This is my OT 640 FW debrief video!  I look forward to hearing more about all of your fieldwork experiences, and hope that this succinctly explains my two week experience in the skilled nursing facility.

-Lauren Leiser 

Article Summary

     The article journal I chose to review examined the Effectiveness of Activity-Based Group Work in Community Mental Health: A Systematic Review.  This study was a systematic review of  136 potential articles, and a full text review of 27 articles.  After reviewing the final 27 articles and adhering to the inclusion and exclusion criteria, only 3 articles were left to use for this review.  In the introduction of the study, the researchers discuss how all occupational therapists serving in mental health that they surveyed responded stating that they all used group interventions in their practice, which were more often than not activity based group interventions.  This journal article advocates for community mental health, and for the lack of research that has been done to prove how truly effective activity based group interventions can be for clients with mental health in an occupational therapy group.

     The study identified three qualified articles after the systematic review was conducted.  For me the most important part of this study is that each article had the same thing in common, which was activity based groups are more effective than verbal based groups but for different reasons such as: improving self-perceptions of social interaction skills, improving social behavior, providing greater symptom reduction, and increasing levels of community functioning.  The results of the studies also showed a statistical significance in social interaction skills for the group members.  This study strives to collect relevant, valid, and reliable articles to support the evidence of activity based intervention groups in occupational therapy. 

 

     Having read this article, as I move into my 3 month mental health rotation (now set to be in a court/justice system) I further feel it is important to acknowledge the importance and power that activity based group interventions may have on our clients.  I now know moving forward as a future practitioner that thinking, planning, and executing an activity based group, I can refer to this article to remind/inform myself and my employers of the benefits that activity based interventions may have.  I know often outsiders that look into our activity based groups think that we are just using "another worksheet" or "making another craft" however this research is showing that activity interventions are more effective than simple verbal groups for our clients with mental health diagnosis.  Having research to support this will assign reason to the activity for the individuals that are not occupational therapists.  If we could prove nothing more from this article, we could prove that activity based interventions increase and positively support social interaction skills.  Many mental health disorders present with an occupational barrier of social interaction skills, and to identify that activity based group interventions help support the goal of social interaction is huge for OT!  Moving forward, I will keep this article readily available to evidence my future practice in fieldwork (and possibly my future job)! 

References 

Bullock, A., & Bannigan, K. (2011). Effectiveness of activity-based group work in community      mental health: A systematic review. American Journal of Occupational Therapy,65(3), 257-266. doi:10.5014/ajot.2011.001305 

12 Step Meeting Experience

     On Sunday evening, 2/24/18, I attended a Narcotics Anonymous (NA) meeting at Hope Church accompanied by one of my classmates, Katelyn Grammes.  This was a rich OT student experience for me because this was the first 12-step meeting I have attended.  I had the opportunity to not only see how a real life group meeting is conducted, but further had the chance to hear the group members personal stories, struggles, and successes.  There was a great sense of community during this meeting, bringing an element of comfort to each group member.  I watched most every group members occupational role shift during the session from identifying as a narcotic user to the role of a friend and a group member.  The group members did a great job identifying why and how narcotics have effected their occupational performance and daily roles, and how without the narcotics their quality of life is much greater and more productive.  

     The group leader used a facilitative group leader style.  He began by discussing what would be covered during the session and then preceded to hand out the reading materials to group members, got the names and information of the new attendees, and then he took suggestions for the group topic(s) for the session.  I feel like he handed out the materials to group members that he felt would be comfortable reading out loud and would participate without being embarrassed or hesitant.  The assigned group members then read the papers (ground rules and other materials) to the rest of the group members.  The group leader let the group members go around and freely speak out and say what topics they wanted to talk about.  From there he said, "Ok, this is your meeting, with these topics".  He then turned the group meeting over to the members to run until the end, and then he wrapped up the session and asked for any announcements the members may have.  The members showed a sense of community by sharing who had been "clean" or "sober" for x amount of time, celebrating my saying congratulations or cheering when they heard the news.  Kate and I chose not to speak up because upon our arrival we discussed with one of the group leaders that we were there to observe.  He said it was an open meeting, and that would be fine, but to not introduce ourselves or to participate in the discussion.  I think this was our best choice because the other group members may have felt like they were being "spied on" or judged by us if we announced to the group session what we were there for and we were just "observing". 

