Evidence-Based Practice
for the Helping Professions


More Detailed Help Posing COPES Questions

CHAPTER 3 (Edited From Evidence Based Practice for the Helping Professions)
POSE A SPECIFIC QUESTION OF IMPORTANCE TO YOUR CLIENT’S WELFARE
“You’ve got to be careful if you don’t know where you’re going ‘cause you might not get there!” (Berra, 1998)

Overview

Yogi’s right. If we don’t know where we’re going, we just might not get there. Stated positively, if we can learn to pose a specific question, we have hope of fining a specific answer. This topic is that basic and the most important in this text. This chapter spends considerable time on learning to pose questions, because a well-built question is essential to all the other steps of EBP. The whole process of EBP depends on a good question. Other texts on evidence-based practice place posing a question first (Sackett, Straus, Richardson, Rosenberg & Haynes, 2000, p. 13), and many write articles and whole chapters just about posing specific questions (Armstrong,1999; Gibbs, 1991, pp. 109-133; McKibbon, Richardson & Walker-Dilks, 1999; Richardson, 1998, Richardson, Wilson, Nishikawa, & Hayward, 1995).

Initially, problems caused by vague questions are discussed to show why practitioners need question wording skills. Then this chapter defines generally what it means to pose a specific question, first with reference to COPES concepts (Client Oriented Practical Evidence Search), then with reference to elements present in clear questions as stated in Table 3-1. This Table includes five types of practice questions (Effectiveness, Prevention, Assessment, Description, and Risk) and four features of a well-built question relative to each (Client Type and Problem, What You Might Do, Alternate Course of Action, What You Want to Accomplish). Do study Table 3-1 carefully to get the gist of this chapter’s organization. Its examples will clarify the question types and criteria for clarity.

For each of the five question types, this chapter will give background regarding real practice situations and will derive specific COPES questions regarding each one. As you read each situation, try to put yourself in the practitioner’s and client’s positions. Practice posing your own clear answerable question from the case material, then read the example question to see how well you did relative to criteria for a specific question. Doing so will prepare you for the three exercises at the end of the chapter.

This chapter’s three exercises concern successively more complex questioning tasks. Exercise 3-A gives you practice classifying and posing specific questions from case material. Next, Exercise 3-B helps to practice posing questions regarding real clients even if you do not have your own clients. Exercise 3-B will guide you through the process of soliciting a question from a practitioner in any discipline, either by phone or by letter, and clarifying your question. Exercise 3-B can supply you with a question that you can work on in later chapters (e.g. searching for related evidence, evaluating that evidence, deciding what action to recommend). Exercise 3-C assumes that you are employed in an agency and have access to your own clients. This exercise guides you through posing a specific question from your own practice.

The Need to Pose Vital Questions and Example General Questions

Here are some reasons for learning how to pose specific questions about practice:

  • Learning how to pose questions from practice is essential to improving practice, because if we never pose questions about what we are doing we can never change what we are doing on a rational basis.
  • Learning how to pose a specific question can save us time during an electronic search for the answer.
  • Learning how to pose questions is essential to the process of lifelong learning that will continually improve our ability to serve clients. If social work education intends to produce learners who are independent thinkers, then social workers must have a predisposition to pose specific, answerable questions.
  • Learning how to pose specific questions from our practice is an excellent countermeasure against arrogance, because those who seek answers will discover how tentative our answers are and how much we don’t know.
  • Learning how to pose questions can stimulate us and excite us, because it will awaken our “curiosity and delight in learning” (Richardson, 1998, p.) [about how to better serve our clients].
  • Learning how to pose a well-built question can foster better communication with other practitioners who are familiar with the format for clearly worded questions (Richardson, 1998).
  • Because a vague question can only lead to a vague answer, we must pose a specific question to ever hope to get a specific answer (useful) answer regarding our practice. (Yogi Berra says so.)

