Matthew O. Howard

Teaching Evidence-Based Practice: Toward a New Paradigm for Social Work Education

The scientific literature relevant to social work practice has grown expansively in recent years. Corollary developments, including the widespread availability of electronic bibliographic databases, improved indexing services, and increased acceptance of systematic reviews and evidence-based practice guidelines, have made research findings increasingly accessible to practitioners. For the first time in the history of the profession, social work educators are confronted with the challenges posed, and opportunities afforded, by this accumulating body of practice-relevant scientific information. Evidence-based practice is a new paradigm that promotes more effective social interventions by encouraging the conscientious, judicious, and explicit use of the best available scientific evidence in professional decision making. Pedagogically, evidence-based practice involves teaching students the values and skills they need to identify, critically appraise, and apply practice-relevant scientific evidence over the course of their professional careers. This article describes the potential benefits of evidence-based social work professional education and ongoing efforts of the George Warren Brown School of Social Work at Washington University to implement curriculum-wide changes supportive of evidence-based professional practice education.

Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: Results of a randomized controlled pilot trial

Abstract Mindfulness training may disrupt the risk chain of stress-precipitated alcohol relapse. In 2008, 53 alcohol-dependent adults (mean age = 40.3) recruited from a therapeutic community located in the urban southeastern U.S. were randomized to mindfulness training or a support group. Most participants were male (79.2%). African American (60.4%), and earned less than

Adolescent Substance Abuse Treatment: A Synthesis of Controlled Evaluations

20,000 annually (52.8%). Self-report measures, psychophysiological cue-reactivity, and alcohol attentional bias were analyzed via repeated measures ANOVA. Thirty-seven participants completed the interventions. Mindfulness training significantly reduced stress and thought suppression, increased physiological recovery from alcohol cues, and modulated alcohol attentional bias. Hence, mindfulness training appears to target key mechanisms implicated in alcohol dependence, and therefore may hold promise as an alternative treatment for stress-precipitated relapse among vulnerable members of society.

Inhalant use among antisocial youth: prevalence and correlates

Objective: A synthesis was conducted to assess outcome findings and methodological characteristics of controlled evaluations of adolescent substance abuse treatments. Method: Extensive computerized and manual bibliographic searches were employed to identify controlled evaluations of adolescent substance abuse treatment. Meta-analytic techniques were utilized to gauge effect sizes across studies to determine which interventions are most effective. An index of methodological quality was computed for each study using ratings of 13 study design factors. Interventions were classified by a combination of their design strength, achievement of desired effect, and other evidence factors. Results: Findings indicate that multidimensional family therapy and cognitive-behavioral group treatment received the highest level of evidentiary support. Seven other interventions showed evidence of effectiveness as well. Conclusions: Several interventions are effective for treating adolescent substance abuse. These treatments are psycho-social in nature, exist within a structured framework, and should be appealing to social work practitioners.

INTEGRATING EVIDENCE-BASED PRACTICE AND SOCIAL WORK FIELD EDUCATION

The current (2.9%), annual (19.6%), and lifetime (34.3%) prevalence of inhalant use among 475 youth (M age = 15.5; SD = 1.5; 87.4% male) on probation in a western state of the United States was assessed. Inhalant users reported significantly less family support and cohesiveness and lower self-esteem, and significantly more lifetime thoughts of suicide and suicide attempts, neighborhood gang activity, peer and parental substance abuse, intentions to engage in illegal behavior, substance-related criminality, and substance abuse than did nonusers. Ethnicity, self-esteem, suicidality, number of substance-using peers, and extent of substance-related criminality significantly discriminated inhalant users from nonusers in a logistic regression analysis. Multiple linear regression analyses indicated that age, perceived school ability, age at initiation of alcohol use, self-esteem, and substance-related criminality significantly predicted age at onset of inhalant use (R2 = .30). Age at initiation of inhalant use, gang membership, truancy, and substance-related criminality significantly predicted lifetime frequency of inhalant use (R2 = .20). Study findings indicate that inhalant-using delinquents evidence significantly greater antisocial attitudes, personal and familial dysfunction, and substance abuse, than do their non-inhalant-using counterparts.

Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: Results from an early-stage randomized controlled trial.

