ACCESSING & USING EVIDENCE

Accessing & Using Evidence in Social Work Practice

Crystal A. McMillon, BASW
Wayne State University
SW 3810

ACCESSING & USING EVIDENCE

Accessing & Using Evidence in Social Work Practice

The Need for Change
Sexual abuse is a monolithic issue globally that doesnt discriminate against anyone.
Sexual abuse is forced unwanted sexual activity and is the act of taking advantage of victims not
able to give proper consent. Socially, sexual abuse affects us all; it creates a population, a world
full of people that live in constant fear, and often out of a place of insecurity. Those insecurities
and that fear at some point indirectly affect everyone, everywhere. Women, children, men, and
infants are victims of sexual assault, and the consequences of that assault are always painful, it
doesnt matter the age, or the gender of the person that the abuse was inflicted upon.
We live in a world where sexual abuse is a common occurrence, but still not a common
conversation, which is why I want to work with this particular population. The majority of sexual
abuse survivors, and victims are still fearful of speaking out. Victims, and even victors live in
silence mainly due to the dark cloud of shame that is associated with being sexually abused.
When people dont speak they cant be healed, and there is a large demographic of unhealed
victims that never plan on receiving any type of therapy or help, due to their fear of the
drawback.
We as a society still havent learned how to make the majority of victims feel comfortable
enough to speak out against their abusers, or their traumtic experiences and open themselves up
to a world that involves healing. Those who have been sexually abused are apart of a very
vulnerable population, which is why I care to work within this area: to protect them from further
harm from a psychological perspective. I know that I cant reverse the act of sexual abuse, but I
further know that I can help provide a platform to release some of the hurt that it caused. I want
to extend a heart, an ear, and a safe place for survivors to tell their stories.

ACCESSING & USING EVIDENCE

Sexual abuse is a tornado that sweeps up everything in its path, and I want to provide
shelter in the aftermath of the storm. There is no solution for sexual abuse, but there are several
solutions that assist with the healing process thats necessary, and mostly unavailable. Sexual
abuse is not just the little sisters problem, its a problem that belongs to us, and in order to help
those affected by it we have to set our own fears aside and be willing to approach truth, open
heartedly and full on.
Empirical Research
Eye movement desensitization and processing (EMDR) is a fairly new nontraditional
type of psychotherapy that is popular in the treatment of post-traumatic stress disorder. This
experimental study explores the effectiveness of EMDR with adult female survivors of childhood
sexual abuse. Within this randomized study 59 participants were assigned randomly to one of
three groups: individual EMDR treatment with a total of six sessions, routine individual
treatment also with a total of six sessions, and delayed treatment control group. According to the
study EMDR is an eight-phase treatment approach, along with specific protocols for the
treatment issues. The eight-phases include: 1) obtaining a thorough client history and from that
developing sound treatment plan; 2) preparing the client for using EMDR; 3) assessing the target
issue components to be addressed; 4) desensitizing the target material with eye movements or an
alternate form of stimulation; 5) installing the desired cognition; 6) conducting a body scan to
determine if any residual material from the target issue remains; 7) closure; 8) re-evaluation
(Edmond, Rubin, Wambach, Wambach 1999). Routine individual treatment in this study refers to
20 different interventions all incorporated by therapists who work with adult female survivors of
childhood sexual abuse, with a few of the techniques being the same as those in EMDR
treatment.

ACCESSING & USING EVIDENCE

The therapists that participated in the study included four white females; two of the
therapist received their masters in psychology and the other two received their masters in social
work. All therapists had experience in working with the target population. Only one of the
therapists was knowledgeable about EMDR prior to the study, she was positively biased toward
the method. One of the therapists was negatively biased towards the method. These biases within
the study could affect the internal validity of the study due to the therapists personal bias.
Furthermore, the therapists during the evaluation werent blinded to the experiment, which could
result in a bias. Howerver, the findings show that the biases didnt affect the overall results.
Research Design
The research design for this study followed more of a mixed methods approach. The
study has threats to both internal and external validity. The controlled internal validity within the
study would be the randomization of the participants within the three groups. In addition to
having a placebo and a blind set up for the participants. The uncontrolled internal threats to
validity in the study include; the pretest, the instrumental issues, and the scheduling conflict
among the participants during the follow-up. Threats to the external validity could be the pretest
given to the participants, which could potentially make participants aware of the upcoming
treatments. The demographics play a major role in the external validity as well, with the
population selected one would have to keep in mind that the treatment may only work for the
studied population which limits the generalization of the study. Controlling the external validity
could be done by the representation of a larger population. The survivors in this study may not
fully represent the population due to the fact that they were all women from Texas. Therefore, if
the demographics were broader the results would vary as well.