COPES Questions
Three Features of COPES Questions

COPES questions are worthwhile questions. COPES questions come directly from practice. COPES questions have three general features. First, they are questions from daily practice, posed by practitioners, that really matter to the client’s welfare—they’re Client Oriented (Here the word “client” refers to an individual, to a group of clients, or to a community). Generally speaking, COPES questions concern issues that are central to the welfare of the client and to those whose lives are affected by the client. For example, the accuracy and reliability of an assessment of a child to determine whether it is autistic would concern a matter of central importance to the child and to the child’s parent. If the child is autistic, then an effort might be made specific to that child’s problem, but first the assessment presents a central problem. Another concern of central importance to a client might be a young woman who experiences feelings of panic in social situations. This problem presents a real problem for her. She thinks her quality of life will improve dramatically if she can get the problem under control; so the answer to a related question regarding the efficacy of treatments for her problem would be client-oriented. Regarding still another question, the effectiveness of group treatment for men who have abused their wives would be of vital importance for obvious reasons to the men, to their wives, and to their probation and parole agent who conducts the group. Regarding gangs, knowing which factors most frequently precede Hmong boys’ joining gangs might help a community organizer and community leaders to design a gang prevention program for them. All of these questions are Client Oriented. They begin with a matter of importance to clients.

Second, COPES questions have Practical importance in several ways. In addition to their central importance to the client and to persons affected by the client, COPES questions have practical significance if they concern problems that arise frequently in everyday practice. For example, if a child protective service worker takes telephone intake duty for at least one day a week, and these telephone contacts generally require some assessment of risk, then asking a question about what types of clients present the greatest immediate risk for child abuse would have repeated practical significance. COPES questions also have practical significance if they concern the mission of the agency. For example, asking a question about how to match hard to place children with foster families most likely to meet the child’s needs would be a question central to a foster care agency. A COPES question will also have practical significance if knowing the answer concerns something within the realm of possibility. For example, a school social worker searching for the answer to whether the Lovaas method will help an autistic child demonstrates a question that has no practical value if funds for the treatment are unavailable or if no one in the region can administer the treatment.

Third, COPES questions can guide an Evidence Search. In order to guide an evidence search, a question must be posed specifically enough to get an answer in an electronic search. The process of formulating a specific question begins with a somewhat vague general question and then proceeds to a well-built question. COPES questions generally fall into five types that all meet four criteria for answerability (See Table 3-1).

Before we move on to examples of the five types of general questions and how these questions can become worked into well-built, answerable ones, it might help to know that COPES questions are sometimes called POEMs in medicine (Slawson & Shaughnessy, 1997). POEMs concern Patient Oriented Evidence that Matters (have real importance worth investigating) (p. 947). Since many practitiones don’t work in a medical setting, and they may call the persons whom they serve “clients,” the acronym POEM would not do generally.

Also as an aside before we move to posing five types of questions specifically, the term COPES was not my invention. To give due credit, I must tell you where the term came from. For many hours my search went on without success for an acronym for practitioners aside from medicine that would get the features of a good question, but one that would not be a POEM! One just would not come to mind, until I noticed two women doing crossword puzzles in their seats next to me during an airline flight. Between their comments about heroes of the soap operas and gum chewing, the women solved several complex crossword puzzles with incredible speed and efficiency. Their ability to discuss a TV episode and to simultaneously solve a puzzle showed incredible verbal fluency. I wondered if they would mind directing their fine minds to the POEM acronym problem; they did, and they solved it in ten less than ten minutes with: Client Oriented Practical Evidence Search (COPES) (Brown, Sept. 16, 1999).

Five COPES Question Types and Four Features of Well-Built Questions

Table 3-1 below gets the essence of this chapter. On the vertical left you will see the five question types. Across to the right next to each question type you will find the question worded from left to right in a way that includes all four elements of a well-built COPES question. Do study the table for several minutes to get the most of the examples that follow the table.

