{"id":73,"date":"2018-12-07T15:39:25","date_gmt":"2018-12-07T15:39:25","guid":{"rendered":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/chapter\/module-2-chapter-2\/"},"modified":"2024-11-20T23:18:51","modified_gmt":"2024-11-20T23:18:51","slug":"module-2-chapter-2","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/chapter\/module-2-chapter-2\/","title":{"rendered":"Module 2 Chapter 2: Formulating Practice Evidence Questions"},"content":{"raw":"<div>\u201cThe search question is the engine that drives\u201d a search for and review of evidence to inform practice (Bronson &amp; Davis, 2012, p. 16). Thus, attention to the process by which practice questions are formulated warrants attention.<\/div>\r\n<div><\/div>\r\n<div>In this chapter you learn:<\/div>\r\n<ul>\r\n \t<li>the COPES framework for developing strong practice questions to inform the search for evidence,<\/li>\r\n \t<li>the PICO framework for developing practice questions,<\/li>\r\n \t<li>a working example where COPES was applied.<\/li>\r\n<\/ul>\r\n<h2>Question Formulation<\/h2>\r\nThe questions that drive a social worker\u2019s search for evidence to inform practice decisions differ somewhat from the kind of questions that drive social workers to understand diverse populations, social work problems, and social phenomena. Two frameworks for helping develop questions for evidence-based practice are prevalent in the literature: <strong><em>COPES<\/em><\/strong> and <em><strong>PICO<\/strong><\/em>.\r\n\r\n<img class=\"aligncenter size-full wp-image-66\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2018\/12\/ch2-question-formaul.png\" alt=\"Abstract art containing many question marks\" width=\"974\" height=\"304\" \/>\r\n<h3>Using the COPES Framework to Formulate the Practice Question.<\/h3>\r\nThe COPES framework refers to engaging in a <span style=\"text-decoration: underline\"><strong>C<\/strong><\/span>lient <span style=\"text-decoration: underline\"><strong>O<\/strong><\/span>riented <span style=\"text-decoration: underline\"><strong>P<\/strong><\/span>ractical <span style=\"text-decoration: underline\"><strong>E<\/strong><\/span>vidence <span style=\"text-decoration: underline\"><strong>S<\/strong><\/span>earch. In this framework, the client system might be an individual client, individuals in a relationship, a family, a group, an agency or institution, a neighborhood or community, or larger social system.\r\n\r\nWell-formulated COPES practice questions, according to Gibbs (2003) have four features:\r\n<ol>\r\n \t<li><em>Client type and problem. <\/em>The practitioner to specifically identifies the client system, what problem the client system experiences, and the practice context in which intervention would or could occur. This is at the heart of the\u00a0<span style=\"text-decoration: underline\"><strong>C<\/strong><\/span>lient <span style=\"text-decoration: underline\"><strong>O<\/strong><\/span>riented approach\u2014the COPES question is central to the welfare of the client system and those whose lives are affected by the client. For example, a social worker in a hospital setting being able to address an individual\u2019s probable alcohol use disorder is important to that person, as well as to that person\u2019s family, friends, co-workers, and others (including the general public who share the road with this person when driving). The problem is complicated by the fact that feedback handled poorly leads to a person becoming become angry and resistant to seeking treatment for the suspected alcohol problem.<\/li>\r\n \t<li><em>What you might do.\u00a0<\/em>This involves identifying a possible strategy for intervening around the identified practice problem. This includes whether the approach will be a specific treatment intervention, acting to prevent a problem, measuring to assess a problem, screening to assess risk, surveying clients, or engaging in some other specific action. Considering our alcohol use disorder example from step 1, the strategy might be to engage in screening for an alcohol problem and to provide feedback about the screening results using a Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach\u2014SBIRT is based on principles of screening and feedback using a motivational interviewing (MI) approach.<\/li>\r\n \t<li><em>Alternative course(s) of action<\/em>. This involves the practitioner identifying at least one main alternative course of action for addressing the identified problem. This might possibly include doing nothing, observing and monitoring over time, or applying a specific intervention protocol. In our alcohol use disorder example, the alternative might be to monitor the problem over time if the screening result indicates a low likelihood of a substance use problem. Or, it might be to refer the individual for specialized assessment and treatment for an alcohol\/substance use disorder if the screening result indicates a moderate or high likelihood of an alcohol\/substance use problem.<\/li>\r\n \t<li><em>What you want to accomplish<\/em>. This feature specifies what will be accomplished with the intervention the evidence leads you to select. In other words, what outcome(s) should be expected if the intervention is successful\u2014defining the goal of intervening in this way. This is directly related to the <span style=\"text-decoration: underline\"><strong>P<\/strong><\/span>ractical aspects of the COPES question\u2014not only does it have practical relevance to the client, it has relevance to social workers who encounter this problem with frequency in their routine practice. In our alcohol problem example, the goal would be for the person to engage in alcohol treatment if the drinking problem is serious enough or for the person to cut down on drinking if the problem does not warrant treatment but is causing problems for the person (and significant others).<\/li>\r\n<\/ol>\r\nFurthermore, the COPES question leads the practitioner\u2019s\u00a0<span style=\"text-decoration: underline\"><strong>E<\/strong><\/span>vidence <span style=\"text-decoration: underline\"><strong>S<\/strong><\/span>earch. It contains information to guide the selection of key terms for an electronic search of literature and other appropriate sources of evidence. To complete our example, the COPES question could be phrased as follows:\r\n<blockquote><em>If a person seen in the hospital setting is suspected of having an alcohol use disorder, would the SBIRT or Johnson Model Intervention be more likely to result in either becoming engaged in treatment for an alcohol use disorder (if warranted) or decreasing problematic alcohol use (if treatment is not warranted)? <\/em><\/blockquote>\r\nSearching for evidence around this question led the social worker to support adopting an SBIRT approach within the medical\/hospital setting. (The Johnson Model is similar to what you see on the television show,<em>Intervention<\/em>. The evidence does not consistently support applying this confrontational approach.)\r\n\r\nIn addition to specifying the four features of a well-constructed COPES question, Gibbs (2003) identified five general types of COPES questions:\r\n<ul>\r\n \t<li>effectiveness<\/li>\r\n \t<li>prevention<\/li>\r\n \t<li>assessment<\/li>\r\n \t<li>description, and<\/li>\r\n \t<li>risk.<\/li>\r\n<\/ul>\r\nHe provided examples of each in a table with the prior four features of well-constructed COPES questions across the top and these five question types down the left side. This format (adapted from Gibbs, 2003) guides practitioners in moving toward a well-specified COPES question.