Columbia University School of School Work

CLINICAL RESEARCH:

USING EVIDENCE IN CLINICAL DECISION MAKING

(44501.005)

SpringQuarter 2017

Mondays 1:30 – 4.20p.m.

Instructor: Leyla Ismayilova, PhD

Email:

Tel:773-834-0401

Office:SSA,E-2

Office Hours: Mondays, 12:00 – 1:00 pm

Course Description

The overall goal of Clinical Research course is to provide students with an understanding of how research is used to evaluate social work practice. The course also seeks to foster the development of critical and analytical skills for assessing and translating knowledge about effective social work interventions into real-world practice situations. The course is designed to provide students with an overview of the methods, concepts, and principles of practice evaluation research in order to become practitioners who can engage in self-directed evaluation of their own practice and to make meaningful contributions to program evaluation efforts. The course will expand students’ empirical knowledge, capacity for critical assessment, and research skill development in the generation, analysis, and use of information during each phase of the assessment and intervention process. Students will learn: 1) sound assessment procedures to identify and clarify the problem for intervention; 2) the ongoing evaluation of practice as it occurs.

Building on principles of social scientific inquiry and basic research methodology covered in Introduction to Social Work Research, this course will reinforce and extend understanding of a scientific, analytic approach for social workers in advanced clinical practice so that they may build knowledge for practice and evaluate their service delivery. In addition, a systematic approach to knowledge building and evaluation of service delivery relevant to the advanced clinical practice method is reinforced and enhanced by other advance curriculum areas, including required advanced Clinical Practice courses; field of practice platform courses; and advanced practice electives. Students are expected to draw on previously acquired knowledge from prior research and clinical coursework regarding problem formulation, measurement, and research design as they learn to formulate and analyze research questions for clinical practice. Strict adherence to ethical standards of scientific inquiry will be emphasized, with particular attention to protecting and promoting the well-being of vulnerable and oppressed populations.

Students will be expected to demonstrate competency in “process evaluation” by engaging in ongoing qualitative assessment and monitoring as an essential part of the intervention. Furthermore, students will be expected to construct, critically assess, and adapt qualitative and quantitative tools for “outcome evaluation” involving monitoring and evaluation of client progress in reaching their goals. Such tools include various types of individualized and standardized measures, such as individualized rating scales, logs, observational measures, and rapid assessment instruments.

Students will be expected to demonstrate competence in the critical examination and development of tools, within an agency context, either to assess unmet client or agency needs or evaluate clinical practice. These tools will include developing skill in designing a single-system evaluation for use with a single client, or client system, such as a couple or family, to assess clinical progress over time; and designing an original and “well-crafted” questionnaire for use with a small group of clients or clinicians engaged in a common clinical purpose. Examples of a common clinical purpose include clients participating in a therapeutic or support group or agency clinicians providing feedback about unmet needs or underutilized interventions for a particular group of clients. Finally, students will be introduced to software for statistical analysis and graphing of data from single-system designs and questionnaires.

Students will apply one or more of these tools in a final evaluation project which will be conducted, whenever possible, within a specific clinical context from their field placement settings. The final project will address the planning, design, and execution of the evaluation, including data collection and analysis, as well as the reporting and application of findings to influence practice decisions.

Course Content

The role of theory (social work, social science, programmatic) in guiding accountable social work practice;
The history, steps, and rationale for Evidence-Based Practice (EBP) and how EBP relates to the ethical practice of social work and practice evaluation;
Qualitative assessment of competing issues to choose target(s) for intervention
Measurement
Review of reliability and validity
Wording items for single cases versus for small-group questionnaires
Measurement reactivity
Use of multiple measures and perspectives
Selecting measures of client change, including
Behavioral observations
Qualitative and quantitative logs
Individualized “self-anchored” scales
Standardized instruments for rapid assessment
Critical appraisal of empirically supported treatments and best practices
Client self-monitoring and clinician monitoring
To assess targeted problem at baseline as well as changes during intervention and at follow-up
To maintain fidelity and integrity of practice intervention over time
Design options for core practice evaluation methods
Qualitative, quantitative, visual, and statistical analysis of data

