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How Groups Can Make a Difference for Hispanic Immigrant Children

Elaine Clanton Harpine, Ph.D.
Elaine Clanton Harpine, Ph.D.

How Groups Can Make a Difference for Hispanic Immigrant Children

Elaine Clanton Harpine, Ph.D., Thomas Reid, Ph.D., William D. Harpine, Ph.D., Adam Pazda, Ph.D., Shana Ingram, B.A. & B.S., and Collytte Cederstrom

The Latina/Latino ethnic group has the lowest educational scores of any large ethnic/racial group in the United States (Mroczkowski & Sánchez, 2015).  According to the Nation’s Report Card, only 26% of Hispanic 4th graders scored as proficient in reading (National Center for Education Statistics (NCES, 2014).  Hispanic kindergarteners also score lower than other racial groups on reading readiness; 42% were listed in the lowest group (Gándara & Contreras, 2010).  The need to improve reading programs for Hispanic children, especially Hispanic immigrant children, becomes obvious.  Groups have been identified as being more effective than one-on-one tutoring (National Reading Panel, 2000).  Prevention groups have also been shown to be effective in academic settings (Kulic, Horne, & Dagley, 2004).  The question is:  Would a group-centered prevention approach for teaching reading be a better approach for meeting the needs of Hispanic immigrant children struggling to learn to read in English?  

Introduction

The cause of reading failure for Hispanic immigrant children is the same as it is for all children:  lack of phonemic awareness (Keller & Just, 2009; Lyon, 2002).  Phonemic awareness is defined as being able to hear, understand, and make use of letter sounds or phonemes (Shaywitz & Shaywitz, 2007).  As Shaywitz (2003) stated, anyone learning to read must be able to decode (break down) words into letter sounds and then encode (reassemble) the sounds back into words.  Lack of training in phonemic awareness becomes a major concern for schools, since according to the Nation’s Report Card, 74% of Hispanic children are not able to read at grade level by 4th grade (NCES, 2014).  Yet, U. S. census findings show that 22% of all children under the age of 18 are Hispanic and 11% of those children are foreign-born (Fry & Passel, 2009).  

Purpose of the Study

Do Hispanic immigrant students need a different teaching approach than other students in the classroom?  Not really, but research has supported claims that the classroom teaching method is a major cause of reading failure (Foorman et al., 2003; Torgesen et al., 2001).   Neuroimaging research has also provided evidence that children who have failed in learning to read using typical whole language, “look-say,” Reading Recovery, or word list memorization methods can be taught to read when the teaching methods are structured to meet the actual needs of the children (Keller & Just, 2009; Meyler et al., 2008).  Learning to read is one of the most critical developmental steps for any child (Fleming et al., 2004) because it is not only related to development across the life span, but also to mental well-being (Maugban, Rowe, Loeber, & Stouthamer-Loeber, 2003).  

Hispanic immigrant children need to learn how to speak, read, write, and work with the English language (Coll & Marks, 2012; Gándara & Contreras, 2010).  This becomes important in school because Hispanic immigrant children need to be accepted by their peers, to display academic accomplishment, and to develop a positive self-identity in their new culture while maintaining a sense of pride in their family culture (Suarez-Orozco & Suarez-Orozco, 2001).  

About the Intervention Being Tested:  Camp Sharigan

We tested the group-centered approach with Hispanic immigrant children to determine whether the group-centered approach would work with students who were failing in reading at school.  We used the ready-to-use group-centered program packet, Camp Sharigan, designed for first through third grade students (Clanton Harpine, 2016).  

Camp Sharigan is a one-week, group-centered prevention program that emphasizes both learning (reading) and counseling (social skills).  This group-centered week-long intervention’s primary goal is to teach children skills (both cognitive and non-cognitive) that will improve reading ability and thereby improve mental wellness and quality of life.  Camp Sharigan emphasizes phonemic awareness, word decoding skills, oral reading, listening and attention skills, writing, encoding skills (spelling), reading fluency, and reading comprehension.  

Learning.  To teach phonemic awareness, the intervention uses vowel clustering (Clanton Harpine, 2011), a method that teaches children to break words down into letter sounds or phonemes.  Vowel clustering teaches children to break words down into sounds and then put those sounds back together as a word.

Previous Research.  We chose this program as our teaching method because it had been tested previously with Hispanic immigrant children.  In a previous study, first through third grade children from a Mexican-descent, inner-city immigrant neighborhood were randomly selected to participate in a test of two different teaching methods.  The group-centered set participated in the week-long, 10-hr Camp Sharigan program, while the other students participated in a 10-hr structured one-on-one tutoring intervention.  

The group-centered students outscored the children who participated in the one-on-one tutoring program.  One year later, during follow-up testing, the Camp Sharigan group was still showing significant improvement over the one-on-one tutoring group just from the one-week intervention (Clanton Harpine & Reid, 2009).   

Multiple Case Study:  Single-Subject Design

The Group Intervention

Although previous group research supported the effectiveness of the group-centered approach, we wanted to examine the impact that a group program like this could have on an individual student, especially students who were failing in school.  The goal was to discover a new effective group-centered teaching method for helping Hispanic, immigrant children improve their reading skills so that they could succeed in the classroom.  

Participants

We chose first graders from a one-on-one tutoring group because we wanted to examine teaching methods without the added burden and stress of multiple years of failure. We know that repeated academic failure compounds the social-emotional and learning problems of students, especially Hispanic immigrant students striving to learn English as a second language (Castro-Olivo et al., 2011).  

We chose 3 children. All of the participants (3 males) were starting first grade when randomly selected for the one-on-one tutoring group and just prior to starting second grade when they participated in the group-centered Camp Sharigan program.  The three students chosen were from the same neighborhood, and attended the same school, participated in the same English as a Second Language instructional program at school, and attended the same after-school program.  

Study Design:  Single-Case Experimental Design

We used single-case graphic analysis to chart each student’s progress.  Macgowan and Wong (2014) suggest that repeated measures should be taken on a single subject or small group of subjects under treatment and no-treatement (baseline) conditions.  Macgowan and Wong (2014) also state that the subject serves as its own control and that single-case design is a valuable research design for applied study with groups.  Kazdin (1) supports the value of studying group participants individually and states that interventions must be tested in real-world settings to prove practical application.

The Howard Street (Morris 2005) assessment procedures were administered to all three participants because the test reported high reliability and validity (predictive validity of .70 and an internal reliability of .85) (Morris, Tyner, & Perney, 2000).  All tests were age-appropriate.  Assessment scores reflected the number missed (Morris, 2005).  

All three children selected for this study were pre- and post-tested at grade level in spelling, oral reading, and sight words.  All three children received the same Howard Street pre-, mid-, and post-test instruments. All three children received pre- and post-tests the summer before first grade.  The three students were then give the same test at mid-point testing.  The summer before second grade, the three students were pre-tested directly before Camp Sharigan and post-tested again immediately after the Camp Sharigan program.  Words on the assessments were not targeted during the one-on-one tutoring or Camp Sharigan program.  

Assessment was scored on the number missed in an untimed test (Morris, 1999).  Self-corrections were not counted as words missed.  Substitutions, omissions, and insertions all counted as words missed.  

Results of the Test

The results show moderate but consistent improvement in reading and sight word recognition after participating in the 10-hr group-centered Camp Sharigan program (see Figures 1 and 2).  The baseline data incorporated each student’s first grade year in school and one full year of one-on-one tutoring before they entered the Camp Sharigan program.  Longitudinal follow-up testing was not possible with this group because of the transient nature of the population.  Improvement is indicated by reduction in number missed at post-testing. The decrease in missed reading words from the first pre-test (M = 12.67, SD = 2.52) to the last post-test (M = 6, SD = 4.58) demonstrates the program’s effectiveness, as does the decrease in missed sight words from the first pre-test (M = 10.33, SD = 0.58) to the last posttest (M = 5.67, SD = 0.58). 

