Counseling with CompassionAmy Monk, M.Ed. - Home



Research and Program EvaluationAmy A. MonkCNDV 5353 Section C02Lamar UniversityCNDV 5353 Final Course ProjectMillions of adolescents struggle with substance abuse every year. School-based prevention and treatment programs have tried to combat the serious problems that stem from alcohol and drug use, yet the statistics seem to only be getting worse. According to Shekhtmeyster, Sharkey, & You (2011), “adolescent substance use increases the risk of significant mental health problems such as conduct disorder, depression, anxiety, and substance dependence” (p.386). A clearer understanding of effective factors within substance abuse programs should be examined and evaluated in order to improve future prevention and treatment programs aimed at helping at-risk youth with substance abuse. The Counseling Profession and ResearchImportance of ResearchIn order to practice responsibly by respecting the dignity and promoting the welfare of our clients, counselors must to stay current with evidence-based practices. Counselors need to use data to determine treatment, plan appropriate interventions, and evaluate outcomes in a timely manner to more effectively solve client problems (Sheperis, Young, & Daniels, 2010). Research is at the core of the counseling profession and enables counselors to use best-practice methods to achieve desired outcomes.G. Brigman, E. Villares, and L. Webb (2011) show the need for counselors to use “well designed and carefully conducted cognitive and social and emotional learning programs in their comprehensive guidance and counseling programs” (p. 414). As a future school counselor, I want to implement evidence-based approaches that produce multiple benefits and have a track record for achieving intended results. It is also very important for school counselors to present current research to decision makers using the language of effect sizes. When it comes to outcome research, meta-analysis with higher effect sizes can be very compelling to decision makers and can change old ways of doing something to effectively help students. C. Sheperis (2010) advises counselors to consider all various methods of research presented carefully and to develop a sense of competence in understanding their application to professional work. The three types of research methods that counselors need to evaluate are quantitative, qualitative, and mixed methods.MethodologiesQuantitative Designs. The goal of quantitative research is to describe a phenomenon or make inferences based on a certain phenomenon by using a large number of participants and measurable, objective hard data that allow statistical control and generalizability across various populations (Sheperis, Young, Daniels, 2010). Surveys and experimental methods allow for large data collection opportunities to gain valuable information. Being able to make generalizations allows counselors to predict, explain, and understand a phenomenon. Quantitative research generates reliable population based data that can be used for establishing cause and effect relationships.Qualitative Designs. The goal of qualitative studies is to obtain the viewpoint and experience of a phenomenon from the participants by collecting, analyzing, and interpreting data through observations and interviews on a personal level. This type of research is much more subjective and uses a much smaller sample size giving it little generalizability. The researcher must actively self-reflect to minimize biases that could influence the data and requires an “inductive inquiry whereby a researcher enters a naturalistic setting to understand the phenomena of interest and provide rich descriptions in order to give voice to multiple perspectives” (Sheperis, Young, & Daniels, 2010, p.268). Mixed Methods. A mixed methods approach combines the use of qualitative research and quantitative research to inform each other and increase validity. Sheperis, Young, & Daniels (2010) explain that mixed methods design is an ideal framework for counseling research since the qualitative research shows how counselors interact with clients and the quantitative research shows how counselors conceptualize client problems. Considerations when deciding to use a mixed methods design are: determine the order you will implement the qualitative and quantitative aspects of your study, determine the significance that will be given to the data, determine how the two types of data will be combined, and determine the theory that will guide your design (Sheperis, Young, & Daniels, 2010, p.193).Substance Abuse Interventions & At-Risk YouthNecessity for InterventionsAll counseling professionals should feel obligated to work towards improving our country’s current drug problem, especially when working with at-risk youth. Lev-Wiesel (2009) explains characteristics of at-risk youth stating they have been found to have a “low-frustration threshold, impulsivity, impaired-self-control, difficulty in abstract thinking, low level of verbal expression, feelings of alienation, low level of aspiration for the future, and little hope as to their social mobility” (p.384). At-risk students are much more likely to use drugs than other students and are more likely to use them to cope with stressors (Hopson & Steiker, 2008). School counselors should implement evidence-based practices to prevent and reduce substance use among this population. According to Falck et al. (2002), drug use by young people is a precursor to substance abuse, which represents this nation’s number one health problem and correlates with other serious consequences. If not prevented or treated at a young age, risky behaviors can be established and affect their well being later in life (Jackson et al., 2011). This complex problem is an ongoing concern without an easy solution. However, school based interventions can be an effective approach if done correctly. It is essential that counselors work towards developing effective interventions to help at-risk students struggling with substance abuse. Factors of Effective ProgramsSchools Influence. Shekhtmeyster, Sharkey, & You (2011) led a quantitative study to determine the influence of school support and school meaningful participation on substance use among adolescents by using a multigroup logistic regression. 