a judicious consideration of relevant theory as possibly pertinent to one’s searching for evidence, in terms of helping to make practice decisions it posits a decided preference for relying on sound data-based studies in lieu of theoretical conceptualiza82 tions. Though there is nothing as practical as a good theory, there is also nothing as harmful as a bad one (Thyer, 2012). Many theories in social work have been and are actively injurious to practitioners and clients. They waste our time, most are not well-supported empirically, and … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10