For example, Student #1.  This student, when first tested before first grade, could only read two words in English from the sight word list for pre-kindergarten: “cat” and “go” and could not read words from the oral passage or pre-primer story.  After a year in first grade and with a full year of one-on-one tutoring during first grade, Student #1 was still barely reading at the pre-primer level (below kindergarten).  The student did show some improvement with sight words, but not oral passages.  He memorized a list of words but could not recognize those words when he encountered them again in a story.  After one week with the group-centered Camp Sharigan vowel clustering teaching method, the student was showing improvement with both sight words and in reading oral passages.  Although he was still below grade level and struggling, a mere 10-hour group program showed more benefit for this student than an entire year in first grade with one-on-one tutoring.  

Student #2 made very slow but gradual improvement throughout the first-grade year in school, even with one-on-one tutoring.  By the middle of first grade (6-month post-test), the student was only able to read two new words.  At the end of first grade, the student could only read four new words.  After Camp Sharigan, the student could read 8 new words.  The student demonstrated as much improvement after a 10-hr program as throughout the entire first year of classroom instruction.  Again, vowel clustering and a group-centered teaching method helped this student improve.  

Student #3 demonstrated a similar outcome.  He could not read at all during the first pre-test when he was tested before first grade.  He missed every word on the sight word list and every word on the oral passage at the pre-primer level (below kindergarten).  At the 6-month point in first grade, using Morris assessment, Student #3 was actually doing worse than when he was first tested before school.  He had given up hope.  At the end of first grade, he could only read four new words from the sight word list.  His oral passage score at the end of first grade remained the same as his original pre-test before first grade; he could not read the pre-primer story—not one word.  After the Camp Sharigan intervention, he not only read the pre-primer level story, but moved up in reading oral passages and even made progress in sight words.  The change in teaching method made success possible.  As Kazdin (1982) states, if individual analysis research can show that change occurred immediately after an intervention, then a strong case can be made that the intervention is working (see Figures 1 and 2). 

Discussion

The group-centered approach helps to meet the needs of struggling Hispanic immigrant students in reading:  (1) vowel clustering offers a new, effective approach for teaching phonemic awareness, (2) group-centered interventions offer a new approach for teaching reading and social skills in a positive cohesive group atmosphere, and (3) hands-on workstations with step-by-step directions offer a new approach to teach reading comprehension and strengthen intrinsic motivation.  

What Made the Group-Centered Approach Effective?

Camp Sharigan, a one-week, 10 hr, group-centered reading program, emphasized improving phonemic awareness, interpersonal skills and rebuilding self-efficacy (belief that the child could read), using group cohesion, vowel clustering, and intrinsic motivation (Ryan & Deci, 2000) in an environment of hands-on reading-based activities in accordance with Bandura’s (1997) self-efficacy theory.  The children did not receive prizes or award; the program worked entirely with intrinsic hands-on motivators and group-centered interventions.  

What Are the Advantages of a Group-Centered Approach?

The Group-Centered Teaching Approach Individualizes Instruction. Sometimes student problems are misidentified in school.  By using six different teaching methods, the needs of the student can often be clarified.  This was true with Student #2.  What at first seemed like stubborn refusal to cooperate was a lack of phonemic awareness.  The student had never been taught to focus on letter sounds.  Instead, the child relied on memorization.  When the student encountered a word that the student did not know, the student stalled and seemed uncooperative.  After the student was taught vowel clustering, the student was willing to attempt new words.  The Snake Pit workstation provided a perfect work place for sounding out words.  This new skill was reinforced at the Rainbow Bridge workstation where the student practiced reading a vowel clustered story.  By the end of the week-long 10-hour group-centered Camp Sharigan program, Student #2 was showing improvement.  Groups really can make a difference.

The Group-Centered Approach Combines Learning and Counseling. The importance of combining learning and counseling into the same program along with the therapeutic power of cohesive group interaction became especially evident on the last day of the program.  Thursday evening, a horrendous thunderstorm struck the city and flooding.  When we opened the doors, all but three children were standing on the sidewalk waiting to enter.  The three not attending had a fever and upper respiratory infection from being out in the rain all night.  The children wanted to finish their pop-up books and to present their puppet play.  The pop-up book was a challenging project that required the children to read and follow directions to assemble their book and to write a story in English before the book could be taken home.  Children who started the week with no desire to read worked hard all week and were excited and motivated to read their finished pop-up book stories.

How Does This Report Help Group Psychologists?

This intervention report provides a new method for working with Hispanic immigrant children.  If Hispanic children in the United States do not learn to read in English, the stigmatization of failure can mark them throughout their lives (Ruiz et al., 2011; Toppelberg, Medrano, Peña Morgens, & Nieto-Castañon , 2002).  If reading scores improve, especially in the early elementary years (Lyon, 2002), then we can increase school completion rates and reduce stress as well as aggressive and dysfunctional behavior (Pressley et al., 2007; Zea et al., 2003).  

The group-centered approach is one innovative technique showing promise.  This study is but a first step.  Replication is needed.  Yet, Moerbeek and Wong (2008) emphasize that selecting a small test group for analysis can be just as effective as a large sample with individual analysis.  

As this study also demonstrates, some children will need more than a mere 10 hr group program.  Group prevention can also be used for year-long classroom and after-school programs (Clanton Harpine, 2013).  Group prevention can make the difference between success and failure for a child (Brigman & Webb, 2007).

References

Bandura, A.  (1997).  Self-efficacy:  The exercise of control.  NY:  W. H. Freeman.

Brigman, G., & Webb, L.  (2007).  Student success skills:  Impacting achievement through large and small group work.  Group Dynamics:  Theory, Research, and Practice, 11, 283-292.

Castro-Olivo, S., Preciado, J., Sanford, A., & Perry, V. (2011). The academic and

socio-emotional needs of secondary Latino English Learners: Implications for screening, identification, and instructional planning. Exceptionality 19, 160-174.

Clanton Harpine, E.  (2011).  Group-Centered Prevention Programs for At-Risk Students.  New York:  Springer.  

Clanton Harpine, E.  (2013).  After-school prevention programs for at-risk students:  Promoting engagement and academic success.  New York:  Springer.  

Clanton Harpine, E.  (2016).  Erasing failure in the classroom, vol. 1:  Camp Sharigan, a ready-to-use group-centered intervention for grades 1-3 (3rd ed.).  North Augusta, SC:  Group-Centered Learning.  

Clanton Harpine, E., & Reid, T.  (2009).  Enhancing academic achievement in a Hispanic immigrant community:  The role of reading in academic failure and mental health.  School Mental Health, 1, 159-170.  doi:  10.1007/s12310-009-9011-z

Coll, C. G., & Marks, A. K.  (2012).  The immigrant paradox in children and adolescents:  Is becoming American a developmental risk?  Washington DC:  American Psychological Association.

Fleming, C. B., Harachi, T. W., Cortes, R. C., Abbott, R. D., & Catalano, R. F.  (2004).  Level and change in reading scores and attention problems during elementary school as predictors of problem behavior in middle school.  Journal of Emotional and Behavioral Disorders, 12, 130-144.

Foorman, B. R., Breier, J. I., & Fletcher, J. M.  (2003).  Interventions aimed at improving reading success:  An evidence-based approach.  Developmental Neuropsychology, 24, 613-639.

Fry, R., & Passel, J. S.  (2009).  Latino children:  A majority are U. S. – born offspring of immigrants.  Washington, D. C.:  Pew Hispanic Center.

Gándara P., & Contreras, F.  (2010).  The Latino education crisis:  The consequences of failed social policies.  Cambridge, MA:  Harvard University Press.

Kazdin, A. E.  (1982).  Single-case research designs:  Methods for clinical and applied settings.  New York:  Oxford University Press.