Table 3-1: Five COPES Question Types and Four Corresponding Features of a Well-Built Question

Across:  Four Elements In a Well-Formulated Question _________

Down:  Five Question Types  

 

Client Type and Problem What You Might Do Alternate Course of Action What You Want to Accomplish
  How would I describe a group of clients of a similar type? Be specific. Apply a treatment; act to prevent a problem; measure to assess a problem;  survey clients; screen clients to assess risk. What is the main alternative other than in the box to the left?

Outcome of treatment or prevention? 
Valid measure?  Accurate Risk Estimation,  revented Behavior, Accurate Estimation of Need

 

Example Effectiveness Question If disoriented aged persons who reside in a nursing home Are given   Reality Orientation Therapy Or   Validation Therapy

Which will result in Better Orientation to Time, Place, Person?

 

Example Prevention Question If sexually active high school students at high risk for pregnancy Are exposed to Baby-Think-It-Over Or to Didactic Material on Proper Use of Birth Control Methods

Then will the former have Fewer Pregnancies During an Academic Year, Knowledge of Birth Control Methods?

 

Example Assessment Question If aged residents of a nursing home who may be depressed or may have Alzheimerís Disease   or Dementia Are administered Depression Screening Tests Or a Short Mental Status Examination Tests

Which will measure will be the Briefest, Most Inexpensive, Valid and Reliable Screening Test to Discriminate Between Depression and Dementia?

 

Example Description Question If members of a hospital team who are concerned about team functioning Take the Preliminary Checklist (Clinical) Team Effectiveness test Or take the Interdisciplinary Team Weekly Inventory

Which measure will most reliably and validly reflect the teamís ability to accomplish tasks

 

Example Risk Question If crisis line callers to a battered women shelter Are administered a risk assessment scale by telephone Or we rely on practical judgment unaided by a risk assessment scale

Then will the Risk Assessment Scale have higher reliability and predictive validity for violent behavior?

 

This table follows Sackett, D. L.,  Richardson, W. S., Rosenberg, W., & Haynes, R. B. (1997). Evidence-based Medicine: How to practice and teach EBM New York: Churchill Livingstone. Adapted with permission.

Examples of General Questions and Related COPES Questions

Each of the ten situations below implies a COPES question or questions. Note how the situation is Client Oriented in that it concerns a matter of importance to the client. Notice how each question arose logically out of a practitioner’s concern for how to approach the problem in a Practical way using available resources and skills, and notice too that the accompanying well-built question is posed so specifically relative to four criteria that it can guide an Evidence Search.

Each situation came from practice in an assortment of agencies and client types. All of the questions used in this chapter concern real clients, real members of the helping professions, and real practice issues, though the situations are modified slightly to protect confidentiality. None in this book are real client names.

Please note also that the five questions each exemplify one of five types including the following: Effectiveness, Prevention, Risk, Assessment, and Description. In the situations below, each question type is defined first, then for each question type two situations will be given including a general question and a well-built or specific question. At each general question, you might want to practice posing your own COPES question before you read the example question. To do so, you might take a piece of paper and slide it down to cover the Related Well-Built…Question and try to pose it yourself before looking at the example. Doing so will help you to prepare for Exercise 3-A.

Effectiveness Question: Definition by General Concept and Two Examples

Effectiveness Questions concern the direct effects of an intervention on clients who share a particular problem and who have been exposed to the intervention (treatment).

Box 3.1 Example Effectiveness Question Regarding Long-Term Care for Residents of a Nursing Home