\r\n<table style=\"width: 100%;height: 107px\" border=\"2px\">\r\n<thead>\r\n<tr style=\"height: 28px\">\r\n<td class=\"shaded\" style=\"width: 20%;height: 28px\"><\/td>\r\n<td class=\"shaded\" style=\"width: 19.864314789687924%;height: 28px\"><em>client type and problem<sup>[1]<\/sup><\/em><\/td>\r\n<td class=\"shaded\" style=\"width: 20.135685210312076%;height: 28px\"><em>what you might do<sup>[2]<\/sup><\/em><\/td>\r\n<td class=\"shaded\" style=\"width: 20%;height: 28px\"><em>alternative course of action<sup>[3]<\/sup><\/em><\/td>\r\n<td class=\"shaded\" style=\"width: 20%;height: 28px\"><em>what you want to accomplish<sup>[4]<\/sup><\/em><\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td class=\"shaded\" style=\"width: 20%;height: 15px\" scope=\"row\">effectiveness<\/td>\r\n<td style=\"width: 19.864314789687924%;height: 15px\"><\/td>\r\n<td style=\"width: 20.135685210312076%;height: 15px\"><\/td>\r\n<td style=\"width: 20%;height: 15px\"><\/td>\r\n<td style=\"width: 20%;height: 15px\"><\/td>\r\n<\/tr>\r\n<tr style=\"height: 16px\">\r\n<td class=\"shaded\" style=\"width: 20%;height: 16px\" scope=\"row\">prevention<\/td>\r\n<td style=\"width: 19.864314789687924%;height: 16px\"><\/td>\r\n<td style=\"width: 20.135685210312076%;height: 16px\"><\/td>\r\n<td style=\"width: 20%;height: 16px\"><\/td>\r\n<td style=\"width: 20%;height: 16px\"><\/td>\r\n<\/tr>\r\n<tr style=\"height: 16px\">\r\n<td class=\"shaded\" style=\"width: 20%;height: 16px\" scope=\"row\">assessment<\/td>\r\n<td style=\"width: 19.864314789687924%;height: 16px\"><\/td>\r\n<td style=\"width: 20.135685210312076%;height: 16px\"><\/td>\r\n<td style=\"width: 20%;height: 16px\"><\/td>\r\n<td style=\"width: 20%;height: 16px\"><\/td>\r\n<\/tr>\r\n<tr style=\"height: 16px\">\r\n<td class=\"shaded\" style=\"width: 20%;height: 16px\" scope=\"row\">description<\/td>\r\n<td style=\"width: 19.864314789687924%;height: 16px\"><\/td>\r\n<td style=\"width: 20.135685210312076%;height: 16px\"><\/td>\r\n<td style=\"width: 20%;height: 16px\"><\/td>\r\n<td style=\"width: 20%;height: 16px\"><\/td>\r\n<\/tr>\r\n<tr style=\"height: 16px\">\r\n<td class=\"shaded\" style=\"width: 20%;height: 16px\" scope=\"row\">risk<\/td>\r\n<td style=\"width: 19.864314789687924%;height: 16px\"><\/td>\r\n<td style=\"width: 20.135685210312076%;height: 16px\"><\/td>\r\n<td style=\"width: 20%;height: 16px\"><\/td>\r\n<td style=\"width: 20%;height: 16px\"><\/td>\r\n<\/tr>\r\n<\/thead>\r\n<\/table>\r\nHere are examples Gibbs (2003) provided, edited for format (see originals at \u00a0<a href=\"http:\/\/www.evidence.brookscole.com\/copse.html\">http:\/\/www.evidence.brookscole.com\/copse.html<\/a>and <a href=\"http:\/\/www.evidence.brookscole.com\/moredetails.html\">http:\/\/www.evidence.brookscole.com\/moredetails.html<\/a>). Note that [1]through [4]refer to each of the four features of well-formulated COPES questions running along the top of the table.\r\n<ul>\r\n \t<li><em>Effectiveness.\u00a0<\/em>Effectiveness questions ask about the direct effects of exposure to an intervention for a specified type of client or population. Gibbs\u2019 (2003) first example:\r\n<blockquote><em style=\"text-align: initial;font-size: 1em\">\u201cIf disoriented aged persons who reside in a nursing home<sup>[1]<\/sup>are given Reality Orientation Therapy<sup>[2]\u00a0<\/sup>or Validation Therapy<sup>[3]\u00a0<\/sup>which will result in better orientation to time, place, person<sup>[4]<\/sup>?\u201d\r\n<\/em><\/blockquote>\r\n<span style=\"text-align: initial;font-size: 1em\">Gibbs\u2019 (2003) second example:\r\n<\/span>\r\n<blockquote><em style=\"text-align: initial;font-size: 1em\">\u201cAmong adult criminal offenders on probation,<sup>[1]\u00a0<\/sup>will a group cognitive intervention program<sup>[2]<\/sup> compared to no such program<sup>[3]<\/sup> result in a lower recidivism (re-offense) rate<sup>[4]<\/sup>?\u201d<\/em><\/blockquote>\r\n<img class=\"aligncenter size-full wp-image-67\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/locked-exit-turnstile.png\" alt=\"locked exit turnstile\" width=\"320\" height=\"220\" \/><\/li>\r\n<\/ul>\r\n<em>Prevention.<\/em>The prevention type of question is also an effectiveness question, but it concerns interventions intended to avoid the problem occurring rather than treat it after the fact. Gibbs\u2019 (2003) first example:\r\n<blockquote><em style=\"text-align: initial;font-size: 1em\">\u201cIf sexually active high school students at high risk for pregnancy<sup>[1]<\/sup> are exposed to Baby-Think-It-Over<sup>[2]<\/sup> or to didactic material on proper use of birth control methods,<sup>[3]<\/sup> will the former have fewer pregnancies during an academic year and better knowledge of birth control methods?<sup>[4]<\/sup>\u201d\r\n<\/em><\/blockquote>\r\n<span style=\"text-align: initial;font-size: 1em\">Gibbs\u2019 (2003) second example is a little different from the previous examples in that the social worker does not yet know which specific intervention to search:\r\n<\/span>\r\n<blockquote><em style=\"text-align: initial;font-size: 1em\">\u201cAmong Hmong and Asians less than sixteen years old,<sup>[1]<\/sup> which gang prevention program<sup>[2,3]<\/sup> will most effectively prevent them from joining the gang<sup>[4]<\/sup>?\u201d<\/em><\/blockquote>\r\n<img class=\"aligncenter size-full wp-image-68\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/shadowy-figures-dancing.png\" alt=\"shadowy figures dancing\" width=\"400\" height=\"262\" \/>\r\n<ul>\r\n \t<li><em style=\"font-size: 1em\">Assessment.\u00a0<\/em><span style=\"font-size: 1em\">Social workers engage in assessment at multiple points in the process of intervening with client systems. Assessment involves applying standardized procedures or measures with the goal of determining whether the client system demonstrates a particular problem or strength. Assessment is also used to determine whether an intervention has achieved its goals. The literature search can help identify valid and reliable approaches to screening and assessment. Gibbs\u2019 (2003) first example:\r\n<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cIf aged residents of a nursing home who may be depressed or may have Alzheimer\u2019s Disease or dementia<sup>[1]<\/sup> are administered depression screening tests<sup>[2]<\/sup> or short mental status examination tests<sup>[3]<\/sup> which measure will be the briefest, most inexpensive, valid and reliable screening test to discriminate between depression and dementia?<sup>[4]<\/sup>\u201d\r\n<\/em><span style=\"text-align: initial;font-size: 1em\">Gibbs\u2019 (2004) second example also presumes that the social worker has little pre-existing knowledge about the best assessment tools:\r\n<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cTo detect children with shaken baby syndrome<sup>[4]<\/sup>, which assessment or diagnostic procedure will provide the most valid and reliable determination<sup>[2,3]<\/sup> that the child has been injured by shaking<sup>[1]<\/sup>?\u201d\r\n<\/em><span style=\"text-align: initial;font-size: 1em\">Gibbs (2003) offered a third example of an assessment question, one which is actually about screening, which is a step that precedes a more detailed, in-depth assessment.\r\n<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cFor hospitalized aged persons suspected of having dementia,<sup>[1]<\/sup> which rapid assessment measure<sup>[2,3]<\/sup> will most quickly, reliably, and validly identify demented patients<sup>[4]<\/sup>?