Keller, T., A., & Just, M. A.  (2009).  Altering cortical connectivity:  Remediation-induced changes in the white matter of poor readers.  Neuron 64, 624-631.  

Kulic, K. R., Horne, A. M., & Dagley, J. C.  (2004).  A comprehensive review of prevention groups for children and adolescents.  Group Dynamics:  Theory, Research, and Practice, 8, 139-151.

Lyon, G. R.  (2002).  Reading development, reading difficulties, and reading instruction educational and public health issues.  Journal of School Psychology, 40, 3-6.

Macgowan, M. J., & Wong, S. E.  (2014).  Single-case designs in group work:  Past applications, future directions.  Group Dynamics:  Theory, Research, and Practice,18, 138-158.   doi:  10.1037/gdn0000003

Maugban, R. R., Rowe, R., Loeber, R., & Stouthamer-Loeber, M.  (2003).  Reading problems and depressed mood.  Journal of Abnormal Child Psychology, 31, 219-229.

Meyler, A., Keller, T. A., Cherkassky, V. L., Gabrieli, J. D., & Just, M. A.  (2008).  Modifying the brain activation of poor readers during sentence comprehension with extended remedial instruction:  A longitudinal study of neuroplasticity.  Neuropsychologia, 46, 2580-2592.

Moerbeek, M., & Wong, W. K.  (2008).  Sample size formulae for trials comparing group and individual treatments in a multilevel model.  Statistics in Medicine, 27, 2850-2864.   doi:  10.1002/sim.3115

Morris, D.  (2005). The Howard Street tutoring manual:  Teaching at-risk readers in the primary grades.  NY:  Guilford Press.

Morris, D., Tyner, B., & Perney, J.  (2000).  Early steps: Replicating the effects of a first-grade reading intervention program.  Journal of Educational Psychology, 92, 681-693.

Mroczkowski, A. L., & Sánchez, B., (2015).  The role of racial discrimination in the economic value of education among urban, low-income Latina/o youth:  Ethnic identity and gender as moderators, American Journal of Community Psychology, 56, 1-11.   doi:  10.1007/s10464-015-9728-9

National Center for Education Statistics.  (2014).  The nation’s report card:  Reading 2014 (NCES 2014-457).  Washington DC:  Institute of Education Sciences, US Department of Education.

National Center for Education Statistics.  (2015).  The nation’s report card.  (NCES 2015-Reading Assessment).  Washington DC:  Institute of Education Sciences, US Department of Education.

National Reading Panel, (2000).  Teaching children to read:  An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction (NIH Publication No. 00-4754).  Washington, DC:  National Institute for Literacy.

Pressley, M., Mohan, L., Raphael, L. M., & Fingeret, L.  (2007).  How does Bennett Woods Elementary School produce such high reading and writing achievement?  Journal of Educational Psychology, 99, 221-240.

Ruiz, M., Kabler, B., & Sugarman, M.  (2011).  Understanding the plight of immigrant and refugee students.  Communique, 39, 23-25.  

Ryan, R. M., & Deci, E. L.  (2000).  Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemporary Educational Psychology, 25, 54-67.  

Shaywitz, S., & Shaywitz, B.  (2007).  Special topic:  What neuroscience really tells us about reading instruction: A response to Judy Willis.  Educational Leadership:  Improving instruction for students with learning needs, 64 (5) 74-76.

Suarez-Orozco, C., & Suarez-Orozco, M. M.  (2001).  Children of immigration.  Cambridge, MA:  Harvard University Press.

Toppelberg, C. O., Medrano, L., Peña Morgens, L., & Nieto-Castañon, A.  (2002).  Bilingual children referred for psychiatric services:  Associations of language disorders, language skills, and psychopathology.  Journal of the American Academy of Child and Adolescent Psychiatry, 41, 712-722.

Torgesen, J. K., Alexander, A. W., Wagner, R. K., Rashotte, C. A., Voeller, K. S., & Conway, T.  (2001). Intensive remedial instruction for children with severe reading disabilities:  Immediate and long-term outcomes from two instructional approaches.  Journal of Learning disabilities, 34, 133-158.  doi: 10.1177/002221940103400104

Zea, M. C., Asner-Self, K. K., Birman, D., & Buki, L. P.  (2003).  The abbreviated multidimensional acculturation scale: Empirical validation with two Latino/Latina samples.  Cultural Diversity and Ethnic Minority Psychology, 9, 107-126.

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Running Psychoeducational Groups: Ideas for Early Career Psychologists

Sean Woodland, Ph.D.
Sean Woodland, Ph.D.

Recently, a colleague and fellow ECP asked me to help her solve a problem with one of her groups.  She is a psychological assistant in an intensive outpatient program for a local hospital.  She noticed that in her new Distress Tolerance class patients were quite disengaged with instruction, often preferring side conversation.  Relatively new to group treatments, my colleague was left confused and discouraged for future groups.  I am grateful that that through my experience teaching, researching, and associating with Division 49 I was able to set her aright.  In our exchange I was reminded of previous publications from Division 49 members (Brown, 2011; Burlingame & Woodland, 2013) regarding conducting psychoeducational groups (PEGs).  Drawing on their writings and on personal experience thus far, here are a few simple guidelines to follow for any ECP new to PEGs.

Set the Tone

As with any therapeutic encounter, it is important to be prepared.  In PEGs this means having a well-defined lesson plan.  This is manifest through study and preparation of the material, as well as clearly communicating group rules and norms once the class has begun.  This is especially vital in class-oriented groups in which enrollment is open-ended.  One rule of thumb that has worked for me is that if there is ever a new member in the class, it’s safe to assume they don’t know the rules and norms.  So, instead of assuming they will “figure it out,” make a habit of repeating the class rules, at the very least by leaving a space on the whiteboard to display them.

Another way in which the PEG therapist sets the tone is in setting up the room such that the environment promotes engagement in instruction.  In my colleague’s Distress Tolerance group, the pre-established norm was for group members to be seated along three walls of a large, rectangular multi-purpose room.  While this configuration allowed for all group members to see each other clearly, it also created a great deal of space between teacher and learner.  This space seemed to invite side conversation, and also put a strain on members trying to see across the entire room toward the whiteboard.  Some members also had to re-adjust in their chairs to properly see instruction.  The solution to this problem was simple and surprisingly effective: chairs were placed in two rows of semicircles around the instructor.  This moved the dead space in the room from between the teacher and learner to behind the entire class.  And more importantly, side conversation was nearly eliminated.

Focus on Emotional Learning

If you were to ask group members what they learned in their last group, chances are the majority would not be able to recite the principles that were taught, much less grasp the content in the way in which the therapist intended for them.  Rather, group members and class members alike retain what they are ready to learn.  And in most instances, this learning is tied to an emotion.  With this said, it is important that the PEG therapist not be committed to “getting through” all the lesson material.  They should, rather, reward active engagement with reflection, expounding productive comments, and setting a foothold for engaging other class members.  Focusing on emotional learning can also lead to the use of experiential activities, which if used properly can enhance understanding.

For example, I recently taught a PEG on ADHD.  As might be expected, “telling” about things like executive function was not as effective as having them experience it.  An activity we called “Sound Ball” was particularly effective.  In this activity, participants were asked to make nonsense sounds while passing a ball in a circle.  They were required to repeat the sound produced by the ball-thrower as they received the ball.  They were then required to make up a nonsense sound as they passed the ball to someone else.  For almost all patients this created a challenge in executive function, a fair share of awkward moments, and was a powerful teaching tool.  Class members readily reported that experiencing difficulties mentally shifting, processing, and storing information during the activity illustrated a type for these same challenges in their daily lives.

