Different types of Intervention groups in

occupational therapy, Implementing

intervention group, Developing group
protocols

By - Satabdee Prusty, MOT 1ST Yr

Guide - Ms. Shubhangi, Assistant Professor
• Group interventions in OT provide opportunities to develop task skills and interpersonal
interaction skills (Mosey, 1973) that would be difficult to develop through interventions directed at
the individual.
• Groups used in OT intervention typically fall into four categories: functional groups, activity
groups, task groups, and social groups (AOTA, 2014)
• Groups are planned based on the purpose or goal of the group and include,
for example: psychoeducational groups, social skills groups, activities of daily living groups,
reminiscence groups, leisure groups, and sensorimotor groups,
INTERVENTION GROUPS IN OCCUPATIONAL THERAPY
Why OT practitioners use group intervention in their practice ???..

According to Schwartzberg et al. (2008);

• Groups provide an occupation-based experience that is reality-oriented and that promotes

adaptation.

• Groups are a natural environment that can provide feedback and support for individual and social
needs

• Through participating in group activities that promote growth and change, members can learn and
practice skills to master and achieve competence in activities required for daily life.

• When groups provide an opportunity for dealing with real-life issues and objects, people can
maintain, improve or enhance their occupational nature to fulfill social demand (p. 39).
DIFFERENT FORMS OF INTERVENTION GROUP

• Client-centered groups
• Developmental groups
• Task groups
• Activity groups
• Functional groups
 Client-Centered Group

• It is based primarily on the humanistic approach to mental health care.

• Client-centered groups facilitate client self-expression, identification of strengths

and weaknesses, prioritization of problem areas, identification of goals, awareness
of options and choice, and exploration of the impact of context on occupational
performance and participation (Cole, 2012).

• It can help with Anxiety, Dementia,Depression, Mood disorder, PTSD etc..

Client-centered therapy operates according to 3 basic principles that reflect the attitude of the
therapist to the client:
1.The therapist is congruent with the client.
2.The therapist provides the client with unconditional positive regard.
3.The therapist shows an empathetic understanding to the client.
 Developmental groups

• Mosey (1970) describe the nature of developmental groups and

postulated that group interaction skills develop in a specific sequence
from;
from parallel group participation, through project group, egocentric
cooperative group, to cooperative group, and, finally to mature group
participation
 TASK GROUP

• Task groups provide an opportunity for active involvement in occupation in natural contexts.
• A task is defined as any activity or process that produces an end product or provides service for
the group as a whole or for persons not in the group (1981) believed that task group interventions
facilitate the development of adaptive skills, including sensory integration skills, cognitive skills,
dyadic interaction skills, group interaction skills, self-identity skills, and sexual identity skills.
• Task-oriented group interventions provide a shared work experience that facilitates the integration
of thinking, feeling, and behavior and provides structure for interaction as well as opportunities for
problem solving and skill development (Fidler, 1969).
TASK SKILLS THAT CAN BE LEARNED IN A
GROUP SETTING
• Appropriate use of tools and materials
• Willingness to engage in doing tasks

• Sustained interest in a task

• Ability to follow demonstrated, oral, and written directions

• The ability to solve problems that arise in performing a task

• Ability to organize tasks in a logical manner

Tasks chosen should provide the “just right challenge” for group members; tasks that are too easy or
too difficult will not provide an experience conducive to skill development.
 ACTIVITY GROUP

• Activity groups focus on the process of engaging in meaningful activity with others.

• Activity groups are frequently designed to build a positive self-concept, manage and express
emotions constructively, and improve communication skills among group members (DeCarlo &
Mann, 1985).

• Eg. Expressive arts, crafts, music, dance, role-play scenarios, and games are typical modalities in
activity groups.

• Haltiwanger, Rojo, and Funk (2011) describe a group intervention for women with cancer that is a
combination of an expressive art activity group and a peer support group.

• Through the creative arts, participants can express their feelings as well as reestablish self-
confidence. Through the peer support of others who have similar concerns, participants can learn
adaptive behaviors and coping skills and the social isolation often associated with a cancer
diagnosis is reduced.
 FUNCTIONAL GROUP
• The goal of a functional group is to promote adaptation (i.e. adjustment to the environment) and health through
group action and engagement in occupation (i.e., action or behavior of a member in the group)

• According to Schwartzberg et al. (2008), “it is through the dynamic interaction of these four types of action
that the group matures and members develop their ability to function”

1) Purposeful action: meaningful for individuals and group as a whole

2) Self-initiated action: Member takes initiative verbally or nonverbally.
3) Spontaneous action: Action occurs in the here and now.
4) Group-centered action: Member actions are interdependent.

