Phase 1: leader composing the group protocol & planning for the group (size, member characteristics, location of meetings).
Orientation Phase
Phase 2: members learn about what the group is about, making preliminary commitment, developing initial connections
Intermediate Phase
Phase 3: developing interpersonal bonds, groups norms, & specialized member roles through involvement of goal-directed activities & clarification of group's purpose
Conflict Phase
Phase 4: members challenge the group's structure, purpose, and/or processes; characterized by dissension & disagreements among members.
Unsuccessful resolution=dissolution of the group
Successful resolution=modifications to the group that are acceptable to members, enabling the group to proceed to the next phase
Cohesion
Phase 5: members regroup with a clearer sense of purpose & reaffirmation of group norms & values; leads to group stability
Maturation
Phase 6: members use their energies & skills to be productive & achieve group goals
Termination
Phase 7: dissolution, due to lack of engagement, inability to resolve conflict, administrative constraints (only 4 sessions allotted for D/C planning group), goal attainment, or task completion.
Group Roles (3)
Describe the patterns of behavior that are typical within groups
1. Instrumental roles: functional & assumed to help group select, plan, and complete the group's task (initiator, organizer).
2. Expressive roles: functional & assumed to support & maintain the overall group & to meet member's needs (encourager, compromiser)
3. Individual roles: dysfunctional & contrary to group roles, serve an ind. purpose & interfere with successful group functioning (agressor, blocker).
Group norms-Therapeutic norms
1. Encourage self-reflection, self-disclosure, & interaction among members
2. reinforce value of being on time & well prepared
3. establish atmosphere of support & safety
4. maintain confidentiality & respect5. Regard group members as effective agents of change; don't place group leader in expert role
Establishment of _______, ______, ______, ______ are priority in all group situations
norms, safety, confidentiality, respect
Group cohesiveness
degree in which members are committed to a group & extent of members' liking for the group
sense of we-ness
Directive leadership styles
therapist is responsible for the planning/structuring
cognitive, social, verbal skills, engagement are limited
parallel or project group
select act.to be used
clear verbal/demo to complete task
provide maintenance & feedback
leader's role is task accomplishment
Facilitative leadership
therapists shares responsibility
members' skill levels of engagement are moderate
ego-centric-cooperative or cooperative
collaborate with members to select act.
share instruction
maintenance & feedback by members with leader facilitating process
Leader's role is to have members acquire skills through the expereince
Advisory leadership
therapist is resource
members set the agenda, structure
members skills & engagement are high
members select & complete act. with advice from therapist
maintenance roles indepent by members
feedback occurs as natural part of the groups self-directed process
Therapists goals is to have members understand & self-direct the process
Medicare indicators for group membership
engage willingly in group
attend to group guidelines/procedures
actively participate
benefit from group leadership input
benefit from group membership/peers input
respond appropriately
incorporate feedback
complete act. toward goal attainment
greater benefit from group versus 1:1
Medicare criteria for group leadership
provides active leadership
instructs
monitors & documents participation & response
provide ind. guidance & feedback
document ind. progress toward goals
Altruism
giving of oneself to help others
catharsis
relieving of emotions by expressing one's feelings
universality
recognizing shared feelings & one's problems are not unique
existential factors
accepting the fact that the responsibility for change comes from oneself.
self-understanding (insight)
discovering & accepting the unknown parts of oneself
family reenactment leads to
understanding what it was like growing up in one's family thought the group expereince
guidance comes from
accepting advice from other group members
identification invloves
benefiting from imitation of the positive behaviors of other group members
instillation of hope is
experiencing optimism through observing improvement of others in group
interpersonal training occurs when
receiving feedback from members regarding one's behavior (input)
interpersonal learning occurs by
learning successful ways of relating to members (output)
Evaluation Group
Purpose: enable client & therapist to assess client's skills, assets, & limitations regarding group interaction
Assumption: one must observe the ind. in setting where skills can be observed
Type of client: all ind. who will be involved in groups or lack group interactions skills
Role of therapist: 1) selects & orients memb. to purpose 2) selects act. require collaboration & interaction & provides supplies 3) doesn't participate or intervene (except for safety) 4) observes, reports
5) asks for clients input 6) validates assessment & establishes tx goals with each ind.
Activities: tasks completed in one session & requires interaction to complete
Thematic Group
Purpose: assist members in acquiring knowledge, skills, & attitudes needed to perf. specific act.