Following Up

In PEGs following up can be incredibly important.  For example, using homework assignments can help clients gain clear direction about the message the PEG therapist is trying to communicate.  If the PEG only constitutes one session, creating a memorable experience in which the therapist polls “takeaways” can be a useful tool.  This may also be effective for the final class in a multi-session PEG.  Either way, if the instructor has done their job, there was likely a small change wrought upon the patient.  The proper handling of that change can help clients retain important knowledge and skills, and will enhance learning of principles to guide their own lives.

Recently I employed the “takeaway” strategy in a pain management class.  I asked class members what (if anything) they would take with them after the class was over. One member expressed an excitement for instruction on mindfulness meditation, and stated that she would try mindfulness on a daily basis to help cope with her pain.  Conversely, another stated that mindfulness was not for her, but that she preferred coping with a hot bath and a good book.  While at first it may seem that the first class member “got it” while the other did not, both reactions to the instruction were valuable!  Both class members left with greater knowledge of how to cope with their condition: one found a new tool that works, and another confirmed to herself what didn’t.  As the instructor, I decided to reinforce both types of learning.  This not only validated the disparate experiences, but also silently validated the varied experiences of the other members of the class.


As with any therapeutic modality, in psychoeducational groups (PEGs) rests great potential for learning. This may be didactic or “academic” learning, and can also be practical or emotional.  When treated with this scope and with the proper preparation, PEGs have the potential to be transformed from the reading of slides to seeing change on and individual and group level.  And perhaps most of all, they can be enriching to the instructor.  As PEGs continue to gain favor in the therapeutic array, seeing them as fertile ground for therapeutic gain will transform them from classes into therapy that reflects the emotional and interpersonal learning for which group attendees will continue to yearn.

References

Brown, N. W. (2011). Psychoeducational groups: Process and practice. Taylor & Francis.

Burlingame, G. M., & Woodland, S. (2013). Conducting psychoeducational groups. In Koocher, G.  P. Norcross, J. C., & Greene, B. A. (Eds.) Psychologists’ desk reference, 3rd ed. (pp. 380-383). New York, NY, US: Oxford University Press.

*Sean Woodland, PhD is a psychological assistant registered in the State of California, and works at Kaiser Permanente Stockton Medical Center.  The opinions expressed belong to Dr. Woodland, and may not reflect those of Kaiser Permanente.  For questions or concerns, Dr. Woodland may be reached by email at seanc.woodland@gmail.com, or by phone at 801-602-8278.

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Explaining Therapeutic Change in Residential Wilderness Therapy Groups

Lee Gillis, PhD
Lee Gillis, Ph.D.
Keith Russell, Ph.D.
Keith Russell, Ph.D.

Residential wilderness therapy or adventure therapy is “the prescriptive use of adventure experiences provided by mental health professionals, often conducted in natural settings that kinesthetically engage clients on cognitive, affective, and behavioral levels.” (Gass, Gillis & Russell, 2012 p.1).  The term adventure therapy is used in the literature interchangeably with “wilderness therapy” (Russell, 2001) and “outdoor behavioral healthcare (OBH)” (Russell & Hendee, 2000).  All these terms refer to treatment that takes place with small groups often in outdoor settings utilizing either short (1-5 days) forays into nature or extended expeditions (14-60 days) where participants are immersed in a wilderness setting. White’s (2015) history of the field points to an evolutionary tree for adventure therapy whose DNA includes therapeutic summer camps, Boy Scouts, Outward Bound, and even The Church of Jesus Christ of Latter-day Saints.  The recorded history of this therapeutic intervention dates back to 1861.

How does Outdoor Behavioral Healthcare look in practice?

Therapeutic outdoor experiences typically occur in small groups (4-8 clients). Most of the groups are “open” with clients entering and leaving as they go through intake or discharge; it is rare these days to have a cohort of clients who go through a whole program together.  Thus, the group climate can be in constant flux and how congruent a member’s perceptions are with the rest of the group has been found to have implications for treatment progress. At least that is the premise put forth in the Gillis, Kivlighan, & Russell (2016) manuscript in volume 53 of Psychotherapy.

Theoretically, the OBH group therapy that takes place has the members’ shared experience(s) of paddling, hiking, rock climbing, etc. on which to reflect and give feedback to one another.  Individuals set therapeutic intentions prior to an outing and project when they may have opportunities to engage in that intention.  For example, prior to a recent river crossing, one group member, based on his past history with the group, wanted to step up and take the lead with his peers as he had been sitting back and letting others take charge in previous activities.  He projected that once they arrive at the river would be his first opportunity to step forward.  Conversely, another group member stated his therapeutic intention was to stay quiet and listen to others as he had previously blurted out what he was thinking with little regard for what other group members wanted to do.  In each case the group members offered suggestions to clarify the intentions and question how they might see it realized.  The intentions are written down in the group room and then used as the basis for feedback in the group session following the experience.

Many of us who embrace this particular experiential approach find a strong foundation in principles of Gestalt Therapy, Psychodrama, and Carl Rogers’ Person Centered groups while grounding ourselves in evidence based cognitive behavioral approaches to treatment.  The conscious and intentional use of metaphor (Bacon, 1983; Gass, 1991), influenced by Milton Erickson’s work, is also prominent among many adventure therapists.  For example, the river crossing mentioned above provides numerous therapeutic metaphors to discuss in a group session whether they be being mindful of how one steps forward in life when the footing is unsteady or simply the challenges of getting from one place to another (one side of the river to the other).

Making sense of the adventure therapy group climate black box

The metaphor of a “black box” (Ashby, 1956) is often used when trying to make inferences about how change takes place within a program when examining only inputs (pretests) and outputs (posttests). Positive pre to post treatment changes in client progress as measured by the Outcome Questionnaire 45.2 (OQ 45.2) (Lambert & Finch, 1999) and Youth Outcome Questionnaire 2.0 SR (YOQ 2.0 SR) (Bulingame, et al 1996) during adventure therapy experiences for adolescents and young adults has been well documented (c.f., Bettmann et al., 2016, Gillis, et al. 2016, Norton et al, 2014). Meta-analyses have consistently demonstrated moderate (d = 0.45) effect sizes for adventure therapy (c.f., Bowen, Neill & Crisp, 2016; Cason & Gillis, 1994).

Russell, Gillis, & Heppner (2016) recently found that changes in the non-reactive factor of trait mindfulness (Baer, et al., 2008) helped explain OQ 45.2 change in young adults being treated for substance use disorder in an OBH program despite the program studied not having formal mindfulness training.  The authors posited adventure therapy as a mindfulness-based experience (MBE) especially when involved in reflecting on their excursions into the wilderness with explicitly stated therapeutic goals to achieve while out on trail.

The global changes in the non-reactive mindfulness factor among clients does not examine how engagement in the group experience influences outcome.  That was the purpose of the Gillis et al. (2016) manuscript in volume 53 of Psychotherapy. We examined how other member and person context moderate the relationship between group members’ perceptions of engagement and their treatment outcome using the actor partner interdependence model (APIM).

When the other group members generally see the group climate as engaged, higher general perceptions of engagement for the member are related to fewer depression and anxiety symptoms, clarity of social roles and interpersonal relationships.

When the other group members generally see the climate as not engaged, higher general perceptions of engagement for the member are related to more problems.

When the group member generally sees the climate as engaged, higher member biweekly perceptions of engagement related to fewer problems during that 2-week period.

When the member generally sees the climate as not engaged, higher biweekly perceptions of engagement for the member are unrelated to changes in problems.

Summary and Conclusions

In essence, this research is highlighting the role that congruence in member, group, and leader perceptions play in effectuating treatment outcome. When these perceptions become misaligned, individual client well-being can be affected, which in turn could create a cascading effect, leading to isolation and withdrawal from the group, thus affecting overall group engagement.  Monitoring these perceptions of engagement in conjunction with progress monitoring is warranted.  Practical implications for group therapists are to routinely monitor how group members view the group climate.