• Schwartzberg et al. (2008) recommend considering the following:

 The occupational goals should be meaningful to the clients.
 Clients should have input in the choice of occupations.
 The demands of the occupation should be congruent with the clients’ ability to participate.
 Clients should be able to interact with the environment at a subcortical level.
 Occupations should be chosen that are compatible with the clients’ ages, skills, and
performance levels (Case Study 38-1).
A CASE STUDY about MARCUS

Marcus is a 32-year-old sergeant in the U.S. Army. He is serving in his third deployment with the Airborne
Ranger sniper team and is the current leader of his reconnaissance platoon. During his first deployment,
Marcus sustained a blast injury to his right side in combat, which required extensive OT rehabilitation
intervention. During this combat, he also witnessed the death of two members of his platoon. Although
the death of his colleagues could not have been prevented, his injury had prevented him from employing
a rescue attempt. For this, he suffered frequent nightmares and flashbacks. His right upper extremity,
although functional, continued to be weak. The weakness of his dominant right upper extremity led to a
repetitive use injury in his left shoulder that required him to be on pain medication. The mission
commander referred Marcus to the Combat and Operational Stress Control (COSC) unit because of
growing concern that he was consuming an excessive amount of pain medication and potentially
becoming drug dependent. It was also noted by his superiors, as well as his subordinates, that he was
making critical decisions too quickly, reacting impulsively and sometimes explosively during
mission planning and debriefing meetings.
The sergeant was in danger of losing his position as the platoon leader. The COSC
prevention team, consisting of a U.S. Army occupational therapist, a physician extender,
and a psychiatrist, performed a mental health evaluation. The evaluation revealed a
history of substance and alcohol abuse, chronic pain related to an injury sustained in an
automobile accident as a child, and posttraumatic stress disorder (PTSD) and major
depressive disorder that had not been formerly diagnosed or treated. Marcus’s treatment
plan consisted of a planned reduction of pain medication dependence through
incorporation of an individualized physical fitness program to include daily stretching and
strengthening exercises. ​

A cognitive behavioral program was designed for Marcus to address his frequent
expressions of distorted thinking, impulsivity, and verbally explosive outbursts to his
supervisor and his subordinates. The cognitive behavioral module was delivered through
group therapy. The format of the group allowed soldiers to come together and discuss
traumatic events. The U.S. Army occupational therapist, who led the group as a
facilitator, gave the soldiers new opportunities to discuss events with a group of
peers who had experienced similar traumas.
The group leader used projective art techniques, leisure activities, pet therapy, stress reduction, and
anger management strategies. The group sessions were often saturated with strong emotions like anger,
resentment, guilt, and grief. During a final session, Marcus shared an insight. Sometimes I just get so
angry, and I don’t even know what the anger is about. Jonathon, our group leader, asked me a question
about something I said in our group and I got mad at him, really laid into him. The other members just
stared at me. I told him that I didn’t have to explain anything to him. But I realize now, it wasn’t about his
question or even about the group. What I learned is that I didn’t want to answer questions because I was
afraid I’d get it wrong and fail like I failed my soldiers when I didn’t rescue them.

The occupational therapist used a facilitative approach and provided a format for progressive relaxation,
diaphragmatic breathing, and mindfulness meditation at the close of each group session. The short 1383
term goal and outcome for the group was to provide a sense of relief and closure that would facilitate
gradual behavioral changes resulting in improved mental health. The long-term goal was to normalize
traumatic events that are unfortunately associated with combat, to teach coping skills, and to educate
soldiers about warning signs of posttraumatic stress. Perhaps the most important advantage for use of a
therapeutic group in this case was the unmistakable peer support shown for one another. Peer support is a
protective factor for mental health and facilitates resiliency in the face of danger and the physical and
psychosocial effects of traumatic events.
 IMPLEMENTING INTERVENTION GROUP

Cole (2012) has provided an excellent framework for implementing OT

intervention groups that consists of a 7-step process;
1. Introduction
2. Activity
3. Sharing
4. Processing
5. Generalizing
6. Summary
 I STEP : INTRODUCTION

 Leader and group members introduce themselves: simple, easy, non-stressful-

(includes therapist asking the members to greet the group by saying their names. This
procedure does more than just help the members learn one another's names; it acknowledges
their membership in the group and invites them to be a part of it)
 Warm-up/ice breaker
(Ot is concerned with the receptivity of the members. How alert are they? How
preoccupied are they?? A warm-up is an exercise that captures the group's attention, relaxes
them, and prepares them for the experience to follow)
 Expectations/ground rules for group
(Ot will explain what he will be expecting by the group members in the session and lay
ground rules)
 Explain purpose of group & briefly outline session
(Describing the purpose of the session and gives members a clue to the session's focus)
 II STEP ACTIVITY