\u201d\r\n<\/em><span style=\"text-align: initial;font-size: 1em\">And, Gibbs offered an example that looks at assessment of an interdisciplinary team\u2019s functioning, rather than assessing specific client systems\u2014he classified this example as descriptive, but it seems to fit as an assessment question (see what you decide):\r\n<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cIf members of a hospital team who are concerned about team functioning<sup>[1]<\/sup> take the Preliminary Checklist (Clinical) Team Effectiveness test<sup>[2]<\/sup> or take the Interdisciplinary Team Weekly Inventory<sup>[3]<\/sup> which measure will most reliably and validly reflect the team\u2019s ability to accomplish tasks<sup>[4]<\/sup>?\u201d\r\n<img class=\"aligncenter size-full wp-image-69\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/group-of-chalk-drawn-figures-with-teamwork-written.png\" alt=\"group of chalk drawn figures with teamwork written\" width=\"345\" height=\"181\" \/>\r\n<\/em><\/li>\r\n \t<li><em>Description. <\/em>This is what Gibbs (2003) said about description questions:\r\n<em style=\"text-align: initial;font-size: 1em\">\u201cDescription questions most often concern surveys of client needs or client satisfaction, but can include any kind of effort that involves observations of clients within a sample and generalizations made from that sample. Description Questions can include qualitative studies that often seek an in-depth understanding for client experiences and perceptions\u201d (retrieved from <a href=\"http:\/\/www.evidence.brookscole.com\/moredetails.html\">http:\/\/www.evidence.brookscole.com\/moredetails.html<\/a>)\r\n<\/em><span style=\"text-align: initial;font-size: 1em\">Gibbs (2003) offered a description question to consider:<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cAmong children in integrated children\u2019s homes or orphanages,<sup>[1]<\/sup> at what age<sup>[2,3]<\/sup> do they first begin to see themselves as being either of white or black race<sup>[4]<\/sup>?\u201d\r\n<\/em><span style=\"text-align: initial;font-size: 1em\">Another example that Gibbs (2003) presented starts out sounding like an effectiveness or assessment type question, but becomes a description question in the end:<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cIf family members of persons diagnosed with aphasia meet in a support group<sup>[1]<\/sup> and receive a short client satisfaction questionnaire for all support group participants<sup>[2,3]<\/sup> which will the clients list as their area or areas of greatest and least satisfaction<sup>[4]<\/sup>?\u201d<\/em><em style=\"text-align: initial;font-size: 1em\">\r\n<\/em><img class=\"size-full wp-image-70 aligncenter\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/horizontal-gauge-with-arrow-pointing-at-a-smily-face.png\" alt=\"horizontal gauge with arrow pointing at a smily face\" width=\"243\" height=\"158\" \/><\/li>\r\n \t<li><em>Risk.\u00a0<\/em>Risk is another type of assessment question that attempts to predict the future. In medical terms, this is often called the prognosis. It is about the probability of a specific consequence happening and often includes specification of that consequence and the time frame under consideration. Gibbs\u2019 (2003) first example\u201d<em style=\"text-align: initial;font-size: 1em\">\u201cIf crisis line callers to a battered women shelter<sup>[1]<\/sup> are administered a risk assessment scale by telephone<sup>[2]<\/sup> or we rely on practical judgment unaided by a risk assessment scale<sup>[3]<\/sup> then will the risk assessment scale have higher reliability and predictive validity for violent behavior<sup>[4]<\/sup>?\u201d<\/em><span style=\"text-align: initial;font-size: 1em\">Gibbs\u2019 (2003) second example is:\r\n<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cFor abused or neglected children placed in foster care by a protective service worker,<sup>[1]<\/sup> which risk assessment measure will provide the greatest predictive accuracy<sup>[2,3]<\/sup> to predict re-abuse when children are placed back into their homes with their families<sup>[4]<\/sup>?\u201d<\/em><span style=\"text-align: initial;font-size: 1em\">A third example provided by Gibbs (2003) is:<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cAmong chronically mentally ill clients,<sup>[1]<\/sup> is the Brief Psychiatric Rating Scale<sup>[2]<\/sup> compared to other suicide prevention instruments<sup>[3]<\/sup> as accurate at predicting actual suicide or suicidal behaviors<sup>[4]<\/sup>?\u201d\r\n<img class=\"aligncenter size-full wp-image-71\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/collection-of-tarot-cards.png\" alt=\"collection of tarot cards\" width=\"352\" height=\"233\" \/><\/em><\/li>\r\n<\/ul>\r\nA final note about the examples presented by Gibbs is warranted: these were published prior to a point in time when social work professionals were conscientiously addressing the language that we use to describe people and populations. If he were writing today, Gibbs would likely revise many of these COPES questions to eliminate labelling language (e.g., \u201cdisoriented aged persons,\u201d \u201cadult criminal offenders,\u201d and \u201cchronically mentally ill\u201d). It is a sign of the times that we address this issue of language use at all.\r\n<h3>Using the PICO Framework to Formulate the Practice Question.<\/h3>\r\n<div>The PICO framework comes from literature on evidence-based practice in medicine and nursing. This is demonstrated in its full name, the <span style=\"text-decoration: underline\"><strong>P<\/strong><\/span>atient, <em><strong>I<\/strong><\/em>ntervention, <em><strong>C<\/strong><\/em>omparison, <em><strong>O<\/strong><\/em>utcome framework. Social workers refer to clients, client systems, or consumers of services; medical professions refer to patients. The PICO framework results in the comparison of two intervention options.<\/div>\r\n<ul>\r\n \t<li><em><span style=\"text-decoration: underline\">P<\/span>atient<\/em> (or client or consumer) refers to specifically identifying the characteristics of the population around which the search for evidence is directed.<\/li>\r\n \t<li><em><span style=\"text-decoration: underline\">I<\/span>ntervention<\/em> requires specification of the interventions or other practice activities (e.g., type of assessment or clinical test, treatment, prevention, or policy) under consideration.<\/li>\r\n \t<li><em><span style=\"text-decoration: underline\">C<\/span>omparison<\/em> is the act of comparing the intervention options identified in the prior step.<\/li>\r\n \t<li><em><span style=\"text-decoration: underline\">O<\/span>utcome<\/em> refers to the goal or goals to be achieved by intervening.<\/li>\r\n<\/ul>\r\n<div>Here is an example of a PICO practice question mapped with the numbered COPES steps[1-4].<\/div>\r\n<blockquote>\r\n<div>\u201cIf an elder residing in a nursing home[1] participates in a pet therapy program[2] or attends an adult day program[3] which intervention will result in lower depression[4]? (Heltzer, n.d., p. 2)<\/div><\/blockquote>\r\n<div>As you can see, the resulting practice question is structured just as it would be using the COPES approach.