Ethics and Group Protocol

Question 1

Symptoms of Schizophrenia (neg vs pos)

Answer 1

Positive (“added” stuff): Hallucinations, delusions, grossly disorganized speech/behavior, loosening of associations

Negative (“subtracted” stuff): Apathy, flat affect, avolition (lack of goal-directed behavior), psychomotor retardation (“potato” like)

Question 2

Delirium vs Dementia

Answer 2

DELIRIUM has a rapid onset of symptoms induced by outside factors, and can last from a few hours to weeks. Can be induced by fever, head injury, hospital stay in acute care/ICU, or even UTI in women. Causes reduced alertness/awareness, disorganized thinking (impaired memory, incoherent speech).

DEMENTIA is severe impairment of short- and long-term memory. ABSENCE of delirium. Impaired thinking/judgment; social/occupational impairment; probable organic cause.

Question 3

Restraints

Answer 3

Any device attached or adjacent to one’s body that restricts freedom of movement or normal access to one’s body. Used only as last resort in emergency; if patient begins to physically and violently harm self/others.
SR=Safety Risk OR RS=Risk of Safety

Question 4

Seclusion

Answer 4

Isolation from others. Used only as last resort in emergency; if patient begins to physically and violently harm self/others.
SR=Safety Risk OR RS=Risk of Safety

Question 5

Competency/Incompetency

Answer 5

Competency=Communicates wishes, understands consequences, constant over time, understands relevant info., has personal values.

Incompetency=Opposite of Competency. 2 kinds: 1) those who were never competent, and 2) those who were competent once and no longer are. Also, minors.

Question 6

Involuntary Commitment

Answer 6

Consent from patient is not required if patient is in danger to themselves or others. Patient cannot refuse treatment. Legal process that varies by state law. Includes holding patient in in/outpatient care, usually no longer than 96 hours.

INvoluntary= INtent to harm; IN care by mental health professionals

Question 7

Autonomy

Answer 7

Self-determination; right to accept or refuse tx. Involves patient choice. (ie: depressed patient offered meds with explanation of risk etc., but patient opts for homeopathic tx).

Question 8

Informed Consent

Answer 8

Patient told the cost/risk/benefits of a treatment in order to make an informed decision.

Question 9

Confidentiality

Answer 9

Not disclosing patient info. HIPAA. Exceptions:
• Harm to self/others
• STDs reported to law enforcement/govt. agencies
• Report if suspect patient is being hurt by others

Question 10

Group Cohesiveness

Answer 10

Solidarity; sense of closeness and identification with others in the group. Occurs with frequency of meetings, intermember similarity, instillation of hope, guidance, family reenactment (feels like family), altruism, and universality (others in same boat).

Question 11

Intermember Similarity

Answer 11

Group members believe they are like the others, or share the same purpose. Part of group cohesiveness.

Question 12

Universality

Answer 12

Group members feel the others are in the same boat. Part of group cohesiveness.

Question 13

Group Goals

Answer 13

The purpose for the meeting; group must have meaning. Must be clear, consistent and fair. Used to evaluate the group’s success.

Question 14

Group Norms

Answer 14

Rules and standards for expected behavior in the group. Learned by socialization and sanctions.

Question 15

Socialization

Answer 15

Group behavior expectations (norms) are taught/told by the OTP.

Question 16

Sanctions

Answer 16

Group behavior expectations (norms) are enforced by punishment of transgressions.

Question 17

3 Main Categories of Group Functional Roles:

Answer 17

Task Roles: Develop in relationship to the group’s goals and the problems they each must solve.

Group Maintenance Roles: Needed to promote and maintain cohesiveness and closeness. Leader takes on several depending on group’s changing needs.

Antigroup or Egocentric Roles: Individuals that interfere with group’s progress by dominating, attacking, clowning, etc.

Question 18

Purpose of OT Groups

Answer 18

• To help person succeed in personally valued occupational roles
• To help members “gain awareness” and support in “exploration of new roles”
• To examine what roles person already has ability to take, and which need development

Question 19

Group Dynamics

Answer 19

Constantly evolving/never static quality of group. Based on individual members and reactions to each other. OTA identifies which functional group roles are needed for the person’s occupational role. Done by observing interactions, watching nonverbal cues, etc. The functional role falls into 3 categories: Task, Group Maintenance, or Antigroup/Egocentric.
* Leader (OTA) assumes only the roles that the group members cannot.

Question 20

Scapegoating

Answer 20

Group gangs up against one member, blaming that person for group’s failure to achieve goals.

Question 21

Leader Behaviors (Types)

Answer 21

1) Consistency= Foundation of successful groups; show same respect/interest/authority to all members; group knows what to expect from leader.
2) Autonomy= Leader gives as much independence as is appropriate to group.
3) Nurturing= Any behavior that supports/promotes growth of individual members.
4) Interpersonal Learning= Everything learned is from interactions with others; use resources of group to help each member learn more about self and others; interactive as opposed to leader-mediated group; members seek supervision as needed.

Question 22

Mosey’s Level of Group Interaction Skills

Answer 22

Five levels (hierarchy) of interaction/role required of therapist in a group based on their skills. (Level is named for skill group is to acquire.)

*Parallel Group= Lowest level. Members have limited attention span, may not be aware of others. Therapist plays largest role (explaining, assisting, setting limits)
V
Project Group > Egocentric-Cooperative Group > Cooperative Group=Three mid levels. Therapist takes on progressively less interactive role.
V
*Mature Group= Highest level of skill. Members are learning roles and how to maintain balance btw group task and meeting emotional needs of group. Therapist as a member; may demonstrate roles, select members based on skills etc.

Question 23

Components of Group Protocol (list)

Answer 23

1) Name of Group (should convey purpose)
2) Description (brief; sense of what happens)
3) Structure (time/place/size/leader characteristics)
4) Goals/Behavioral Objectives (clear, behavioral, specific as possible)
5) Referral Criteria (describes kind of patient who might benefit; may include intake procedure)
6) Methodology (medium/activity and method/how it’s used; detail of flow of activities during meetings)
7) Curriculum/Agenda (for educ groups; details of instruction covered)
8) Leader’s Roles (what leader does/does not do; functional roles of group leader)
9) Evaluation (how achievement of goals assessed)