Practice Situation

Aged, long-term care residents of nursing homes often experience mental confusion due to Alzheimer’s Disease and other degenerative processes in their brain. Such confusion can cause wandering, disorientation, dizziness and impulsive behaviors. Geriatric workers face a dilemma. On one hand behaviors related to mental confusion are serious particularly because they can cause injuries including those associated with falling. To prevent injuries, harm to others, and to protect medical devices used in the resident’s treatment, various restraints are used to limit movement including “mitts, belts, crotch/pelvis devices, sheet ties, ankle ties, geri chairs, wrist ties, fixed tray tables and lap trays, side-rails [on beds to keep residents from rolling out of bed onto the floor]], and vests”. (Hause, May 5, 1999, p. 3) Social workers, nurses and administrators at a nursing home were faced with a dilemma regarding restraints. Restraints have a negative side. Geriatric professionals, who generally value helping clients in the least restrictive possible environment, are reluctant to use restraints. Restraints are thought to aggravate a loss of steadiness and balance, problems of elimination, skin break down, obstruction in circulation, stress to the heart, and discomfort to the resident due to loss of personal control over mobility. The dilemma here concerned whether to adopt a new policy in a nursing home that would eliminate restraints entirely. To help to resolve this dilemma, Erin Hause posed this question:

 

General Effectiveness Question:

“What happens to the number of falls among elderly nursing home residents when restraints are removed”. (Hause, 1999, p. 3)

 

Related Well-Built Effectiveness Question

Among aged residents of nursing homes with dementia (Element #1 concerning Client Type), what is the effect of removing restraints (Element #2, Course of Action Possible), relative to continuing to use restraints (Element #3, Alternate Course of Action) on residents’ rate of falls and injuries? (Element #4, Intended Result)

 

Box 3-2 Example Effectiveness Question Regarding a Probation and Parole Agent’s Use of Cognitive Group Treatment

Practice Situation

Those who work with clients in the criminal justice system as probation and parole agents often observe that criminal offenders reason differently than non-offenders. They note that clients who have committed a sexual assault, armed robbery, battery, or theft reason differently. Corrections workers note an impulsive thinking in many corrections clients, an inability to place themselves in the position of others including their victims, a difficulty reasoning about how to cope with stresses, and rationalizations for their behavior that insulate them against taking responsibility for their own behavior. Consequently, group cognitive treatment programs have been developed to counter ineffective reasoning among their clients. The premise of such cognitive programs is that if offenders recognize their errors in thinking that they will also be less likely to commit new offenses. The general question below was posed by a probation and parole agent who was contemplating using cognitive group treatment methods with her clients.

 

General Effectiveness Question:

“Will attending fifteen two-hour sessions of the Phase Two Cognitive Intervention Program effectively reduce criminal behavior among the offenders in the group [cognitive treatment]?” (Thibado, 1998, p. 1)

 

Related Well-Built Effectiveness Question

Among adult criminal offenders on probation, will a group cognitive intervention program compared to no such program result in a lower recidivism (re-offense) rate?

 

Prevention Question: Definition by General Concept and Two Examples

Prevention Questions concern the effectiveness of interventions (treatments) that intend to prevent the initial occurrence of a problem before it can happen.

Box 3.3:

Practice Situation

The worldwide acquired immune deficiency syndrome (AIDS) epidemic is well publicized, but many school social workers are concerned about widespread ignorance and risky behaviors by teen-aged pupils in their schools. The message of how human immunodeficiency virus spreads does not get to many at- risk youths who have multiple sex partners, often with tragic results. The Prevention Question posed below comes from a Red Cross social worker who wanted to effectively use local funds given to Red Cross for AIDS/HIV education in area schools. The social worker wanted to use the funds to get the greatest effect possible from an HIV/AIDS prevention program in as many middle schools and high schools in a thirteen county area. The Red Cross social worker was looking for the least expensive and most effective program to prevent risky sexual behaviors that could lead to infection.

 

General Prevention Question

“What is the most effective way to educate youth about HIV/AIDS? (Wiederholt, 1999, p. 3)

Related Well-Built Prevention Question

Among teenage school children, which AIDS/HIV prevention program will result in the highest percent of condom use during sexual encounters?

