The Functional Group

Model
Katelyn Darrenkamp, Gretchen Kempf, Maria Licitra,
Lauren Patire, Colleen Sullivan, Tara Wisbauer
Dr. Sharan Schwartzberg
Objectives
Introduce the focus and theory of the Functional Group Model

Give insight to using the Functional Group Mode to guide
intervention

Provide research that support this model

Present an assessment that is congruent with the Functional Group
Model

Introduce and discuss a case study that describes and gives insight
about the functional use of this model in occupational therapy

Development
Created by: Dr. Sharon Schwartzberg
o Co-founders: Margot Howe, Mary Barnes

First introduced in 1986

Used in physical disability settings

Dr. Schwartzberg currently works at Tufts University in Boston, MA
The Focus of the Model
Discussion and group dynamics to resolve intrapersonal and
interpersonal difficulties.

Developing communication and interaction skills to enhance
occupational performance.

Group of people interacting together in order to achieve a common
aim or purpose.

The Focus of the Model

Focus on purposeful activity and the act of doing
o Action oriented
Four action components:
o Purposeful
o Self-initiated
o Spontaneous
o Group-centered
The Focus of the Model
Advantages of groups
o Natural context for addressing clients interpersonal problems

o Social Support

o Clients can share relevant knowledge and experiences

The Focus of the Model
Groups characterized
o Structure
o Cohesion
o Stages of development
Formation
Building relationships
Deciding aims and procedures
Accomplishing tasks
Terminating

The Focus of the Model
Characteristics of a true group
o Interaction among members
o Share one common goal
o Relationship between size and function
o Members desire to be part of the group
o Self-determination

Centennial Vision (OT MONTH )
Widely recognized profession
Used throughout different practice areas
Developed and researched by an OT
Meeting societys occupational needs
Activities and group is suppose to be seen as relevant to the clients needs, goals and life roles.
Evidence-Based
Evidence supporting the successfulness of the model
Theory
Concepts
Adaptation- the adjustment of the organism to its
environment or the process by which it adjusts
Occupation- also referred to as action



Theory
Principles:
Groups encompass a common goal and dynamic interaction of their
members
Groups has capacity for self-direction
Groups can become increasingly independent of designated
leadership
Groups can address individual needs
Groups provide multiple types of feedback and support
Groups can support members growth and change
How Does it Frame Problems and
Challenges?
Frames the clients problems in a here-now reality
Elicit growth and change
All members can contribute toward a common goal or task
The challenges are given a place to provide function in the reality
to learn skills, and address them
This model puts challenges in a functional position and the client is
expected to respond to environmental expectations

What Does Intervention Focus On?
The focus of intervention is the use of the four action components
purposeful, self-initiated, spontaneous, and group-centered action and
tasks to support member's achievement of desired goals and for ultimate
group success.
Intervention involves: the development of a plan, selection of group
members and methods, and planning the structure of the group and its
tasks.
The role and encouragement of the therapist is of critical importance to the
intervention and group success.
o During intervention, the therapist takes appropriate leadership action
and conducts assessments




Intervention
The design of the functional group is important
The following factors should be considered and achieved in planning,
running, and reviewing the group for success:
o Maximum involvement through group-centered action
o A maximum sense of individual and group identity
o A flow experience
o Spontaneous involvement of members
o Member support and feedback
Plan may have to be adapted throughout the various phases of the group
development.




Levels of Group Development
Each level represents an increasingly cohesive, balanced,
and self-determining group
Parallel groups
Project groups
Egocentric cooperative groups
Cooperative groups
-Identified by Mosey (1970)
Research that Supports the Model
Most research deals with how to do groups, how to manipulate the
variables, and how to get the best results from group intervention.

Strong Evidence in regards to:
Group size and interaction
Cohesiveness and effectiveness of intervention
Choice and control, when a group has client-centered goals, there is greater
client satisfaction and participation
Group composition and cohesiveness
o Groups with members with similar performance skills, goals, and
abilities have increased participation in groups
Research Studies: (Schwartz & Schwartzberg,
2011)
Two types of psychodynamic groups were developed for a population of elders
with depressive disorders: a verbal group and an activity group.
The verbal group focused on working through experiences, exploring
feelings, maladaptive patterns, self-understanding, and interpersonal
relationships.
The activity group had four major characteristics:
Purposeful action
Self-initiated action
Spontaneous (here and now) action
Group-centered action
Research Studies: (Schwartz & Schwartzberg,
2011) Contd
Azima and Azima (1959) stated that the difference between activity groups and verbal
groups are that in activity groups, the person is able to verbalize and do things to objects.
Participating in activities can evoke unconscious reactions
Modalities in an activity group include arts and crafts, music, cooking, gardening, etc.
Verbal groups found that therapists needed a lot of energy to spark initiation for older
adults with depression
Conclusions:
Therapists need to adapt the groups as necessary to the groups needs.
Therapists may find one approach better than another.
As people lose functional capacity in one area, they may find strengths in another.
Research Studies: (McDermott, 2008)
Activity-based, awareness-oriented verbal groups were found to be more effective
than purely verbal groups for developing interpersonal skills (DeCarlo & Mann,
1985; Mumford, 1974).
Parallel task groups, compared to activity-based verbal groups, had more
interactions between members, and less non-communicating members
(Schwartzberg, Howe, & McDermott, 1982).
The authors of this study found that task groups, compared to verbal groups and
activity-based verbal groups, had positive outcomes on patient interaction.
High amount of peer interaction
Low number of members not communicating actively
Promotion of social skills, perhaps due to the natural, comfortable, and non-
threatening environment and exchange of interaction during task group