<\/div>\r\n<h2>Where COPES and PICO Questions Fit<\/h2>\r\nThere are two general categories of questions that practitioners might ask: background and foreground questions. COPES and PICO questions fit under the heading of foreground questions because the practitioner seeks evidence to inform professional practice decision-making. COPES and PICO questions are complex forms of foreground questions. The COPES framework was developed on the PICO structure, but designed for use in non-medical contexts (Gibbs, 2003), which explains why they appear to be so similar. The main reason for sharing the PICO framework is because social workers often work on interdisciplinary teams with practitioners trained in medical models. Knowing how to engage in COPES prepares social workers to function with colleagues trained in PICO, and vice versa.\r\n<h2>Working Example: Addressing High School Dropout<\/h2>\r\nHere is an example of a practice question that we can follow through the next chapters. The example details steps in evidence-based practice decision-making described in a chapter by Kelly and Franklin (2011).\r\n\r\n<img class=\"aligncenter size-full wp-image-72\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/image-of-a-student-with-a-diploma.png\" alt=\"image of a student with a diploma\" width=\"322\" height=\"214\" \/>\r\n<h3>Background<\/h3>\r\n<div>The Forest Grove (Illinois) community was charged by the school board to address a problem with too-high rates of high school dropout:<\/div>\r\n<blockquote>\r\n<div>\u201c\u2026we can\u2019t keep doing the same things we\u2019ve been doing and expecting a new result. It\u2019s time to make some changes in our dropout interventions\u2026\u201d (Kelly &amp; Franklin, 2011, p. 141).<\/div><\/blockquote>\r\n<div>A local newspaper reported a dramatic increase in dropout from the community\u2019s two high schools, particularly among the African American and Hispanic student populations. The schools were being accused of \u201cpushing out\u201d students as a means of improving scores related to meeting standards imposed by the 2002 <em>No Child Left Behind<\/em> policy. District data indicated that the rate of students failing to complete high school in four years at Forest Grove North (FGN) and Forest Grove South (FGS) had doubled from 12% to 24% over the past 10 years, and the dropout rate among African American and Hispanic students was disproportionately high: 35%.<\/div>\r\n<div><\/div>\r\n<div>First, the team generated a general question:<\/div>\r\n<blockquote>\r\n<div>What are best practices for preventing student dropout from high school?<\/div><\/blockquote>\r\n<div>This question was too general to direct the practical, client-oriented search for evidence (the school district\/board being the client). As a next step, a social worker on the team explored literature concerning two background questions, one describing the problem seriousness and the other describing factors contributing to observed disparities in student dropout:<\/div>\r\n<blockquote>\r\n<div>What are the outcomes of the problem?<\/div>\r\n<div>How are poor and minority youth at risk of dropping out?<\/div><\/blockquote>\r\n<div>This general literature review indicated that students who drop out, never returning to complete a general high school equivalency education, are at risk of earning less, having poorer job prospects, poorer health, and incarceration as adults (Kelly &amp; Franklin, 2011). As far as disparities were concerned, the evidence indicated nation-wide concerns with higher dropout rates in urban (compared to suburban) communities, and among ethnic minority and male students. Much of this was attributed to lower socioeconomic status\/income in communities with high dropout rates. These two questions and the descriptive evidence were followed up with the team developing a specific practice question.<\/div>\r\n<div><\/div>\r\n<div>Engaging in the COPES process resulted in the team developing their practice question as:<\/div>\r\n<blockquote>\r\n<div>\u201cIf students deemed at risk for dropping out of high school are given a specific school-based dropout intervention program or standard school-based intervention, such as counseling and academic advising, will the school-based dropout program produce better outcomes, specifically helping youths stay in school and graduate on time? (Kelly &amp; Franklin, 2011, p. 147).<\/div><\/blockquote>\r\n<div>In the next chapter, we learn how the team went about identifying evidence to inform their practice decisions.<\/div>\r\n<h2>Stop and Think<\/h2>\r\n<div style=\"float: left;min-height: 120px;width: 99%;margin-bottom: 10px;padding: 10px;background-color: #f1f7fe\">\r\n\r\n<img class=\"size-full wp-image-194 alignleft\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/Stop_ThinkV2-150x150-1.png\" alt=\"Stop and Think\" width=\"150\" height=\"150\" \/>Take a moment to complete the following activity.\r\n\r\n[h5p id=\"4\"]\r\n\r\n<\/div>\r\n<h2>Chapter Summary<\/h2>\r\n<div>In this chapter you learned two similar approaches to developing practice questions that guide the search for evidence to inform intervention: PICO and COPES. The steps in the process were demonstrated with examples. This leads to our next topic: where practitioners might seek evidence that will help them address their practice questions.<\/div>","rendered":"<div>\u201cThe search question is the engine that drives\u201d a search for and review of evidence to inform practice (Bronson &amp; Davis, 2012, p. 16). Thus, attention to the process by which practice questions are formulated warrants attention.<\/div>\n<div><\/div>\n<div>In this chapter you learn:<\/div>\n<ul>\n<li>the COPES framework for developing strong practice questions to inform the search for evidence,<\/li>\n<li>the PICO framework for developing practice questions,<\/li>\n<li>a working example where COPES was applied.<\/li>\n<\/ul>\n<h2>Question Formulation<\/h2>\n<p>The questions that drive a social worker\u2019s search for evidence to inform practice decisions differ somewhat from the kind of questions that drive social workers to understand diverse populations, social work problems, and social phenomena. Two frameworks for helping develop questions for evidence-based practice are prevalent in the literature: <strong><em>COPES<\/em><\/strong> and <em><strong>PICO<\/strong><\/em>.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-66\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2018\/12\/ch2-question-formaul.png\" alt=\"Abstract art containing many question marks\" width=\"974\" height=\"304\" srcset=\"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2018\/12\/ch2-question-formaul.png 974w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2018\/12\/ch2-question-formaul-300x94.png 300w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2018\/12\/ch2-question-formaul-768x240.png 768w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2018\/12\/ch2-question-formaul-65x20.png 65w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2018\/12\/ch2-question-formaul-225x70.png 225w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2018\/12\/ch2-question-formaul-350x109.png 350w\" sizes=\"auto, (max-width: 974px) 100vw, 974px\" \/><\/p>\n<h3>Using the COPES Framework to Formulate the Practice Question.