Chapter 6 2 Describe strategies to manage and facilitate group process. 3 Write long-term and short-term goals for groups. 4 Identify the key components of goals. The group frame of reference and the leadership style are determined by the clients’ needs and characteristics. As previously discussed, there are different types of group structures: open, closed, continuous, and time-limited groups. In open groups members may be heterogeneous, change frequently, and have diverse abilities; therefore, cohesiveness among the members is low. The open group sessions focus on autonomous short-term goals associated with general outcomes in a particular area such as the acquisition of skills. For example, open groups are offered in acute inpatient psychiatric units where there is a high turnover of patients. In this setting, the changing membership creates challenges such as the level of trust among members and practitioners’ lack of opportunity to meet and assess members before they attend a group. In contrast, a time-limited group, such as a psychoeducational group, usually has closed membership once the program has started, and new members are admitted when a new psychoeducation program is started. These groups have members who are homogeneous (similar characteristics—e.g., diagnosis, problem, or age) and the length of the program is a predetermined number of structured sessions. The long-term goals are clearly delineated and sessions are sequentially organized to facilitate change in behavior or acquisition of knowledge and skills. An example is a community-based psychoeducational stress management group based on a cognitive-behavioral therapy frame of reference, with 10 weekly sessions, in which there are explicit criteria for members, such as diagnosis or gender (e.g., women with children diagnosed with anxiety disorder). However, irrespective of the group type, core principles apply to the development of a group program, the planning of a group session, and the facilitation of a group session. This process starts with assessing the needs of the target client population and selecting the type of group intervention based on the evidence of best practice. In this section, the process of developing a group program is outlined in three stages. These are the preplanning needs assessment and proposal stage, the development of a group program, and finally designing individual sessions. The initial stage of determining whether a group-based intervention is the optimal occupational therapy service to meet the clients’ and organizational needs begins with a practitioner asking and answering critical programmatic questions. These questions are designed to identify the research evidence to support the proposed group program as the most effective intervention to meet the targeted clients’ needs and to determine if the proposed program is feasible within the organizational infrastructure in which he or she is employed. The Preplanning a Group Program template (Box 6-1) provides a list of questions a practitioner must address in the process of determining the group intervention to be offered. Working systematically through the template yields the necessary data for making a programmatic decision about providing a group intervention as part of occupational therapy services before moving forward and investing time and resources in stages two and three. It also is the basis of a proposal for a new service initiative that will be submitted to either a funding source or administration for resources or as a tool to review an existing program. Although this stage may seem time consuming, especially if the decision has been made to provide a group intervention, it should still be completed. It ensures that the type of group program developed will meet the clients’ needs, be based on the best practice model, and have the necessary resources to deliver the service, and will therefore meet our ethical responsibility to “use, to the extent possible, evaluation, planning, intervention techniques, and therapeutic equipment that are evidence-based and within the recognized scope of occupational therapy practice.”1 The process and the core elements of planning a group intervention are generic in that they follow a common structure. Taking the time to create an overall program plan leads to a logical development of clients’ skills or a successful process of change, coherent delivery of information, and therapeutic outcomes being met. Therefore, when the decision has been made to provide a group intervention based on the data gathered in the preplanning stage, the next step is to develop systematically a group program that involves outlining the purpose, writing the long-term goals, determining the sessions that will be offered, identifying materials and evaluation methods, and meeting the practicalities of offering the group program. An inexperienced practitioner may be tempted to jump straight in to planning the individual sessions. The results will be poorly articulated goals and a lack of coherence among the group sessions designed to meet the long-term goals. Box 6-2 provides a template for the practitioner to work through this planning process and an example is provided in Chapter 9, “Groups for Adolescents.” Short-term goals define the desired outcomes of a single session and do not always depend on all members having attended previous sessions. Time-limited groups are more likely to be interrelated and require a progression from one group to the next, whereas in open groups with a fluid membership it is important that the sessions are more discreet entities in which the short-term goals can be attained without previous group attendance. However, in all groups the purpose of the individual sessions is to move members forward to achieving the long-term goals while also presenting achievable immediate outcomes specifically related to the current group activity. Similarly, they need to accommodate clients’ different rates of progress. In addition to the group goals, it is common for clients to have individualized goals that are integral to their occupational therapy intervention plan (see Chapter 7). Writing Group Goals: Long-term and short-term goals are structurally the same.9 The wording and the order of the components of a goal may differ from practitioner to practitioner or among settings, but goals always have four mandatory components and a component that is usually present, though not essential. The mandatory components are: Subject or Actor—The subject or actor specifies who will do the behavior (e.g., Group members will. . .). Behavior or Skill—Group members will develop, practice, or modify a behavior or skill through the group intervention to participate in their occupations successfully or to enhance their occupational performance in their natural context. A behavior is not a single action performed solely in the group session; it must be transferrable to the clients’ occupational performance beyond the group.
Managing and Facilitating Groups
The Fundamentals of Group Development and Management
Development of a Group Program
Planning Group Program
Group Goals
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Managing and Facilitating Groups
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