In this article we used the five item engagement subscale of MacKenzie’s (1983) Group Climate Questionnaire. We have recently switched to the Group Questionnaire available at oqmeasures.com in an attempt to examine how the three factor structure (positive bonding, positive working, and negative relationship) might provide more information to both therapist and to group members when used in progress monitoring. We will continue to examine the effects that bonding and working relationships has on treatment outcome both in the moment and during the weeks prior to group and community meetings because of our preliminary findings.

Finally, as authors, we are deeply indebted to Dr. Dennis Kivlighan for the APIM analysis and mentorship with the statistics!

References

Ashby, W. R. (1956). An introduction to cybernetics. An introduction to cybernetics. London: Chapman & Hall Ltd

Bacon, S. B. (1983). The conscious use of metaphor in Outward Bound. Denver, CO: Colorado Outward Bound School

Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., Walsh, E., Duggan, D., & Williams, J. M. G. (2008). Construct validity of the Five Facet Mindfulness Questionnaire in meditating and no meditating samples. Assessment, 15(3), 329-342.

Bettmann, J. E., Gillis, H. L., Speelman, E. A., Parry, K. J., & Case, J. M. (2016). A meta-analysis of wilderness therapy outcomes for private pay clients. Journal of Child and Family Studies, 1-15.

Bowen, D. J., Neill, J. T., & Crisp, S. J. (2016). Wilderness adventure therapy effects on the mental health of youth participants. Evaluation and Program Planning, 58, 49-49.

Burlingame, G. M., Wells, M. G., Hoag, M. J., Hope, C. A., Nebeker, R. S., Konkel, K., McCollam, P., & Reisenger, C.W. (1996). Manual for youth outcome questionnaire (Y-OQ). Stevenson, MD: American Professional Credentialing Services.

Cason, D. & Gillis, H.L. (1994). A meta-analysis of outdoor adventure programming with adolescents. Journal of Experiential Education17(1), 40-47.

Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, practice, & research. NY: Routledge Publishing Company

Gass, M. A. (1991). Enhancing metaphor development in adventure therapy programs. Journal of Experiential Education14(2), 6-13.

Gillis Jr, H. L., Speelman, E., Linville, N., Bailey, E., Kalle, A., Oglesbee, N.,Sandlin, J., Thompson, L., & Jensen, J. (2016). Meta-analysis of treatment outcomes measured by the Y-OQ and Y-OQ-SR comparing wilderness and non-wilderness treatment programs. Child & Youth Care Forum, 45, 851-863

Gillis, H. L. (L.), Jr., Kivlighan, D. M., Jr., & Russell, K. C. (2016). Between-client and within-client engagement and outcome in a residential wilderness treatment group: An actor partner interdependence analysis. Psychotherapy, 53(4), 413-423. http://dx.doi.org/10.1037/pst0000047

Lambert, M. J., & Finch, A. E. (1999). The Outcome Questionnaire. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed.) (pp. 831-869). Mahwah, NJ: Lawrence Erlbaum Associates.

MacKenzie, K. R. (1983). The clinical application of a group climate measure. In R. R. Dies & K. R. MacKenzie (Eds.), Advances in group psychotherapy: Integrating research and practice (pp. 159–170). Madison, CT: International Universities Press.

Norton, C. L., Tucker, A., Russell, K. C., Bettmann, J. E., Gass, M. A., Gillis, H. L., & Behrens, E. (2014). Adventure therapy with youth. Journal of Experiential Education37(1), 46-59.

Russell, Keith C. (2001). What is wilderness therapy? Journal of Experiential Education, 24(2) 70-79.

Russell, K. C., Gillis, H. L., & Heppner, W. (2016). An examination of mindfulness-based experiences through adventure in substance use disorder treatment for young adult males: A pilot study. Mindfulness, 7(2), 320-328.

Russell, K. C., & Hendee, J. C. (2000). Outdoor behavioral healthcare: Definitions, common practice, expected outcomes, and a nationwide survey of programs. Idaho Forest, Wildlife, and Range Experiment Station.

White, W. (2015). Stories from the field: A history of wilderness therapy.  Wilderness Publishers.

*This article was first published in The Society for the Advancement of Psychotherapy February 26, 2017.  Gillis, H. L., & Russell, K. C. (2017, February). Explaining therapeutic change in residential wilderness therapy groups. [Web article]. Retrieved from: http://www.societyforpsychotherapy.org/explaining-therapeutic-change-in-residential-wilderness-therapy-groups

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Brief Articles

Group Specialty Council: Promoting Group Psychology and Psychotherapy

Promoting Group Psychology and Psychotherapy

Nina Brown, Ed.D., LPC, NCC, FAGPA
Nina Brown, Ed.D., LPC, NCC, FAGPA
Eleanor F. Counselman, Ed.D., ABPP, CGP, LFAGPA
Eleanor F. Counselman, Ed.D., ABPP, CGP, LFAGPA

The Group Specialty Council, with members from Division 49, the American Board of Group Psychology (ABGP), the International Board for Certification of Group Psychotherapists, and the American Group Psychotherapy Association (AGPA) is hard at work preparing a new petition to have group psychology and psychotherapy approved as an APA specialty.

As part of the petition we must show four model programs that demonstrate group specialty training. Finding such programs has been a challenge and has awakened us to the need to have group psychotherapy training better publicized.  Group training programs are not well publicized or visible so that prospective students, the general public, and regulating bodies such as CRSPPP, can easily determine that such training programs are available in a doctoral program, or an internship, or a post-doctoral residency.

There are over 200 APA accredited doctoral and internship programs in the United States, all of which are supposed to have education and training program information on their websites, but our review of these websites did not reveal any group psychology and group psychotherapy training programs.  The absence of visible programs is a major hindrance for the current petition to gain recognition for group as a specialty in training programs.

It is important and essential that members of The Society who are faculty at university APA accredited doctoral and internship programs in clinical, counseling and school psychology work to get their group education and training programs more visible on the website and other public materials, and to get their programs to formally designate group as an emphasis, or track or concentration and to publicize this. Sometimes this is just a matter of updating an existing website. Or it might mean creating a link to new material.

We are confident that there are numerous educational and training opportunities in group psychology and group psychotherapy.  Josh Gross, the director of the Florida State University’ College Counseling Center surveyed  College Counseling Training Directors, 42 responded  and found ten that had possible group training opportunities and requirements that could be designated as a program, or an emphasis, or a track, or a concentration but had not been designated so or recognized as such in their public materials.

We need your assistance in bringing more visibility to the group psychology and group psychotherapy doctoral and internship training programs, emphases, concentrations, or tracks. We believe there will be increased demand for group therapy in the future, as it is an evidenced-based treatment for many disorders  (see the AGPA Practice Resources website) that is efficient and cost effective. However, psychologists who do not have adequate group therapy training are being asked to lead groups, and this is not good for the profession, much less the patients. Specialty status and promotion of training opportunities will help support group therapy and the training sites that offer it.

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Brief Articles

University/College Therapeutic Diabetes Support Group Therapy

Kathleen Lehmann, MA
Kathleen Lehmann, MA

Abstract

This paper serves as a proposal for a therapeutic support group for those with type 1, type 2, and gestational diabetes in university/college environment. While a great deal is known about the medical implications of diabetes, those living with the conditions find very few opportunities in which they are able to gain psychological support to help come to terms and cope with the condition. This paper outlines a professional therapeutic diabetes support group, in which professionals would come together to learn more about diabetes and increase compliance and accountability. Over the span of the group, members will learn details about diabetes, learn ways to cope with and fight stigma, and also build rapport and develop a community from which they can obtain support in the future. The aim of the group is to have members end up with a better understanding of diabetes and develop ways to help maintain a healthier lifestyle physically and psychologically.