ACCESSING & USING EVIDENCE

Sampling
The women in this study were victims of sexual abuse who were not currently receiving
any type of treatment. The demographics of the overall study: predominantly white women,
mean age 35, majority full time job, 24% married, 20% divorced, 17% cohabiting, and 3%
widowed. 90% of participants had received some type of therapy prior to study. One advantage
within this study is that participants werent required symptoms in order to be a participant,
which reduced some bias and increased the sample size. Participants for this study were recruited
through newspaper ads and flyers that followed a telephone screening interview, and ending with
a 90-minute office interview, in central Texas.
Measurement
The study has a few main variables. The independent variable is the choice of
intervention, which is EMPR. The dependent variable in this study is the decrease in posttraumatic stress symptoms in the participants. Another factor to take into consideration would be
abuse-specific variable, meaning the history of the women who were sexually abused during
their childhood. Everyone defines abuse differently, what one considers abuse another may not.
The results could have been different if the variable would have been defined in a different way
by the overall history of the abuse; if the abuse varied the results could have been different as
well.
Data Collection
Four different instruments were used to measure the results of the participants: 1) the
state anxiety scale of the State-Trait Anxiety Intervention (STAI) which measures the anxiety
related to a particular issue; 2) Impact of Event Scale (IES) that measures post-traumatic stress
symptoms; 3) the Beck Depression Inventory (BDI) and 4) the Belief Inventory which identifies

ACCESSING & USING EVIDENCE

and measures common distorted beliefs among adult survivors of childhood sexual abuse. The
instruments used test participants' anxiety related to a particular issue, post-traumatic stress
symptoms, rapidly, measure and identify common distorted beliefs. In addition, the study used
one scale for the participants verbal reporting of ones emotional distress. Majority of the
instruments has accurate validity and reliability, on the other hand, some didn't. The scales
validity of cognition (VOC) and subjective units of disturbance (SUD) used had no known
effectivness along with the proof of validity or reliability, which is a limitation within the study.
The results from the instruments include high levels of anxiety, detected moderate depression,
detected high levels of post-traumatic stress, and one showed zero results. The use of the two
scales created a vulnerability to demand characteristics.
Both participant groups were post-tested six weeks after their pretest. Treatments were
supposed to be completed within six weeks, scheduling conflicts did result, but didn't lead to
attrition. Previous studies show greater results in post-testing after more than six weeks, which is
another limitation. The number of participants between groups varied from the post-test to the
three month follow up could have an influenced the overall results.
Ethics and Cultural Considerations
There are a myriad of ethical concerns and considerations to keep in mind when dealing
with such a vulnerable population. Ethical concerns of the sexually abused population can be
both beneficence and nonmaleficence. A few things that the research could have done to ensure
the safety of the participants: check participants support system and relationships with the
alleged abuser to benefit the participants. When finding the right intervention its best to keep in
mind the appropriateness of the intervention so further harm isnt generated. When memories are
repressed and then resurfaced it could bring about more risks than the initial start. Another