<\/h3>\n<p>The COPES framework refers to engaging in a <span style=\"text-decoration: underline\"><strong>C<\/strong><\/span>lient <span style=\"text-decoration: underline\"><strong>O<\/strong><\/span>riented <span style=\"text-decoration: underline\"><strong>P<\/strong><\/span>ractical <span style=\"text-decoration: underline\"><strong>E<\/strong><\/span>vidence <span style=\"text-decoration: underline\"><strong>S<\/strong><\/span>earch. In this framework, the client system might be an individual client, individuals in a relationship, a family, a group, an agency or institution, a neighborhood or community, or larger social system.<\/p>\n<p>Well-formulated COPES practice questions, according to Gibbs (2003) have four features:<\/p>\n<ol>\n<li><em>Client type and problem. <\/em>The practitioner to specifically identifies the client system, what problem the client system experiences, and the practice context in which intervention would or could occur. This is at the heart of the\u00a0<span style=\"text-decoration: underline\"><strong>C<\/strong><\/span>lient <span style=\"text-decoration: underline\"><strong>O<\/strong><\/span>riented approach\u2014the COPES question is central to the welfare of the client system and those whose lives are affected by the client. For example, a social worker in a hospital setting being able to address an individual\u2019s probable alcohol use disorder is important to that person, as well as to that person\u2019s family, friends, co-workers, and others (including the general public who share the road with this person when driving). The problem is complicated by the fact that feedback handled poorly leads to a person becoming become angry and resistant to seeking treatment for the suspected alcohol problem.<\/li>\n<li><em>What you might do.\u00a0<\/em>This involves identifying a possible strategy for intervening around the identified practice problem. This includes whether the approach will be a specific treatment intervention, acting to prevent a problem, measuring to assess a problem, screening to assess risk, surveying clients, or engaging in some other specific action. Considering our alcohol use disorder example from step 1, the strategy might be to engage in screening for an alcohol problem and to provide feedback about the screening results using a Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach\u2014SBIRT is based on principles of screening and feedback using a motivational interviewing (MI) approach.<\/li>\n<li><em>Alternative course(s) of action<\/em>. This involves the practitioner identifying at least one main alternative course of action for addressing the identified problem. This might possibly include doing nothing, observing and monitoring over time, or applying a specific intervention protocol. In our alcohol use disorder example, the alternative might be to monitor the problem over time if the screening result indicates a low likelihood of a substance use problem. Or, it might be to refer the individual for specialized assessment and treatment for an alcohol\/substance use disorder if the screening result indicates a moderate or high likelihood of an alcohol\/substance use problem.<\/li>\n<li><em>What you want to accomplish<\/em>. This feature specifies what will be accomplished with the intervention the evidence leads you to select. In other words, what outcome(s) should be expected if the intervention is successful\u2014defining the goal of intervening in this way. This is directly related to the <span style=\"text-decoration: underline\"><strong>P<\/strong><\/span>ractical aspects of the COPES question\u2014not only does it have practical relevance to the client, it has relevance to social workers who encounter this problem with frequency in their routine practice. In our alcohol problem example, the goal would be for the person to engage in alcohol treatment if the drinking problem is serious enough or for the person to cut down on drinking if the problem does not warrant treatment but is causing problems for the person (and significant others).<\/li>\n<\/ol>\n<p>Furthermore, the COPES question leads the practitioner\u2019s\u00a0<span style=\"text-decoration: underline\"><strong>E<\/strong><\/span>vidence <span style=\"text-decoration: underline\"><strong>S<\/strong><\/span>earch. It contains information to guide the selection of key terms for an electronic search of literature and other appropriate sources of evidence. To complete our example, the COPES question could be phrased as follows:<\/p>\n<blockquote><p><em>If a person seen in the hospital setting is suspected of having an alcohol use disorder, would the SBIRT or Johnson Model Intervention be more likely to result in either becoming engaged in treatment for an alcohol use disorder (if warranted) or decreasing problematic alcohol use (if treatment is not warranted)? <\/em><\/p><\/blockquote>\n<p>Searching for evidence around this question led the social worker to support adopting an SBIRT approach within the medical\/hospital setting. (The Johnson Model is similar to what you see on the television show,<em>Intervention<\/em>. The evidence does not consistently support applying this confrontational approach.)<\/p>\n<p>In addition to specifying the four features of a well-constructed COPES question, Gibbs (2003) identified five general types of COPES questions:<\/p>\n<ul>\n<li>effectiveness<\/li>\n<li>prevention<\/li>\n<li>assessment<\/li>\n<li>description, and<\/li>\n<li>risk.<\/li>\n<\/ul>\n<p>He provided examples of each in a table with the prior four features of well-constructed COPES questions across the top and these five question types down the left side. This format (adapted from Gibbs, 2003) guides practitioners in moving toward a well-specified COPES question.<\/p>\n<table style=\"width: 100%;height: 107px\">\n<thead>\n<tr style=\"height: 28px\">\n<td class=\"shaded\" style=\"width: 20%;height: 28px\"><\/td>\n<td class=\"shaded\" style=\"width: 19.864314789687924%;height: 28px\"><em>client type and problem<sup>[1]<\/sup><\/em><\/td>\n<td class=\"shaded\" style=\"width: 20.135685210312076%;height: 28px\"><em>what you might do<sup>[2]<\/sup><\/em><\/td>\n<td class=\"shaded\" style=\"width: 20%;height: 28px\"><em>alternative course of action<sup>[3]<\/sup><\/em><\/td>\n<td class=\"shaded\" style=\"width: 20%;height: 28px\"><em>what you want to accomplish<sup>[4]<\/sup><\/em><\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td class=\"shaded\" style=\"width: 20%;height: 15px\" scope=\"row\">effectiveness<\/td>\n<td style=\"width: 19.864314789687924%;height: 15px\"><\/td>\n<td style=\"width: 20.135685210312076%;height: 15px\"><\/td>\n<td style=\"width: 20%;height: 15px\"><\/td>\n<td style=\"width: 20%;height: 15px\"><\/td>\n<\/tr>\n<tr style=\"height: 16px\">\n<td class=\"shaded\" style=\"width: 20%;height: 16px\" scope=\"row\">prevention<\/td>\n<td style=\"width: 19.864314789687924%;height: 16px\"><\/td>\n<td style=\"width: 20.135685210312076%;height: 16px\"><\/td>\n<td style=\"width: 20%;height: 16px\"><\/td>\n<td style=\"width: 20%;height: 16px\"><\/td>\n<\/tr>\n<tr style=\"height: 16px\">\n<td class=\"shaded\" style=\"width: 20%;height: 16px\" scope=\"row\">assessment<\/td>\n<td style=\"width: 19.864314789687924%;height: 16px\"><\/td>\n<td style=\"width: 20.135685210312076%;height: 16px\"><\/td>\n<td style=\"width: 20%;height: 16px\"><\/td>\n<td style=\"width: 20%;height: 16px\"><\/td>\n<\/tr>\n<tr style=\"height: 16px\">\n<td class=\"shaded\" style=\"width: 20%;height: 16px\" scope=\"row\">description<\/td>\n<td style=\"width: 19.864314789687924%;height: 16px\"><\/td>\n<td style=\"width: 20.135685210312076%;height: 16px\"><\/td>\n<td style=\"width: 20%;height: 16px\"><\/td>\n<td style=\"width: 20%;height: 16px\"><\/td>\n<\/tr>\n<tr style=\"height: 16px\">\n<td class=\"shaded\" style=\"width: 20%;height: 16px\" scope=\"row\">risk<\/td>\n<td style=\"width: 19.864314789687924%;height: 16px\"><\/td>\n<td style=\"width: 20.135685210312076%;height: 16px\"><\/td>\n<td style=\"width: 20%;height: 16px\"><\/td>\n<td style=\"width: 20%;height: 16px\"><\/td>\n<\/tr>\n<\/thead>\n<\/table>\n<p>Here are examples Gibbs (2003) provided, edited for format (see originals at \u00a0<a href=\"http:\/\/www.evidence.brookscole.com\/copse.html\">http:\/\/www.evidence.brookscole.com\/copse.html<\/a>and <a href=\"http:\/\/www.evidence.brookscole.com\/moredetails.html\">http:\/\/www.evidence.brookscole.com\/moredetails.html<\/a>). Note that [1]through [4]refer to each of the four features of well-formulated COPES questions running along the top of the table.