Keywords: diabetes, type 1, type 2, gestational diabetes, group therapy, therapeutic support group, diabetes stigma, university

University/College Therapeutic Diabetes Support Group Therapy

Diabetes is a medical condition in which your body has issues that cause blood glucose (sugar) levels to rise higher than normal (American Diabetes Association, 2015). There are two main types of diabetes: Type 1 and Type 2. In type 1 diabetes, the body, more specifically the pancreas, does not produce insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Type 2 diabetes is the most common form of diabetes. With type 2, the body does not use insulin properly, referred to as insulin resistance. At first, the pancreas makes extra insulin to make up for it. Over time it is not able to keep up and cannot make enough insulin to keep the blood glucose at normal levels (American Diabetes Association, 2015). In addition to problems with insulin regulation, diabetes can cause complications with high blood pressure that can raise the risk for heart attack, stroke, eye problems, and kidney disease if left untreated (American Diabetes Association, 2015).

Purpose of Group

The prevalence of type 1 and type 2 diabetes has been increasing worldwide in the last few decades (Unnikrishnan, Bhatia, E., Bhatia, V., Bhadada, Sahay, Kannan, & Sanjeevi, 2008). Diabetes is a growing challenge for health care systems worldwide. Recent estimates have predicted that more than 300 million people will have the condition by the year 2025 (Gomersall, Madill, & Summers, 2011; King, Aubert, & Herman, 1998; Zimmet, Alberti, & Shaw, 2001). These numbers are shocking, and preventions and interventions for diabetes are crucial now more than ever. While the medical field is doing what it can to aid developing these interventions and preventions, assistance from the experts in psychology would help to bolster the effort even more.

While it is known that there is currently a diabetes epidemic, little attention is given to the ever growing young adult population diagnosed with diabetes (Wolpert & Anderson, 2001). Young adults with diabetes face unique challenges as they transition to self-care, and yet they fail to fit into neither pediatric nor adult medicine to help address these challenges. Because of this, they tend to be a forgotten group within the university/college population and counseling centers. University/college counseling centers, according to Gallagher (2014), typically include groups for students struggling with, anxiety disorders, crises requiring immediate response, psychiatric medication issues, clinical depression, learning disabilities, sexual assault on campus, self-injury issues, (e.g. cutting to relieve anxiety), and problems related to earlier sexual abuse.

However, there is a paucity of diabetes support groups in these counseling centers. When they are present, utilization and participation of these groups are low. Many young adults are affected by serious disorders, such as epilepsy, diabetes, or autism, and support for these groups of people on college campuses falls short. People in general tend to close their eyes and are blind to these groups. Research has shown us that these disorders, specifically diabetes, come with a number of negative implications, such as depression, anxiety, and poor self-esteem (Schabert, Browne, Mosely, & Speight, 2013). However, the research is limited in that it does nothing to provide these groups of people with the psychological support they need when dealing with diabetes. For all of these reasons, the need is greater now more than ever for a support group that targets under serviced groups.

The diabetes epidemic is much more of an issue than the public realizes (Schabert et al., 2013). While the above facts give examples of how the medical field acknowledges the severity of the disease, the ways in which the field of psychology and counseling helps to support people with diabetes are few. There is a huge stigma and misconception around diabetes (Schabert et al., 2013). People with diabetes know all too well the reality of living in a world where they are labeled and judged because they have a medical condition. Many people with diabetes experience constant worry, and many consistently face feelings of self-blame, fear, disgust, and feeling the need to fit into societal norms and avoid their disease. They also fear being judged, rejected, and discriminated against due to their condition (Schabert et al., 2013). This concept may give indication as to why compliance and accountability are huge issues with diabetes. People with the diagnosis may be in denial about their condition, where admitting that they have diabetes would mean admitting that there is something wrong with them (more than a medical condition). Because of this, they may be more likely to be noncompliant with their diabetes self-care and have little accountability over the decisions they make. The stigma has been found to cause serious issues with a person’s psychological well-being (Schabert et al., 2013). There is a great shame in people with diabetes; that somehow it is their fault that they have this medical condition. For that reason, therapeutic diabetes support groups need to be established to help people realize that they are not alone in their disease and that it is not a character fault.

The young adult period marks a critical point in a person’s life, where lifelong routines of self-care are set (Wolpert & Anderson, 2001). This presents a window of opportunity to intervene and influence habits that will help maintain good health later in life. For that reason, this paper proposes that we target this young adult group during college and as they start settling into their careers. In addition, the incidence of diabetes is so high and steadily increasing and more people are left with having to come to terms and deal with the ramifications of this condition. A therapeutic diabetes support group would aim at making the transition easier on people new to the diagnosis, as well as allowing people who have lived with the condition for many years to have much needed support. The overall purpose of the group would be two-fold: help with the medical aspects of the condition, such as education on what diabetes is, information about blood glucose/testing, and dietary/exercise information, as well as provide support and accountability to help increase compliance. The focus will be to not only provide emotional and psychological support to those with diabetes, but to help normalize the concept of diabetes and to try to help end the stigma as well.

Type of Group

The therapeutic diabetes support group plans to focus on psychoeducation, skill development, and support for emerging adults with diabetes. Research has found that self-management is the most used approach to diabetes control (Gomersall, Madill, & Summers, 2011). In this self-management approach, patients are awarded the responsibility for managing their illness, for example adopting new diets and regular exercise. To control diabetes, individuals must oversee daily behavior and long-held habits that often have to be changed (Gomersall, Madill, & Summers, 2011). Understandably, this leaves room for the client to curb or even ignore compliance to these guidelines. It has been found that for people with diabetes, adhering to these programs of self-care is often problematic (Nagelkerk, Reick, & Meengs, 2006). In addition to compliance in general, a number of other barriers have been cited to cause problems. The most frequently reported barriers were lack of knowledge of a specific diet plan, lack of understanding of the plan of care, helplessness and frustration from a lack of glycemic control, and continued disease progression despite adherence to the guidelines (Nagelkerk, Reick, & Meengs, 2006). In light of these findings, a support group that focuses on the development of skills needed for diabetic maintenance, as well as psychoeducation on the disease in general, will be the most effective approach in working with this population. The therapeutic support group will focus on developing a collaborative relationship between the facilitator and group members, maintaining a positive attitude that prompts proactive learning, and having a support person who provides encouragement and promotes accountability.

Screening Criteria  

Screening criteria for the therapeutic diabetes support group will be simple but rigid. Members must have a diagnosis of type 1, type 2, or gestational diabetes. The main caveat with this group is that it will aim to be a professional diabetes group. Professionals are people with the standards of education and training that prepare members of the profession with the particular knowledge and skills necessary to perform the role of that profession. For that reason, members should be working graduate level students or professionals in emerging adulthood. Making the group a professional association works to ensure stricter compliance, accountability, attendance, and higher group rapport. The group will have a rolling admissions, and members will be able to pick up where they need. Members can be selected through a referral program or through their job place/college campus.

In addition, each member must have a blood glucose meter or a continuous blood glucose monitoring system readily available. They must have access to a computer and/or smartphone for tracking of blood sugar levels. There will be a strict attendance policy due to the fact that compliance and accountability are key components of the group. Missing a session will result in termination from the group (extenuating circumstances will be evaluated on a case by case basis). Members must agree to these conditions and sign a contract at the beginning of the initial session. Finally, research has suggested that “stage of change” may be a good predictor of attendance at diabetes prevention and intervention sessions and have implications for intervention design and assessment (Helitzer, Peterson, Sanders, & Thompson, 2007). Because of this, the group should include only people in at least the preparation stage of change. The stage of change model explains that there are five stages a person goes through when they are making a behavior. The stages include pre contemplation, contemplation, preparation, action, and maintanence (Prochaska & DiClemente, 1983). The success of the group will be based heavily on each member’s willingness to change and devotion to the rules and regulations of the group. An evaluation by the member’s therapist, doctor, and/or an interview with the group facilitators as to what stage of change the client is believed to be in will be necessary for admittance into the group. This will help ensure a higher chance that the members will attend the sessions and therefore have higher chance for success with compliance.