 

 

Box 3.4: A Community Organizer’s Question Regarding Preventing Hmong Boys’ Joining Gangs

Practice Situation

Within a county of approximately 60,000 residents, there are 2,300 Hmong refuges. Many Hmong families are under great stress trying to adapt to their new environment. Though about 95% of the Hmong in the area are employed, approximately 50% live below poverty level due to low wages and large families. Many of the Hmong elders, single parents, and recent arrivals to the United States are socially isolated. Though the leaders of the thirteen local clans, local elders, and parents have managed to cope well with many stresses as their families adapt to their new culture, they are concerned that some Hmong youth become isolated and turn to delinquent gangs for peer support. A social worker employed as a youth leader working for the Hmong Mutual Assistance Association has become concerned about the extent of the problem and wants to initiate a program that will prevent young Hmong boys from joining the gangs. This social worker’s question is as follows:

 

General Prevention Question

“Which is the most effective way to prevent Hmong youth from joining gangs?” (Wood, 1998, p. 3)

 

Related Well-Built Prevention Question

Among Hmong and Asians less than sixteen years old, which gang prevention program will most effectively prevent them from joining the gang?

 

Risk/Prognosis Question: Definition by General Concept and Two Examples

Risk/Prognosis Questions concern the likelihood or probability that a particular type of client will experience undesirable consequences within a give interval of time.

Box 3.5: A Protective Service Worker’s Concern for Risk of Re-abuse In the Child’s Home

Practice Situation

This question was motivated by the mission statement in the handbook of a county department of human services. That mission states; “The Department is guided by the following beliefs and principles: The well-being of the family and individuals enhances the well-being of the community. The family is the cornerstone of the community. Children are best protected and nurtured when families are strong” (Eau Claire County Department of Human Services, n.d.) The social worker who cited this statement worked as a protective service worker who served abused children and their families. The social worker felt torn in two directions. On the first, some abused/neglected children had to be removed from their homes and placed in foster homes for a while to prevent further abuse and neglect. But on the second, after working with the families when the risks were judged acceptable, the children needed to be reunited with their families as soon as possible to allow them to live and grow with their natural family. So the question becomes: When are the family’s problems sufficiently resolved and understood to risk reuniting them? This is a tough decision. If you are too conservative, children are unnecessarily kept from living with their families. If you are too liberal, children will be placed in their homes and abused or neglected again.

 

General Risk/Prognosis Question

“Is there an easy way to administer, quick, reliable risk scale with high positive predictive validity to determine if children should be returned to their natural homes from foster care? (Troy, 2000, p. 5)

 

Related Well-Built Risk/Prognosis Question

For abused or neglected children placed in foster care by a protective service worker, which risk assessment measure will provide the greatest predictive accuracy to predict re-abuse when children are placed back into their homes with their families?

 

Box 3.6: A Community Support Worker’s Question Regarding Risk for Suicide

Practice Situation

This question arose out of a tragedy. It comes from a social worker in a Community Support Program (CSP) that serves the mentally ill. CSP’s workers make every effort to help the mentally ill to live independently or in group homes where they have various levels of personal freedom. CSP social workers work intensively with their clients. They visit some almost daily. They assist their clients with living skills as teachers and with employment skills; they help them to locate jobs with the help of local supportive employment agencies, and they monitor their clients’ behaviors for possible drug side effects and behaviors that might harm others or themselves. Tragically, a CSP client jumped from a local building to his death. The young man had recently been diagnosed a “schizophrenic” and had joined the CSP caseload. Workers at CSP were deeply affected by the tragedy, and one posed the question below related to the predictive accuracy of a measure used by CSP workers

 

General Risk/Prognosis Question

How effective is the Brief Psychiatric Rating Scale at assessing suicide risk in the chronically mentally ill? (Zenz, 1999, p. 2)

 

Related Well-Built Risk/Prognosis Question Among chronically mentally ill, is the Brief Psychiatric Rating Scale compared to other suicide prediction instruments as accurate at predicting actual suicide or suicidal behaviors?

Assessment Questions: Definition by General Concept and Two Examples

Assessment Questions concern standardized measures or procedures to determine whether a client has a particular problem or strength and whether a client has benefited from an intervention (treatment).

