Choose the ONE systematic review topic that is of most interest to you, or most relevant to your practice situation, from the required List of Approved Systematic Reviews (Links to an external site.)Links to an external site..

2. Follow the grading criteria below to formulate your practice issue, which must be based on the topic of the systematic review you have selected.

3. Download the required Milestone 1 Practice Issue and Evidence Summary Worksheets (Links to an external site.)Links to an external site. (both worksheets appear in ONE form) to document the practice issue presented and approved by your instructor in the Week 2 Discussions.

4. You are required to complete the form using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the “.docx” format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.)Links to an external site.. Click on the envelope at the top of the page.

5. Your practice issue will be the same for all three Milestone assignments in this course.

6. Please type your answers directly into the worksheet.

Evidence Summary Worksheet Directions

1. Develop an evidence summary by following the grading criteria below.

2. Document this on the evidence summary portion of the worksheet.

3. You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2 assignment.

4. Please type your answers directly into the worksheet.

THE CHOSEN REVIEW SYSTEM

Obstetrics/Delivery

McFadden, A., Gavine, A., Renfrew, M. J., Wade, A., Buchanan, P., Taylor, J. L., … MacGillivray, S. (2017). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD001141. doi:10.1002/14651858.CD001141.pub5

Abstract

Background

There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant’s diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation.

Objectives

To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.

To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.

To examine the effectiveness of different care providers and (where information was available) training.

To explore the interaction between background breastfeeding rates and effectiveness of support.

Search methods

We searched Cochrane Pregnancy and Childbirth’s Trials Register (29 February 2016) and reference lists of retrieved studies.

Selection criteria

Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care.

Data collection and analysis

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach.

Main results

This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. Results of the analyses continue to confirm that all forms of extra support analyzed together showed a decrease in cessation of ‘any breastfeeding’, which includes partial and exclusive breastfeeding (average risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.95; moderate-quality evidence, 51 studies) and for stopping breastfeeding before four to six weeks (average RR 0.87, 95% CI 0.80 to 0.95; moderate-quality evidence, 33 studies). All forms of extra support together also showed a decrease in cessation of exclusive breastfeeding at six months (average RR 0.88, 95% CI 0.85 to 0.92; moderate-quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95% CI 0.71 to 0.89; moderate quality, 32 studies). We downgraded evidence to moderate-quality due to very high heterogeneity.

We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes.

Authors’ conclusions

When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.

 

This week, you will be assessed on the use of diagnosis, assessment, and intervention in a multiple-choice final exam. This exam is modeled in the National Clinical Mental Health Counseling Exam (NCMHCE) format that is used in many states as their licensure exam and for the Certified Clinical Mental Health Counselor (CCMHC) national certification. As opposed to other exams where you are asked to recall specific facts, this exam is based on case scenarios where you will apply your clinical problem-solving ability to assess, diagnose, and treat crisis and trauma situations. You will focus on identifying “the best answer”—as opposed to the “correct” answer. This means that each question contains more than one correct answer, but only one answer is the best. As “best answer” exams require a great deal of discernment, be sure to read each question carefully, look for the correct answers, and then discern the “best” answer. Taking a comprehensive exam in this format will pay off in the end when you sit for the NCMHCE in the future. I need this completed by 11/02/18 at 7pm. .

QUESTION 1

1. Case #1 – Jenna

Jenna is a six-year-old Caucasian female who currently resides with her foster parents, her older biological sister, and two foster brothers. Jenna and her siblings were taken from her biological parents because of suspected sexual abuse and neglect. It is reported that Jenna lived in a home without food, water, and utilities. Jenna’s foster parents report that her biological mother “may have some disabilities and has never had the financial means to take care of her children.” Jenna’s biological brother is in a separate foster home. He is suspected of sexually abusing both Jenna and her older sister. It has been reported that he sexually abused Jenna, while her sister was helplessly told to watch. Jenna has expressed this trauma with agitated behavior. The traumatic event is re-experienced by repetitive play where she stimulates herself on furniture. Jenna avoids the stimuli associated with the trauma by avoiding conversations associated with sexual abuse. Jenna avoids activities, places, and people associated with the trauma except for her sister who was also a victim. Jenna also has a sense of a foreshortened future. She frequently brings up death with her foster parents. Jenna has persistent symptoms of increased arousal that were not present before the trauma as indicated by irritability and outbursts of anger nearly every day with her biological sister and her foster father. Jenna is also hyper vigilant and does not want her foster father around. The disturbances have lasted for over a month and have caused clinically significant social impairment to the point she is unable to attend a full day of school due to emotional breakdowns.

