Writing a Group Protocol Cole Chapter 11 Somaya Malkawi, PhD November 24, 2011.

Writing a Group Protocol

Cole Chapter 11Somaya Malkawi, PhDNovember 24, 2011

Purpose of a Group ProtocolOrganize factors of effective group plan Sell the plan to administrators/managersCommunicate the plan to treatment teams or other professionalsCommunicate the plan to referral sourcesServe as guideline for funding and budgeting for supplies, space, etcGuides session interventions for OT or others

Population Choice

Interest areaFieldwork experiencePersonal experience with disabilityCase studies, fictional worksVolunteer experiencesCuriosity about unfamiliar populationsMay involve some initial research/reading

Population in the settingWorksheet 11-1

Goal: Familiarize self with population chosen for group protocol assignmentIn lieu of needs assessment for student learningStep 1: Identify nearby clinical settings Identify possible resources Use personal connections or experiences Make initial contact with OT or other supervisor

Purpose: Reality checkMay change to match other areas of protocol

Client CharacteristicsYour descriptions are approximate, not exactCriteria for admission to center/programAge range, male/female/both Health conditions and approximate percentages Clients' education level and socioeconomic status (average or range)Occupation/work status

Predict Rehabilitation Potential

Approximate level of cognitive functioning (high, medium, low) Describe physical limitations (acute or chronic)Verbal ability/interaction potential Desired outcomes for program as a whole

Social and Cultural Context

Describe the context where a group intervention would occurFacility’s mission Criteria for admissionFunding source(s)Staff disciplines (members of the treatment team)Staff/client ratioTypes of interventions offeredFrame of reference (if known)

Needs Assessment Your first step as a new therapist in any settingNecessary for a client-centered approachSteps: (use at least two methods) 1. Gather background data 2. Do a survey 3. Use secondary data 4. Analyze data

Needs Assessment, cont. 1. Gather background data:

From supervisor/person who hired you From textbooks, internet, other resources Learn all you can about client population,

health conditions 2. Identify participants for a survey:

Written survey (1 page maximum) Face to face interviews Telephone interviews Key informants Focus group

Needs Assessment, cont.

3. Use secondary data Other OTs or professionals (former or

current) records or reports Volunteers or fieldwork students past

experiences, reports Purpose: Learn what has worked in the

past Don’t repeat past errors

Needs Assessment, cont.

4. Analyze the data: Summarize results of survey Consider opinions of other professionals Compare with OT approach to determine

relevance Consider interests, preferences, and

goals of potential clients Make own judgment as to the best

strategies for OT group interventions or programs

Select a Frame of Reference

Consider Contact setting’s frame of reference Health conditions being addressed Functional areas being addressed Function-dysfunction continuums Mechanisms of change Evaluation and intervention methods

that will work best with chosen population

Frame of Reference, cont.

Bring the chosen “F.O.R.” and explain why you chose them Factors to consider: Definition of function/dysfunction Motivational issues Functional goals Intervention time frame Intervention options

Framework Domain Worksheet

A. List 10 areas of the occupational therapy domain that your clients may want or need to work onYou may choose from any of the domain categoriesSome overlaps may occur as you consider different categories

Framework domain, cont.

1. Performance in areas of occupation includes: Activities of daily living, instrumental activities of daily living, education, work, play, leisure, and social participation2. Performance skills include: Motor skills, process skills, and communication/interaction skills3. Performance patterns include: habits, routines, and roles

Framework Domain, cont.4. Seven contexts are specified: Cultural, physical, social, personal, spiritual, temporal, and virtual5. Activity demands are listed as follows: Objects used and their properties, space demands, social demands, sequencing and timing, required actions, required body functions, and required body structures6. Client factors are specified as: Body functions, and body structures. This aspect includes both mental and physical functions or capacities

Framework Domain, cont.B. For each areas listed, choose one of these

five intervention approaches: 1. Create, promote (health promotion) 2. Establish, restore (remediation,

restoration) 3. Maintain 4. Modify (compensation, adaptation) 5. Prevent (disability prevention)

Write a statement using one of these for each of your 10 areasExample: Use positioning strategies to prevent muscle fatigue or injury while performing repetitive hand movements

Framework Domain, cont.

C. Define the scope of your intervention and discuss reasons why this scope is appropriate for your client populationExample, sessions might include: Several IADLs, such as child rearing, home

establishment and management, shopping, meal preparation and cleanup, and care of pets

Focus may be modifying the activity demands for only one of these areas, such as meal preparation and cleanup, for all six sessions

Identifying the scope affects goal selection and interventions for the session outlines

Group Protocol Outline

Group titleAuthorFrame of referencePurposeGroup membership and sizeGroup goals and rationaleOutcome criteriaMethodTime and place of meetingSupplies and costReferences

Protocol Outline Steps

Title for series of sessions: Suggests purpose Suggests strategies Does not identify diagnosis No negative stigma Catchy and memorable

Examples: “your kitchen” (adaptive skills training for persons recovering from a stroke); “Combat training” (sensory integrative exercises for boys with ADHD)

Protocol Outline, cont.