Box 3.7: A Protective Service Worker’s Question About Shaken Baby Syndrome

Practice Situation

This question followed a protective service social worker’s visit to the hospital to remove an infant from the custody of its parents. The child had almost died in the hospital from its injuries. The infant had been shaken by its father so severely that a CAT scan revealed major brain damage including that from multiple strokes and resultant paralysis on the left side of its body. The social worker wondered (through her tears) how accurately shaken babies can be identified by specific behavioral or physiological signs to give a reliable and valid assessment. The social worker was particularly concerned that shaken babies not go unnoticed and that they be identified early, before the child might be injured by another shaking.

 

Related General Assessment Question

“What is the most valid, reliable assessment tool for diagnosing Shaken Baby Syndrome?” (Stamm, 2000)

 

Related Well-Built Assessment Question

To detect children with shaken baby syndrome, which assessment or diagnostic procedure will provide the most valid and reliable determination that the child has been injured by shaking.

 

Box 3.8: A Hospital Social Worker’s Question Regarding How to Screen for Dementia

Practice Situation

One of the principal duties of hospital social workers involves discharge planning for physically and mentally impaired individuals who will need various forms of continued care, including nursing home placement. This question arose in response to a hospital social worker’s experience with a client who was discharged from the hospital to her home. The hospital social worker noted that the client appeared preoccupied and confused before her discharge, but the doctor discharged the client without investigating the patient’s confusion. The client returned to the hospital emergency room a few days later due to an injury sustained in a fight with a family member over whether the client should go to the dentist. The hospital social worker became interested in a way to screen clients to determine whether the client has dementia so that this evidence might assist the medical team in its discharge decisions.

 

Related General Assessment Question

“What is the most valid, reliable, and rapid assessment measure for determining level of orientation for hospital/nursing home patients?” (Bloomfield, 1999)

 

Related Well-Built Assessment Question

For hospitalized aged persons suspected of having dementia, which rapid assessment measure will most quickly, reliably, and validly identify demented patients?

 

Description Questions: Definition by General Concept and Two Examples

Description 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.

Box 3.9: A Youth Worker’s Question Regarding the Age When Racial Identity Takes Place*

Practice Situation

This question comes from someone who counseled children in a home for children near Durbin, South Africa. The counselor noted that great changes in South African society have been reflected in events in the children’s home. Less than a decade ago, South Africans abolished Apartheid by democratic means, and the Nationalist Party that had enforced racial segregation and repressive policies toward blacks lost its power. The African National Congress replaced these policies with ones that gave greater freedom to blacks including their right to services previously denied to them. These policies affected the residents of the children’s home by integrating black children into the previously all white children’s home. What concerned the social worker were the ways black children seemed to demonstrate racial identity problems when integrated for several years into the children’s home. Zulu children learned English and Afrikaans and could not speak with their Zulu relatives. Some of the children complained at having to be with blacks; they made statements that they were “really white”, and screamed and cried when taken home by black relatives. Such events prompted the social worker to wonder at what age racial identity takes place with the idea that if this age could be known, then it might be possible to initiate action at this age to help them to retain their black racial identity.

 

Related General Description Question

“At what age do children develop racial awareness?” (Weber, 1999, p. 5)

 

Two Related Well-Built Description Questions

Among children in integrated children’s homes or orphanages, at what age do they first begin to see themselves as being either of white or black race?

Among children of black and white races who live in children’s homes or orphanages, comparing blacks in all black institutions compared to blacks in integrated institutions, at what age do children first see themselves as being black?

 

* A possibly more important question might be an Effectiveness Question regarding the effects of programs designed to foster or to negate racial identity. We have not yet gotten to questions of value that underlie any COPES question.

Box 3.10: A Special Needs Adoptions Worker’s Question Regarding Adjustment of Children Placed With Homosexual Couples

Practice Situation

This question was posed by worker who does studies for special needs adoptions at a state agency. Such adoptions concern hard-to-place children (e.g. huntington’s chorea, down’s syndrome, older children, children with behavioral problems, older minority children). These children require a careful match between the child and prospective parents to best meet the needs of the child and to make sure the parents will have the stamina and sensitivity to care for the child. The social worker’s concern arose when a homosexual couple applied to the agency to adopt a child. Homosexual adoptions are illegal in some states, but not in the state that employed the worker. This was the first application from a homosexual couple that the social worker’s agency had ever encountered. The social worker wondered what types of interpersonal adjustment problems, if any, the child would encounter if placed in a homosexual home.