     The environment was relaxed!  They made coffee for the group members before their arrival, which I thought gave the environment a coffee shop vibe in a church helping it seem less judgmental .  The chairs were set up in a circle in the middle of the room for anyone who wanted to sit there, and there were also many other chairs in rows to choose to sit in (this is where Kate and I sat, along with the majority of the other group members).  I observed the more regular and secure group members were the ones to sit in the circle (maybe 8 people).  Where the group members sat did not influence how much or little they spoke, members from within the circle and the rows both spoke equally. 

     This was a thriving therapeutic group and setting!  I was delighted that the group leader allowed the group members to decide which topics they wanted to chat about.  The members would use one another as support during therapeutic conversation by making eye contact, shaking their heads in approval, and beginning a new discussion or thought off of another group members thoughts or comments.  The group members appeared to leave with full hearts and weightless minds like they had been refueled and motivated for another week until next weeks meeting. This therapeutic group used a Cognitive Behavioral approach, focusing on changing and shaping the way the group members thought about narcotic use.  The group members were beginning to change their thoughts towards narcotics as one of harm versus pleasure.  The group members were focused on changing their occupational performance patterns from no longer using narcotics, to pursuing a fulfilling life without the narcotics and with the hope of creating new roles, routines, and patterns moving toward a narcotic free life. 

     

     

OT 532 Post Group Facilitation Reflection #2

I give myself a 9/10 on my introduction.  It was chaotic at 11 am when the facilitation was supposed to begin, and I had came from a 10:30 am meeting directly before the facilitation.  When beginning the group I did not give (in my opinion) a clear introduction of what we would or should cover during the session at hand.  The warm up, time frame, and clear communication went well.

I give myself a 9/10 on the main activity.  I feel like the activity was explained clearly and accomplished the goals I set in the protocol, but I would still like to have a more creative way in the future for the group members to design their physical activity routines (such as a board game or a fun way to motivate them to fill out the routine).  I did ask the group for feedback on the exercise options I provided them, and received great feedback on what to add and possibly take off for future groups I may have.  I feel as if the timing, materials, and environment were appropriate for the given activity.

I give myself a 10/10 on sharing.  I feel like we went even a little over time because the group members seemed comfortable and enjoyed sharing their thoughts, routines, habits and goals with me which made me feel good as a facilitator.  I tried to make good eye contact with each group member when sharing as well as I tried to provide examples of my weaknesses and bad habits in relation to physical activity.

I give myself a 10/10 on processing.  When I asked each group member to fill out the habit worksheet and share what habit or barrier could keep them from engaging in their physical activity routine, each member was able to process through their thoughts and share.

I give myself a 9/10 on generalizing.  I would have liked to have spent a bit more time discussing with each group member one activity that they could do at home (more occupation-context based) to help them generalize that physical activity can be free and be vacuuming and doing laundry that day.  It does not have to always be structured and jogging or doing zumba. Overall though, I know we did discuss in the group that physical activity could be things as simple as walking your dog, or doing some squats at home.  The group members seemed to be catching on to the generalization during this session.

I give myself a 10/10 on group motivation.  I would use the term for Fridays sessions Fri-yay to describe the feeling of my group.  I began with a high energy warm up to hope to provide the group with a positive feeling and morale.  Everyone was excited that it was Friday and to have the weekend ahead of them! They were motivated to not only complete the warm up and main activity but also to engage in discussion pertaining to the activities and their interests.   

Limit setting I give myself a 10/10.  I feel like I stayed on track with timing and allowed each group member more than enough time to share and I tried to not cut anyone off when they were talking.  I as well tried to not let the group stray off topic for more than one minute, directing the attention to the next group member sharing. 

I give myself a 10/10 on application.  I used many examples (including personal) and showed how physical activity can relate to everyday life.

 I give myself a 9/10 on summary because sometime I feel awkward repeating back to my classmates what we covered and why it is important.  Although I know these are not my "peers" but they are group members during my facilitation, it can be tough sometimes to role play with my peers.

Overall I gave myself a 86/90 because there is always room for improvement.  I will give feedback and say designing a group protocol and then facilitating it in a group was intimidating and difficult, but rewarding once it was over.  I really think this is a great class to prepare us as students for our mental health field works and feel more empowered and comfortable looking toward my 3 month mental health rotation.  Thank you both for helping me and my peers through this process, and it all really is starting to make sense! 

Leadership Summit Lauren Newell Leiser

     I did my leadership summit with Lauren O'brian and Katherine Manning.  We both facilitated on the same date, and we thought that would be a good group to bring together for this summit.  During my time with Lauren and Katherine, we discussed the FoR, activity ideas, and narrowed down topics for our group facilitations.

