This blog began as a journal of a Winston Churchill Memorial Trust Travel Award visit to the USA to study how Lifestyle Redesign could be used in Occupational Therapy to improve the hospital/home interface for older people. It has continued to record developments and inspiration gained from that experience since returning from Los Angeles early in 2012.

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Saturday, 4 February 2012

Functional Groups in Occupational Therapy

In both Communication Skills for Effective Practice and Lifestyle Redesign classes this week, the topic was functional groups and the skills OTs need to develop to ensure they are an effective tool for intervention.
In Communication Skills we looked information in some of the course books e.g.

Schwartzberg S, Howe M & Barnes M (2008) Groups: Applying the Functional Group Model. F A Davis. USA.

-and discussed the preparations that needs to go into the planning of a group- the Who?/What?/When?/Where? questions.
We looked at how to attract participants, also how to deal with groups that are already set up but may not have a clear rationale so potentially tricky for an OT who 'inherits' a group to know where to begin. The discussion about attracting participants was interesting for me as there was a lot more emphasis than I am familiar with on attracting participants from what could be described as the 'well general public' for groups that might deliver 'enhancement' activities e.g. after school extra curricular activities for kids and teenagers, or groups with a preventive emphasis. In the UK my feeling is that it is less common to be recruiting in this way Perhaps this is because a lot more OTs here in the US work in private practice or clinics, but I also wonder if it reflects a greater development of the role of OT in preventive and wellness work. Or is it that the higher level of private work has allowed for this development? I'd be interested to hear people's views.
We looked at the importance of having a clear rationale for the group, including being explicit about how the population (that the group is aimed at) benefit and how the goals connect to the outcome measures chosen.
This class will be working in small groups using the theory to plan a group protocol and will demonstrate it later in the semester with other class members role playing the participants.
The class will also complete the self assessment form (Adler p 256)

Adler RB & Elmhorst, JM (2010) Communicating at Work, 10th Edn. McGraw Hill. USA

In Lifestyle Redesign we began to delve into 'the manual'

Mandel, D. R., Jackson, J. M., Zemke, R., Nelson, L. & Clark, F. A. (1999). Lifestyle redesign®: Implementing the well elderly program. Bethesda, MD: The American Occupational Therapy Association.

in more detail. We looked at the planning and study that had gone into the original design of the Well Elderly Programme. We considered the 4 key principles of OT that framed the design:
1. Occupation is life itself
2. Occupation can create new visions of possible selves
3. Occupation ha a curative effect on physical and mental health and on a sense of life order and routine
4. Occupation has a place in preventive care
(Mandel et al 1999)

As groups are often a key part of the delivery of Lifestyle Redesign based interventions, we again studied the importance of the skills of a group facilitator and how important it is for OTs to develop these skills to a high level if a group is to function as a therapeutic intervention. Four of the main methods of delivery are:

Didactic presentation
Peer exchange
Direct Experience
Personal Exploration

In the weight management group sessions that I have been involved in, this process is clearly evident and the facilitation skills of the OT appear relaxed and informal on the surface but are also operating at a deeper and more subtle level to facilitate the sessions and enable the group to achieve their goals.

My interest is in how Lifestyle Redesign methodology can be applied at the hospital/home interface for older people. This is currently an area where OT intervention is usually individualised, even though there are some issues that are common to many people and therefore could benefit from a group based intervention. A question that arises is how comfortable and confident OTs working in physical hospital settings, especially fast moving acute settings, would feel about introducing group work to their practice, or are many already doing so?

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