Group Protocols

A Psychosocial Compendium

Diane Gibson

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317773177
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

Here is a valuable book intended to help those occupational therapists working in mental health settings to refine their critical thinking about the group activities they select and the protocols they design. Experts focus on practicing sound clinical reasoning and clinical decision making to ensure careful assessment of which activities, structured in what fashion, are appropriate for particular populations. They also address the topic of providing services that are relevant, practical, have already delineated goals and objectives, produce outcome data, and can be replicated across settings. Group Protocols: A Psychosocial Compendium offers readers a systematic approach to the assessment and design of group protocols, plus a wide variety of sample protocols from which treatment strategies may be drawn. Because this volume represents a style of thinking rather than a singular theoretical frame of reference, it will be useful to any occupational therapist for whom groups are an essential aspect of professional practice.

Preface:
Selecting Group Protocols: Recipe or Reasoning?

Susan Haiman, MPS, OTR/L

INTRODUCTION

The health care delivery systems of the 1990s promise to be more demanding of evidence that occupational therapists provide essential services in psychosocial settings. Mandates to demonstrate predictable outcomes, relevance and efficiency require more research around theory and clearer definitions of practice. We can no longer justify reimbursement for occupational therapy by relying on the conventional wisdom. Instead, we must substantiate the efficacy of ‘the various groups and programs we select as tools for intervention. We must take time from routinized methods of program planning to look anew at the use of occupational therapy’s philosophy, domain of concern and theoretical bases for making sound clinical judgements. Refining our use of clinical decision-making and clinical reasoning enables us to determine: which groups best integrate our frames of reference/practice models; which groups are indicated for specific patients; when in the course of illness the groups are appropriate interventions; and in what settings should groups occur, e.g., acute or long term settings.

Using this opportunity to move slowly through the steps in the process of group protocol design or selection allows us to set the parameters within which occupational therapists can use reasoning, not recipes, to enhance practice. Of course, there are critical ingredients common to all groups, but let us take the time to blend them from scratch, rather than taking the shortcut of using a mix!

The first step is to look at group activities as interventions evolving from particular historical and environmental contexts. Next we will look at how to use the process of clinical decision-making, thus producing protocols that truly reflect our critical thinking around the techniques we believe to be effective (Parham, 1987; Pelland, 1987; Mattingly, 1988; Neuhaus, 1988). Finally, a case example will highlight some of the issues addressed in the more theoretical aspects of this paper.

ESTABLISHING THE CONTEXT

It is not the purpose of this editorial to review the history of the role of groups in the era of moral treatment during the nineteenth century, or during the evolution of occupational therapy practice. Suffice it to say, that although patients were engaged frequently in tasks within group settings, it was not until the 1950s that theories of group dynamics and group process emerged, fostering the concept of groups as agents of change in addition to the traditional view of groups as vehicles for social interaction. During the 1950s group activity was used for skill building to enhance functioning. From 1950s to 1970s the focus was on intrapsychic or ego skill building, while in the 1980s the focus is on performance in occupational roles and activities of daily living (Howe & Schwartzberg, 1986; Mosey, 1979; Fidler, 1984).

As we move toward the 1990s, and look prospectively at group activity as a viable intervention, we must consider the environmental context in which our current practice occurs and the environmental context in which future practice will occur. None of us could be strangers to the crisis in health care, as it has had impact on every mental health care delivery system (Fine, 1987; Bonder, 1987), The reality is that resources are diminishing, while costs rise; consumer demands for quality care intensify in the face of increased pressure to shorten lengths of stay. These factors have forced practitioners in acute care settings to consider "re-evaluation of the objectives and methods for short lengths of stay … and rehabilitation interventions to provide basic foundation far post-hospital adjustment” (Fine, 1987, p. 9). Similarly, occupational therapists in longer term inpatient and community settings must re-assess their program goals and objectives in order to assume the task of working with patients who may be increasingly acutely ill, less stabilized on medications, and more chronically impaired than those in past years.

In addition to the impact of increased accountability and decreased resources, what are other environmental factors to bear in mind when designing group interventions? Some critical ingredients to consider include the facility’s loca...

Table of contents

• Cover Page
• Table Of Contents
• Group Protocols: A Psychosocial Compendium
• Group Protocols: A Psychosocial Compendium
• Foreword
• Preface: Selecting Group Protocols: Recipe or Reasoning?
• Group Protocols
• Evaluation and Orientation Services
• Expressive Art Therapy
• Health Management
• Independent Living Skills
• Leisure Services
• Patient Government
• Physical Activity
• Social Competence
• Task Skills
• Vocational Services
• Special Population: Chronic Schizophrenia Rehabilitation Unit