I had picked MOHO and PEO as my FoR's for Health Management and Maintenance, and at the time I had not decided on physical activity for my group session.  Thus we spent our time brainstorming on how to fit all of health management and maintenance within an hour group session.  After talking to Katherine and Lauren, I realized that narrowing down my topic may be in my best practice because trying to work on sleep, stress, mental health, physical health, and nutrition in an hour would be too much for myself as the facilitator and for my group members.  We discussed doing a questionnaire for my protocol, but I could not find online a good holistic questionnaire for physical activity, and I wanted the group members to leave feeling empowered and not bad about themselves from my group session. Thus I opted for no questionnaire.  I as well gave suggestions to Lauren to have each member go around and verbally communicate their stress levels at the beginning of her session and I told Katherine that a questionnaire or inventory for her session may be a good idea.  Katherine's session was over leisure and Lauren's was over stress management.  My protocol was in the baby stages when we met, so I never shared with them the activities I did for my group facilitation.

     Ultimately, I found this to be a rich experience.  I enjoyed hearing about what my peers ideas were for leading their group activities, and it really helped me to look at FoR's through another students lens.  I appreciated the girls time and honesty as I was developing my protocol and feel like it helped me form a productive and successful group facilitation for the other group members.  I would recommend keeping the leadership summit for future students, and also like that you both provided us with time during class to meet together for this summit if needed. 

OT 532 Professionalism Co-facilitation Group Evaluation

     Valerie and I were the facilitators for the group, Pursuing Positivity!  I would give myself a 9/10 on the introduction section.  The time and planning put into the introduction was a 10/10, but the way the day played out effected the efficiency of the intro.  The intro started off a little unfocused, and we had a warm up planned.  Several of our group members had a tough (hectic morning) and reflecting back on the introduction phase of our group session, it would have been a good choice to give the group 5 minutes to each go around and say how they were doing, and why they were good or bad that day.  We opted to begin the group with an ice breaker warm up, which was the feelings m and m game.  Everyone seemed to enjoy it, but were still a bit distracted with their own thoughts (noticeably). 

     I give myself a 8/10 on the main activity, the positivity petals.  I think that the activity was a good idea, but we should have gone around in a circle and asked each person to share what their group members wrote about them.  This would have required each group member to be present in the moment, and to take a moment and be proud of how their peers view them.  Having our group members speak out loud about their flowers could bring a positive spirit/nature to the group, and we did not have them do that.  The best part about this activity was to take a moment as the facilitators and look around at each group member and see them smiling down at their flower and what other people said about them.  The down fall to this activity is that someone could say something hateful, or fail to be able to find something nice to say to another group member in a different clinical setting or environment.  This may be an activity that is best for a cohesive and established group moving forward (as our group is). 

     I give myself and our group a 10/10 on sharing.  As facilitators we were patient and calm, thinking on our toes if the group was not responding to the questions that we asked.  We understood that thinking positively on a Monday may be difficult, and sharing your feelings can take time to become comfortable doing.  Ultimately, I was very impressed at how everyone around the middle of the group session began opening up and sharing their own stories and feelings towards the questions and topic of the day. 

     I give myself a 9/10 on processing.  We went into our group session with 3-4 good questions to help process through each group members feelings and thoughts.  I do not think we could have been anymore prepared with the questions,  I would have liked to have seen a little more depth in the feedback and responses shared, and there is space always to improve so this is why I gave myself a 9/10. 

     I give myself a 10/10 on generalizing.  We took the time to specifically ask our group members which technique or strategy they can use to build self confidence and ultimately use positive thinking daily.  This was a slow start to being answered, but I feel like each group members response was meaningful and authentic and they really thought through either the strategy they do or could use moving forward to deal with negative thoughts. 

     I give myself a 9/10 on group motivation.  Sometimes I struggle with wanting to be too positive or "cheerleader type of motivation", when in all reality I accepted the conditions on Monday.  Like several group members shared, they had experienced a tough morning, and we had picked fieldwork locations not even an hour before the group session was held.  Asking the group members to transition quickly from (what could have been a negative experience for each member depending on if they got the FW they wanted) was asking a lot.  I did try and motivate the group, but I am sure deep down I was thinking about the stresses of the week as well.  I always feel like I can improve on being present for all moments 100 percent. 

     I give myself a 10/10 on limit setting.  I try and always hear each group member, and offer a meaningful response, smile, eye contact, or nod for them to know I am hearing them and they have my undivided attention.  Valerie and I did stay on schedule, and we did not let the conversation veer off topic onto other topic and we kept the group busy, focused, and challenged with questions. 

