Nursing

Identification of Group (10 points)

A.         Brief description of the group and target population

B.         Group Purpose and Rational

C.         Membership of group

1.   Criteria for selection

2.   Screening of members

3.   Other demographic information

II.         Theoretical Framework for Group (10 points)

A.         Support and synthesize selected theoretical approach

(based on a brief literature review at least 4 articles)

B.         Discussion of group design/format/structure

1. Open / Closed / Length of Time

C.         Describe contributions to the group

(Include topical outline, group exercises, and activities)

III.        Analysis of Group Process and Client Outcomes (10 points)

A.         Group interaction / dynamics

B.         Phases of the group:  Forming Storming, Norming, Working, Termination

C.         Level of cohesiveness and contributing factors with implications such as environment, topic, leadership style, member to member interaction, type of group. (provide examples to support your finding)

D.         Describe group norms

IV.        Evaluation of Group Outcomes (10 points)

A.         Individual client outcomes (measurable) or group outcomes (measurable)

B.         Curative factors demonstrated (provide examples)

C.         Describe measurement tool and rationale for use.

V.         Evaluation of Self as Group Leader (10 points)

A.         Strengths and weaknesses of the experience

B.         Approach/style of Leadership

This what I have done so far:

1. Identification of Group

Group description: Group therapy designed for adolescents with antisocial behavior, youth delinquency behavior, and emotional disorder in the juvenile justice system. The group focuses on the teens and their families; children and adolescents range from ages 10-17 years using psychoeducation. These youth often incur high long- term social and economic costs to themselves, their families, and their communities. The group aims at providing effective treatment for this population for the benefits of these children/youth, such as healthier and more successful lives,  and society (e.g., reduced crime and associated costs (Weisz & Kazdin, 2017). Risks factor group identifies for antisocial behavior in adolescents, i.e., family relations, peer associations, and school performance, those that had no support, delinquencies (Weisz & Kazdin, 2017). At-risk antisocial behavior adolescents, those that have involvement in the Juvenile Justice system; youth at imminent risk of out-of-home placement due to criminal offenses; physical aggression at home, at school, or in the community; verbal aggression, verbal threats of harm to others; and substance abuse those with deviant peers, commonest child and adolescent psychiatric disorder (Weisz & Kazdin, 2017).

2. Group purpose and rationale: These youth often incur high long- term social and economic costs to themselves, their families, and their communities. The group aims at providing effective treatment for this population for the benefits of these youth, such as healthier and more successful lives ) and society (e.g., reduced crime and associated costs (Weisz & Kazdin, 2017). The ultimate aim is to surround the youth with a context that supports prosocial behavior such as prosocial peers, involved and effective caregiver, supportive school, replacing the context that is conducive to antisocial behavior (Weisz & Kazdin, 2017). Eliminate or significantly reduce the frequency and severity of the youth’s referral behavior(s). Empower parents with the skills and resources needed to: Independently address the inevitable difficulties that arise in raising children and adolescents () Empower youth to cope with family, peer, school, and neighborhood problems. The rationale is to reduce crime in the society ( Weisz & Kazdin, 2017).

3. Membership of group

1. Criteria for selection: The juvenile justice system refers most of the youth/ children from all races with severe and chronic patterns of offending and at high-risk justice system with severe and persistent patterns of offending and at high risk for out- of -home placement such as inceration, residential treatment as well as teenagers with conduct disturbances and substance abuse problems referred by the child welfare or mental health systems (Weisz & Kazdin, 2017). At Chicago Lakeshore, most of the teens are being referred by DCFS, and Chicago school districts. At least one of the parents of the child,  usually we admit two families on each session, a nurse, a mental health counselor,  and two therapists. The MST staff mostly did the screening within 10 minutes before the group therapy begins.

2. Screening of membership: Programs will need to exclude: Youth living independently or youth for whom a primary caregiver cannot be identified despite extensive efforts to locate all extended family, adult friends, and other potential surrogate caregivers.Youth who are actively suicidal, homicidal, or psychotic. Teenagers whose psychiatric problems are the primary reason leading to referral, or who have severe and severe mental issues (Weisz & Kazdin, 2017).

Juvenile sex offenders (sex offending in the absence of other delinquent or antisocial behavior). MST–Problem Sexual Behavior (MST-PSB), however, is an adaptation of MST that is available for youth with externalizing, delinquent behaviors, including aggressive (e.g., sexual assault, rape) and non-aggressive (e.g., molestation of younger children) sexual offenses. Youth with moderate to severe difficulties with social communication, social interaction, and repetitive behaviors, which may be captured by a diagnosis of autism (Weisz & Kazdin, 2017).

3. Other demographic information: The two scales that would be beneficial for this group include the Columbia Suicide Severity Rating Scale (C-SSRS) and the MST Feasibility Questionnaire. An MST Program developer usually assesses the needs of the future MST program site by reviewing the resources needed to operate a successful MST program and to exclude suicide.

2.Theoretical Framework for the group

The Theoretical Framework for group therapy will utilize a multisystemic therapy approach (MST), Cognitive behavioral therapy, functional family therapy (FFT), and multidimensional treatment foster care (MTFC).  For this assignment, MST will be focused. MST was designed to address the multiple risk factors associated with juvenile offending that has been identified through decades of basic research on the cause and correlates of antisocial behavior. The risk factors exist and interact within and across multiple domains of a person’s life. The socio-economical model provides a useful organizing framework for MST; the model also maintains that youth behavior is mostly determined by the functioning of the multiple systems such as family, school, peer, and neighborhood in which the youth is embedded and the reciprocal interplay between these systems.eg. Contact between caregivers and school personnel (Weisz & Kazdin, 2017). The following studies have shown the success of MST treatment of adolescents with antisocial behavior, youth delinquency behavior, and emotional disorder in the juvenile justice system.