92,616 ninth and eleventh grade students took the California Healthy Kids Survey and 7,642 were used in the sample as participants. The Resilience and Youth Development Module measured external assets and the family support scale measured supportive relationships with adults in the home environment, and the school support scale measured supportive relationships with adults in school (Shekhtmeyster, Sharkey, & You, 2011). The findings indicated school support as being a significant influential variable beyond the influences of other factors. According to Shekhtmeyster, Sharkey, & You (2011), “school connectedness and teacher bonding have been related to less substance use among high school students, and the results were especially strong for males” (p.398). School-based groups that promote self-awareness and problem solving are also found to decrease substance use among youth.Social Self-Control. Pokhrel et al. (2007) used a time series design to see if lack of social-self control would lead to increased drug use among adolescents from nine traditional and nine alternative high schools. The researchers surveyed 3,908 students and used 2,081 in their final sample analysis. The Problem Consequences Subscale of Personal Experience Inventory gave discriminant validity between interview-derived diagnostic groups, and a simple sample t-tests and chi-square test were calculated comparing the analysis sample and the full baseline sample (Pokhrel et al., 2007).The researchers found that drug use at baseline was found to predict lower social self-control at follow-up indicating that social self-control and drug use share a reciprocal relationship (Pokhrel et al., 2007). Increased drug use is likely to further decrease social-self control. In order to prevent drug use, schools should provide skills-based interventions and trainings to improve students’ social self-control.Culturally Grounded. Hopson & Steiker (2008) conducted a mixed methods study to evaluate versions of a culturally grounded substance abuse prevention program (keepin’ It REAL) for high-risk youth in four alterative schools. The authors hypothesized that curriculums would be more effective if grounded in the life experiences and culture of the participating youth. The mixed methods design included a quasi-experimental pretest and posttest design with a six-week and three-month follow up and focus groups (Hopson & Steiker, 2008). Focus groups deepened the understanding of students’ drug and alcohol choices, attitudes, and behaviors and helped the researchers target questions necessary to make changes on future research procedures (Hopson & Steiker, 2008). The SSP-LO was used to measure characteristics that facilitate learning and define a school’s culture, as well as to plan for implementing a prevention strategy. Hopson & Steiker (2008) found that abstinence messages are seen as unrealistic with this population, but the adapted version of keepin’ It REAL, depicting real life experiences of local students, were more accurate. The results also stressed the importance of consulting with students to “ensure that they feel the intervention is relevant for them”, for the curriculum to empower students to be educators about problems with substance use in their schools, and to allow students to discuss their perceptions of substance use and possible solutions in the focus groups (Hopson & Steiker, 2008, p.125). Strengths-Based. Harris et al. (2012) conducted a qualitative study to evaluate 52 post-treatment interviews with adolescents following their completion of a five-week strengths-based residential program for substance abuse use issues to understand the components they attributed to their success. The 56 participants ranged in age from 15-18 years and majority being female. Thematic analysis was used to identify, analyze, and detail themes discovered. Specific aspects that were found to be helpful was how the program encouraged and helped them identify their strengths and recognize that strengths can be used to help them cope in challenging times, goal setting and accomplishing, and the concept of bravery and resilience (Harris et al., 2012). The researchers concluded, “the strengths-based approach promoted engagement and was the most useful aspect of treatment in this program” (Harris, et al., 2012, p.396).Family Involvement. K. Hedges (2012) conducted a qualitative study to understand the experience of children growing up in a substance using homes in order to comprehend how norms and values within the family may contribute to children’s initiation of substance use. 25 girls between 14-18 years old in a residential substance abuse treatment program were asked to “tell the story of your life”, providing the narrative interviews used for data collection.After lengthy observations and interviews, Hedges (2012) found that substance abuse is an accepted family norm, making addiction to substances a kind of inheritance and way of bonding with family members. A repeated experience is for the youth to return home to the accepted behaviors of substance use after treatment. Hedges (2012) believes “it is critical for adolescent treatment programs to involve families in the treatment” and to strategize and plan for their lives after treatment (p.270). ImplicationsSchools play an influential role in the lives of students and should provide support that has been proven to decrease substance abuse. Establishing caring relationships between staff and students, along with engaging students in meaningful participation, promote positive outcomes and reduce negative outcomes related to substance abuse (Shekhtmeyster et al., 2011). Effective factors that should be incorporated