Unlike tier 1 (universal—school wide, classroom wide) interventions which promote positive mental health for all students, tier 2 interventions are targeted to specific populations of students or subgroups who are at-risk for developing a mental disorder or who may already be exhibiting some clinical symptoms associated with mental illness. As Bazyk (2011) pointed out, Tier 2 interventions generally account for 10-15% of students and support children and youth with learning, emotional, and life experiences that place them at risk for engaging in problematic behaviors, developing mental health challenges, or both. Read the article by Anderson and Borgmeier article on Tier II interventions. Pay particular attention to the essential features of intervention in this tier. The group intervention template is a good tool for assessing the fit of the interventions you are considering for your school.

Retrieved from : TOT 2: Groups with Peers as Mental Health Delivery Tool (2019)

Targeted or Tier 2 interventions are often provided in small group formats with students who share similar situations. Most often, tier 2 prevention groups focus on symptoms related to impoverished emotional regulation, violence reduction, anxiety, depression, post-traumatic stress, substance misuse, social skills development and truancy. Nitza and Conyne (2013) also noted their success in addressing bullying, dropout, gang and pregnancy prevention efforts. Fazel (2014) found that group models tend to be effective in school-based prevention efforts and that engagement and participation rates tend to be high among group participants.

Miami University of Ohio put together a school-based mental health toolkit and recommended the following evidence-based tier 2 interventions:

• Girl’s Circle

• Promoting Alternative-Thinking Strategies (PATHS)

• Second Step

• Peacemakers Program

• Winning Against Violent Environments (WAVE)

• LifeSkills

• Families and Schools Together (FAST)

• Teen Parent Curriculum

Additional prevention groups named by Conyne and Clanton (2010) include:

• Spartan Mentor Program

• Bully Busters

• Project FREE (Family, Rejuvenation, Education, and Empowerment)

• GOPED (Group Oriented Psychoeducational Prevention)

Retrieved from : TOT 2: Groups with Peers as Mental Health Delivery Tool (2019)

Group Discussion post

Research one of the groups listed above online. Using the template in the Anderson & Borgmeier article as a guide, identify the essential characteristics of the group program that you chose. Then post your review on your group discussion form. Go to the Thread TOT2 Week 4 Tier II EBP group review and reply to the introduction post. Briefly summarize the group you chose, explain what you like and what you might do differently, if anything, and then upload your review. I have placed a Group Intervention Template based on Anderson and Borgmeier in the Readings and Resources folder for this week.

The Girl’s Circle is a program that covers eight weeks of courses to help integrate self-efficacy, development, and competence in girls that are currently in the juvenile detention system. The Program works hard to evaluate the girls over the course of a year to improve their attachment to school, social relationships, self-efficacy, decrease alcohol dependency, increase body images, and work on the social supports within these girl’s lives. The participants can range in age from 9-18 years old and look to decrease delinquency rates in young females by promoting positive self-competence and the confidence to engage in school, social groups, and increase their overall mental health (preventing self-harm, negative body image, alcohol abuse, etc.). The Girl’s Circle looks to obtain the long-term goals set for the girls by taking steps with short-term goals that are targeted throughout the 8-week long course. This program uses Tier II intervention by targeting a large group of juvenile teens and using preventative and intervention strategies to help the girls develop the skills necessary to create self-efficacy within themselves. This Tier II program has had really good success rates measured by the return rates to the juvenile system.

Prevention groups are gaining popularity among school-based mental health professionals (Coyne, 2010). This is due to two key factors: (1) prevention efforts have been identified as viable strategies to furthering health and well-being and proactive rather than reactive approaches and (2) groups can be an ideal setting in which to encourage new learning, sustained behavior changes, and fostering therapeutic connections (Clanton-Harpine, 2010).

Prevention groups are designed to enhance members’ strengths and competencies while providing knowledge and skills to avoid harmful or potentially risky situations or mental health problems. They use group process to the fullest extent to facilitate interaction, cohesion, and behavior change among group participants. The therapist is intentional about getting participants to interact with one another, learn from one another, and maintain interaction throughout the group. It is precisely in those interactions that the therapeutic value surfaces.

Many mental health problems might be eliminated if effective prevention efforts are provided at the right time. As Conyne (2010) noted, timing is everything with respect to prevention—intervening at the right time can make the difference between success and failure. To stop mental illness before it starts may be one of our most needed strategies.

A 3-tiered public health approach to school mental health promotion and illness prevention supports a proactive approach to early detection of emotional and psychological disorders. It is important for occupational therapy practitioners to be aware of prodromal or early symptoms of a psychiatric disorders and mild functional impairments that are associated with the early onset of mental illness. Early detection and primary prevention are the key strategies for “front-loading” efforts at the earliest sign of trouble rather than “back-loading” efforts long after significant issues have surfaced an a diagnosis is confirmed (Bazyk, 2011).

