week 5: Developing a Group Program

Effective Leadership

This means developing the skills for a variety of group situations. Be prepared to use observation and multiple approaches within the group, and switch them when needed.

Activity

Dynamics between members and

Interaction between leader(s) and members

6 steps to Professional (therapeutic) Reasoning 

1. Generating questions about the person/population

2. Gathering info about the person/population

3. Using information to create theory-based explanation of person/population

4. Generating goals and strategies

5. Implementing/monitoring therapy process

6. Assessing outcomes

were goals acheived

The Red Thread: Professional Reasoning in OT

What makes group therapeutic?

What makes it OT reasoning, rather than SW reasoning, or Therapeutic Recreation reasoning, or…PT?

How do we articulate it all to others?

Professional Reasoning aka clinical reasoning aka therapeutic reasoning

Terms describe the process that practitioners use to plan, direct, carryout, and reflect on interventions and care provided to clients (Boyt-Schell in W&S, 2014)

Refers to how therapists actually think which requires a metacognitive understanding---it does not describe what practitioners “choose to do” nor does it describe theories/models/FoRs (Boyt-Schell in W&S, 2014)

Population Assessment

Promotes collaboration with potential people and key stakeholders and collects background information

Can you accurately describe the intended population for the group? How have you familiarized yourself with the population?

Are you able to accurately describe the setting/level of care where the group will take place? How do you suppose that will impact group delivery?

What (issues/topics/tactics) are you skillfully attending to as you design a group for that setting/level of care?

started here

Group Protocol -akin to treatment plan

A written plan that outlines the goals of a group and the methods by which goals will be addressed and achieved.

Think of it as the clinical reasoning backdrop or the justification piece that supports the session plan. It will explicitly note the integrated chain of logic or “red thread.”

An exercise in CREATIVITY and PROBLEM SOLVING

Group Protocol

Provides a framework for the entire group program.

Developed based on population or group needs and evidence.

Establishes the long-term goals

If the original leader cannot run the group, a new person uses the protocol to help plan and run the group in their absence.

This is a living document and will likely need to be reformulated periodically.

Used to create documentation process

Intervention (therefore Facilitation) is about the GOAL

The group program, the session plan, the process, the monitoring and response to the dynamics and the interpersonal events, are all done to facilitate successful goal achievement.

Every session must start with a goal.

The anatomy of a Group Protocol

Goals are the specific actions that the individuals in the group are expected to be able to do, that they cannot do now, when your group is concluded.

These goals are a direct reflection of the barriers you identified to the Role Tasks

Protocol goals will lead directly to the outcomes you identified in your population assessment.

Goals are observable and measurable.

Goals address barriers – those tasks they can’t do it now because of condition, stigma, socioeconomic status, lack of knowledge, etc. (Would it be a goal if you can do it?)

Goals are not activities “Learn how to…” They are what people will do when the learning and practicing and incorporating (the therapy) is all done.

Goals for open groups are different than closed groups.

Goals are dependent on your facility and the kind of group you are running (open or closed).

Parts of a Goal

1. The action, task, behavior, skill, ability, that the group or members do not have now that they will have when you are done with therapy!

2. Any conditions that might be in place as the participants work through the goals.

3. The criteria – what do you have to observe to know they have made a change?

   •No Target dates needed for protocol goals. 

Reflecting Medical Necessity in Goals

Until we are able to articulate the positive relationship of social interaction and healthy participation to physical health we will need to attend to this requirement in individual goals for people with Medicaid and Medicare.

However, your group protocol is not part of the legal record

The rest of the protocol

Name – Name it something attractive . Be creative here so that people are comfortable saying they are going to your group.

Rationale – explain the purpose – draw this from your work in the pop assessment. Consider it an advertisement for your group. Write if for people who might refer members, or to the members themselves.

Frequency and length – include if open or closed here. Total number of sessions. This is not the length of your simulation. This is the length that you think you will need to get goals met and have good therapy sessions.

Meeting space – you can create this for your needs.

Goals – must reflect the objectives…

Group composition – who is this for?

Staff – this is you. If you are working with another discipline, then add them as leaders. If you plan on bringing them in as guest, that goes later.

Roles – this is considering co-leadership. Include setting up the group, as well as running it.

EBP – support the goals and activities. Bonus if you find something with groups in it.

Group methods. Here do a rough outline of Coles steps – go ahead and combine them as we did in the PowerPoint. Then list some of the activities in the warm up and activity section. Discuss how you might process, generalize and apply the content given your population. Include guests in this section (dietician, PT for ?). Put in timings here. This will serve two purposes – 1 as a general guide for your sessions, and 2. for your referrers and potential participants to know what to expect.