A. The following studies have shown the success of MST treatment of adolescents with antisocial behavior, youth delinquency behavior, and emotional disorder in the juvenile justice system. The first article reviewed was randomized controlled trials reporting the efficacy of MST among youths presenting with antisocial behavior and psychological disorder, respectively (Tan, & Fajardo, 2017). The result concluded that MST is an efficient intervention for severe antisocial behaviors in the reduction of delinquency and should be included in clinical practices. MST is shown to have a positive effect on the emotional disorder. 12 RCTs (n = 1425) reported the efficacy of MST vs. TAU in youths presenting with antisocial behavior and emotional disorder. Clinically significant treatment effects of MST showed a reduction of antisocial behavior, which includes delinquency. MST, vs. psychiatric hospitalization, was associated with a reduction of suicidal attempts in youths presenting with psychiatric emergencies (Tan & Fajardo, 2017). The second article reviewed is a  qualitative study that explored parents’ and young people’s experiences of MST, focusing on aspects of the intervention that promoted or limited change  Tighe et al., (2012).  The findings support the MST theory of change as well as point to some outcomes not usually measured in MST outcome studies. They also suggest some adaptations that may increase the impact of the intervention, including more attention to the influence of deviant peers, and ongoing support for families struggling to maintain strategies beyond the prescribed treatment period (Tighe et al., 2012).

The third article reviewed was by Sawyer & Bordium (2011). The intent-to-treat analyses showed that felony recidivism rates were significantly lower for MST participants than for IT participants (34.8% vs. 54.8%, respectively) and that the frequency of misdemeanor offending was 5.0 times lower for MST participants. Also, the odds of involvement in family-related civil suits during adulthood were twice as high for IT participants as for MST participants. The fourth article reviewed was an article by Welch & Greenwood (2015). The article explores the progress that state governments across the country are making in implementing the three most widely used evidence-based programs (EBPs) for delinquent youth: multisystemic therapy (MST), functional family therapy (FFT), and multidimensional treatment foster care (MTFC). They concluded that five states are making substantially more significant progress in implementing these EBPs: New Mexico, Louisiana, Maine, Connecticut, and Hawaii. In addition to the highest availability of these programs, ranging from 9.4 to 13.0 therapist teams per million population, these states share several key features that demonstrate that direct and purposeful state action is behind the expansion of these programs (Welch & Greenwood, 2015).

B. Discussion of group design/ format/ structure: The design and format is a long -term closed group format for stability, and time- extended, including week-ends (Yalom & Leszcz, 2005). MST staff with a full-time masters-level therapist, who each caseload of two families. Two or four therapists work within a team, and each group is supervised by an advanced master -or doctorate -level superior, who devotes at least 50% of his time to the side. Team members usually work for private service organizations contacted by juvenile public justice: child welfare and mental health authorities. The group is conducted as a closed-door for in-patient group therapy (Weisz & Kazdin, 2017). Clinicians provide 24 -hours 7 days a week availability, which allows sessions to occur at times convenient for families and enables therapists to react (Weisz & Kazdin, 2017). The duration of treatment is relatively brief 3- 5 months; the intervention is intensive and often involves 60 hours or more of direct contact between the therapist and the family (Weisz & Kazdin, 2017). At Chicago Lakeshore MST groups 4-8 hours per 16 hours shifts Monday – Saturday.

C. Describe contributions to the group (include a topical outline, group exercises, and activities): The size of the group is usually between 8-10 members, with each session lasting two hours, each client is to attend four sessions in 16 hours shift (Yalom & Leszcz, 2005). MST staff members work on a clinical team of 2-4 therapists and a supervisor. The group leader and co-leader conduct a group debrief without the members present. The leader prepares the group before commencement. The leader introduced himself, and each member of the group, he clarifies misconceptions and expectations, he provides patient and family with a cognitive structure that facilities participation and he generate realistic expectation. (Yalom & Leszcz, 2005). All components of the MST program are manualized; the leader follows the manual and, in the end, gives homework to the pateints and the caregiver. Multisystemic Therapy has materials available in languages other than the English language. Groups—activities for video games, card playing. The nurse gives psychoeducation via teaching materials and videos. Topic outlines include but not limited to parent management training, treatment for anger management, therapy for caregiver or youth substance abuse, family communication training. Group exercise includes listening to music, painting, crafting, and breathing to relieve anger, and meals usually are served during breaks hours.

 

References

Tan, J. X., & Fajardo, M. (2017). Efficacy of multisystemic therapy in youths aged 10-17 with severe antisocial behavior and emotional disorders: a systematic review. London journal of primary care9(6), 95–103. https://doi.org/10.1080/17571472.2017.1362713

Tighe, A., Pistrang, N., Casdagli, L., Baruch, G., & Butler, S. (2012). Multisystemic therapy for young offenders: Families’ experiences of therapeutic processes and outcomes. Journal of Family Psychology26(2), 187–197. https://doi.org/10.1037/a0027120

Weisz, J.R. & Kazdin, A.E. (2017). Evidence-based psychotherapies for children and adolescents (3rd ed.).  New York: Guilford Press.

Welsh, B. C., & Greenwood, P. W. (2015). Making it happen: State progress in implementing evidence-based programs for delinquent youth. Youth Violence and Juvenile Justice13(3), 243–257. https://doi.org/10.1177/1541204014541708

 
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