ACCESSING & USING EVIDENCE

important factor to keep in mind is the participants support system and their relationship with
their abuser. The research did well addressing the cultural issues due to the cultural competence
of the therapists. All of the therapists were competent in dealing with the target population, in
addition to having years of experience.
Results and Implications
MANOVA and MANCOVA were the instruments used to measure the differences in the
post-test among all of the groups. MANOVA was viewed as more of a powerful analytical
procedure than MANCOVA. Within the study pretest and post-test results were significantly
different in EMDR and routine individual treatment. According to the results within the study,
On every outcome measure the EMDR participants scored significantly better than controls at
posttest, indicating that EMDR reduced trauma-specific anxiety, trauma-specific post-traumatic
stress, depression, and negative beliefs (Edmond, Rubin, Wambach, Wambach 1999).
Generalization is a key factor in any research. In this study, the research is generalizably
proven by the results that show the treatment of EMDR to be effective for the target population.
There are a number of ways to improve generalization. As stated previously, we could improve:
the demographics, maturation effects, instrumental bias, experimental morality, and personal
bias.
Survivors of sexual abuse face a myriad of long term effects throughout one's life:
negative psychological and interpersonal effects that are both long term and short term. If a
victim does not receive the proper help, it only makes matters worst: by internalizing the
problem or by self-blame. Victims not receiving the proper help only increase their risk of
symptoms: depression, anxiety, post-traumatic stress disorder, substance abuse, attachment
disorders, re-victimization. Victims of sexual abuse also have future relationship problems, due

ACCESSING & USING EVIDENCE

to lack of trust. The research reviews a few of the problems related to sexual abuse, and
researches some of the effective treatments such as EMDR.
Finding an intervention for sexual abuse is a very complex process. There are numerous
treatment methods for those who have been assaulted, and overall it boils down to what works
best for that particular individual. An effective intervention plan will be beneficial for both the
victim as well as future generations of this population. The research intervention study aims to
reduce the trauma symptoms among the survivors of sexual abuse. Picking the EMDR
intervention for this population was challenging due to the imperfections within the study, but
along with the limitations the results prove that the mind can heal from trauma.
Research for the study is valid due to the findings within the research. Barriers within the
intervention that would make it infeasible would be the issue that participants have to relive a
traumatic event that is triggered by PTSD. The participant may become distressed due to the
repressed memory, which could cause an emotional avalanche affecting areas of the participants
life. The overall intervention addresses the practice need for an outlet for adult survivors of
sexual abuse. The research states that the effectiveness of the intervention compared to that of
the routine individual treatment was significantly higher in reducing PST symptoms of the adult
survivors. The research is valid due to the instruments used to collect the data. The statical
significance of the reported results generally support the effectiveness of EMDR in reducing
trauma symptoms among adult female survivors (Edmond, Rubin, Wambach, Wambach 1999).
Summary
Evidence Based Practice (EBP) is taking knowledge and evidence that was gathered from
previous empirical research and applying it to a particular population. There are a myriad of
advantages and disadvantages of using EBP with the population of the sexually abused. If you

ACCESSING & USING EVIDENCE

view it from a scientific perspective, the treatments can be effective which will increase
adherence along with the production of positive outcomes. In addition, the advantages of EBP
helps you think more critically about the problem at hand due to prior studies and interventions.
Other positive factors are the results that you find which can be used to further assist you and
other people as well. Furthermore, giving you the ability to plan more effective interventions for
future clients within this population.
As with any scientific research there are chances of error, due simply to human error.
This doesnt necessarily have to be viewed as a negative aspect because in actuality it puts you in
the position to learn from past mistakes. But we must keep in mind that ineffective treatments
can potentially cause more harm, which is another advantage of having past empirical research.
Research that I found while completing my own research was that a lot of information was
incomplete, due to the weakness of the evidence and misinformation. One of the main
disadvantages of using evidence-based practice with this population is the divergent limitation of
abuse, what one may consider abuse another may not. To conclude, when it comes to EvidenceBased Practice, research has been validly proven scientifically through evidence. Although EBP
is time consuming, research can potentially be worth every second producing positive outcomes
for you and the population in which you work.

ACCESSING & USING EVIDENCE

10
References

Edmond, T., Rubin, A., & Wambach, K. G. (1999). The effectiveness of emdr with adult
females survivors of childhood sexual abuse. ProQuest, Retrieved from
http://search.proquest.com.proxy.lib.wayne.edu/socialservices/docview/212139712/fulltextPDF/
D98AB25BC6D34944PQ/1?accountid=14925