into prevention programs include: being culturally-based and grounded in relevant life experiences, building and focusing on students’ strengths, and implementing a comprehensive program that includes families and the community. Culturally Based & Relevant. Intervention programs need to implement curriculums that reflect the culture and life experiences of a culturally diverse student body (Hopson & Steiker, 2008). A “one-size fits all” program will not be effective for all schools. Schools should use focus groups to allow students to determine if the program is reflective of their schools’ culture and issues. Hopson & Steiker (2008) believe empowering students is another key element of an effective program. Students can be a schools’ best way of informing educators about problems involving substance abuse and should be heard in the planning stages.Focus on Strengths & Build Skills. Developing resilience is essential to helping youth face challenging times. Harris et al. (2012) portrays youth as being disengaged, misusing, or not being aware of their strengths and that bringing information about individual strengths into focus for each youth is positive and productive. School staff should be trained in strengths-based programs to help them connect with students and assist in identifying what they are good at. Interventions should also “build personal and social skills that help students resist pressure to use alcohol” according to Stigler, Neusel, & Perry (2011, p.157). Prevention programs designed for high school students need to teach self-control and interpersonal skills to build their overall social self-control skills that have been shown to lower drug use (Pokhrel et al., 2007). Include Family & Community. Hedges (2011) encourages treatment programs to identify and discuss with family the issues of using substances together in order to make progress and then learn new and healthier ways to spend time together. In homes where substance use is considered normal, schools must implement programs to change that perception and reinforce that substance use is not cool or normal. Shekhtmeyster et al. (2011) suggests the school’s role may be to “target health behavior thoughts early, as they are most modifiable, and to prevent substance use by changing perceptions of social images in which substance abuse is positive and reidentifying perceptions that substance use is normative” (p.400). Alcohol is the most prevalent and resistant to change type of drug use, therefore requiring continued comprehensive interventions that address all areas in the social lives of youth. Schools should be the place for primary prevention and linking youth to families, places of work, media, and community policies is an efficient public health approach in helping to prevent drug use (Stigler et al., 2011).Current State of ResearchIt is widely known that at-risk youth are more likely to engage in risky behavior. Alternative schools that are primarily made up of at-risk youth report needing interventions for preventing substance abuse, yet relatively little research has examined the implementation and effectiveness of preventions in these type of settings aimed for this population (Hopson & Steiker, 2008). The current state of research is especially lacking when it comes to substance prevention programs aimed for the elementary and high school years. Pokhrel et al. (2007) wants programs created for the elementary school children to focus on imparting self-control skills and interpersonal skills as protective effects on drug use, but more research needs to done in this area. Hopson & Steiker (2008) point out “research is lacking sufficient evidence to support or refute the short or long term efficacy of school-based interventions in elementary or high school settings and does not fully address interventions for special populations, including culturally specific programming” (p.159). Literature has also identified a critical need to understand the role that schools can play in preventing adolescent substance use, according to Shekhtmeyster, Sharkey, & You (2011) who later found that schools do influence drug use. Cultural Implications & LimitationsCultural implications certainly exist when planning effective prevention and treatment programs. Cervantes & Goldbach (2012) discuss the need to implement cultural values relevant to the target audience and the need for more integrated and comprehensive prevention programming to address the needs of Hispanic youth, but also for other cultures that exist in the school. Currently there are only four drug abuse prevention models that utilized “control trials, targeted Hispanic youth, and had Hispanics representing 70% or greater of the sample” (Cervantes & Goldbach, 2012, 282). Existing evidence-based interventions need to be adapted to fit the needs of special populations for use in understudied populations. Stigler, Neusel, & Perry (2011) explain that majority of interventions have been implemented with primarily White urban and suburban youth, however, Hispanic students have been found to have higher rates of substance use than Whites, and there is a need for interventions tailored for special populations.This literature reviewed mainly looked at studies that used participants between the ages of 14-18 years old and who were identified as being at-risk. The qualitative studies examined in this review used interviews where the respondents answers or discussions may have been influenced by the relationship they had with the interviewer. Small sample sizes were also noted in many of the studies so the information may not be generalizable. It is also important to know the respondents were all from students in school and it would be valuable to obtain information from students who dropped out of high school regarding substance abuse and their reasons for leaving. PsychInfo was the only database used to search studies and I only looked at English language papers from the past ten years.Current Trends & Areas