<\/p>\n<ul>\n<li><em>Effectiveness.\u00a0<\/em>Effectiveness questions ask about the direct effects of exposure to an intervention for a specified type of client or population. Gibbs\u2019 (2003) first example:<br \/>\n<blockquote><p><em style=\"text-align: initial;font-size: 1em\">\u201cIf disoriented aged persons who reside in a nursing home<sup>[1]<\/sup>are given Reality Orientation Therapy<sup>[2]\u00a0<\/sup>or Validation Therapy<sup>[3]\u00a0<\/sup>which will result in better orientation to time, place, person<sup>[4]<\/sup>?\u201d<br \/>\n<\/em><\/p><\/blockquote>\n<p><span style=\"text-align: initial;font-size: 1em\">Gibbs\u2019 (2003) second example:<br \/>\n<\/span><\/p>\n<blockquote><p><em style=\"text-align: initial;font-size: 1em\">\u201cAmong adult criminal offenders on probation,<sup>[1]\u00a0<\/sup>will a group cognitive intervention program<sup>[2]<\/sup> compared to no such program<sup>[3]<\/sup> result in a lower recidivism (re-offense) rate<sup>[4]<\/sup>?\u201d<\/em><\/p><\/blockquote>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-67\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/locked-exit-turnstile.png\" alt=\"locked exit turnstile\" width=\"320\" height=\"220\" srcset=\"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/locked-exit-turnstile.png 320w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/locked-exit-turnstile-300x206.png 300w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/locked-exit-turnstile-65x45.png 65w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/locked-exit-turnstile-225x155.png 225w\" sizes=\"auto, (max-width: 320px) 100vw, 320px\" \/><\/li>\n<\/ul>\n<p><em>Prevention.<\/em>The prevention type of question is also an effectiveness question, but it concerns interventions intended to avoid the problem occurring rather than treat it after the fact. Gibbs\u2019 (2003) first example:<\/p>\n<blockquote><p><em style=\"text-align: initial;font-size: 1em\">\u201cIf sexually active high school students at high risk for pregnancy<sup>[1]<\/sup> are exposed to Baby-Think-It-Over<sup>[2]<\/sup> or to didactic material on proper use of birth control methods,<sup>[3]<\/sup> will the former have fewer pregnancies during an academic year and better knowledge of birth control methods?<sup>[4]<\/sup>\u201d<br \/>\n<\/em><\/p><\/blockquote>\n<p><span style=\"text-align: initial;font-size: 1em\">Gibbs\u2019 (2003) second example is a little different from the previous examples in that the social worker does not yet know which specific intervention to search:<br \/>\n<\/span><\/p>\n<blockquote><p><em style=\"text-align: initial;font-size: 1em\">\u201cAmong Hmong and Asians less than sixteen years old,<sup>[1]<\/sup> which gang prevention program<sup>[2,3]<\/sup> will most effectively prevent them from joining the gang<sup>[4]<\/sup>?\u201d<\/em><\/p><\/blockquote>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-68\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/shadowy-figures-dancing.png\" alt=\"shadowy figures dancing\" width=\"400\" height=\"262\" srcset=\"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/shadowy-figures-dancing.png 400w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/shadowy-figures-dancing-300x197.png 300w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/shadowy-figures-dancing-65x43.png 65w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/shadowy-figures-dancing-225x147.png 225w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/shadowy-figures-dancing-350x229.png 350w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/p>\n<ul>\n<li><em style=\"font-size: 1em\">Assessment.\u00a0<\/em><span style=\"font-size: 1em\">Social workers engage in assessment at multiple points in the process of intervening with client systems. Assessment involves applying standardized procedures or measures with the goal of determining whether the client system demonstrates a particular problem or strength. Assessment is also used to determine whether an intervention has achieved its goals. The literature search can help identify valid and reliable approaches to screening and assessment. Gibbs\u2019 (2003) first example:<br \/>\n<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cIf aged residents of a nursing home who may be depressed or may have Alzheimer\u2019s Disease or dementia<sup>[1]<\/sup> are administered depression screening tests<sup>[2]<\/sup> or short mental status examination tests<sup>[3]<\/sup> which measure will be the briefest, most inexpensive, valid and reliable screening test to discriminate between depression and dementia?<sup>[4]<\/sup>\u201d<br \/>\n<\/em><span style=\"text-align: initial;font-size: 1em\">Gibbs\u2019 (2004) second example also presumes that the social worker has little pre-existing knowledge about the best assessment tools:<br \/>\n<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cTo detect children with shaken baby syndrome<sup>[4]<\/sup>, which assessment or diagnostic procedure will provide the most valid and reliable determination<sup>[2,3]<\/sup> that the child has been injured by shaking<sup>[1]<\/sup>?\u201d<br \/>\n<\/em><span style=\"text-align: initial;font-size: 1em\">Gibbs (2003) offered a third example of an assessment question, one which is actually about screening, which is a step that precedes a more detailed, in-depth assessment.<br \/>\n<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cFor hospitalized aged persons suspected of having dementia,<sup>[1]<\/sup> which rapid assessment measure<sup>[2,3]<\/sup> will most quickly, reliably, and validly identify demented patients<sup>[4]<\/sup>?\u201d<br \/>\n<\/em><span style=\"text-align: initial;font-size: 1em\">And, Gibbs offered an example that looks at assessment of an interdisciplinary team\u2019s functioning, rather than assessing specific client systems\u2014he classified this example as descriptive, but it seems to fit as an assessment question (see what you decide):<br \/>\n<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cIf members of a hospital team who are concerned about team functioning<sup>[1]<\/sup> take the Preliminary Checklist (Clinical) Team Effectiveness test<sup>[2]<\/sup> or take the Interdisciplinary Team Weekly Inventory<sup>[3]<\/sup> which measure will most reliably and validly reflect the team\u2019s ability to accomplish tasks<sup>[4]<\/sup>?