Group Interactive Structured Treatment (GIST); An evidence-based - - PowerPoint PPT Presentation

Group Interactive Structured Treatment (GIST); An evidence-based social competence program applied in a community-based setting

Presented at the Brain Injury Association of Massachusetts Annual Conference March 28, 2019 Sarah Lovell, MSW, CBIS Corinne McCafferty Ted Stachulski Non Presenting author: Barb Kresge, MS, OTR/L, CBIS

Goals for this presentation

• Understand skills and goals that are addressed

in the GIST curriculum

• Understand keys to success and challenges in
• ffering a GIST group
• Understand the benefits and challenges of the

GIST group from a participant perspective

Why GIST?

• Brain injury survivors frequently experience

challenges in the area of “social competence”

• GIST is designed specifically for use with BI

survivors

• Clear-cut curriculum
• Inexpensive
• Multidisciplinary
• Evidence-based (Hawley & Newman, 2010)

Skills of the Great Communicator

• 1. Maintains comfortable eye contact
• 2. Asks questions and respond with comments that are on topic
• 3. Discusses a variety of topics
• 4. Respects boundaries
• 5. Takes turns talking and listening
• 6. Comes across as friendly, relaxed, and confident (voice,

expressions, and body language)

• 7. Gets to the point
• 8. Offers support
• 9. Gives an appropriate amount of information

10.Shows a sense of humor

Let’s Chat

• Turn to a person sitting near you (who you do

not know)

• Have a 3 minute long “get to know you”

conversation

How did it go?

• What went well?
• What was challenging?
• What would you do differently if we asked to

you to do this exercise again?

More about GIST

Two Goals

• 1. Address social skills challenges through a 13

week group curriculum design

• 1. Improve participants’
• a. social communication skills
• b. interpersonal skills
• c. pragmatic language skills

More About GIST

PHASES

• 1. Engagement
• 2. Awareness
• 3. Goal Setting
• 4. Skills Mastery
• 5. Generalization (applying

knowledge to daily life) ELEMENTS

• Structured curriculum +

group process

• Holistic approach
• Individualized goals
• Repetition, Reinforcement &

Feedback

• Family Involvement/Support

System

• Consistent attendance
• Additional elements: Optimal Group Size of 5-8

members with 2 facilitators

• Self-assessments (pre-test, post-test)

GIST at Krempels Center

Group Participation Criteria

• Ability to commit to 13-week

group, forgoing other groups

• ffered at Krempels Center
• Medical Stability
• Some degree of insight
• Self-regulation (participate

without a caregiver)

• Receptive and expressive

communication skills allowing for group interaction Process

• 1. Information Session
• 2. Application
• 3. Group participation vetting

(based on criteria)

• 4. Notify accepted members
• 5. Pre-test assessments (starting

where the client is at) during pre-group orientation

• 6. Hold sessions 1-12
• 7. Post-test assessments &

Celebration

Purpose of Criteria

❖ To increase group member participation and

potential for improvement

➢ Keys to Success:

• 1. At least 12 months post-injury; 6 months

for mild injuries

• 2. Family support
• 3. Some motivation to improve
• 4. Ability to self-assess strengths &

weaknesses

• 5. Ability to accept feedback

Topics Covered in GIST

• 1. Orientation and

assessment

• 2. Skills of a great

communicator

• 3. Self-assessment and goal-

setting

• 4. Starting conversations
• 5. Keeping conversations

going and using feedback

• 6. Assertiveness and solving

problems

• 7. Social Confidence through

positive self-talk

• 8. Practice in the community

(outing)

• 9. Social Boundaries
• 10. Video taping
• 11. Video feedback- practice

in the community

• 12. Conflict resolution
• 13. Closure and celebration

Group Norms Established

To provide nurturing atmosphere of trust with the goal of learning from each other's successes and limitations/challenges

• 1. Will participate by listening to
• thers, providing respectful

feedback to peers and being

• pen to receiving

constructive feedback from

• thers
• 2. Mindful of allowing and

promoting the full participation of all group members

• 3. Supportive of the goals of

each group participant

Groups Norms Continued

• 4. Outside conversation about the group should be

geared towards each member’s own personal growth, and should uphold the confidentiality of

• ther group members

Group facilitator norms:

• 1. Provide guidance to the group
• 2. Promote a supportive and constructive

environment which allows group members to work toward their personal goals

Participants’ Goal Setting

After asking to identify their social strengths/challenges, facilitators asked participants to think of 2-3 social skills goals they wished to work on during the duration of the group

Some potential social skills goals

• 1. Making new friends
• 1. Starting conversations
• 1. Staying focused during conversations
• 1. Feeling confident in social interactions
• 1. Being assertive
• 1. Resolving conflicts during social interactions
• 1. Controlling emotions in relationships

Successes (facilitator perspective)

• THE GROUP! (Observational)
• Member feedback
• Maintaining Conversations
• Video Feedback Session
• Elevating Awareness
• Small gains vs. Big gains
• Group Cohesion, Mutual Aid, Commitment and Effort
• Member success stories
• Strengthening communication and social skills
• Adjusting curriculum as needed for integration into KC

program

• Switching gears, taking breaks, adjusting content

Challenges (facilitator perspective)

• Ambivalence to change
• Varying levels of discomfort
• Group Dynamics & Differing levels of

participation

• Stage of rehabilitation, acceptance and insight
• Storming phase! (Tuckman & Jensen, 1977)
• Memory Challenges of Members