1) What intake information should be obtained and assessed to formulate a provisional DSM-5 diagnosis? Select AS MANY as you consider essential.

 

a.

History of learning disabilities.

 

b.

Length of time problematic behaviors have   persisted.

 

c.

Changes in sleeping patterns.

 

d.

Substance use.

 

e.

Attention problems.

 

f.

Details of sexual trauma.

 

g.

Hypervigilance or increased arousal.

2 points   

QUESTION 2

1. What assessment tools might offer meaningful information on this client? Select the ONE most appropriate option. (Refer to Case #1)

 

a.

Beck Anxiety Inventory

 

b.

Attachment Questionnaire for Children (AQC)

 

c.

Clinician Administered PTSD Scale for Children   and Adolescents (CAPS-CA)

 

d.

Child and Adolescent Needs and Strengths (CANS)

2 points   

QUESTION 3

1. Based on the available information, what would appear to be the most appropriate provisional DSM-5 diagnosis? Select the ONEmost appropriate primary diagnosis. (Refer to Case #1)

 

a.

Disruptive Mood Dysregulation Disorder (296.99)

 

b.

Postttraumatic Stress Disorder (309.81)

 

c.

Acute Stress Disorder (308.3)

 

d.

Adjustment Disorder with Mixed Disturbance of   Emotions and Conduct (309.4)

2 points   

QUESTION 4

1. Based on the provisional diagnosis, what interventions might work best as you begin to work with this client? Select AS MANY as you consider indicated. (Refer to Case #1)

 

a.

Group Therapy

 

b.

Behavioral Rehearsal

 

c.

Grounding Techniques

 

d.

Play Therapy

 

e.

Flooding Techniques

 

f.

Medical Referral for Anxiety Medication

 

g.

Assertiveness Training

2 points   

QUESTION 5

1. In developing a collaborative treatment plan with the client, identify immediate goals to be addressed. Select AS MANY as you consider correct and necessary. (Refer to Case #1)

 

a.

Reunification with Biological Family

 

b.

Addressing Sexualized Behaviors

 

c.

Increasing Emotional Regulation

 

d.

Preventing Revictimization

 

e.

Reenactment of Traumatic Events

2 points   

QUESTION 6

1. Case #2 – Morgan

Morgan is staying at a local shelter after she experienced a natural disaster that destroyed her home three days ago. She is a 25-year-old lesbian female who was living with her partner. She has a flat affect and makes no eye contact as she talks about having to vacate her home in the middle of the night as the waters were filling her condo. Her partner did not make it out and drowned in the storm. She has not made contact with any of her other relatives who she says she has been distant from for “many years.” She mentions that before the storm she was taking “some meds to help with my moods” but is not sure of the medication name. Since she arrived at the shelter, she has laid in her cot, not taken any showers, eaten very little food, and avoided any contact with shelter workers or other families. She has a significant startle response when approached and has difficulty remembering basic information. She cries herself to sleep and has moments where she screams out at night after having “nightmares about drowning.”

What intake information should be obtained and assessed to formulate a provisional DSM-5 diagnosis? Select AS MANY as you consider important.

 

a.

Substance abuse history

 

b.

Medical history

 

c.

Educational history

 

d.

Military history

 

e.

Quality of family relationships

 

f.

Psychiatric history

 

g.

Employment history

 

h.

Threat to self or others

2 points   

QUESTION 7

1. What assessment tools might offer meaningful information on this client? Select the ONE most appropriate option for your work while she is at the shelter. (Refer to Case #2)

 

a.

Beck Depression Inventory

 

b.

Inventory of Complicated Grief

 

c.

Triage Assessment Form

 

d.

The Behavioral Assessment Rating Scales

2 points   

QUESTION 8

1. Based on the available information, what is the most appropriate provisional DSM-5 diagnosis? Select the ONE most appropriate primary diagnosis. (Refer to Case #2)

 

a.