Course Objectives

By the completion of this course, students are expected to demonstrate:

An understanding of the importance of evaluating clinical practice in social work, including strengths and limitations;
Knowledge and skills in accessing, critiquing, and utilizing empirical research to formulate practice-related research questions and evaluate client outcomes;
An appreciation of the importance of racial, ethnic, and cultural diversity and

oppression within the context of conducting evaluation of social work practice;

Comprehension and adherence to ethical standards of scientific inquiry, including

those in the NASW Code of Ethics and university/agency Institutional Review
Boards, especially with regard to the well-being of vulnerable and oppressed clients;

Skill in clinical assessment and specification of client problems and goals;
An ability to operationalize client problems and goals;
An understanding of the steps involved in evaluating 1) an individual clinical case and 2) a small group of clients or clinicians engaged in a common clinical purpose, such as a support group or clinicians’ assessments of unmet client or clinical needs;
An ability to select or develop measurement tools appropriate for use with 1) a specific client and their client system; and 2) a group of clients or clinicians;
Proper choice of evaluation design options;
Critical selection of intervention method/s appropriate for use with specific client

problems/issues and systems;

Collection of data and the use of actual data (primary or secondary) whenever feasible;
Skill in documenting and analyzing the effects of social work intervention;
Ability to appropriately and effectively apply evaluation findings to practice;
Ability to report clinical findings to clients and to a larger audience of practitioners.

Note: We will adhere to University and School policies regarding accommodations for students with disabilities, religious holidays, incomplete work, plagiarism, and students' evaluations of the course and its instruction, as stated in the SSA/University of Chicago Student Handbook. Except when an "incomplete" grade will be granted, the final grade will be lowered if absence from class is excessive (i.e. more than two classes including any excused absence). Students with disabilities are strongly encouraged to follow University procedures to ensure that necessary accommodations are made at the beginning of the semester.

Course Format

This is an advanced level course designed with strong emphasis on lectures, class discussions, group exercises, class presentations, and computer lab sessions. Audiovisual tapes may occasionally be used to supplement the class lectures.

Student Evaluation

The written assignments, in-class presentation and quizzes are designed to assist you in: (a) integrating course material with field work content, (b) developing skills in differential assessment and intervention, and (c) integrating research concepts, theory, and practice.

It is expected that student's assignments and class participation will reflect an understanding of both required and independent readings and critical thinking. Assignments are due at the beginning of class on the stated dates.All written assignments should be submitted electronically via Chalk.Grades will be lowered for failure to follow directions from the syllabus and the specific assignments. An “incomplete” grade must be requested in advance and will be granted only in extraordinary circumstances.

The grade value of assignments is as follows:

Assignments Value

Quizzes 20 points
Mid-term paper: Evaluation Proposal30 points
Final paper: Evaluation / Self-monitoring Findings 30 points
Class Presentation10 points
Class Attendance and participation in class activities 10 points

100 points total

The grade for Class Attendance and Participation will be based upon promptness, attendance, and the quality and quantity of class participation. This does not mean that excessive participation, such as monopolization during class discussions, will be valued. For full credit in this area, I will look for a reasonable level of quality participation, beyond formally required class presentations. This will include your willingness to share during class discussions with your colleagues: 1) perceptions, feedbacks and questions from assigned readings; 2) measures and empirical clinical research from independent literature searches you conduct; and 3) case material and issues from your field placement, outside reading, or other sources.

Presentations: Students will be required to make one class presentation of their projects. Students will have a choice of presenting their mid-term evaluation proposals orfinal results of their projects. Students who miss presentations by classmates will have 2 points deducted from their final grade for each day of presentations missed.

Quizzes: To better facilitate students’ understanding of this course and prepare for the SW license exam, students are expected to take two quizzes given throughout the semester. Quizzes will include multiple-choice questions related to the assigned readings and lectures.

Percentage and Letter Grading Scale:

95-100=A83-87.4=B73-77.4=C

90-94.9=A-80-82.9=B-70-72.9=C-

87.5-89.9=B+77.5-79.9=C+Below 70=Failing.