Assumptions: 1) improvement of ability to engage outside the group results from teaching act. in group 2) learning is facilitated by practice & experiencing needed behaviors, with reinforcement of app. behaviors
Type of client: 1) Det. by specific goals of the group 2) needs, concerns, goals must match objectives of the group 3) must have min. group interaction skill level PARALLEL GROUP
Role of therapist: 1) select, structure, grade act. to teach needed skills
2) range from highly structured to advisor
3) reinforce skill dev.
Activities: simulated, clear, structured act. to enable members to practice & learn needed skills, attitudes knowledge
act. directly related to needed skills-Cooking group to learn how to cook
Topical Groups
Purpose: discuss act. members are engaged in outside of group to enable them to engage in more effective, need-satisfying way
1) Concurrent topical groups-already engaged in (parenting skills group)
2) anticipatory-expected to be done in future (D/C planning group for ind. completing short-term rehab)
Assumptions: 1) improvement of ability to engage in specific act. outside group result from discussion of these act.
2) discussion of problem areas & potential solutions facilitate skill aquisition
Type of client: 1) ind. share current or anticipatory problems in functioning
2) Ego-centric-cooperative group
3) Sufficient verbal, cognitive skills to engage in discussion & problem-solve
Role of therapist: 1) facilitate group discussion
2) help members problem-solve, give feedback & support, reinforce skill aquisition
3) share leadership with members; act as role model
Activities: 1) verbal discussion on circumscribed act. that members are engaged in or will be (parenting, homemaking, D/C from hospital, work, leisure)
2) discussion of fears, problems, solutions, coping
3) role play & homework
Task-oriented group
Purpose: 1) increase ind. awareness of their needs, values, ideas, feelings, & behaviors while engaged in group task.
2) improve intra-and interpsychic functioning by focusing problems which emerge in the process of choosing, planning, & implementing group activity.
Activities: 1) short-term, participation 2 or more ind.
2) shareable, requires interaction to complete
3) group interaction, not project completion is emphasized
Egocentric-cooperative group (developmental)
Level 3
Purpose: 1) enable members to select, implement long-term act. which requires group interaction
2) meet needs of themselves & others (safety, esteem)
Role: 1) less active, direct leader
2) facilitate allow ind. to fullfill leadership roles to fun. independently
3) provide guidelines & assistance if needed
4) reinforce meeting needs of self & others
5) serve as role model
Activities: 1) 5-10 people to work together
2) selected, implemented by members
3) long-term, more than 2 meetings to complete
Cooperative Group (developmental)
Level 4
Purpose: 1)allows free expression & ideas
2) develop trust, love, belonging, cohesion
3) identify & meet socio-emotional needs
Role: 1) advisor
2) leader & members mutually responsible for giving feedback, identifying & meeting needs, reinforcing behaviors
Activities: 1) allow/facilitate free expression of ideas & feelings
2) act. secondary to need fullfillment & may not produce end product
Mature Group (developmental)
Level 5
Purpose: 1) assume all fun. socio-emotional & task roles
2) members reinforce behaviors which result in need satisfaction & task completion
Role: 1)acts as peer, equal, group member
2) members assume all roles, therapist only filling in if needed
3) all members satisfy needs & reinforce behaviors while maintaining balance btwn need satisfaction & task completion
Activities: 1) number of people working together
2) requires end product or time limit
3) act. may be stopped to explore what is going on within the group
Instrumental Group
Purpose: 1) help members fun. at highest level as long as possible
2) meet mental health needs
Assumption: 1) ind. at highest level, cant change/progress
2) supportive, structured env. which provides app. act. can prevent regression, maintain function, & meet mental health needs
Client: 1) ind. who have demonstrated in tx inability to change/progress
2) Ind. cant ind. meet their mental health needs &/or assistance to maintain function due to cognitive, psychological, perceptual-motor, &/or social deficits.
2) select, design act. meet health needs & maintain highest possible fun.
3) assist as needed
4) make no attempt to change client
Activities: 1) successfully complete act. with structure, & assistance as needed
2) non-threatening, non-demanding
3) interesting, enjoyable, attractive
4) meet mental health needs enable to exp. pleasure, fun, & socialize with others
5) maintain fun. with sensory, cognitive, perceptual-motor, & social act.
Group used to acquire the knowledge & skills to perform a specific occupational performance "active doing"
Thematic Group
Group members discuss act. that they are engaged in outside of the group
Topical group
group with a psychodynamic frame of reference used to increase intra & inter psyhic function.
Task-oriented groups
Group where activities are selected to help members examine their behaviors to increase self-understanding
Task-oriented
Group used to prevent decline, maintain function, promote well-being.