 

Related General Description Question

“What social problems do[es] a special needs child frequently encounter with his/her identity and self esteem because of the child’s openly homosexual adoptive parent(s)?” (Scheithauer, 1999, p. 3)*

 

Related Well-Built Description Question

Among children with special needs who are placed in heterosexual homes or homosexual homes, will there be any differences in the frequency and type of personal adjustment problem for the child?

 

*This question implies a particular direction for an answer. Truth seeking implies an open mindedness to all possible answers to the question. This “let truth fall where it may” approach to seeking the answers to questions will be discussed in depth in the next chapter.


Lessons Learned from Practitioners’ Questions
Incredible Diversity of Questions


All of the eighty-four well-built COPES questions in Table 3-1 (omitted to save space) came from human service practitioners (e.g. social workers, teachers, nurses, physicians, psychiatrists, counselors, clinical psychologists). Students in research methods classes collected these questions as part of their assignment. Their assignment required them to ask practitioners for an Effectiveness Question to form the basis for their research methods assignment. Please read the questions carefully. They’re fascinating in their diversity, and they tell a lot about real problems that practitioners encounter in their life-affecting work. Perhaps someday you might want to go beyond this work, and you might want to do a representative survey of practitioners regarding which questions matter to them most? Such a survey could support a rational basis for setting research priorities in the future.

Practitioners Pose Vague Questions

Note also in Table 3-1 how each question includes all four elements of a well-built question whose four elements appear in order from left to right. Note how, as you read the questions they state first the client type, then the course of action being considered, then, where appropriate, an alternate course of action, and finally the intended result. These eighty-four questions came from a pile of hundreds that have been collected over two decades. Not one question was well-built relative to twelve criteria for a specific question (Gibbs, 1991, pp. 109-133). Apparently, practitioners may have not learned to pose specific questions. All of the original practitioners’ questions in Table 3-1 had to be reworded to make them well built. Therefore, another worthwhile area for research concerns how best to teach practitioners to pose specific questions about their practice.

Questions Concern Effectiveness and Other Issues as Well

Note also that all of the questions in Table 3-1 are Effectiveness Questions. Practitioners should be encouraged to ask questions of greatest importance to their clients; so limiting my research students to Effectiveness Questions only, though defensible for practical reasons, artificially limited the task for practitioners. When given wider choices, practitioners will ask other types of questions. Our limited experience with an Evidence-Based Practice assignment over a three-year period (taught by Donald Mowry, Richard Ryberg and myself) has shown that Effectiveness Questions account for slightly over half of the questions posed by our fieldwork students in their Evidence-Based Practice exercise. The rest come from the remaining four question types. Here are the numbers and proportions for each type of question during the three-year period: Effectiveness (N=35; 53%), Prevention (N=4; 6%), Assessment (N=15; 22%), Description (N=5; 8%) and Risk/Prognosis (N=7; 11%). Though we have no data on a wider scale, these data imply that practitioners may, when given the choice, ask Effectiveness Questions for about half of their practice questions. Another area for research concerns the need for surveys to discover which question types concern practitioners most in different settings.

Questions Need to be Posed as Questions of Fact

Note also how all of the questions in Table 3-1 are ones of fact. All COPES questions meet criteria for being Questions of Fact, because they can be answered by making observations through a process of testing or verification, a process that we would most commonly call, “doing a study”. Questions of fact can be posed in “if/then” format. In contrast, Questions of Value assume some underlying belief about what is fair and worthwhile in the world. Usually questions of value contain the word “should” either stated or implied within them. Questions of value generally cannot be answered through a process of verification or by test; they rely for an answer on what is in your heart. Each of the questions in Table 3-1 were posed because a human service worker had answered affirmatively an underlying related question of value including these: “Is it worthwhile to seek the answer to this question?” “Yes!” “Should we find out the answer to this question?” “Yes!”