Required Texts:

Rubin, A. and J. Bellamy (2012). Practitioner’s Guide to Using Research for Evidence Based Practice. 2nd Edition. Hoboken, NJ: John Wiley & Sons, Inc.

Bloom, M. & Britner, P.A. (2012). Client-Centered Evaluation: New Models for Helping Professionals. Boston: Allyn & Bacon.

Other required readings can be retrievedfrom the Chalk site or will be available on reserve at the SSA library.

SESSION OUTLINE AND READING LIST

Note: Articles are available for download on the Chalk site

WEEK 1Overview of the Course. Introduction to Evidence-Based Practice and Practice Evaluation. Locating the Evidence.

 Integrating evaluation and practice

 Arguments for and against evaluation

 Similarities and differences between evaluation and research

Overview of the steps involved in practice evaluation
A first run through the single-subject approach
Practice wisdom vs. evidence-based knowledge

In-class Activity: Introducing EBP to an agency.

REQUIRED READINGS:

*Go to the Evidence-based Behavioral Practice Project /EBBP website ( register for the EBBP.org training portal, and complete two modulesEBBP Process Moduleand Search for Evidence Module.

*Gibbs, L., & Gambrill, E. (2002). Evidence-based practice: Counterarguments to objections.Research on Social Work Practice, 12(3), 452-476.

Rubin, A. & Bellamy (2012). Practitioner's Guide to Using Research for Evidence-Based Practice.

Chapter 1: Introduction to Evidence-Based Practice

Chapter 2:Steps in EBP Process

WEEK 2Moving Beyond Empathy and Rapport: Empirically Supported Interventions. Assessing the Quality of Evidence

Hierarchy of Evidence
Critical selection of interventions
Campbell and Cochrane Collaborations
The Campbell Collaboration (C2): Systematic Reviews for psychosocial, behavioral, and educational interventions
Use of manual-based treatments with empirical evidence of effectiveness
Systematic Reviews and Meta Analyses

In-class Activity: Review of systematic reviews, practice guidelines, and treatment manuals in small groups

REQUIRED READINGS:

*EBBP.org: Complete the following modules:

Systematic Review Module
Critical Appraisal Module

Rubin, A. & Bellamy (2012). Practitioner's Guide to Using Research for Evidence-Based Practice.

*Chapter 3: Research Hierarchies

*Chapter 4: Criteria for Inferring Effectiveness

Chapter 8: Critially Appraising Systematic Review and Meta-Analyses

*Review one systematic review of your choice:

Bisson J, Andrew M (2009) Psychological treatment of post-traumatic stress disorder (PTSD). Systematic Review. The Cochrane Collaboration. JohnWiley & Sons, Ltd.

Jones C, Hacker D, Cormac I, Meaden A, Irving CB (2012). Cognitive behavioural therapy versus other psychosocial treatments for schizophrenia. Systematic Review. The Cochrane Collaboration. JohnWiley & Sons, Ltd.

De Silva MJ, Cooper S, Li HL, Lund C, Patel V (2013). Effect of psychosocial interventions on social functioning in depression and schizophrenia: meta-analysis. British Journal of Psychiatry, 202:253-260.

Lilienfeld, S. O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2(1), 53-70.

Recommended readings:

Greenhalgh, T. (1997). How to read a paper: Papers that summarise other papers (systematic reviews and meta-analyses). British Medical Journal, 315(7109), 672-675.

WEEK 3Assessment and Research Tools

 Incorporatingdifferent approaches within interviewing, assessment, and intervention.

 Attention to race, gender, ethnicity, power and life history

In-class activity: Assessing a client using SCID (Structured Clinical Interview for DSM Disorders).

REQUIRED READINGS:

Find a systematic review, best model, or practice guidelines pertinent for one of two clients (brother or sister) from the Prince of Tides movie. Be prepared to discuss in class why the chosen intervention is the most appropriate for this client. To conduct the search, use online databases presented in class (Campbell Collaboration library, Cochrane Collaboration library, SAMHSA’s National Registry of Evidence-based Programs and Practices, etc).

Link to watch The Prince of Tides movie for free.

Do not download it. Just hit "Play"otherwise the site will request payment.