Instrumental
Group used for those with chronic conditions with residual or progressive symptoms where the activities don't remediate rather they are in the moment, enjoyable, and help with QOL
Instrumental
Purpose of this group is to evaluate group interaction skills
Evaluation group
Leadership where therapist is responsible for structuring, planning most of what takes place in group
Directive
Leadership style in acute inpatient psyhchitric unit
Directive
Leadership style when therapist shares responsibility for the group & group process
Facilitative
Leadership style in psychsocial clubhouse
Advisory
leadership style where therapist functions as a resource, members set agenda & structure the group
advisory
Leadership style in vocational rehab
facilitative
Type of developmental group in acute units
parallel or project
Types of developmental groups in community-based setting with stable population & extended stay
3. limit movement/transport, mask pat. when leaving room
Contact precautions
1. isolation room
2. wear gloves when entering, remove prior to leaving, wash hands
3. wear gown, remove prior to leaving
4. single pt. use of equipment
5. limit movement/transport, precautions when leaving room
What is used for comparative analysis of an individual's score
norms
Ind. characerists must meet the characteriscs of the population
if client is diff. from "normed" populaiton, interpretations would be inaccurate
Measures the assessment's accuracy to determine if the tool measures what its intended to measure
Validity
Establishes how well the assessment appears "on the face of it" to meet its stated purpose
(an activity configuaration looks like it measures time use)
Face validity
establishes that the content included in the eval is representative of the content that should be measured
(does the content of a role checklist provide adequate listing of roles)
Content validity
Compares the measure to another established tool
Criterion validity
Concurrent-compares results of 2 instruments given at same time
Predicitive-compares degree to which an instrument can predict pref. on future criterion.
Reported as a coorelation & higher the coorelation, better the _________ validity.
Criterion Validity
Establishes the consistency & stability of the evaluation
Reliability
Reliability is either scored as a _________ or ___________ to identify the degree to which the two items agree/relate
correlaiton or percentage
Produce scores that compare ind. perf. to a set population's perf.
Norm-referenced
Provide scores that compare the ind. perf. to a pre-established criterion
Criterion-referenced
Intervention used to reduce the incidence/occurance of a disease/disorder within a population that is currently well or considered to be at risk
Primary Prevention
Intervention for parenting skills class for teen parents to prevent child neglect or abuse
Primary Prevention
Prevention: early detection of problems in a population at risk to reduce the duration of a disorder/disease and/or minimize its effects through early detection/diagnosis, early appropriate referral, and ealry/effective interventions
Secondary prevention
Screening for infants born prematurely for developmental delays & immediate intervention for the delays
Secondary prevention
Prevention: Elimination or reduction of the impact of dysfunction on an individual
Tertiary prevention
Prevention for the provision of rehab services to maximize community participation
Tertiary
AOTA practice framework __________ __________ is used to designate interventions that address the needs of ind. with or without disabilities who are considered at risk for problems with occ. perf.
disability prevention
OT tools of practice
1. Occupation-goal directed, ordinary/familiar
2. Purposeful act.-goal-directed tasks that make up occupations
3. Activity/Task analysis-breaking down
4. Teaching-Learning Process-OT designs experiences to help ind. gain knowledge & skills for living
5. Clinical reasoning-complex mental process OT uses when considering the client in relationship to context, disability, social, cultural
6. Therapeutic use of self-conscious,planned use of one's personality to interact with ind. & family
7. Group process
_______ prevention is concerned with promoting wellness & maintaining health
Primary
If level of prevention is not indicated on test question, primary prevention is the likely answer
T/F Primary prevention is concerned with remediation
F
In _________ prevention OT would develop violence prevention program for school. What types of interventions? (2)
Primary
Conflict resolution & assertiveness training
Interventions related to occupations & purposeful activities must be __________, ____________, ___________, _____________.
goal-directed
meaningful
task-oriented
role-related
_________ _________ are the expected & accepted behaviors in a group. Ex: Inds. in the group wait to eat before everyone is served, don't smoke during group, & they all clean up.
Group Norms
A _______ _________ outlines the group's membership criteria, goals, and activities
Group Protocol.
_________ are implemented only in a group if members' behaviors call outside the group norms & are considered deviant
Sanctions
Altered task method
uses same objects in same environment but task is altered to make task more feasible for ind. who has certain injury/disability such as using one handed technique to tie shoes.
Motivational enhance therapy
avoids opposing client or arguing for change
rolls with it versus opposing resistance directly
resistance is sign that OT needs to act differently in responding to client
when resistance decreases, then OT can explore ind. feelings toward change
