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Group work and program participation

Groups can often be challenging for people with complex needs, so special consideration is needed. There are also simple steps you can take to improve their level of engagement in your service's programs.

Improving group work

A key consideration when facilitating a group that includes people with complex needs is that group situations are often overwhelming. This can be due to the level of information provided in a group, and the depth and speed of discussion. Other factors which may contribute to this include communication barriers, tiredness and negative past experiences of group work or sharing personal information.

A person with complex needs may find any group or education-like setting confronting. People who had difficulty at school may have had negative group experiences, resulting in shame and humiliation, and so may become anxious about participating in groups as it may lead to failure or embarrassment.

A person with a cognitive impairment may have difficulties in understanding the subtleties in communication in a group setting. For example, they may interrupt at inappropriate times, such as a powerful silent moment after somebody has shared some information. Making these subtle communication messages explicit in a non-confronting way is a useful starting point.

People who have been in prison may also find a therapeutic group environment difficult due to their experience of the prison environment, where sharing intimate information with others can be dangerous. Learning to trust others and trust the environment will take time. Allowing people to take time to feel safe and build trust in the group environment is an important aspect of managing this. It may take a few sessions before some people feel comfortable to participate in group situations.

Tiredness is a common challenge when working in drug and alcohol settings. It may result from the intense nature of participating in a rehabilitation treatment setting, or it may be a feature of a cognitive impairment. Taking regular short breaks (in groups, counselling and casework sessions) and allowing people the recovery time they need to be able to concentrate properly is important.

Checking one to one with individuals after each group session will give you, as a group facilitator or case manager, the chance to check for understanding, clarify any aspects of the session that may have been misunderstood, and provide positive feedback on group participation.

Some people with cognitive impairment such as FASD may not understand the confidentiality and privacy obligations of working in a group. It's important to reiterate confidentiality and privacy at each group session. If a person is disregarding the privacy and confidentiality of others when outside of the group, don't assume this is in malice. Check they understand the concepts of privacy and confidentiality, as they may not fully understand the consequences of their actions. Work with them to implement strategies to help them maintain the confidentiality of others.

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Group work quick tips

To facilitate understanding:

  • Recap on the previous session
  • Repeat the group rules at each session
  • Repeat key questions and ideas
  • Check regularly for understanding.

To build a supportive group culture:

  • Let people know from the start that groups are hard work for some people
  • Provide positive feedback for people who are struggling but making some attempts at participation
  • Make explicit that lots of people feel like they're going to say the wrong thing, but that group work is, instead of a test of knowledge, a way of learning and growing together
  • Allow people to express themselves in the way they're most comfortable with
  • Recognise that, although a person may not seem engaged, they may still be taking the information in and participating at their level.

For session duration and amount of material covered:

  • Take short breaks to improve people's attention and concentration
  • Cover no more than two concepts in each session
  • If possible, limit the duration of group sessions and introduce strategies to extend the learning experience outside the session - preferably one to one.

Additional group work strategies to support understanding and participation include:

  • Using physical and visual activities
  • Providing revision sessions outside of the group session
  • Letting people use their own terminology to assist in understanding concepts
  • Writing strategies on (laminated) cards that people can take with them
  • Checking in with people one to one after the group to gauge their understanding and the level of support they require.

Improving clients' engagement in programs

Across both individual and group-based components of a drug and alcohol program, there are a number of practice tips that will increase the engagement and participation of clients with complex needs:

  • Use aids to help people with low literacy. Use a digital recorder or voice recognition software installed on a computer instead of a journal. Include pictures with homework that people can use to explain their thoughts to the worker/group, instead of written content only.
  • Change activities frequently to support those people who have short attention spans or who are easily distracted.
  • Use strategies that have lower literacy demands, such as those involving art and music.
  • Use movement-based activities, including outdoor activities such as walking and other forms of exercise.
  • Make sure the physical environment is not cluttered or overstimulating.
  • Explicitly teach generalisations. Don't assume a lesson learned or information applied in one context will automatically transfer to another.
  • Implement a mentoring or buddy system to help people participate in the program.

Continually reflecting on your practice and regularly seeking client feedback will ensure you develop a strong rapport with clients and maximise their participation in program activities. Don't assume people know what interventions involve or what the terminology means. Take the time to explain what the interventions will involve, whether they will be one-to-one or group work, how frequent they will be, and what the expectations are during the session.

Remember that counselling, case management and group work are all abstract concepts. This means that clients who've had little or no previous service contact, those who have complex needs and those who come from CALD backgrounds may not know what they mean in the context of a drug and alcohol service.

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Find out more

See a case study of modifying group work in a correctional setting for people with a cognitive impairment.

See Three Case Studies - Complex Needs in Practice for examples of how drug and alcohol services have implemented changes like these at an organisational level.

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