Writing a Group Protocol
Cole Chapter 11
Somaya Malkawi, PhD
November 24, 2011
Purpose of a Group Protocol
Organize factors of effective group plan
Sell the plan to administrators/managers
Communicate the plan to treatment teams
or other professionals
Communicate the plan to referral sources
Serve as guideline for funding and
budgeting for supplies, space, etc
Guides session interventions for OT or
others
Population Choice
Interest area
Fieldwork experience
Personal experience with disability
Case studies, fictional works
Volunteer experiences
Curiosity about unfamiliar populations
May involve some initial research/reading
Population in the setting
Worksheet 11-1
Goal: Familiarize self with population chosen for
group protocol assignment
In lieu of needs assessment for student learning
Step 1: Identify nearby clinical settings
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Identify possible resources
Use personal connections or experiences
Make initial contact with OT or other supervisor
Purpose: Reality check
May change to match other areas of protocol
Client Characteristics
Your descriptions are approximate, not
exact
Criteria for admission to center/program
Age 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 occur
Facility’s mission
Criteria for admission
Funding source(s)
Staff disciplines (members of the treatment
team)
Staff/client ratio
Types of interventions offered
Frame of reference (if known)
Needs Assessment
Your first step as a new therapist in any
setting
Necessary for a client-centered approach
Steps: (use at least two methods)
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1.
2.
3.
4.
Gather background data
Do a survey
Use secondary data
Analyze data
Needs Assessment, cont.
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1. Gather background data:
 From supervisor/person who hired you
 From textbooks, internet, other resources
 Learn all you can about client population, health
conditions
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2. Identify participants for a survey:
 Written survey (1 page maximum)
 Face to face interviews
 Telephone interviews
 Key informants
 Focus group
Needs Assessment, cont.
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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.
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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
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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:
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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 on
You may choose from any of the
domain categories
Some 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 participation
2. Performance skills include: Motor skills,
process skills, and communication/interaction
skills
3. Performance patterns include: habits,
routines, and roles
Framework Domain, cont.
4. Seven contexts are specified: Cultural,
physical, social, personal, spiritual, temporal,
and virtual
5. 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 structures
6. 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:
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1.
2.
3.
4.
5.
Create, promote (health promotion)
Establish, restore (remediation, restoration)
Maintain
Modify (compensation, adaptation)
Prevent (disability prevention)
Write a statement using one of these for each of
your 10 areas
Example: 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 population
Example, sessions might include:
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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 title
Author
Frame of reference
Purpose
Group membership and size
Group goals and rationale
Outcome criteria
Method
Time and place of meeting
Supplies and cost
References
Protocol Outline Steps
Title for series of sessions:
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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 used
Should be short, preferably no longer than three
sentences summarizing the overall scope of the group
plan
Example: 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
Size
Based on client population worksheet
General diagnostic factors, factors like age,
functional level, gender and role identity might
be included
For purposes of referral, both inclusionary and
exclusionary criteria should be described
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Inclusionary criteria describes characteristics which
are appropriate for your group
Exclusionary describes characteristics which are not
appropriate
Size: 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 worksheet
List 3 to 8 overall goals
Behavioral goals should be observable and
measurable
Goals and sessions may not be an exact
match
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Several sessions may work on same goal
Each session may work on several goals
Outline: Goals and Rationale
Rationale: Explains why goals were chosen.
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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 Criteria
Desired results of the group should be stated in
behavioral terms. These reflect the goals stated earlier
Develop a measurable way to demonstrate the
effectiveness of the group to the client, the administrator
and to those responsible for payment of services
Specific procedures should be outlined, such as a preand post-questionnaire or a pre-post rating scale for
each client
Attach an appropriate assessment tool:
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Adapt an existing evaluation specifically for the group offered
Most students will need to create their own outcome rating
sheet
Outline: Method
Media Used and Leadership Style
Media
Leadership style
Outline: method, cont.
Leadership style depends upon Frame of Reference:
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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:
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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:
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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
assignment
The following environmental factors could be included:
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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
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Characteristics of the client population chosen
Activities to be included
Outline: Supplies and Cost
List materials and supplies needed for all
sessions
Their total cost is summarized here
Assume that copies of forms and paper and
pencils or pens are generally available in most
settings at no cost
If specific items such as videotapes or
assessment materials are to be used, the name
and address of the source of these should also
be listed
This section is more easily done after specific
sessions are outlined
Outline: References
List 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 materials
References should use the format of the American
Psychological Association (2001):
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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:
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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