\u201d<br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-69\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/group-of-chalk-drawn-figures-with-teamwork-written.png\" alt=\"group of chalk drawn figures with teamwork written\" width=\"345\" height=\"181\" srcset=\"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/group-of-chalk-drawn-figures-with-teamwork-written.png 345w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/group-of-chalk-drawn-figures-with-teamwork-written-300x157.png 300w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/group-of-chalk-drawn-figures-with-teamwork-written-65x34.png 65w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/group-of-chalk-drawn-figures-with-teamwork-written-225x118.png 225w\" sizes=\"auto, (max-width: 345px) 100vw, 345px\" \/><br \/>\n<\/em><\/li>\n<li><em>Description. <\/em>This is what Gibbs (2003) said about description questions:<br \/>\n<em style=\"text-align: initial;font-size: 1em\">\u201cDescription questions most often concern surveys of client needs or client satisfaction, but can include any kind of effort that involves observations of clients within a sample and generalizations made from that sample. Description Questions can include qualitative studies that often seek an in-depth understanding for client experiences and perceptions\u201d (retrieved from <a href=\"http:\/\/www.evidence.brookscole.com\/moredetails.html\">http:\/\/www.evidence.brookscole.com\/moredetails.html<\/a>)<br \/>\n<\/em><span style=\"text-align: initial;font-size: 1em\">Gibbs (2003) offered a description question to consider:<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cAmong children in integrated children\u2019s homes or orphanages,<sup>[1]<\/sup> at what age<sup>[2,3]<\/sup> do they first begin to see themselves as being either of white or black race<sup>[4]<\/sup>?\u201d<br \/>\n<\/em><span style=\"text-align: initial;font-size: 1em\">Another example that Gibbs (2003) presented starts out sounding like an effectiveness or assessment type question, but becomes a description question in the end:<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cIf family members of persons diagnosed with aphasia meet in a support group<sup>[1]<\/sup> and receive a short client satisfaction questionnaire for all support group participants<sup>[2,3]<\/sup> which will the clients list as their area or areas of greatest and least satisfaction<sup>[4]<\/sup>?\u201d<\/em><em style=\"text-align: initial;font-size: 1em\"><br \/>\n<\/em><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-70 aligncenter\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/horizontal-gauge-with-arrow-pointing-at-a-smily-face.png\" alt=\"horizontal gauge with arrow pointing at a smily face\" width=\"243\" height=\"158\" srcset=\"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/horizontal-gauge-with-arrow-pointing-at-a-smily-face.png 243w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/horizontal-gauge-with-arrow-pointing-at-a-smily-face-65x42.png 65w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/horizontal-gauge-with-arrow-pointing-at-a-smily-face-225x146.png 225w\" sizes=\"auto, (max-width: 243px) 100vw, 243px\" \/><\/li>\n<li><em>Risk.\u00a0<\/em>Risk is another type of assessment question that attempts to predict the future. In medical terms, this is often called the prognosis. It is about the probability of a specific consequence happening and often includes specification of that consequence and the time frame under consideration. Gibbs\u2019 (2003) first example\u201d<em style=\"text-align: initial;font-size: 1em\">\u201cIf crisis line callers to a battered women shelter<sup>[1]<\/sup> are administered a risk assessment scale by telephone<sup>[2]<\/sup> or we rely on practical judgment unaided by a risk assessment scale<sup>[3]<\/sup> then will the risk assessment scale have higher reliability and predictive validity for violent behavior<sup>[4]<\/sup>?\u201d<\/em><span style=\"text-align: initial;font-size: 1em\">Gibbs\u2019 (2003) second example is:<br \/>\n<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cFor abused or neglected children placed in foster care by a protective service worker,<sup>[1]<\/sup> which risk assessment measure will provide the greatest predictive accuracy<sup>[2,3]<\/sup> to predict re-abuse when children are placed back into their homes with their families<sup>[4]<\/sup>?\u201d<\/em><span style=\"text-align: initial;font-size: 1em\">A third example provided by Gibbs (2003) is:<\/span><em style=\"text-align: initial;font-size: 1em\">\u201cAmong chronically mentally ill clients,<sup>[1]<\/sup> is the Brief Psychiatric Rating Scale<sup>[2]<\/sup> compared to other suicide prevention instruments<sup>[3]<\/sup> as accurate at predicting actual suicide or suicidal behaviors<sup>[4]<\/sup>?\u201d<br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-71\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/collection-of-tarot-cards.png\" alt=\"collection of tarot cards\" width=\"352\" height=\"233\" srcset=\"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/collection-of-tarot-cards.png 352w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/collection-of-tarot-cards-300x199.png 300w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/collection-of-tarot-cards-65x43.png 65w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/collection-of-tarot-cards-225x149.png 225w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/collection-of-tarot-cards-350x232.png 350w\" sizes=\"auto, (max-width: 352px) 100vw, 352px\" \/><\/em><\/li>\n<\/ul>\n<p>A final note about the examples presented by Gibbs is warranted: these were published prior to a point in time when social work professionals were conscientiously addressing the language that we use to describe people and populations. If he were writing today, Gibbs would likely revise many of these COPES questions to eliminate labelling language (e.g., \u201cdisoriented aged persons,\u201d \u201cadult criminal offenders,\u201d and \u201cchronically mentally ill\u201d). It is a sign of the times that we address this issue of language use at all.<\/p>\n<h3>Using the PICO Framework to Formulate the Practice Question.<\/h3>\n<div>The PICO framework comes from literature on evidence-based practice in medicine and nursing. This is demonstrated in its full name, the <span style=\"text-decoration: underline\"><strong>P<\/strong><\/span>atient, <em><strong>I<\/strong><\/em>ntervention, <em><strong>C<\/strong><\/em>omparison, <em><strong>O<\/strong><\/em>utcome framework. Social workers refer to clients, client systems, or consumers of services; medical professions refer to patients. The PICO framework results in the comparison of two intervention options.<\/div>\n<ul>\n<li><em><span style=\"text-decoration: underline\">P<\/span>atient<\/em> (or client or consumer) refers to specifically identifying the characteristics of the population around which the search for evidence is directed.<\/li>\n<li><em><span style=\"text-decoration: underline\">I<\/span>ntervention<\/em> requires specification of the interventions or other practice activities (e.g., type of assessment or clinical test, treatment, prevention, or policy) under consideration.<\/li>\n<li><em><span style=\"text-decoration: underline\">C<\/span>omparison<\/em> is the act of comparing the intervention options identified in the prior step.<\/li>\n<li><em><span style=\"text-decoration: underline\">O<\/span>utcome<\/em> refers to the goal or goals to be achieved by intervening.<\/li>\n<\/ul>\n<div>Here is an example of a PICO practice question mapped with the numbered COPES steps[1-4].