Author: Amaal Edwan, OTR

Frame of reference: Brief summary of frame of reference and why chosen for this population

Example from Developing Cultural Competence Group: “A cognitive behavioral frame of reference is chosen because it encourages students to examine their own thinking process regarding cultures of self and others. This frame of reference teaches students to use reasoning to question and dispute some of their beliefs regarding cultures different from their own”

Outline: Purpose

Purpose: The group's general intent. Overall goals of the group should be stated, as well as the general nature of the activities to be usedShould be short, preferably no longer than three sentences summarizing the overall scope of the group planExample: the purpose of a leisure planning group might be “to assist clients whose disability requires a loss of the worker role, to identify and plan for leisure activities to meet their social and emotional needs. Clients will complete written exercises, participate in group discussions and plan and carry out individual leisure activities as part of group requirements”

Outline: Group Membership and SizeBased on client population worksheetGeneral diagnostic factors, factors like age, functional level, gender and role identity might be includedFor purposes of referral, both inclusionary and exclusionary criteria should be described Inclusionary criteria describes characteristics

which are appropriate for your group Exclusionary describes characteristics which

are not appropriateSize: Students should plan for 3 to 8 members in a closed group format

Outline: Group Goals and Rationale

Goals are derived from the Intervention domain worksheetList 3 to 8 overall goalsBehavioral goals should be observable and measurableGoals and sessions may not be an exact match Several sessions may work on same goal Each session may work on several goals

Outline: Goals and Rationale

Rationale: Explains why goals were chosen. Client population issues Inherent limitations or dysfunctions Evidence based research if available

Limitations: When might a goal NOT be appropriate? How might group be adapted?Precautions: What client safety issues need to be considered?Adaptations: Applications of group for other populations, and/or alternative strategies

Outline: Outcome CriteriaDesired results of the group should be stated in behavioral terms. These reflect the goals stated earlierDevelop a measurable way to demonstrate the effectiveness of the group to the client, the administrator and to those responsible for payment of servicesSpecific procedures should be outlined, such as a pre- and post-questionnaire or a pre-post rating scale for each clientAttach an appropriate assessment tool:

Adapt an existing evaluation specifically for the group offered Most students will need to create their own outcome rating

sheet

Outline: MethodMedia Used and Leadership Style

MediaLeadership style

Outline: method, cont.Leadership style depends upon Frame of Reference:

If a psycoeducational format is used, the therapist may include short lectures on skills to be learned (see handout for example)

The therapist's frame of reference will determine the type of introduction and explanation given to clients during each session

The group protocol should reflect a consistent frame of reference

Examples: If a psychoanalytic or developmental or cognitive behavioral

approach is used, more emphasis may be placed on group interaction (facilitative)

Cognitive perceptual, cognitive disabilities, or sensorimotor groups for lower level clients require more structured environments with carefully planned therapist assistance (directive)

Outline: Time and Place

Time factors described: For the purposes of this assignment, the time

will be limited to six sessions of 1 hour each

The scheduling of sessions will vary according to the intervention setting. Chronic settings will accommodate weekly sessions. Acute settings may require daily meetings

The length of sessions will vary with client attention span and type of activity chosen

Outline: Time and Place, cont.Ideal place for group meetings may be created for this assignmentThe following environmental factors could be included:

Size of room Contents—Tables, chairs, cabinets, sink, etc Lighting, windows, visual factors (bare walls or more home-

like) Door opened or closed Noise factors (not next to gym or bathroom) Accessibility of medical assistance—Special telephone

equipment needed, if any (kitchen for cooking activities) Availability of assistance from therapist Safety factors

A good room description will take into consideration Characteristics of the client population chosen Activities to be included

Outline: Supplies and CostList materials and supplies needed for all sessionsTheir total cost is summarized here Assume that copies of forms and paper and pencils or pens are generally available in most settings at no costIf specific items such as videotapes or assessment materials are to be used, the name and address of the source of these should also be listedThis section is more easily done after specific sessions are outlined

Outline: ReferencesList all references that were used to create the material for the group sessions, including short lectures, forms to be used as work sheets and other copyrighted materialsReferences should use the format of the American Psychological Association (2001):

Books: Author, date, title, publisher, place of publication Articles: Author, date, title of article, journal name,

volume, and pages Materials: Name of item, (such as videotape, if used)

name and address of source, company, center or hospital, telephone number and approximate cost

All references for sessions may be summarized here

The End

Format for protocol outline: Protocol outline and session drafts

may be handwritten on worksheets in group dynamics book (please bring to lab on due dates)

Final protocol will be reworked on computer using outline headings, printed, and handed in the end of this semester

GROUP PROTOCOL PREPARATION CHECKLIST

____: ( ) Population Worksheet (come prepared) ____: ( ) Needs assessment (bring to class)____: ( ) Frame of Reference (bring to class)____: ( ) Framework Domain Worksheet (bring to class)____: ( ) Session Outlines____: ( ) Final Submission of Group Protocol is due____ Demonstrates thoughtful pre-planning of protocol ____ Contributes to discussion of progress at each stage ____Asks appropriate questions ____Holds realistic view of population chosen ____Demonstrates knowledge of evidence on effective interventions with population chosen