Does transitional care prevent older adults from rehospitalization? A review.

The purpose of the authors in this article is to present a review of experimental research assessing whether transitional care is effective in preventing older adults from rehospitalization in the United States. The prevalence of rehospitalization among Medicare beneficiaries is high, but a considerable portion of rehospitalizations could have been prevented and decreased. One strategy which can prevent these unplanned rehospitalizations is transitional care. Older adults age 65 and over, in particular, are considered to be potential beneficiaries of transitional care. Studies examining the effects of transitional care were identified through electronic bibliographic databases and manual searches from inception through April 2011, limited to English language. A total of nine experimental studies meeting the inclusionary criteria were reviewed. Seven of nine studies detected positive effects of transitional care in preventing older adults from rehospitalization, although these effects varied at different follow-up periods. Based on this narrative review it may be concluded that the published experimental studies support the hypothesis that transitional care generally prevents rehospitalization among the elderly. Additional studies involving more traditionally under-represented clients, and with longer follow-up periods are needed.

The Divergent Paths of Behavior Analysis and Psychology: Vive la Différence!

Twenty years ago I suggested that behavior analysts could effect a quiet and covert takeover of the American Psychological Association (APA). I gave as precedents the operation of similar initiatives in the nineteenth and twentieth centuries, the Darwinian-inspired X-Club, and the psychoanalytically-oriented Secret Ring. Though a conscientious program of working within established APA bylaws and rules, behavior analysts could ensure that behavior analysts were nominated for every significant elective position within the APA, and move to get their colleagues placed in appointive positions, such as journal editorships, review boards, and major committees. This would be one approach to remake psychology along behavioral lines, which was an early ambition of B. F. Skinner. The community of behavior analysts ignored my suggestion, and instead pursued the path of creating an independent discipline of practitioners, one with its own degree-granting programs, conventions, journals, and legal regulation. This effort has been immensely successful, although much critical work remains to be done. In retrospect, I was wrong to suggest changing psychology from within, and I have been delighted to witness the emergence of our new and independent field.

Novel unsupported and empirically supported therapies: patterns of usage among licensed clinical social workers.

BACKGROUND: While considerable attention has been focused in recent years on evidence-based practice, less attention has been placed on clinical social workers' choice to use ineffective or harmful interventions, referred to in the present paper as Novel Unsupported Therapies (NUSTs). METHOD: The present study surveyed 400 Licensed Clinical Social Workers (LCSWs) across the United States in order to determine the extent of their usage of NUSTs, as well as their usage of conventional therapies that lacked support and empirically supported therapies (ESTs). Reasons for selecting interventions were also assessed. RESULTS: While the vast majority (97.5%) reported using some form of EST, 75% of our sample also reported using at least one NUST. Logistic regression analysis revealed that NUST usage was related to female gender and trauma specialization. A split plot ANOVA revealed that respondents rated positive clinical experience higher than published research as a reason for selecting an intervention. LCSWs with a CBT theoretical orientation rated research evidence more highly than those of other theoretical orientations. However, even within the group of LCSWs with a CBT orientation, clinical experience was rated more highly than research evidence. CONCLUSIONS: Implications for practice are discussed.

Science and pseudoscience in developmental disabilities: guidelines for social workers.

Individuals with a developmental disability can now be provided a variety of empirically supported treatments that have been shown to be useful in promoting educational attainments, social and vocational skills, and self-care, and in reducing behavioral problems. Unfortunately, a large number of pseudoscientific or bogus therapies continue to be offered to this population and their families. We review the characteristics of pseudoscientific and bogus treatments and provide several examples of unsupported or harmful interventions offered by contemporary social workers and other human service professionals, to the detriment of people with disabilities. We encourage social workers to identify pseudoscientific interventions and avoid providing these, in favor of using empirically supported treatments.

Ethical guidelines for designing and conducting evaluations of social work practice.

We review selected aspects of current ethical guidelines pertaining to the design and conduct of social work evaluation and research studies. We contend that there are significant differences between social science research and evaluation studies, and that the uncritical application of ethical guidelines suitable for regulating social science research may hinder social workers undertaking clinical and program evaluations. What is needed are ethical guidelines that distinguish between retrospective and prospectively designed studies, which enumerate when voluntary and informed consent may not be necessary in order to use data obtained from clients, and clearer standards pertaining to exempting evaluation studies from oversight by Institutional Review Boards.

Evidence-based macro practice: addressing the challenges and opportunities.

Steps involved in the process of evidence-based practice are reviewed in terms of their applicability to macro-level social work. These steps include (1) posing answerable questions; (2) locating credible research studies, (3) critically evaluating this research and its applicability to a practice situation; 4. selecting an intervention(s) by integrating research evidence with professional expertise, ethical standards, and the situation's unique circumstance; and (5) evaluating outcomes. This process has clear and compelling applications to macro-practice. A substantial body of research applicable to macro-level social work currently exists. Widespread adoption of EBP has great potential to improve social work programs and policies.

Evaluating wraparound services for seriously emotionally disturbed youth: pilot study outcomes in Georgia.

Since the early 1990s, intervention strategies designed to preserve the family system while serving children diagnosed with severe emotional disturbances (SED) have been on the rise. Many of these strategies sought to provide families with comprehensive approaches that link various agencies and services, thus providing a complete system of care. The term wraparound services was coined to describe these approaches. However, evaluation studies of the outcomes of these programs remains limited. In order to assess the impact of wraparound services, outcome evaluation programs need to be implemented and their feasibility assessed. This paper focuses on the feasibility and implementation of a computer-based field assessment system and the ability to provide empirically based feedback to the programs. In addition, an assessment of 15 participating children and families, comparing selected aspects of clinical functioning at intake and 6-month follow-up, is presented and discussed.

Bibliometrics and social work: a two-edged sword can still be a blunt instrument.

In order to improve the productivity and impact of social work scholarship, the profession must look beyond bibliometrics to other issues that must be considered. These include the lag time between acceptance and publication of articles, the quality of peer review experienced by social work authors, and the overabundance of journals being published in social work.

Evidence-Based Practice and Social Work.

The essential features of contemporary evidence-based practice (EBP) are outlined, with specific reference to the applications of this model to various areas of social work, micro through macro. EBP is seen as a welcome addition to our field, representing a fuller and more comprehensive development of earlier and related positions such as empirical clinical practice within social work, and the delineation of empirically-supported therapies within psychology. Social work should proactively adopt EBP as its preferred conceptual model, reorient BSW and MSW training programs along the lines advocated by EBP, and inculcate these principles into the delivery of social work services. This is seen as both a professional and ethical imperative necessary for the survival of the field.