<\/div>\n<blockquote>\n<div>\u201cIf an elder residing in a nursing home[1] participates in a pet therapy program[2] or attends an adult day program[3] which intervention will result in lower depression[4]? (Heltzer, n.d., p. 2)<\/div>\n<\/blockquote>\n<div>As you can see, the resulting practice question is structured just as it would be using the COPES approach.<\/div>\n<h2>Where COPES and PICO Questions Fit<\/h2>\n<p>There are two general categories of questions that practitioners might ask: background and foreground questions. COPES and PICO questions fit under the heading of foreground questions because the practitioner seeks evidence to inform professional practice decision-making. COPES and PICO questions are complex forms of foreground questions. The COPES framework was developed on the PICO structure, but designed for use in non-medical contexts (Gibbs, 2003), which explains why they appear to be so similar. The main reason for sharing the PICO framework is because social workers often work on interdisciplinary teams with practitioners trained in medical models. Knowing how to engage in COPES prepares social workers to function with colleagues trained in PICO, and vice versa.<\/p>\n<h2>Working Example: Addressing High School Dropout<\/h2>\n<p>Here is an example of a practice question that we can follow through the next chapters. The example details steps in evidence-based practice decision-making described in a chapter by Kelly and Franklin (2011).<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-72\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/image-of-a-student-with-a-diploma.png\" alt=\"image of a student with a diploma\" width=\"322\" height=\"214\" srcset=\"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/image-of-a-student-with-a-diploma.png 322w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/image-of-a-student-with-a-diploma-300x199.png 300w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/image-of-a-student-with-a-diploma-65x43.png 65w, https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-content\/uploads\/sites\/185\/2024\/08\/image-of-a-student-with-a-diploma-225x150.png 225w\" sizes=\"auto, (max-width: 322px) 100vw, 322px\" \/><\/p>\n<h3>Background<\/h3>\n<div>The Forest Grove (Illinois) community was charged by the school board to address a problem with too-high rates of high school dropout:<\/div>\n<blockquote>\n<div>\u201c\u2026we can\u2019t keep doing the same things we\u2019ve been doing and expecting a new result. It\u2019s time to make some changes in our dropout interventions\u2026\u201d (Kelly &amp; Franklin, 2011, p. 141).<\/div>\n<\/blockquote>\n<div>A local newspaper reported a dramatic increase in dropout from the community\u2019s two high schools, particularly among the African American and Hispanic student populations. The schools were being accused of \u201cpushing out\u201d students as a means of improving scores related to meeting standards imposed by the 2002 <em>No Child Left Behind<\/em> policy. District data indicated that the rate of students failing to complete high school in four years at Forest Grove North (FGN) and Forest Grove South (FGS) had doubled from 12% to 24% over the past 10 years, and the dropout rate among African American and Hispanic students was disproportionately high: 35%.<\/div>\n<div><\/div>\n<div>First, the team generated a general question:<\/div>\n<blockquote>\n<div>What are best practices for preventing student dropout from high school?<\/div>\n<\/blockquote>\n<div>This question was too general to direct the practical, client-oriented search for evidence (the school district\/board being the client). As a next step, a social worker on the team explored literature concerning two background questions, one describing the problem seriousness and the other describing factors contributing to observed disparities in student dropout:<\/div>\n<blockquote>\n<div>What are the outcomes of the problem?<\/div>\n<div>How are poor and minority youth at risk of dropping out?<\/div>\n<\/blockquote>\n<div>This general literature review indicated that students who drop out, never returning to complete a general high school equivalency education, are at risk of earning less, having poorer job prospects, poorer health, and incarceration as adults (Kelly &amp; Franklin, 2011). As far as disparities were concerned, the evidence indicated nation-wide concerns with higher dropout rates in urban (compared to suburban) communities, and among ethnic minority and male students. Much of this was attributed to lower socioeconomic status\/income in communities with high dropout rates. These two questions and the descriptive evidence were followed up with the team developing a specific practice question.<\/div>\n<div><\/div>\n<div>Engaging in the COPES process resulted in the team developing their practice question as:<\/div>\n<blockquote>\n<div>\u201cIf students deemed at risk for dropping out of high school are given a specific school-based dropout intervention program or standard school-based intervention, such as counseling and academic advising, will the school-based dropout program produce better outcomes, specifically helping youths stay in school and graduate on time? (Kelly &amp; Franklin, 2011, p. 147).<\/div>\n<\/blockquote>\n<div>In the next chapter, we learn how the team went about identifying evidence to inform their practice decisions.<\/div>\n<h2>Stop and Think<\/h2>\n<div style=\"float: left;min-height: 120px;width: 99%;margin-bottom: 10px;padding: 10px;background-color: #f1f7fe\">\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-194 alignleft\" src=\"https:\/\/pressbooks.ulib.csuohio.edu\/projectmanagement2ndedition\/wp-content\/uploads\/sites\/185\/2024\/08\/Stop_ThinkV2-150x150-1.png\" alt=\"Stop and Think\" width=\"150\" height=\"150\" \/>Take a moment to complete the following activity.<\/p>\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-4\" class=\"h5p-iframe\" data-content-id=\"4\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Module 2 Chapter 2\"><\/iframe><\/div>\n<\/div>\n<h2>Chapter Summary<\/h2>\n<div>In this chapter you learned two similar approaches to developing practice questions that guide the search for evidence to inform intervention: PICO and COPES. The steps in the process were demonstrated with examples. This leads to our next topic: where practitioners might seek evidence that will help them address their practice questions.<\/div>\n","protected":false},"author":3,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-73","chapter","type-chapter","status-publish","hentry"],"part":61,"_links":{"self":[{"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/pressbooks\/v2\/chapters\/73","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/wp\/v2\/users\/3"}],"version-history":[{"count":2,"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/pressbooks\/v2\/chapters\/73\/revisions"}],"predecessor-version":[{"id":300,"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/pressbooks\/v2\/chapters\/73\/revisions\/300"}],"part":[{"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/pressbooks\/v2\/parts\/61"}],"metadata":[{"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/pressbooks\/v2\/chapters\/73\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/wp\/v2\/media?parent=73"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/pressbooks\/v2\/chapter-type?post=73"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/wp\/v2\/contributor?post=73"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ulib.csuohio.edu\/swk627\/wp-json\/wp\/v2\/license?post=73"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}