Research Studies: (Schwartzberg, Trudeau, &
Vega, 2013)
There is a need to assess group outcomes to prove the worth of group intervention
in occupational therapy.
Authors of this article suggest ways in which future researchers could assess
outcomes in group intervention:
By measuring the impact intervention has on the patient
Through assessments that are sensitive to change to track differences in
progress
One rater-completed and one patient-completed instrument to ensure desired
group outcomes
Whats to Come in Research
Evidence of higher quality:
Such as randomized control trial study
Comparing Functional Group Model to another model
Measure of fidelity to Functional Group Model






Assessment: Group Leader Self-
Assessment (GLSA)
(Barnes, 2011)
Assessments: Evidence
Group Leader Self-Efficacy Instrument
36 Item Instrument
Participants were 204 counselor trainees - diverse, 30 universities in 20 states
Items with >.40 on factor analysis were kept (ended up losing 1 item)
Validity and Reliability Studies Found:
Construct Validity supported
Reliability:
Cronbachs alpha for the consistency of items on test = .75, high internal
consistency
Test-Retest at 2 week intervals, found to be acceptable
Assessment: Group Leader Self-Assessment (GLSA)
(Barnes, 2011)
Items are adapted from Page, Pietrzack, & Lewis (2001)
Article is a guide
For developing items in relation to leaders self-efficacy in group
leadership.
Barnes adapted 4 Items from the Study:
Items include the self-perceived ability of the leader:
To be supportive and caring
Provide executive functions,
Provide emotional stimulation
Process experiences.
Barnes also utilizes the same 6 Point Likert Scale
Rated from 1 being strongly disagree to 6 being strongly agree.
Group Leader Assessment
Strengths:
Easy to use
Structured and organized
Evidence that supports each area
Continued and updated research

Weakness:
Self-assessment

Case Study
Name of Group: Community Re-entry: Moving Forward
Leaders: 1 OT, 1 COTA
Time/length of meetings: 4X week, 90 mins each
Group format: Closed
Short-Term Group Goals
To describe abilities and strengths.
To be able to select, perform, and coordinate activity schedule
to maintain a balance between rest and work.
To be able to position self physically to promote optimal safety
and life roles.
Identify a peer support network in the community to aid
adjustment to disability


Long-Term Group Goals

Identify changes regarding the result of current disability status in
order to perform aspects of meaningful roles
Identify changes in living environment and relationships necessary
for adaptation to current disability.
Identify potential barriers to adjustment to community living and
discuss strategies for intervening with identified barriers
Use joint protection and/or body mechanic principles to minimize
stress on joints and prevent falls or further injury
Rationale For Use of Functional Group Model
The members of the group are dealing with community re-entry and changes in life
roles, which may include asking others to fulfill some needs.
It is also recognized that members are expected to meet criteria for functional
performance at discharge.
Clients need strategies and support to maintain themselves physically, emotionally,
and socially in the community and to continue to achieve a maximum level of
functioning.
Patient education is necessary to prevent further debilitation/ disability.
Ideas for Intervention?
Intervention
Session 1: Intro to group: purpose, goals, procedures, and ice-breakers
Session 2: Individual collages: What I Value, discussion
Session 3: The Pie of My Life pre-hospitalization and post-hospitalization
Expressive Art Activity, group discussion
Session 4: Energy conservation, pain management, lecture slide-show
demonstration, group discussion
Session 5: Time management principles and discussion
Session 6: Dealing with human and architectural barriers, and identifying
community resources with handouts and discussion
Session 7: Community integration at home/work/socially
Session 8: Group closure
References
American Occupational Therapy Association. (2007). Centennial Vision.http://www.aota.org/
AboutAOTA/Centennial-Vision.aspx
Barnes, M. A. (2011). Group Leader Self Assessment (GLSA). Unpublished tool, Tufts University,
Medford, MA.
Kielhofner, G. (2009). Conceptual foundations of occupational therapy practice. (4th ed.). F.A.
Davis: Philadelphia
McDermott, A. (2008). The effect of three group formats on group interaction patterns.
Occupational Therapy in Mental Health, 8(3), 69-89.
Page, B. J., Pietrzak, D. R., & Lewis, T. F. (2001). Development of the group leader self-efficacy
Instrument. Journal for Specialists in Group Work, 26, 168-184.





References
Schwartz, K., & Schwartzberg, S. L. (2011). Psychodynamically informed groups for
elders: A comparison of verbal and activity groups. GROUP Journal of the Eastern
Group Psychotherapy Society, 35(1), 17-31.
Schwartzberg, S.L., Howe, M.C., & Barnes, M.A. (2008). Groups applying the Functional
Group Model. Philadelphia: FA Davis.
Schwartzberg, S. L., Trudeau, S., & Vega, V. (2013). Principles of Occupational
Therapy Group Outcomes Assessment in Mental Health. Occupational Therapy in
Mental Health: A Journal of Psychosocial Rehabilitation and Research, 29(2),
134-148.