The social work academic community is currently considering and critiquing the idea of evidence-based practice (EBP). Given the vital part that practicum education plays in the social work profession, understanding the views of field instructors on this subject is essential. The George Warren Brown School of Social Work at Washington University surveyed 283 field instructors within 180 agencies and found that the majority (87%, N=235) viewed it as a useful practice idea. However, most of the indicators employed to assess use of scientific evidence in social work practice revealed that it occurs too infrequently. A lack of time was reported as the greatest obstacle.

Psychopathic personality traits and delinquent careers: an empirical examination

OBJECTIVE Opioid pharmacotherapy is now the leading treatment for chronic pain, a problem that affects nearly one third of the U.S. population. Given the dramatic rise in prescription opioid misuse and opioid-related mortality, novel behavioral interventions are needed. The purpose of this study was to conduct an early-stage randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), a multimodal intervention designed to simultaneously target mechanisms underpinning chronic pain and opioid misuse. METHOD Chronic pain patients (N = 115; mean age = 48 ± 14 years; 68% female) were randomized to 8 weeks of MORE or a support group (SG). Outcomes were measured at pre- and posttreatment, and at 3-month follow-up. The Brief Pain Inventory was used to assess changes in pain severity and interference. Changes in opioid use disorder status were measured by the Current Opioid Misuse Measure. Desire for opioids, stress, nonreactivity, reinterpretation of pain sensations, and reappraisal were also evaluated. RESULTS MORE participants reported significantly greater reductions in pain severity (p = .038) and interference (p = .003) than SG participants, which were maintained by 3-month follow-up and mediated by increased nonreactivity and reinterpretation of pain sensations. Compared with SG participants, participants in MORE evidenced significantly less stress arousal (p = .034) and desire for opioids (p = .027), and were significantly more likely to no longer meet criteria for opioid use disorder immediately following treatment (p = .05); however, these effects were not sustained at follow-up. CONCLUSIONS Findings demonstrate preliminary feasibility and efficacy of MORE as a treatment for co-occurring prescription opioid misuse and chronic pain. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

An Investigation of Primary and Secondary Psychopathy in a Statewide Sample of Incarcerated Youth

PURPOSE Few studies have simultaneously investigated psychopathic traits in relation to assorted dimensions of a delinquent career. The current study examined the role that psychopathy might play in facilitating research on the small subset of youth at risk for persistent antisocial behavior. METHOD This study examined psychopathic personality scores using the Antisocial Process Screening Device (APSD) and the Psychopathic Personality Inventory-Short Version (PPI-SV) in a statewide population of 723 juvenile offenders. RESULTS Psychopathy scores revealed a linear score-response such that higher psychopathy scores were associated with increases in general delinquency (including violent and non-violent forms), hostile aggression, and three forms of early onset delinquency, including offending, police contact, and juvenile court referral. Moreover, negative binomial regression, hierarchical linear regression, and logistic regression models revealed that psychopathy factors possessed utility in predicting all dimensions of the delinquent career net the effects of demographic and available risk factors. CONCLUSION Psychopathy should be fully incorporated into criminological investigations of delinquent and criminal careers.

Clinical Practice Guidelines: Should Social Work Develop Them?

There has been considerable interest in the identification of putative subtypes of psychopathy over the past several years although none of this research has focused on juveniles who are high in psychopathic traits. Using a statewide sample of juvenile offenders, the present study sought to identify subtypes consistent with theoretical notions of primary and secondary psychopathy. Among those youths high in psychopathic traits (n = 132), finite mixture modeling of various indicators of psychological distress resulted in a two-class solution. Consistent with theory, one subtype was characterized by higher levels of distress (e.g., anxiety, depression, suicidal ideation), whereas the other subgroup was lower on these dimensions and generally similar to nonpsychopathic control juveniles (n = 135). Analyses of theoretically relevant external correlates (e.g., offense history, drug use, victimization) suggested that the two subtypes differed from each other on certain key variables as well as differed from the nonpsychopathic controls.

Exercise dependence and attitudes toward eating among young adults.

Guidelines for clinical practice have proliferated in recent years. Numerous studies indicate that guidelines can increase empirically based practice and improve clients’ outcomes. Guidelines for social work practice would also promote more informed client decision making, improve clinical training in schools of social work, encourage more cost-effective and accountable practice, and help codify current knowledge in controversial practice areas. The National Association of Social Workers should institute a guidelines development program and ensure that guidelines reflect traditional social work values and the best in available scientific evidence and practice experience.