Schools are probably the most active subscribers of prevention group interventions, namely in an afterschool program capacity (Nitza & Conyne, 2013). Prevention groups have been offered across all ages, but more attention has been given to middle school and high school students. There is growing evidence to suggest that prevention groups can not only support positive mental health but also improve a student’s ability to take the learning that he or she received in the group experience and apply it to the classroom and learning (Clanton-Harpine, 2010). The goal of school-based mental health approach is to create group prevention programs which strengthen school-based mental health promotion through rebuilding necessary skills.

More success has been associated with interactive, hands-on experiences with a clear focus on skill development (and real doing) but many school-based mental health providers are more classically trained in counseling groups and talk-based psychoeducational groups (Clanton-Harpine,2010)…..Are you thinking what I’m thinking???

There is great power is the group process, group dynamics and how participants interact with one another, and group cohesion; when leveraged strategically and therapeutically, group process can be very influential in driving key behavior changes that can minimize risk and support prevention. As explained by Cole (2012), there are key interactions that need to occur among group participants for the intervention to work. Yalom (2005), a group scholar and psychiatrist, has noted 11 classic therapeutic factors that underlie the therapeutic potential of any group intervention and that therapists should try to intentionally and systematically elicit among group members. They are:

• Instillation of Hope

• Universality

• Imparting Information/Guidance

• Altruism

• Recapitulation of the Family Group/Family re-enactment/corrective emotional experiences

• Development of Socializing Techniques

• Imitative Behavior

• Interpersonal Learning

• Group Cohesiveness---(serves as the major catalyst for change!!)

• Catharsis

• Existential Factors

To get more information on each curative factor, review this slideshare presentation http://www.slideshare.net/psychoeducationalgroups/curative-factors-in-psychoeducational-groups

(Or cut and paste into your browser). The last few slides offer you a self-check.

None of these factors occur naturally in group process—they must be built into the design and anticipated by the therapist. An appropriate amount of consideration must be given to activity selection, group member/participant selection, and intentionally encouraging group participants to recognize, examine, and understand their own group process. As a cautionary measure, Clanton-Harpine (2010) noted, self-efficacy and other therapeutic factors cannot be expected by merely placing students in a group together to teach classroom skills. Instead, she suggests that school-mental health professionals must remember that children must experience success in the group, improve their beliefs about their abilities, and be reinforced by their peers. All of this is essential to rebuilding self-efficacy.

“Everyone must be involved. If students are sitting and listening to a [group facilitator] talk as in a classroom, group interaction does not occur and without group interaction you do not have a prevention program!!”(Clanton-Harpine, 2010)

Consider the power of occupation in rebuilding or supporting increased self-efficacy

Retrieved from : TOT 2: Groups with Peers as Mental Health Delivery Tool (2019)

Occupational therapy practitioners have a long history of using group interventions; those working in mental health conduct much, if not almost all, of treatment in group-based interventions (Cara, 2006). In the most recent edition of the Occupational Therapy Practice Framework –OTPFIII (2014), group interventions is distinguished as a type of occupational therapy intervention category. Group interventions use the distinct knowledge of occupation and group leadership techniques to facilitate learning, skills acquisition, and occupational performance across the lifespan (AOTA, 2014). While group interventions are certainly not the primary service delivery model in schools, the potential need for increasing group interventions is certainly plausible with an expanding focus on mental health and, in particular, tier 2 prevention interventions.

Occupation-based groups

Occupation-based groups provide a therapeutic atmosphere in which students have the opportunity to engage in a meaningful activity related to their life roles, namely the roles of student, friend, teammate, and community member. Group activities provide an opportunity to develop performance patterns that support their ability to successfully meet expectations associated with daily school occupations. Per Bazyk (2011), occupation-based groups should focus on providing mastery experiences and develop self-efficacy. Occupation-based groups provide the opportunity for students to share strategies with one another, learn from one another, and be persuaded by feedback from others that they are indeed competent (Bazyk, 2011). Occupation-based group interventions provide participants with an ability to authentically solve real-life problems and gain skills together.

Let's take a look at Tier 2 OT groups in afterschool programs

Read Bream's (2010) article describing after-school groups addressing the mental health needs of adolescents. The article can be found in the folder associated with this module.

Occupational therapist, Alex Lopez, has been gaining visibility and sponsors with his occupation-based program, Par FORE. Check out the website: http://www.parfore.org/ (or cut and paste link into browser) and these videos:

https://www.youtube.com/watch?v=qNY5aomJ1dc (or cut and paste into browser)

https://www.youtube.com/watch?v=ictLxwM92xk (or cut and paste into browser)