Major Depressive Disorder, Single episode, Mild   (296.21)

 

b.

Posttraumatic Stress Disorder (309.81)

 

c.

Generalized Anxiety Disorder (300.02)

 

d.

Acute Stress Disorder (308.3)

 

e.

Adjustment Disorder with Depressed Mood (309.3)

2 points   

QUESTION 9

1. Based on the intake data, identify immediate potential issues to be addressed as a crisis counselor while the client is in the shelter. Select AS MANY as are correct and necessary. (Refer to Case #2)

 

a.

Hygiene

 

b.

Impulse Control

 

c.

Family Relationships

 

d.

Housing

 

e.

Suicidality

 

f.

Medication compliance

 

g.

Employment issues

 

h.

Stress management

2 points   

QUESTION 10

1. Based on the provisional diagnosis, what theories or models will likely work best for the client? Select AS MANY as you consider correct and appropriate in working with the client while she is at the shelter. (Refer to Case #2)

 

a.

Group Therapy

 

b.

Psychological First Aid

 

c.

Existential Therapy

 

d.

Grief Therapy

 

e.

Maslow’s Hierarchy of Needs

2 points   

QUESTION 11

1. Case #3 – Bob

Bob is a 45 year old African American man. He was recently medically discharged from the US Navy due to extensive injuries he sustained during his last time in combat. He is separated from his wife and has two teenage children. He has a prescription for an opioid pain medication and discloses that he has been engaging in daily marijuana use and drinks about 5-6 beers a day “to cope.” He has an extensive history of childhood physical and emotional trauma. His mother was alcoholic and his father was physically abusive to him and his siblings. He says that he is struggling over the past few months with “what could have been” if he was not so “damaged.” He sounds very agitated, stating that the pain is unbearable and he “can’t stand it anymore.” He mentions that he might be better off dead.

Based on the available information, what would appear to be the most appropriate provisional DSM-5 diagnosis? Select the ONEmost appropriate.

 

a.

Adjustment Disorder with Mixed Disturbance of   Emotions and Conduct (309.4)

 

b.

Substance-Induced Anxiety Disorder (292.89)

 

c.

Posttraumatic Stress Disorder (309.81)

 

d.

Acute Stress Disorder (308.3)

 

e.

Generalized Anxiety Disorder (300.02)

2 points   

QUESTION 12

1. To better determine the client’s current level of functioning and behavioral problems, what additional data may be helpful? Select AS MANY as are necessary. (Refer to Case #3)

 

a.

Collateral contact with the medical provider.

 

b.

Collateral contact with his spouse and children.

 

c.

Military record review.

 

d.

Substance abuse screening.

 

e.

Legal history review.

2 points   

QUESTION 13

1. Which of the following risk factors are present in the case description? Select AS MANY as you consider indicated. (Refer to Case #3)

 

a.

History of previous attempts.

 

b.

Specific plan.

 

c.

History of drug and/or alcohol use.

 

d.

Cut off from others.

 

e.

Lack of belongingness.

 

f.

Feelings of helplessness.

 

g.

Financial loss.

 

h.

Access to firearms.

 

i.

Radical shifts in behaviors and mood.

2 points   

QUESTION 14

1. Indicate the responses that would be most appropriate for addressing potential suicidal ideation. Select AS MANY as you consider correct. (Refer to Case#3)

 

a.

You say you are suicidal, but what’s really   bothering you?

 

b.

You can tell me. I’m a professional and have been   trained to be objective about these things.

 

c.

It seems like you’ve been suffering so much that   hurting yourself seems like the only way you can make the pain go away.

 

d.

You have so much to live for, think about your   wife and children.

 

e.

Tell me more about your suicidal feelings.

 

f.

You seem to be somewhat upset.

2 points   

QUESTION 15

1. Based on the provisional diagnosis, what interventions and referrals might work best for the client? Select AS MANY as you consider indicated. (Refer to Case #3)

 

a.

Suicide Safety Plan

 

b.

Create a No Harm Contract

 

c.

Family Counseling

 

d.

Medication Review

 

e.

Cognitive Reframing

 

f.

Vocational / Job Training

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