Role of Group Leaders and Facilitation Issues

The biggest facilitation issue will be the compliance and attendance of the group members. Because of this, the attendance policy will be very strict and groups will run weekly. The group should include a small, even number of people – preferably around six. There will be two group leaders. One should have diagnosis of diabetes themselves, and the other should be a person without diabetes who can act as a neutral, non-invested party. At least one should be therapist as well. The role of the group leaders will be to facilitate group discussions, answer questions, hold group members accountable, and provide support.

Methods and Techniques

Each session will begin with the group leaders checking in with all of the members and discussing any issues that arose from the previous week. Every session will focus on a specific topic surrounding diabetes maintenance. The group will be highly collaborative in nature, and each session topic for the following weeks will be picked by the group in the first session. Topics may include things like diets and exercise, psychoeducation on diabetes, how to maintain accountability and compliance, blood glucose meter training, and tracking of blood glucose levels. When appropriate, the group leaders will arrange a guest speaker to come into the session to discuss that week’s topic. This may include help from a dietician, for example, where every group member will be given their own personalized diet plan to follow.

In addition, medical specialists in the field of diabetes will come to educate the group on what diabetes actually is and the science behind what is going on in the body. A session will be devoted to the discussion of the psychological and emotional impacts of diabetes and how to cope with them. A nurse practitioner will attend one session to administer initial blood glucose readings (to serve as a baseline for comparison after the group has ended) and demonstrate proper use of blood glucose meters, as well as appropriate times to test blood glucose throughout the day (typically 1-2 hours after meal times). A personal trainer will attend one group to educate the members about the importance of physical activity and will help each member develop personalized exercise routines. Finally, a guest speaker will come teach the group how to track their levels in a smartphone/computer app. The members will then be able to bring their results to session every week for analysis and discussion. This will also serve as data throughout the length of the group.

Accountability will be the main component of this group. Within the group itself, everyone will be paired up with another individual. In addition to the accountability to the entire group, each member will form a therapeutic alliance with their own personal partner to further facilitate compliance. Weekly check-ins with the therapeutic partner (in addition to the actual group meeting) will be necessary. Further, members should utilize their therapeutic partners on an as needed basis throughout the week for added support. Every group member will also be given the group leaders’ contact information as a last source of support. The group leader will focus on one member every week to stay accountable to and will check in with this person daily.

Duration of Group and Expected Outcomes

Depending on the number of topics selected by the group in the first session, the group will run anywhere from 8-12 weeks. Sessions will be on a weekly basis on the assigned day and time. They will be held in the evening or on weekends to accommodate the members. After the group has ended, it is hypothesized that compliance and accountability towards their diabetes maintenance (adherence to diet, exercise, blood glucose monitoring, etc.) will increase. In addition, the members’ levels of depression, anxiety, and stress involving their diagnosis are hypothesized to decrease. Overall health and well-being (as reported in self-report form and in regards to weight loss, stamina, and overall better sense of self) is expected to increase. Finally, it is hypothesized that there will be a decrease in the overall average blood glucose levels.

Process of Evaluation

Evaluation will take place in the form of self-report, scales, and data collected throughout the span of the group. At the end of the group, the members will submit journal entries detailing their progress and how they feel the group has helped them. Depression, anxiety, and stress will be measured using pre and post scores from the Beck Depression Inventory, the Holmes-Rahe Stress Inventory, and the Health Anxiety Inventory. In addition, the data collected from each member’s smartphone/computer app will be analyzed to review the overall progress of each member and the group as a whole. The more precise blood draw taken by the nurse practitioner to measure blood glucose levels pre and post group will be used in addition to the data collected personally by the members to ensure that their true progress is calculated, and to counteract any deception by the members on their personal recording of levels. Finally, attendance and a self-report of the number of compliance days (diet, exercise, check-ins with partner, etc.) will be recorded as a final measure to check for compliance and accountability.

Conclusion

The aim of the therapeutic diabetes support group is to end with a better understanding of diabetes and how to best maintain a healthy lifestyle, both physically and psychologically, as well as to increase compliance and accountability. Through psychoeducation and a better medical understanding, the group members should be able to combat the stigma against them in better ways. Hopefully, they will be able to spread strength, knowledge, understanding, and positivity to help end the stigma altogether. By using a model of professionals with diabetes, the hope is that there will be more compliance and accountability. These concepts are extremely important in the initial stages as the group in general as it is just starting out. As the number of cases of diabetes continues to increase, creating a group that will help this population is critical. The proposed group will help people to come to terms with their diagnosis, get the emotional and psychological support they need, and ultimately end the stigma.

References

American Diabetes Association. (2015). Retrieved from http://www.diabetes.org

Gomersall, T., Madill, A., & Summers, L. M. (2011). A metasynthesis of the self-management of type 2 diabetes. Qualitative Health Research, 21(6), 853-871.doi:10.1177/104973231 1402096

Gallagher, R.P. (2014) The national survey of college counseling centers. Retrieved from http://www.collegecounseling.org/wp-content/uploads/NCCCS2014_v2.pdf

Helitzer, D. L., Peterson, A. B., Sanders, M., & Thompson, J. (2007). Relationship of stages of change to attendance in a diabetes prevention program. American Journal Of Health Promotion, 21(6), 517-520.

King, H., Aubert, R., & Herman, W. (1998). Global burden of diabetes, 1995-2025. Prevalence, numerical estimates and projections. Diabetes Care 21(9), 1414-1431. doi:10.2337/ diacare.21.9.1414

Nagelkerk, J., Reick, K., & Meengs, L. (2006). Perceived barriers and effective strategies to diabetes self-management. Journal Of Advanced Nursing, 54(2), 151-158. doi:10.1111/ j.1365-2648.2006.03799.x

Prochaska, J. and DiClemente, C. (1983) Stages and processes of self-change in smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 5, 390–395.

Schabert, J., Browne, J. L., Mosely, K., & Speight, J. (2013). Social stigma in diabetes: A framework to understand a growing problem for an increasing epidemic. The Patient: Patient Centered Outcomes Research, 6(1), 1-10. doi: 10.1007/s4027-012-0001-0

Unnikrishnan, A. G., Bhatia, E., Bhatia, V., Bhadada, S. K., Sahay, R. K., Kannan, A., & …Sanjeevi, C. B. (2008). Type 1 diabetes versus type 2 diabetes with onset in persons younger than 20 years of age. Annals Of The New York Academy Of Sciences, 1150239-244. doi:10.1196/annals.1447.056

Zimmet, P., Alberti, K. G., & Shaw, J. (2001). Global and societal implications of the diabetes epidemic. Nature, 414, 782-787.doi:10.1038/414782a

 

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Committee Reports

The Reading Orienteering Club for At-Risk Students: Follow-Up Study

Anna Thompson
Anna Thompson, MA

Presented at the 123rd Annual Convention of the American Psychological Association at Toronto, Canada, August 2015, Thursday, August 6, 1:00 P.M.

Address correspondence to: a.thompson992@yahoo.com

Abstract

Overall, reading scores in the United States of America (US) and South Carolina have been below the national average for the past several years. The majority of students, 66% tested, in the US were reading below the appropriate grade level (National Center for Education Statistics, 2013). According to the National Assessment of Educational Progress, national reading levels are low for not only elementary school children, but also middle school students. Twenty-two percent of students in middle school scored below their appropriate grade level (National Center for Education Statistics, 2013). The Reading Orienteering Club (ROC) after school program is a group-centered prevention program that focuses on improving reading ability and comprehension in elementary school children of Aiken County. Students participating in ROC have difficulties in reading, spelling, and comprehension. This single-subject design study documented improvement in reading levels of seven children in Aiken County before and during participation in ROC. The children were then placed into two groups, based on the length of intervention: one or two years. Children who completed two years of intervention showed greater improvement than children who completed only one year.