• It incorporates all we know about clients, health conditions, and their corresponding
dysfunctions, assessment, intervention planning, activity analysis and synthesis, and
group dynamics. Selecting a therapeutic activity involves the entire process of clinical
reasoning

 SELETECD ACTIVITIES:-

-Should be do-able within time constraints

-Must relate to client goals
- Must be presented at level appropriate for clients
-Leader must consider their knowledge and skill level
-Must analyze prior to doing the activity and adapt as necessary
 III STEP : SHARING

• After completing the activity, each member is invited to share his or her own work
or experience with the group. The structure and process for sharing will vary with
each activity.

- Each member shares own experiences in the form of drawing or writing

something individually or interaction.
- Members can show or explain their experience
- Leader must acknowledge contributions of each member
- Leader must provide support so all members share
 IV STEP : PROCESSING

• Processing how members feel about the whole experience and about the
leader and each other.

• If Done correctly, processing can reveal some important and relevant

information. If members felt anxious, embarrassed, or belittled while
doing an activity, this will help to explain some of their responses when
sharing and discussing it.

• From the OT perspective, this process helps to identify issues that

encourage or discourage "engagement in occupation" and emotions that
causes "barriers to participation"
 V STEP : GENERALIZING

• This step addresses the cognitive learning aspects of

the group.

- Leader mentally reviews group's responses to

activity

- Leader "sums up" responses to the group

 VI STEP : APPLICATION

• The goal of this step is for each member to understand how

they can apply the results of this group experience to help
make their own life more functional outside the group.

• Application of principles learned in group apply to everyday

life. This addresses how the group learning will facilitate
"participation in life."
 VII STEP : SUMMARY

• The purpose of the summary is to verbally emphasize the most important

aspects of the group so that they will be understood correctly and
remembered.

• The points to emphasize should come directly from the group's responses.

• The emotional content of the group is most important to summarize.

Especially when the group feels positive verbal recognition of the good
feelings by the therapis will help members remember the group as a
positive experience.
HOW TO DEVELOP GROUP PROTOCOLS..???

The basic process of developing and implementing a group intervention involves the
following:
1. Identifying and evaluating the client population
2. Selecting a model or theory or frame of reference to use in the design of the group
intervention
3. Determining a focus area or problem for intervention
4. Searching for evidence that can be applied to the group intervention
5. Writing a group intervention outline
6. Developing individual group sessions
7. Implementing the group intervention
8. Evaluating the effectiveness of the group intervention
THEORIES COMMONLY USED IN THE
DEVELOPMENT OF GROUP
INTERVENTIONS:-

Cognitive disabilities
Cognitive behavioral
Psychodynamic
MOHO
Developmental
Sensorimotor
 ARTICLE

TITLE:- Effectiveness of a Cognitive–Functional Group Intervention Among Preschoolers With Attention

Deficit Hyperactivity Disorder

AUTHOR- Lori Rosenberg; Adina Maeir; Aviva Yochman; Idit Dahan; Idit Hirsch

ABSTRACT :-

Objectives : To test functional improvement after a group cognitive–functional occupational

therapy intervention for preschoolers with attention deficit hyperactivity disorder (ADHD).
Method :-
Seventeen preschooler–parent dyads attended 11 weekly group sessions focused on
acquiring executive strategies through occupational performance. Functional
improvement was measured using the Canadian Occupational Performance Measure
(COPM) and Goal Attainment Scaling (GAS); executive function, using the Behavior Rating
Inventory of Executive Function–Pediatric; ADHD symptomatology, using Conners’ Parent
Rating Scale–Revised and Conners’ Teacher Rating Scale–Revised; and social functioning,
using the Social Participation scale of the Sensory Processing Measure.

Results:-
Significant improvement was found on the COPM and GAS measures, whereas mixed
results were found on the other measures, with improvements found in children whose
scores indicated impairment at baseline.

CONCLUSIONS:-
Cognitive–functional group intervention appears to significantly improve daily
functioning, executive function, and social functioning for children who demonstrate
clinical impairment. Further research with a larger sample, a control group, and follow-
up is required.
 References
• Occupational Therapy, By: Willard &Speckman- 13th edition
• Occupational Therapy, By: Willard &Speckman- 12th edition
• Ocupational Therapy for physical dysfunction, By: Pedretti, 8TH edition