Chapter 4: Groups and the Occupational Therapy Framework

Introduction to Groups in OT

• Groups defined as "collective of individuals" in the Framework

• Group intervention involves skilled leadership techniques

• Facilitates learning and skill acquisition across lifespan

• Promotes social interaction and participation

• Essential for achieving full participation, meaning, and purpose

Types of Groups in Healthcare Settings

• Groups of Individuals (2-6 clients- Medicare guidelines)

  • Common problems/disabilities/goals- Coles 7 Steps are meant for this

  • Individual goals serve as outcome measures

  • Active participation in task selection

  • Benefits: increased practice, socialization, encouragement, support from other clients, and the opportunity to work with various therapists

• Family Groups and Context

  • Family-centered parallel to client-centered care

  • Requires expertise in family group dynamics

  • Fundamental Interpersonal Relations model states that individuals have three interpersonal needs:

    • Inclusion

    • Control

    • Affection

• Caregiving and Educational Teams

  • Includes professionals, caregivers, family members

  • Examples:

    • School system teams for children with autism

    • Nursing home staff for dementia care

  • OT practitioners may take leadership roles

  • Focus on occupational performance issues

  • Evidence shows pt/caregiver education for cases of dementia improves:

    • Quality of life

    • Occupational performance

    • Self-efficacy and well-being

    • *of ALL parties involved

• Organizations in OT Practice

  • Defined as entities composed of individuals with a common purpose such as in:

    • Businesses

    • Industries

    • Agencies

  • OT consultants use group leadership to:

    • Identify problems

    • Educate on evidence-based interventions

    • Develop intervention strategies

    • Enable structured occupations for targeted outcomes (e.g.- fundraising, mentoring)

• Community Groups

  • Groups with common occupational issues that affect them (e.g.-intellectual disabilities)

  • Examples:

    • Group homes

    • Adult day care programs

  • OT evaluates group as whole & plans group interventions for targeted outcomes

  • Uses shared activities to address the group as a whole:

    • Meal preparation

    • Home maintenance

    • Leisure participation

• Population-Based Groups

  • Populations share locale or characteristics

  • Examples:

    • City/state residents (e.g.- the residents of Hattiesburg, MS)

    • Groups with similar concerns (e.g.- people w/DM2 Dx in USA)

  • OT designs interventions for whole populations

  • Focus areas:

    • Wellness programs (e.g.- for seniors living in ALF)

    • Community enhancement (e.g.- community center as “client”)

    • Quality of life improvement (e.g.- for underserved people like disabled veterans)

Framework Domains in Groups

• Six interrelated categories:

  • Occupations- 9 areas

  • Client factors- Values, beliefs, spirituality, body functions, body structures

  • Performance skills- Motor, process, social interaction skills

  • Performance patterns- Roles, routines, habits, rituals

  • Context and environment- Personal, External environment, support/relationships, Services & systems

  • Activity demands- What does it take to “do an activity”

Virtual Context in Group Practice

• New addition to OT domain that includes:

  • Chat rooms (now- “social media”)

  • Email

  • Video conferencing (e.g.- Zoom)

  • Remote monitoring

  • Applications:

    • Virtual reality programs

    • Gaming platforms

    • Social networking

Social Support in Groups

• Three types:

  • Practical (tangible assistance- leads to client dependence)

  • Informational (resource guidance- medical info, support groups)

  • Emotional (validation and belonging such as AA)

• Reciprocal process (sharing between members)

• Essential for occupational engagement & builds community connections

Measuring Group Outcomes

• Social Profile Assessment Tool (Donahue)

  • See examples in Table 4-2, Pg 116

  • Measures five levels of group participation:

    • Parallel

    • Associative

    • Basic cooperative

    • Supportive cooperative

    • Mature

  • * Participation levels are dynamic and change depending on goal

  • Evaluates:

    • Activity

    • Group interaction

    • Leadership

Healthcare Team Approaches

• Multidisciplinary

  • Separate roles

  • Coordinated care plans

• Interdisciplinary- the MOST common type of team in therapy!

  • Shared assessments (regular communication a factor)

  • Collaborative planning (shared responsibilities)

• Transdisciplinary

  • Blurred roles

  • Rotating leadership

Key Competencies for OT Practitioners

• Team participation skills:

  • Cooperation

  • Collaboration

  • Communication

  • Integration

• Leadership capabilities

• Client advocacy

• Family/caregiver inclusion- ALWAYS including our clients as active members of the team!

• Continuous care coordination (always present/dynamic)