Keywords: university-community program, group-centered prevention, reading, writing, English language arts

The Reading Orienteering Club for At-Risk Students: Follow-Up Study

by Anna Thompson

This study describes the outcomes of the ROC, “a year-long group-centered after-school community-based prevention program that emphasizes phonological awareness, reading and writing, spelling, and intensive hands-on instruction” (Clanton Harpine, 2013, p. ix). The ROC uses strategies such as vowel clustering, the 4-step method, and group-centered prevention interventions in order to improve the literacy scores and behavior of the children- primarily 1st, 2nd, and 3rd graders, of Aiken County in South Carolina. The 4-step method involves having the children: (a) capture words they do not know, (b) write the word correctly, (c) look up the words in the dictionary to find the definition, (d) and write sentences using these words (Clanton Harpine, 2013). This allows children to correct themselves, learn a new word, and gain a better comprehension of the word. The main goals of this program are for children to practice “reading, writing, spelling, focusing their attention, comprehension, following step-by-step instruction, learning new words, and practicing a specific vowel cluster for the day” (Clanton Harpine, 2013, xi).

A lack of literacy skills has become a growing issue throughout the US. Overall reading scores of the US have been below grade level for the past several years. Sixty-six percent of children tested in the US were reading below the appropriate grade level for their age (National Center for Education, 2013). In this study, Reading Grade Level describes the reading ability of the participants based on grade level. The data was collected from the Dominie Reading Assessment, given by teachers in the Aiken County School District. According to the NAEP, national reading levels are low for elementary and middle school children (National Center for Education, 2013). For example, twenty-two percent of students in middle school scored below their appropriate grade level (National Center for Education, 2013). Programs like the ROC are important in helping improve literacy rates in elementary and middle school students, especially for those who may not be getting the needed support from home.

Additionally, the ROC program is a group-centered intervention program that focuses on academic performance using self-efficacy, intrinsic motivation, and group cohesion (Clanton Harpine, 2008). These goals are accomplished by allowing participants to complete the exercise stations at their own pace in small groups. Consequently, Brigman and Webb (2007) discovered success in using groups as an intervention tool. They studied ways to help students improve their reading skills and attitudes in order to be successful in a school setting, while utilizing both large and small groups.

This study was in response to a previously completed study based on the Group-Centered After-School Community-Based Prevention Program (Thompson, 2014). Thompson’s study examined the impact of the amount of time spent in the ROC program as well as the impact that occurred based on when the children began the intervention. The information gathered was then compared to the literacy scores of forty-six children. The results revealed that early intervention created positive reading outcomes for participants. However, the study did not provide enough evidence to support the hypothesis stating that staying in the program for a greater length of time, increased test scores (Thompson, 2014). The current study also tested two additional hypotheses. Hypothesis 1 states that children who complete the ROC program will show improvement in reading level. The second alternative hypothesis of this study states that children who complete the ROC program in two years will improve more than children who complete the program in one year. These hypotheses were determined based on positive scores of the participants in the previous study.

Method

Participants

The participants of this case study include seven children who received no compensation or coercion in participating. Of this group of participants, three are male and four are female. Participants were enrolled in Byrd Elementary, North Aiken Elementary, Warrenville Elementary, and Aiken Elementary school in Aiken, South Carolina. Two participants completed the intervention during the 1st grade. Three participants completed the intervention during the 2nd grade. Two participants completed the intervention during the 3rd grade. Starting ages ranged from 6-years-old to 8-years-old. All seven participants are African American.

Materials and Design

            In order to correctly evaluate the reading level of each participant, the children all completed the same standardized test. These standardized tests were given by teachers of the Aiken County school system at the completion of the fall, winter, and spring semesters. The test scores included the following: CogAt (measures intelligence), Dominie (measures reading level), and MAP (predicts how scores will be for PASS), PASS (states if student passed or failed the grade). Dominie Text Reading scores which used the core reading benchmark/ bridge level, were used to calculate reading ability based on grade level.

This particular case study uses an AB design, which consists of baseline data as well as data recorded during the intervention. The dependent variable for both hypotheses is the reading grade levels. The independent variable for hypothesis one is successful completion of the ROC program.   The independent variable for hypothesis two is the length of intervention. The two different intervention groups consisted of one year of intervention and two years of intervention. Procedure

The public schools of Aiken County administered multiple standardized tests to students periodically throughout the school year. After all standardized tests are completed all students’ scores are recorded. To obtain the necessary test scores for this study, scores were obtained after the completion of the school year. The tests used by the Aiken County school system includes a standardize test that records scores in reading, language, math, social studies, and science (capitalize subjects). The current study utilized the scores for reading on grade level. After attaining all the information needed, participants’ scores were then compared and analyzed.

Results

The null hypothesis of this study states that the ROC program will have no effect on the reading level of its participants. This study tested two alternative hypotheses: (1) children who complete the ROC program will show improvement in reading level, (2) and children who complete the ROC program in two years will improve more than children who complete the program in one year. Both hypotheses were analyzed using a single-subject AB design.

Overall, the two groups of children included one year of interventions and two years of interventions which revealed improvement in reading levels. The results revealed that with the intervention: two children increased their reading grade level by the end of the first fall season, two children improved their reading grade level by the end of the first winter season, two children improved their reading grade by the end of the first spring, and one child improved their reading grade level after the second fall. At the conclusion of the ROC program intervention, two participants were reading above grade level and five participants were reading at their current grade level. This combined data supports alternative hypothesis one.

After completing the ROC program for either one or two years, children demonstrated improvement. All three participants who completed the ROC program increased their reading grade level by at least one full level. The four participants who completed two years of intervention treatment at the ROC also demonstrated improvement by increasing their reading level two grade levels. Overall, children who completed the program in two years revealed a greater improvement than children who completed the intervention in one year.

Discussion

The current study was completed as a follow-up study to the research accomplished by Thompson (2014) which recorded that staying in the program for a longer length of time, did not always increase test scores. The previous study had flaws in the design and possible complications with participants. Flaws in the design involved the data and analysis. Since there was no real comparison group, age was reported as a covariate (Thompson, 2014). As a result, that data was compared to an above and beyond natural group. Thompson’s study (2014) stated that the participants who continued for more than one year may have more serious learning problems, which would take more effort and time, than the participants who finished the program in the first year. The current study took the previously completed study’s design and results into consideration.

The current study showed that overall; the 7 participants improved their reading grade level while completing the ROC program. Participants who stayed in the program for 2 years improved their reading grade level more than participants who completed the ROC program in 1 year. According to this study, the ROC program showed success in teaching children to read and helped them increase their reading grade level.

References

Brigman, G. & Webb, L. (2007). Student success skills: Impacting achievement through large and small group work. Group Dynamics: Theory, Research, and Practice, 11, 283-292. doi: 10.1037/1089-2699.11.4.283

Clanton Harpine, E. (2013). After-School Prevention Programs for At-Risk Students: Promoting Engagement and Academic Success. New York: Springer. doi: 10.1007/978-1-4614-7416-6

Clanton Harpine, E. (2008).Group Interventions in Schools: Promoting Mental Health for At-Risk Children and Youth. New York: Springer. doi: 10.1007/978-0-387-77317-9

National Center for Education Statistics (2013). The Nation’s Report Card: A First Look:            2013 Mathematics and Reading (NCES 2014-451). Institute of Education Sciences, U.S. Department of Education, Washington, D.C.

Thompson, A. L. (2014). Group-Centered After-School Community-Based Prevention Program. The Group Psychologist. 24