*Tuerk, P., Brady, K. T., & Grubaugh, A. L. (2009). Clinical case discussion: Combat PTSD and substance use disorders.Journal of addiction medicine,3(4), 189-193.

*Corcoran J. and Walsh J. (2010). Clinical Assessment and Diagnosis in Social Work Practice.

Chapter 10: Depression

Chapter 11: Substance Use

(Focus primarily on the assessment and measurement instruments described in Appendix at the end of each chapter)

*Jordan C. & Franklin, C. (2015). Clinical Assessment for Social Workers. Quantitative and Qualitative Methods. (4th Edition).

Chapter 2: Linking Assessment and Intervention

Chambless, D. L. & Holton, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7-18.

WEEK 4Treatment Objectives: Deciding on a Target for Intervention

The interview as a focused clinical assessment method
Problem identification and formulation
Formulating questions from practice
Setting measurable goals
Choosing, implementing, and monitoring the intervention

In-class activity: Reviewing treatment planners and setting treatment objectives(Jongsma, A.E., Jr., Peterson, L.M., Bruce T.J. (2014). The complete adult psychotherapy treatment planner. New York: Wiley, 4thed.)

REQUIRED READINGS:

Assess your client’s problem using SCID interview or any other standardized assessment tool. Be prepared to discuss the results of assessment in class. Feel free to share copies of the assessment tool with the rest of the class.

*Bloom and Britner (2012)

Chapter 2: Conceptualization: Naming what we see in the client situation.

*Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014). Cognitive behavioral therapy (CBT) and meditation awareness training (MAT) for the treatment of co-occurring schizophrenia and pathological gambling: A case study.International Journal of Mental Health and Addiction,12(2), 181-196.

*Chorpita, B.F., Becker, K.D., & Daleiden, E.L. (2007). Understanding the common elements of evidence-based practice: Misconceptions and clinical examples. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 647-652.

Brophy, G. (2000). Social Work Treatment of Sleep Disturbance in a 5-Year-Old Boy: A Single-Case Evaluation. Research in Social Work Practice, 10(6), 748-758.

Lau, A. (2006). Making the case for selective and directed cultural adaptations of evidence-based treatments: examples from parent training. Clinical Psychology, 13(4), 295-310.

*Grinnell R. & Unrau Y.(2007). Social Work Research and Evaluation: Foundations of Evidence-Based Practice (8th Edition).

Part IVBecoming a Culturally Sensitive Researcher

WEEK 5Measurement tools I: Basic Principles & Using standardized measures

Measuring Change: What are we looking for in a measure?

 Review of basic measurement principles

 Reliability, validity, reactivity, utility, directness, and sensitivity to change

 Use of multiple measures

Standardized instruments for rapid assessment
Selecting Standardized Measures for Clinical Planning, Assessment, Monitoring, and Evaluation
The ETS Test Collection (

In-class Exercise: Reviewing standardized instruments.

IN-CLASS QUIZ

REQUIRED READINGS:

*Bloom and Brittner (2012).

Chapter 3: The issues: Measurement theory: Validity, reliability, error messages, sustainability

Chapter 8: Standardized rating scales.

*Berkowitz, S. J., Stover, C. S., & Marans, S. R. (2011). The child and family traumatic stress intervention: Secondary prevention for youth at risk of developing PTSD.Journal of Child Psychology and Psychiatry,52(6), 676-685.

*Rubin, A. & Bellamy (2012). Practitioner's Guide to Using Research for Evidence-Based Practice.

Chapter 11: Critically Appraising and Selecting Assessment Instruments

*Fonagy, P., Target, M., Cottrell, D., Phillips, J., & Kurtz, Z. (2002). Chapter 1: Introduction and review of outcome methodology: The importance of outcome measurement (pp. 1-41). In What Works for Whom?: A Critical Review of Treatments for Children and Adolescents. New York: Guilford. Download at

[Focus primarily on Levels of Outcome Measurement pp. 5-13]

Jordan C. & Franklin, C. (2015). Clinical Assessment for Social Workers.

Chapter 3: Quantitative Clinical Assessment Methods

Chapter 4: Standardized Assessment Measures