of Future ResearchRecent developments reveal the need to adapt. Youth drug prevention has advanced significantly since being initially implemented decades ago. Evidence-based programs currently recognize the overwhelming need for programs to be culturally grounded in order to be effective. Hopson & Steiker (2008) explain the importance of adapting with at-risk youth to “fit their students’ styles and needs” (126). This requires schools to adapt curriculum-based programs to specifically serve the needs to their target audience. Shekhtmeyster, Sharkey, & You (2011) agree that schools should “tailor prevention efforts to meet the specific needs of the population” (401). Cultural re-grounding involves adaptation processes with the design and dissemination phases of prevention interventions. Future research is needed. When it comes to effective interventions for at-risk youth, additional research is needed to fill in some remaining gaps. Stigler, Neusel, & Perry (2011) point out that there is not “sufficient evidence to support or refute the short- or long-term efficacy of school-based interventions and does not address interventions for special populations, including culturally specific programming” (159). Knowing that programs should be adapted to fit the needs of students requires research to prove the value and effectiveness of such changes. Pokhrel et al. (2007) would like to see future research of incorporating social self-control into prevention programs to understand the benefits of such protective effects on drug abuse. Harris et al. (2012) believes additional research is needed to measure and examine different patterns of strengths among youth who abuse substances and those who don’t to better create strengths-based prevention programs. Future research should also examine gender as a moderating influence on the associations between school support, positive social friends, family factors, and substance users (Shekhtmeyster, Sharkey, & You, 2011).ConclusionThroughout this research and program evaluation course, I have gained tremendous knowledge that will help me become a more competent and effective school counselor by increasing my analytical skills. I used to accept statistics and other findings just as they were presented, but now I question the methods and processes used in each study I read. Understanding all of the parts in the research process and how to analyze the information allows me to make well-informed decisions. It is imperative that counselors use data as they work towards solving client problems. C. Sheperis (2010) explains that counselors using the scientist-practitioner model see the importance of utilizing data to determine the focus of treatment, design appropriate interventions, and evaluate outcomes in a timely manner. It is my intention to always apply research to meet the needs of my clients in an ethically sound manner.Sheperis (2010) points out how the practice of research in counseling is governed by our ethical conduct to respect the dignity and promote the welfare of clients. There are several specific codes that help guide how research should be conducted when involving human participants in section G of the ACA Code of Ethics (2014), which I have become very familiar with. Out of all the important things I learned in this class, it is my obligation to contribute to the current knowledge base that stands out the most. I not only feel much more comfortable with research and how to responsibly use it, but I feel a strong desire to conduct research in the field of substance abuse prevention to help students live the life they were created to live.References:American Counseling Association (2014). Code of Ethics. Author: Alexandria, VA.Brigman, G., Villares, E., & Webb, L. (2011). The efficacy of individual psychology approaches for improving student achievement and behavior. The Journal Of Individual Psychology, 67(4), 408-419.Cervantes, R. C., & Goldbach, J. T. (2012). Adapting Evidence-Based Prevention Approaches for Latino Adolescents: The Familia Adelante Program - Revised. Psychosocial Intervention / Intervencion Psicosocial, 21(3), 281-290.Falck, R. S., Wang, J., Carlson, R. G., & Siegal, H. A. (2002). Variability in drug use prevalence across school districts in the same locale in Ohio. Journal Of School Health, 72(7), 288-293.Harris, N., Brazeau, J. N., Clarkson, A., Brownlee, K., & Rawana, E. P. (2012). Adolescents' Experiences of a Strengths-Based Treatment Program for Substance Abuse. Journal Of Psychoactive Drugs, 44(5), 390-397.Hedges, K. E. (2012). A family affair: contextual accounts from addicted youth growing up in substance using families. Journal Of Youth Studies, 15(3), 257-272.Hopson, L., & Steiker, L. (2008). Methodology for evaluating an adaptation of evidence-based drug abuse prevention in alternative schools. Children & Schools, 30(2), 116-127.Jackson, C., Geddes, R., Haw, S., & Frank, J. (2012). Interventions to prevent substance use and risky sexual behaviour in young people: a systematic review. Addiction, 107(4), 733-747.Lev-Wiesel, R. (2009). Enhancing potency among male adolescents at risk to drug abuse: an action research. Child & Adolescent Social Work Journal, 26(5), 383-398.Pokhrel, P., Sussman, S., Rohrbach, L., & Ping, S. (2007). Prospective associations of social self-control with drug use among youth from regular and alternative high schools. Substance Abuse Treatment, Prevention & Policy, 222-8.Shekhtmeyster, Z., Sharkey, J., & You, S. (2011). The influence of multiple ecological assets on substance use patterns of diverse adolescents. School Psychology Review, 40(3), 386-404.Sheperis, C., Young, J.S., and Daniels, M.H. (2010). Counseling Research: Quantitative, Qualitative, and Mixed Methods. Upper Saddle River, NJ: Pearson.Stigler, M. H., Neusel, E., & Perry, C. L. (2011). School-based programs to prevent and reduce alcohol use among youth. Alcohol Research & Health, 34(2), 157-162. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download