     I give myself a 9/10 on application.  I think it could have been nice to have a question directly stating for each group member to say one area in their life they can "apply positive thinking" now that I reflect back on the group session.  This would be a client centered question, allowing each of them to answer they way it was most applicable to their lives. 

     I give us a 10/10 on summary.  We summarized what we covered during the session, why it was important, and even gave the group members one last chance at the end to say anything else that was on their mind before we officially wrapped up the session. 

     In conclusion, I know that Professor Sasse already covered this with Valerie and I in person (which I appreciated).  Professor Sasse acknowledged that Monday (especially right after FW selections were picked was a tough time) to have a group session, especially about positive thinking.  I also know that she acknowledged that we had to work extra hard at times during our session to get out group member motivated to engage and talk with us.  I would be false if I said I walked away from our session feeling 100 percent, but I will say I feel like it was a real life situation.  This group session helped me see the reality of what group session will/may be like during my community health rotation, and for this I am grateful.  I am welcome to any feedback on things I can do better, things you directly saw were weaknesses, and strengths of my group leadership style.  The feedback will only help me moving forward to be the best practitioner I can be.  I give myself an overall score of 84/90 points on my leadership evaluation. 

      

My Beautiful Broken Brain-Neuro Note 5

     My Beautiful Broken Brain was a documentary film about 34 year old Lotje Sodderland's personal journey after having a stroke. I chose to watch this film to learn more about strokes, what our clients experience physically and emotionally when they occur, and the inspiring journey of what life will look like for many following their diagnosis. I watched this film and took notes on her behaviors, experiences, emotions, and stay at the neurology center.  This helped me to note important barriers and challenges that Lotje experienced.

     Lotje was a perfectly normal and healthy individual, when one evening she woke up experiencing flickering of lights, terrible pain in her brain, confusion, euphoria, fear, and as she says during the movie she was "lacking her clever".  Lotje was actually experiencing a inter-cerebral brain hemorrhage at this time and she did not know it.  She traveled to a local nearby hotel and crashed in their bathroom, waking up to find herself very confused and scared in a hospital room recalling nothing that happened before her injury.  They announced at the end of the movie that Lotje had a pre-birth malformation of blood vessels in her brain, and this was the unique cause of her incredibly young age of having a stroke.

     Lotje is such a beautiful young lady inside and out!  From the first second I started watching this  movie, the way she was always smiling, laughing, and positive on how she was going to get her "clever" back was incredibly inspiring for me to watch.  Lotje experienced a severe amount of dysphasia, due to damage to the left side of her brain. For her to output language was the hardest part I noticed, which is referred to as Broca's aphasia.  To be honest, I am not sure how she kept such a positive and happy attitude.  When I was watching this film I was getting frustrated for her because she was clever and smart and to not be able to articulate what we are feeling and thinking has to be one of the most un-empowering and helpless feelings we can feel.

     "Within your own self is a treasury, an ocean of pure bliss, consciousness, intelligence, creativity, love.  We are not defined on limitations but endless possibility."-Mr Lynch.  This is Lotje's motto that she follows through her recovery process.  I love that she sees her new situation as one that is what you make it, one that still has a lot of beauty, intelligence, and love.  I hope as a therapist I can take her advice that she gives us as future therapists in the film which is to " Focus on the things the patients find along the way".  For Lotje, her discoveries along the way were that through typing she could form complete sentences and thoughts which was a huge milestone for her.  She felt like she got back some of her normal and that was such a beautiful moment of communication and her finding some normal that she used to have.

     Overall, I think I realize from watching this movie that first, life and health are so so short.  They can be taken for granted quickly.  We tend to move through our days acting as if they are chores and forgetting to laugh, smile, and celebrate that some people would kill just to be able to articulate and write a paper again.  Many people would be enthused to be able to have a husband to argue with, or a rent to struggle to pay.  I think this is an important concept to grasp especially as we prepare for our rotations as future practice as a therapist.  Our problems often aren't even problems in their opinion.  Their problems are basic, yet life altering.  Focusing on our clients with a self less practice will be necessary.  If we don't, I think they will be able to feel that.  They make have had a stroke, but I often think when one strong sense is taken away from you, other senses may be heightened just like Lotje's.   After her stroke she had very strong sense of feelings, and the feelings of those around her.  As always, I finished this film with a sense of gratitude, and a motivated and excited heart to make a difference in my little corner of the world soon.

Reference

Robinson, S. (Producer),  & Robinson, S & Sodderland, L.  (Director).  (March 18th, 2014).  My   

     Beautiful Broken Brain [Motion picture].  London.