Not Drawing a Distinction Between a Question of
Fact and Question of Value Causes Confusion

Another related lesson here concerns the fact/value distinction. Confusing questions of value with questions of fact can lead to unnecessary and unproductive argument. One of the biggest problems in practice arises when we confuse Questions of Fact with Questions of Value. For example, assume that you have a great deal of your efforts tied up in an anger management program, and you value the program immensely because it concerns a matter of importance to you. You are concerned about violence among young people. You believe that such violence must stop. You believe in your heart that the young should treat each other with respect and kindness and that they should learn to manage their anger. Assume further that another practitioner asks the following question of fact related to your anger management program: “If delinquent adolescents in an inpatient facility receive anger management group therapy as opposed to no such therapy, then will the former have lower anger (State Anger Scale scores)?” You might become incensed and hurt that someone would pose such a question. You might say, "Don’t you care about the problem of violence among adolescents? How could you ask such a question?” Your response would then demonstrate confusing a Question of Value with a Question of Fact. The practioner posing the Question of Fact regarding effectiveness might share your values entirely, but still want to know if in fact the anger management program achieves its objective. Questions of Value determine which Questions of Fact we try to answer. On the other hand, Questions of Fact seek an answer to a specific question through a process of guessing and testing. This book cannot tell you which Questions of Fact to pose. This lies in your heart and in your profession’s value base.

Questions Need to Be Posed So They Do Not Imply an Answer

One more lesson about posing questions: All questions need to be posed so they don’t imply what the answer is expected to be. Question wording should imply an objective search for an answer. For example, does this question imply an objective search for an answer: “If hard to place children are adopted into homes of homosexual couples, as opposed to heterosexual couples, then among the former, how much lower will their interpersonal adjustment scores be?” Such a question implies that it must be lower. To be worth our effort, we need COPES questions that are well-built, that are posed as questions of fact, and that are fair and objectively worded.

Hopefully, the questions below will serve as a model for Effectiveness Questions. You may not want to read other than those that pertain to a particular practice area, but they are included here to demonstrate the incredible diversity of important questions that can arise from practitioners.

Some Final Suggestions Regarding Soliciting Questions from Practitioners

These suggestions may make doing this chapter’s exercises easier. These suggestions concern how to approach a practitioner for a question. Because learning how to pose questions regarding practice does not constitute a standard part of education for practice, doing the exercises below will present a challenge. Many practitioners have never seriously thought to pose specific questions about the effectiveness of their methods, nor seriously wondered if there might be a more accurate way to evaluate risk, nor wondered about the inter-rater agreement of persons doing independent assessments. My students report that some practitioners are struck dumb by the almost unworldly event of being asked to help pose a question. They look at the questioner with the stare of a walleyed pike. Be prepared to encounter a blank look or a puzzled tone of voice when soliciting questions from practitioners. Sometimes practitioners assume that if they help you to pose a question, then they are committing themselves to doing a study, and all the inconvenience and time that entails. It may help to assure them that you are only planning a search for the current best evidence and may plan, but not execute, a study.

Do prepare to solicit your question. It will probably help greatly if you review the concepts in this chapter so that you can clarify for others what a COPES question is, what the five question types may be, and which four elements of a question you need to state. Some practitioners, on the other hand, open the flood gates when asked. They spew out many vague questions in rapid succession, mixing questions of value and questions of fact, all in a jumble, and when asked for clarification they insert still more questions and elements of questions. Such gushy cooperation can induce paralysis in a questioner’s mind as effectively can a walleyed look. To counter the open flood-gate problem, try to focus on a single topic of importance; listen carefully and reflect feelings as questions of value come forward; try to solicit COPES questions that include all elements of a well-built question.

 

 

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