Areas for Improvement

• Application Vetting Process
• Most need vs. Maturity/Insight
• Time Management
• Condensing material for a more cohesive

group

• Seek assessment tools more appropriate for BI

population

Looking at Outcomes

• 1. A review of the literature
• 1. Our Assessments
• 1. Primary outcomes takeaway: self-assessment

tools did not reflect the same “data” as verbal self-reflection and observations from friends, family, and staff

Pre/Post Assessments

• Utilized 3 tools to assess perception of:

– Social/communication skills – Quality of life – Integration into the community

• Chose tools for overlap with other researchers
• Tools proved difficult for most participants
• Small N, so difficult to make generalizations

Social Communication Skills Questionnaire-revised

• Subjective assessment; participants evaluate

themselves on a variety of social communication skills

• 11 questions added to capture all of the

topics covered in the GIST curriculum

○ “I state my ideas clearly.” Always (5) Often (4) Sometimes (3) Rarely (2) Never (1)

Participants A and B results - SCSQ- revised

Participant A Participant B ➔ Improved: 23/37 (62%) 20/37 (54%) ➔ Declined: 4/37 (11%) 3/37 ( 8%) ➔ Remained the same: 10/37 (27%) 4/37 (38%)

Shared areas of improvement: I support my opinions with facts. I avoid insulting the person I’m talking to. I maintain eye contact with the other person. I select topics that won’t offend the other person. I can let others know when I don’t understand, by asking questions to clarify. I feel confident in a conversation. I can use humor appropriately. I control my emotions (during general conversations.)

Participation Assessment with Recombined Tools-Objective

• Developed to examine long-term outcomes
• Items were derived or modified from three measures

commonly found in the TBI literature: Community Integration Questionnaire, Participation Objective/Participation Subjective, and the Craig Handicap Assessment and Reporting Technique

• We utilized the revised instrument of 17 items

– e.g. In a typical week, how many times do you… …socialize with friends, in person or on the phone …give emotional support to other people ➔ No significant change either Participant A or B

Satisfaction with Life Scale

• 5 point scale
• Measure global life satisfaction
• Developed by Diener et al.
• Higher scores = greater life

satisfaction.

• Has been used for persons

with TBI ➔ No significant change pre and post for participants A or B.

Satisfaction With Life Scale (Diener, Emmons,

Larsen, & Griffin, 1985)

1 = strongly disagree 2 = disagree 3 = slightly disagree 4 = neither agree nor disagree 5 = slightly agree 6 = agree 7 = strongly agree __ 1. In most ways my life is close to my ideal. __ 2. The conditions of my life are excellent. __ 3. I am satisfied with my life. __ 4. So far I have gotten the important things I want in life. __ 5. If I could live my life over, I would change almost nothing.

Outcomes

• Discrepancy between formal assessment

results and participants’ self-reflections and anecdotal observations from family, friends, and professionals

Meet Ted S.

My goals

• 1. Stay focused during conversations
• a. Get to the point / reduce extraneous information
• 2. Improve reciprocity (Don’t overpower the conversation)
• 3. Notice social cues (Body language, tone of voice)
• 4. Active listening

Positive Changes

• 1. I greatly improved on recognizing social cues, however, I still

have a hard time ending conversations.

• 2. I also improved on staying focused during conversations and

getting to the point.

• 3. I improved, but still struggle with reciprocity and active

listening.

• 4. I noticed I don’t communicate well when I’m tired / neuro-

fatigued.

Challenges

• 1. It was hard giving feedback to the other participants

because I didn’t want to hurt their feelings.

• 2. The neurofatigue I had by the end of each group session

which lasted for several hours.

Long term impact

• 1. It improved my relationships with my wife, daughter,

friends, and the other participants.

• 2. I feel more comfortable and less pressured during

conversations.

“Awareness is like the sun. When it shines

• n things, they are transformed” -Thich Nhat Hanh

Thank you for joining us today!

Works Cited

Amodeo, V. (2013). Critical Review: Critical Review: Is group therapy for social skills training effective for individuals with traumatic brain injury? Retrieved from https://pdfs.semanticscholar.org/7eec/da9567b09e9327ad1791754332eb83f5addc.pdf. Bogner, J. (2013). The Participation Assessment with Recombined Tools-Objective. The Center for Outcome Measurement in Brain Injury. http://www.tbims.orgcombi/parto (accessed October 1, 2018 ). Dahlberg, C., Cusick, C., Hawley, L., Newman, J., Morey, C., Harrison Felix, C. et al. (2007). Treatment Efficacy of Social Communication Skills Training after Traumatic Brain Injury: A Randomized Treatment and Deferred Treatment Controlled Trial. Archives of Physical Medicine and Rehabilitation, 88, 1561-1573. Dahlberg, C., Hawley, L., Morey, C., Newman, J., Cusick, C. P., & Harrison-Felix, C. (2006). Social communication skills in persons with post-acute traumatic brain injury: Three perspectives. Brain Injury, 20(4), 425-435 Diener, E., Emmons, R., Larsen, J., & Griffin, S. (1985). The Satisfaction With Life Scale. J Personality Assessment, 49(1), 71-75. Hawley, L. A., & Newman, J. K. (2010). Group interactive structured treatment (GIST): A social competence intervention for individuals with brain injury. Brain Injury, 24(11), 1292-1297. Tuckman, B. W. and Jensen, M. A. (1977) Stages in small group development revisited. Group and Organisation Studies 2; 419-427.